ProNurse

 As someone who worked in a care home the answer to the "where was the staff" question is: probably doing something else.  Even the most well-staffed care homes can't keep an eye on everyone at all times - especially being that staff are often in bathrooms and residents rooms assisting with personal care, and while this happens there are even less available to supervise "the floor".  Incidents such as this, and worse - residents have murdered and raped in care homes - can be an everyday occurrence, and there's literally nothing anyone can do about it short of 1 to 1 care.  

I'm not sure what safe wandering areas mean, but at least at some level I'd imagine it assumes that the wanderer gets to wander where we tell them to wander.  This is rarely the case - and indeed may fall under the deprivation of liberty.

Wanderers are definitely more at risk, often from other residents whose rooms they enter whenever they like.  Again, short of 1 to 1 care, it is impossible to stop all instances of this as most care homes will have several wanderers, many of whom follow regular, but personal to them, routes.  Staff will be aware of the worst "offenders" and will attempt to distract them, but there will always be times when the floor is unsupervised.

I have no answer to the problem of violence in care homes.  It happens, probably more often than people imagine, but as we will never have enough staff for one to one, or even two or three to one care; as ward/home design seems to be moving towards warren-like complexity rather than wide open space; and locking people in their rooms or tying them to chairs is a no-no, then incidents will continue to happen.  

Just as an aside, a friend acted as a domiciliary carer to an elderly brother and sister who lived together and both suffered from dementia. They had, at some point, come to see themselves as man and wife and were having a sexual relationship.   After much discussion amongst social services, Drs and nurses etc, it was decided (rightly, thank god) that it was not in their best interests to separate them and a blind eye was turned seeing that no real harm would come from it.  I'm happy that common sense prevailed, but I have spoken to many who would have no hesitation in carting them both off to different care homes.  

I have also supervised two residents who believed they were married to each other, when in fact both were already married to very caring partners who regularly visited. This was extremely distressing for the families as you'd imagine.

My point is that interactions between dementia patients at all levels of confusion are no different than those between perfectly healthy people.  They laugh, they cry, they fight, they fall in love.  If anything, their illness makes these emotions even stronger.