Addressing the Growing Problem of Bullying by Nursing Home Residents

This past May, the Associated Press published an article titled, “It’s Like ‘Mean Girls,’ But Everyone is 80: How Nursing Homes Deal with Bullies.” The article addresses the growing problem of bullying in nursing homes and assisted living centers and contends that the problem has become one of epidemic proportion.

According to Frances Shani Parker, bullying by older adults often includes these behaviors:

Criticizing or ridiculing another person who does not meet the bully’s accepted standards for clothing, social status, religion, sexual orientation, economic background or other characteristics.
Verbally or physically abusing another person by yelling, hitting, pushing or kicking.
Stealing or destroying property and often lying about the person to assert power or authority and to cast that person in a poor light.
Saving seats or reserving spaces for clique members in dining rooms or during outings or other events.

Persons that exhibit elder bullying often have demonstrated this behavior previously in their lives; but, the aging process and the loss of independence, relationships and feelings of powerlessness they experience when entering a controlled environment exacerbates their need to control and manifests itself through bullying behavior.

A recent study by Karl Pillemer, a professor of gerontology in medicine at Weill Cornell College of Medicine in New York, reports that “aggression among residents in nursing homes is widespread and extremely high rates of conflict and violence are common.” Even more startling is this finding: “One in five people living in the nursing facilities studied was involved in at least one ‘negative and aggressive encounter’ with another resident during a four-week period.”

The elderly population is mushrooming, and this growth is reflected in the growing number of elderly persons needing the care provided by nursing homes and assisted living centers. When this increasing need is considered along with the reported increase in aggressive behavior that constitutes bullying (screaming,cursing, yelling, hitting, kicking, biting, inappropriate touching, entering another’s room and rummaging through their things) and sometimes under staffing,the importance of how it is addressed by the organization becomes more significant.

Concerns that potential residents and their families have when they investigate a nursing home or assisted living center usually focuses on safety, cleanliness,socialization opportunities and the staff’s attitude and skills. However, with the reports like those just described, how bullying and relational aggression is addressed and prevented through ongoing training and education of staff becomes a relevant question that more people are asking about when considering a nursing home or assisted living center.

Dr. Robin Bonifas, an assistant professor in the School of Social Work at Arizona State University, has done considerable research and written about bullying by older adults in a variety of senior adult environments including nursing homes and assisted living centers. She has developed a three-part strategy for eradicating bullying and advocates that social workers should lead in its application. The first part involves changes in the organization’s approach to care by developing policies and procedures that cover how residents treat each other and includes an accountability aspect. The second part of the strategy involves interventions directed at the person doing the bullying to help them develop other ways of interacting. The third part involves helping the victims of the bullying learn how to respond by being assertive, speaking up and asking for help.

Another authority on caring for older adults, Dr. Linda Rhodes, suggests a similar multifaceted approach to coping that combines clear expectations and policies with targeted staff training and rapid intervention to reduce the negative impacts bullying often has on victims. She suggests that an organization do the following:

Develop and implement clear expectations and boundaries within the organization so that residents and staff are both aware of the organization’s commitment to having a respectful environment.
Provide ongoing discussions among staff, residents and families along with formal needs assessments to facilitate early identification of potential problems.
Evaluate and implement changes that can “decrease the power of bullies.” For example, prevent residents from being isolated by eliminating reserved seating.
Implement clear and easy reporting processes to encourage reporting bullying and institute a no-tolerance policy regarding bullying. This should include a standard process for resolving bullying incidents like mediation or other methods.
Encourage family members to get involved if they suspect their loved one is being bullied.
Consider having residents sign a code of conduct agreement that commits them to treat others appropriately.
Before determining a course of action, staff should conduct an assessment when inappropriate behavior or bullying is identified to determine possible underlying causes like dementia or medication.

Here are some coping strategies that residents being bullied can be helped to use:

Ignoring the behavior to remove the bully’s perceived power.
Sharing their opinions without aggressiveness or implied hostility.
Avoiding interrupting or provoking bullies.
Maintaining eye contact with bullies.
Trying to understand the reasons why another resident may be bullying.

Although it takes ongoing effort and careful consideration to resolve situations and incidents involving bullying and the disrespectful treatment of others, setting expectations and providing and applying clear consistent rules and policies will help to ensure a positive living environment for all residents.