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Managing Resident Aggression

Resident aggression and violence in the senior living setting is a growing problem, given the rising prevalence of dementia and aging population in the United States (Gimm, Chowdhury, & Castle, 2016). Whether resident-to-resident or resident-to-staff, aggressive/violent occurrences can result in significant injury and, in some cases, even death. These incidents can range from a push/fall, to a slap, or to a more severe attack using an object. Failure to address behavior issues can put other residents, staff, and the organization itself at risk. Consider the following strategies for addressing resident aggression to help reduce the risk to others and the organization.

Workplace Safety Program
A first step is to review your workplace Safety Program and update it to address behavior management issues. Include verbal, as well as physical threats, in your definition of resident aggression. For example, The National Consumer Voice for Quality Long-Term Care has defined resident-to-resident mistreatment as:

‘Negative physical, sexual, or verbal interactions between long-term care residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient.’

The agency and many other sources also include verbal threats and threatening body language in the definition (OSHA, 2015).

The Joint Commission published a Sentinel Event Alert on the topic of Workplace Violence in April 2018, and a Quick Safety bulletin, De-Escalation in Healthcare, in January 2019. Both of these resources can be useful in establishing a Workplace Safety program that better prepares staff to deal with the unexpected and stay safe.

Behavior Risk Assessment
It is advisable to perform a behavioral risk assessment as part of the resident admission process. This will provide a baseline for future evaluation. Risk assessment tools provide a standard for evaluating residents for potential violence and allows for a common frame of reference and understanding.

Individualized Care Plans
Develop individualized care plans based on the assessment. The care plan should address resident specific behavior issues and identify situations that may lead to aggressive behavior. It can also be a useful tool to identify appropriate techniques for staff to use when handling the aggressive behavior.

Staff Training
Provide staff training for all employees and all disciplines on how to recognize behavior issues and de-escalate aggression. There are often identifiable warning signals prior to behavioral outburst.

Some of these include:

  • Arguing with staff or other residents
  • Pacing restlessly
  • Speaking loudly or cursing

Reports and Documentation
Encourage the staff to report and document negative resident interactions. Many healthcare workers consider these incidents as “part of the job” and are reluctant to report them. They should identify the behavior that occurred (physical, verbal, or other), where it happened, what led to the incident, and their response. This information can be valuable in identifying resident specific trends, as well as environmental or program/activity related factors that can often be easily adjusted.

Summary
Resident aggression is a concern in the senior living setting. While it is not always possible to anticipate how a senior may interact with other residents and staff, there are ways a facility can manage the risk of aggressive or violent behavior. Through workplace safety, behavior risk assessments, individualized care plans, and staff training and reporting procedures organizations can better help to protect residents and staff.