When resident aggression turns physical

It’s the violence in nursing homes story that receives far less press: Residents striking out at staff members or other residents.

A recent series of unfortunate headlines, throughout both the United States and abroad, has shown the painful, and even deadly, results of resident aggression manifested into physical form.  

You likely saw the headline on Long-Term Living last week about police in Stillwater, Minn. using a Taser on a male nursing home resident with dementia. The 79-year-old man had reportedly stabbed a female employee with a ballpoint pen, and after police were called to the scene, he refused to drop his weapon and was subdued.

There was another story a few days earlier, one describing resident-on-resident violence, which had an even more unsettling ending. An 80-year-old resident of a Chicago-area nursing home died of head injuries after an alleged fight with another resident. The nursing home allegedly failed to report the incident to authorities, and the man’s family now plans to file suit.

And there’s more; just look overseas. Staff at an assisted living facility in South Wales called police when a 79-year-old female resident became “agitated” and grabbed a table knife.

How are these events significant? Aside from increasing the visibility of resident-on-resident or resident-on-staff violence and aggression that occurs in long-term care facilities, these stories also show how facility management is tasked to respond to all kinds of emergencies.

Seeking insight on how management should respond to violent or aggressive and disruptive behavior, I asked our new safety and security blogger Steve Wilder to provide some appropriate protocol. His responses are refreshing.

“Resident rights must always be considered,” Wilder says. “The response of the worker is not to engage in an altercation. Rather, it is to protect himself or herself and the resident.  Appropriate steps must be taken to do so.

“A resident who is cognitively ‘stable’ may be able to be talked down—verbal de-escalation—while the physically aggressive resident may need to be physically controlled, using appropriate control techniques.”

When it comes to residents fighting one another, Wilder says a facility’s policies should dictate appropriate courses of action. “If [staff members] do step in to physically separate [residents], they need to be trained in the right way to do it, again protecting themselves and the residents,” Wilder says.

Then there’s that whole matter of residents obtaining weapons, as was the case in two of the above-mentioned articles. First, a weapon is always any object that can be used to harm a person, Wilder says. But how should management respond to a resident wielding a table knife, a pen, etc.?

“Calling law enforcement is certainly an option,” Wilder says. “There are other techniques that can be used if staff are properly trained. It may also be prudent to make arrangements to have the resident transferred to a facility better suited to manage their aggression.”

Sounds like an old lesson repeated here many times, but keeping everyone trained and following protocol seems to be the wisest approach. That and reporting altercations when they occur to the people who need to know.

Kevin Kolus

Kevin Kolus wrote for I Advance Senior Care / Long-Term Living when he was an editor. He left the brand in 2012. He is now senior communications manager at Cleveland Clinic.