One of the most difficult aspects of both having a loved one in an assisted living or skilled nursing setting, and of administering those settings safely, is processing often unpredictable behavior of individuals with dementia. The actions of residents often do not correspond to any rational reality we understand. Worse, it is sometimes impossible to figure out what happened, because taking the words and actions of the cognitively impaired at face value is common but often unhelpful in those settings.

Nurses and aides who find themselves at the receiving end of violent behavior may choose to accept it as an occupational hazard. On the other hand, when aggression occurs between residents, the matter becomes more complicated, especially when one or both participants has a cognitive disorder of some sort. Across the nation, elders live in close quarters, within the walls of nursing homes, potentially unaccountable for their actions.

We hear occasionally about extreme and tragic examples of resident aggression, such as in this article. Here, the two individuals were both residents of the same long-term care facility, the attacker was not found to be culpable, and in fact passed away three months after the fact. The circumstances are cold comfort to the victim's family, or to the people who manage the building. It is obviously a tragic case but it is hardly unique. How do we address this issue and spot problems before they become tragedies? It would appear there has simply not been enough research on the problem. While elder care is constantly under clinical observation, and gerontologists and other experts regularly issue reports on related topics, it seems that this phenomenon continues to elude practitioners in this area.

Defining Resident-to-Resident Aggression

According to a study done by The Gerontological Society of America, the definition of resident-to-resident aggression is “negative and aggressive 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 results end up being categorized as five themes, which emerged from events observed during the study: invasion of privacy or personal integrity, roommate problems, hostile interpersonal interactions, unprovoked actions and inappropriate sexual behavior. It is then incumbent upon caregivers and family to develop skills and strategies to recognize these behaviors and redirect them as soon as possible.

The Key to Understanding Resident-to-Resident Aggression

We counsel our clients that there is no substitute for sheer hours spent with loved ones. Consistency in caregiving and staffing is the single best weapon we have against unwanted resident behavior. That time mixed with careful attention should allow a connectivity and pattern recognition to emerge during their behavior. A caregiver (in any setting) who interacts with one person on a regular basis should be able to spot triggers and sensitive spots in the interaction between people. The caregiver must then share these findings with others to build a more complete picture. It is disturbing that caregivers are often made to feel that these insights are without value to their employers and so they simply keep them to themselves. We respectfully submit that academia may not be consulting the true experts in elder care.

One major presence in the long-term care industry is increasingly that of the elder care attorney. Attorneys have a different perspective than researchers, and while we often rely on clinical experts for that side of things, we have an ability to dissect complicated situations and search for practical solutions. An instance of resident aggression is often an opportunity to take stock of a care plan and make significant improvements before a facility or family overreacts. We want to hear any case of resident-to-resident aggression directly from a relative, friend or legal representative. If you know of such a situation, please contact this office for an appointment.