Senior Living
Articles
5 Steps to Manage Aggression in Senior Living
March 12, 2024
Aggressive behaviors are not uncommon in senior living, and they aren’t always predictable. While in an NIH study, staff reported that 15.6% of residents behaved aggressively toward them in the form of physical, verbal, or sexual attacks, this is just part of the picture. There also are instances of aggression on the part of staff and visitors. Steve Wilder, president and founder of Sorensen, Wilder & Associates and AALNA Advisory Council member, shares some tips and insights to help keep residents, staff, and others safe from day to day.
TIP 1: GET TO KNOW RESIDENTS
Sometimes, Wilder said, aggressive behavior goes hand-in-hand with dementia, particularly if the person has a history of being violent or easily angered. “Good intake screening can help,” he said, adding, “Learn what the person’s behaviors at home were like and what kinds of situations or issues might trigger agitation.” Trauma-informed care, a framework for assessing and identifying past traumas and negative feelings that could trigger reactions to various situations or events, is also useful. This can help staff know what issues or activities to avoid and how to make residents feel safe. For instance, if a resident was sexually assaulted as a young woman, she may be resistant to being touched by men. Someone who was mauled by a dog as a child may become agitated if a visiting pet approaches them.
TIP 2: UNDERSTAND THE AGGRESSION CONTINUUM
This is important for everyone to know, stressed Wilder, as it can help them assess the severity of the situation and the potential for de-escalation. Like a stepladder, the first ‘rung’ (‘calm’) is the safest. The next one – ‘verbally agitated’ – is a little less safe but it still is generalized; that is, the person’s feelings aren’t personally directed at any individual. The next level is ‘verbally hostile,’ which is a bit more concerning. However, this level still involves nondirected anger. During these stages, said Wilder, just being quiet and letting the person vent is the best path to de-escalation.
As with the ladder, the highest three ‘rungs’ are the most dangerous. First is ‘verbally threatening,’ and this is where the real risk of violence starts. At this point, Wilder observed, the person’s anger is still being verbalized, but they are beginning to direct it at a specific individual and make verbal threats or demands. Next is ‘physically threatening,’ which comes right before ‘physically violent.’ At this level, the aggressor begins making physical gestures or moves at the person, indicating that an attack may be imminent.
By recognizing the stages and determining when the risk of violence or aggression is real, it will be possible to implement strategies to de-escalate the situation and get help before an attack occurs.
TIP 3: TRAIN, TRAIN, AND TRAIN SOME MORE
Training staff about the Aggression Continuum is a key part of training, said Wilder. It also is important to educate them about behavioral changes and knowing what is likely to trigger each person and how to de-escalate situations. “Most people don’t go from calm to physical violence in one step. There usually are many opportunities for de-escalation before a situation becomes dangerous,” said Wilder. When staff are empowered and trained to defuse situations, it not only will keep everyone safer, but can also contribute to greater job satisfaction and the team’s confidence in their ability to do their jobs.
It is essential to remember that training isn’t one and done, nor one-size-fits-all. Give staff an opportunity to identify those areas where they need more training or resources. And don’t forget to have clear protocols for reporting concerns or situations without fear of retribution. Wilder said, “You need a written workplace violence plan that includes how to respond to threats and who to report them to.”
TIP 4: COMMUNICATE WITH FAMILIES
Families can be a tremendous source of information and support. They can provide guidance on what might trigger violence or agitation in their loved one. They should be encouraged to be open and honest about the resident’s past, including any issues with domestic violence or substance abuse. Teach staff how to ask open-ended questions to get useful information and how to be empathetic and nonjudgmental.
TIP 5: DON’T FORGET STAFF
Employees have things going on in their lives you know nothing about. We’ve worked wth clients where someone’s ex shows up and poses a threat to staff and residents alike. You need to address domestic violence as part of your workplace violence plan, not only to protect employees but others as well,” said Wilder.
Conducting stringent background checks can help identify individuals with violent/criminal histories. For instance, Wilder said, “There was one incident where two rival gang members were hired to work in the kitchen together; not surprisingly, a violent incident in the workplace resulted. A strong background check can help uncover issues that could contribute to on-the-job aggression or violence.”
At the same time, use the interview process to identify any red flags, such as candidates who speak negatively about past employers or co-workers, are impatient or disrespectful, blame others or refuse to acknowledge mistakes, and/or behave defensively or have a bad attitude.