January 2, 2017

A note from the State Long-Term Care Ombudsman:

Although a lot of recent media attention has focused on the issue of bullying, many people see it as something that happens primarily at school, work or online. However, bullying is becoming an increasing problem in long-term care facilities, and because aggressive behavior is often a symptom of an unmet need, this topic is one that long-term care providers need to be aware of and address.

According to the Hazelden Foundation, bullying is "intentional aggressive behavior involving an imbalance of power or strength." It can be verbal (e.g., name calling, teasing, taunting, making threats, using sarcasm), physical (e.g., pushing, hitting, destroying property, stealing) or anti-social (e.g., shunning, excluding, gossiping, spreading rumors, using negative body language), but bullying always has the same effect: it makes its victims feel fearful and powerless.

Because all long-term care residents and tenants have the right to live in a safe environment and be treated with respect and dignity, it is important for facilities to know how to identify and prevent bullying and other forms of resident-to-resident aggression. The article and resources listed below are great tools for beginning a discussion with residents and staff and, as always, the Office of the State Long-Term Care Ombudsman is available if you need additional assistance.

Together, we can make 2017 a safe, healthy and happy New Year for all of Iowa's long-term care residents and tenants.

Deanna Clingan-Fischer, JD

How to recognize and prevent bullying in long-term-care facilities

According to research conducted by Arizona State University, 10-20 percent of long-term care residents/tenants have been bullied by another individual living in their facility. But because society tends to think of older or disabled people solely as the victims and not the perpetrators of bullying, this kind of resident-to-resident aggression can easily be overlooked or misunderstood.

Here are some ways to recognize and prevent bullying in long-term care facilities:

Identify the bully

In long-term care facilities, bullies may intimidate staff as well as other residents; have a tendency to boss others around; criticize others or lack empathy for others; or make repeated complaints about others in a powerful, outraged manner. 

Watch for changes in behavior
Like victims of bullying in any other setting, those who are bullied in long-term care facilities may start to act differently. Pay attention to residents who suddenly begin to isolate themselves; avoid specific areas or activities; take long, circuitous routes to get to and from communal areas; make vague complaints about others "not liking" them or "not letting" them; or become increasingly depressed.

Understand the aggression

When dealing with a bully on an individual basis, facilities can consistently set limits on bullying behavior, offer an appropriate outlet for the person to vent frustrations or work with the individual to identify alternate methods of feeling in control, learn positive communication skills, develop empathy and address feelings of loss. 

Bolster the victims' confidence

Facilities can help those who have been bullied by fostering their self-worth and dignity, addressing and treating any underlying depression and providing skill development sessions that help them avoid being victimized.

Create a "Community of Care"

To address bullying at the organizational level, facilities should work toward creating caring communities for residents and staff that emphasizes respect, trust, accountability and empathy. This can be accomplished by:

• Holding regular staff and resident meetings that discuss communal living and the rules and expectations for behavior;
• Offering staff training and support around recognizing and responding to bullying and aggressive behavior;
• Implementing policies and procedures that guide behavior and encourage reporting of bullying incidents; and
• Training residents in bystander intervention strategies to help them stop bullying when it is observed.

For more information on bullying in long-term care facilities, visit the National Long-Term Care Ombudsman Resource Center to view a webinar or download a brochure.