Tackling resident-on-resident abuse

Elizabeth Newman, McKnight's Senior Editor

While at a post office recently, I watched a woman cut in line to demand the clerk fix the automated posting machine. A fight broke out between her and the man at the front of the line: Voices were raised, threats were issued and I kept my hand on my phone, waiting to dial 911 if violence erupted.

Luckily, the two stalked off to separate corners, and I took deep breaths to lower my heart rate, as yelling is most definitely not my thing. The clerk later told me this kind of incident was a regular occurrence, which made me wonder why this suburban post office seems to bring out the absolute worst in people. How difficult, I thought, is it to be polite? I was reminded of this when a presenter at the Life Services Network of Illinois conference remarked on the rise in allegations of verbal abuse in nursing homes.

Hot topics for Illinois long-term care facilities include pain management, advanced directives, auditing and use of a G-Tub. But resident-on-resident abuse is also a problem, said attorney Matthew Murer, the chair of the National Healthcare Practice Group at Polsinelli Shughart PC.

“In the past six months, we've seen a lot of verbal abuse [reports], generally where one resident is being really mean to another resident,” he said.

Abuse – whether it's verbal, sexual, physical or mental — is covered under F-tag 223, which also incorporates corporal punishment and involuntary seclusion. Guidelines indicate that verbal abuse “is defined as the use of oral, written or gestural language that WILLYFULLY includes disparaging and derogatory terms to resident or their families or within their hearing distance, regardless of their age, ability to comprehend or disability,” notes Joan Redden, the vice president of regulatory and consumer affairs at Skilled Healthcare. 

Long-term care residents may have lost their natural barrier against being mean due to dementia or other neurological complications. “Sometimes we lose the ability to control our inhibitions,” Redden notes.

But the first step for providers is to “screen carefully,” she advises.

Surveyors also have to understand the issue of “willfulness,” she adds. A resident who has had a stroke who is yelling profanity needs to be accommodated in a different way than a resident who is willfully being abusive, she explains.

The resident being yelled at needs to be moved away from the aggressor, and the facility needs to make sure the aggressor doesn't find another target, she says.

“These are not easy issues to manage,” she acknowledges. But “you're still responsible, whether it's willful or not.”