Disagreements, fights and controlling behavior among humans are inevitable. Seniors are not exempt from these natural behaviors, especially when many of them are living together in close quarters. Conflicts in senior living facilities range from small misunderstandings to full-fledged flare-ups between staff members and even other residents. Nearly 7,000 complaints of resident-to-resident conflict in nursing homes and assisted living facilities were reported by the National Ombudsman Reporting System (NORS) in 2013 alone.
While it is impossible to anticipate how a senior may interact with other residents and staff, each facility should be prepared to handle difficult interpersonal issues. “No matter the situation, teaching staff members how to deal with conflict is crucial,” says Carolyn Becchio, Community Relations Director at Brookdale Senior Living in Bonita Springs, Florida. When tension is mismanaged, it affects those involved and disrupts other residents. It can even escalate into physical altercations. But when handled in a respectful, positive way, conflict can be quickly quashed and restore harmony in the rest of the community.
How and Why Seniors Act Out in Senior Living
There are several reasons why seniors may act out or refuse to be cordial to their neighbors in senior living, but care providers should be equipped to handle these difficult behaviors. While some residents may be problematic but harmless, others may be so disruptive or threatening that they may need to move to a higher level of care.
Personality Differences with Staff
Oftentimes seniors act out because of personality conflicts with their aides and nurses, Becchio says. New residents usually have some difficulty adapting to new surroundings and caregivers. They tend to be very picky and difficult when a staff member is trying to get them up in the morning, help them bathe and dress, etc. Certain personality types just clash, especially when a senior is already disgruntled about a move to senior living.
Becchio gives an example of a senior man who is gruff and assertive and doesn’t respect or cooperate with a caregiver who is too timid or gentle. He may see an opportunity to mistreat the caregiver, which is unacceptable. The solution may be as simple as assigning a stronger, more authoritative staff member to this resident, because that’s what he respects. However, that same technique doesn’t necessarily work with everyone.
These disconnects are not necessarily the caregiver’s fault, Becchio stresses. “You can have the best employee who 99 percent of the residents love, but there may be one resident who just can’t stand them.” It’s just the luck of the draw. “Taking the time to learn how a senior likes to be treated enables staff to smooth over conflict or assign different caregivers with similar personality traits.”
Keep in mind, though, that staff are often limited in senior living facilities. Some changes can be made to improve daily care and interactions, but long-term care facilities don’t provide tailored one-on-one care for their residents.
Some Seniors Don’t Outgrow Bullying
Just like in high school, assisted living facilities and nursing homes can have their share of mean girls and bullies. People don’t always grow out of their cattiness and aggressive tendencies as they age. Bullying might consist of derogatory comments made loud enough for other residents to hear, saving seats in the dining room so a certain resident can’t join, or all-out shouting matches.
Sometimes, the resolution is as easy as separating two seniors who are at odds during events/activities and in common areas, Becchio says. If those involved still have their faculties, sitting both residents down with a manager and having a frank discussion may diffuse the situation as well.
Most senior living communities feature programs that help newcomers pair up with a current resident to prevent them from feeling lonesome or ostracized. This can help prevent bullying behavior, but if it does occur, the staff may take a more active role in helping a senior connect and build friendships with other residents.
If the bullying is happening covertly, it’s important to alert an administrator so the situation can be dealt with. Conversely, the staff should be closely monitoring resident interactions and alert family members to any ongoing problems.
The Desire for Control
Sometimes, social manipulation, exclusion and disruptive behaviors have more to do with acquiring a feeling of control at a point in life when older people can feel powerless. Becchio cites an example of a resident who refuses to eat lunch or dinner nearly every day. “No matter what is placed in front of her, she never likes it and always wants an alternative,” she explains. The staff at Brookdale accommodate such requests (within reason), even if they know the behavior is related to control issues.
However, if the controlling behaviors become excessive or disruptive to other residents and staff, serious measures must be taken to try and resolve the situation. Again, a private meeting with the resident and perhaps a respected family member is sometimes helpful.
Mental and Physical Causes of Behavioral Issues
If the aforementioned techniques do not work and a resident’s bad behavior continues, a psychiatric evaluation may be necessary. This is particularly important if a senior’s actions and attitude change suddenly.
Becchio says the resident care director or director of nursing may assess the resident for a urinary tract infection (UTI), medication problems, the onset of dementia or other mental health issues. Both UTIs and worsening dementia share common symptoms, such as emotional outbursts, fear, anxiety and abusive language. Some medications, as well as depression, can cause personality changes. Becchio says the goal is to find out what is causing the behavior and treat accordingly.
Dementia can be particularly problematic in long-term care settings. Depending on the extent of a resident’s cognitive decline, they may either be challenged when it comes to regulating their emotions and behaviors or totally unable to exercise self-control. Escalating dementia-related behaviors is a common reason for residents to move to a higher level of care. Fortunately, specialized settings just for seniors with cognitive decline called memory care units are staffed with individuals who are trained in dementia care. The nurses, aides and administrators are used to handling difficult behaviors and use tactics like redirection to calm residents.
How Senior Living Facilities Handle Bad Behavior
It’s hard for many seniors to accept being dependent on strangers, so it’s not uncommon for them to complain about or rebel against their new caregivers at first. Whether or not these complaints are well founded, it’s important for family members and staff to hear them out and try to help resolve them.
Becchio says that Brookdale holds a full staff meeting on a regular basis including directors, activities managers, personal caregivers, dining room staff and housekeepers. Any behavior problems or conflicts are discussed in detail and everyone works together to find a solution.
A few tactics that can help resolve tensions include:
- Getting to know the resident in question and understand his or her personality.
- Identifying and eliminating triggers that cause outbursts.
- Addressing a resident’s fear and concerns in a supportive manner.
Disruptive Residents Can Overstay Their Welcome
If all attempts to resolve problems have been exhausted and the bad behavior continues, long-term care facilities do have the right to evict a resident. Becchio says this has never happened during her time at Brookdale in Bonita Springs, but every senior living community has clauses in their contracts that specify situations when a resident may be asked to leave. For example, if a senior’s needs have exceeded the care a facility is capable of providing or a senior poses a risk to themselves, the staff or other residents, then the facility is usually within its rights to terminate residency.
Be aware that there are certain termination protocols that must be followed, which vary by state. Generally, the facility must provide a certain amount of notice, compose a discharge plan for the senior’s alternative care, and inform the senior and/or family of their ability to appeal this decision. If you feel an aging loved one’s residency has been unfairly terminated, it’s important to file an appeal and contact the local ombudsman to investigate this matter.