June 2013
Delivered to you courtesy of the FHCA Quality Foundation
In This Issue
Quality at Work
Telegram from Uncle Sam
Facility opens doors to national research project on prevention of infections in nursing homes
There's an App for that!
Seniors shine in Ms. Northwest Florida Senior Pageant
Late at Night, in Rehab, My Anxious Mom, & "A Woman Named Wendy”
Florida tops nation in Quality Award recognition
Tracking Trends
Is it dementia, mental illness or just plain bullying?
AHCA/NCAL Quality Initiative
News You Can Use
QAPI offers data-driven, proactive approach to improving the quality of life, care and services
Resource guide for dementia care
National conference makes culture change resources available
Critical questions - just how prepared are you for a hurricane?
Celebrations
Nurse leaders honored for excellence in care delivery
FHCA members earn national recognition for advocacy efforts
Celebrating caregivers on the frontline
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The FHCA Quality Foundation promotes mentorship and collaboration among long term care providers and stakeholders through a shared commitment to communicate best practices, share resources, promote educational activities and advocate for continuous quality improvement. The Foundation offers scholarships to assist long term care employees in meeting their continued educational goals. In addition, the Foundation hosts an annual awards program recognizing leadership in nursing and quality performance. For more information about the FHCA Quality Foundation, visit the FHCA Web site.
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Tracking Trends
Is it dementia, mental illness or just plain bullying?

By Karen Goldsmith, Goldsmith & Grout
FHCA Regulatory Consultant

Several studies have recently been conducted regarding inappropriate behavior of seniors in assisted living facilities and nursing homes which revealed that some of the inappropriate (bad) behavior exhibited is nothing more than plain old bullying.

There are many reasons for bad behavior. Some are not the fault of the resident, such as dementia, but others are under the control of the resident.  These studies have found that people who were bullies when they were young tend to revert to this behavior at the end of their lives.

Why? These people feel out of control.  Someone has made a decision that they cannot live in their own home where they are surrounded by their own things and where neighbors are familiar.  Suddenly their life is communal and the old coping mechanism of bullying the weaker guy comes into play.  Bullies were not good at sharing in their youth; why should the expectations be different now?

Stress enhances the individual’s need to bully. When the other residents react, the bully ups the ante and becomes worse.  If they don’t react, he increases his bullying to see how much it takes to get a reaction.  In any case, he will get a reaction from the staff, and the old satisfaction he felt as the school bully will return.

Bullying can take several forms.  In the male residents, it usually manifests in aggressive behavior. In the females, it tends to be the kind of behavior that made high school miserable for the bullied: belittling, ignoring, “don’t let her sit at our table” and the like.

For the bullied, the reaction can be very severe, particularly if that person was bullied as a child or young adult.  It can trigger long forgotten (or buried) memories of a time when life was miserable.  Even behavior which stems from dementia, not bullying, can be perceived as such by the victim, thus stirring up the same emotions.

As more studies are conducted, researchers are learning more ways to distinguish the bully from the resident who has dementia or a mental illness.  Of course, this will never be an exact science.  And asking family members about the person’s past may be of no help.  The children of the bully likely don’t know much about his behavior during his school years.

As we learn more about this behavior, we will have more tools to determine who is a bully and who is not. Identifying the victims is often easier.  Think back to your middle school years.  Who were the people who were bullied?  The quiet shy person, the person already anxious, the person who cries easily; those with early stage dementia may already be exhibiting those same behaviors.

Your first priority is to try to protect them.  Being bullied will only increase these characteristics and make them afraid and insecure.  They will withdraw and perhaps refuse to go to the dining room or participate in activities.  They will need special time from social services and others.

Some ideas to get you started:

  • Create an environment in your facility that discourages bullying.
  • Take the time to evaluate the person who exhibits bullying behavior to see why, including helping him/her cope with the issues he/she has in a more positive way.
  • In-service your staff to listen for cues that show a resident who thinks he/she is being bullied. Listen for comments such as, "he doesn’t like me,” “I make him mad,” or “he makes me mad.” Housekeepers and maintenance staff are good people to look for bullying.  Residents may be more willing to share concerns with them in a casual conversation.
  • Residents sitting alone by themselves when this is an unusual behavior for that person may be reacting to bullying – help them vocalize their concerns.
  • Train your staff on current ideas about dealing with the bully.  The same methods that work with teenagers, when modified, will likely help in your facility (just remember the residents’ rights).
  • Find a safe way for your residents to report bullying so that they do not fear retribution.
  • Work on ways to build the self-esteem of residents, both the bully and bullied.
  • Offer anger management programs.  Care plan them.

The study of bullying in nursing homes and assisted living facilities is in its infancy.  We can learn a lot from the same studies which were performed for middle school bullying.  Be creative.  Use new ideas.  Always remember, however, that each bully or victim is unique.  Each may have different triggers that prompt their behavior.  Learning these triggers can help significantly in preventing bullying in the long term care setting.


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