Combative behavior

Due to dementia and other psychological problems, nursing home residents are frequently combative, shouting, kicking and striking out at others, most often nurses, who are the victims 90 percent of the time.

When staff anticipates and de-escalates violent episodes, combative behavior can be managed.

The basic techniques for de-escalation, according to Nursing Homes magazine, are:

* active listening and effective verbal responding – good communication with residents can defuse violent behavior
* redirection – Staff redirects resident attention to other subjects
* stance – by standing about 18” apart from residents, staff can move a resident without losing balance. Positioning to the side instead of in front of a resident, they can avoid being struck
* tincture of time – allow resident time and space to let the outburst dissipate
* don’t jump to conclusions – listen carefully to resident concerns before acting
* controlling the environment – move other residents out of the way, remove objects residents could use to hurt others, block routes residents use to leave the facility
* teamwork – staff members must work together to handle combative behavior

Resident abuse

Everyone knows about the laws that protect residents in long term care facilities from abuse. But LTC employees are protected by laws, too, from abuse by residents.

When an employee at an Iowa LTC facility sued for damages after losing her job for slapping a resident who had sexually abused her, awareness grew about employee rights.

Nursing Homes magazine suggests facilities take these actions to protect their employees from resident abuse:

* Create a policy prohibiting hostile environment in the workplace by residents – sexual harassment policies already on the books should be rewritten to apply to residents, with multiple avenues for complaint procedures employees can pursue
* Provide training on handling resident abuse – train employees to handle sexual harassment by residents and train managers to respond to employee harassment complaints
* Readjust supervisor attitudes toward resident abuse – managers must not believe that resident abuse is “part of the job” -- they must understand that resident behavior can constitute sexual harassment and be actionable under the Civil Rights Act of 1964 and other laws