My junior year of high school I transferred to a new private school where I was an outsider. I inadvertently offended a member of the top clique and he and his friends proceeded to ostracize me for the rest of the school year. I transferred to another private school during my senior year where I was well liked. It was quite the experience going from the bottom of the social order to the top in the matter of one year.
High school kids are known to be petty, with cliques, mean girls, bullies, and various pecking orders. Most people would be surprised to discover that nursing homes have a lot in common with high school. The New York Times ran an article titled, “Personal Conflicts, Even Violence, Are Not Uncommon in Long-Term Care, saying:
Arguments, verbal abuse and aggression are not unusual in elder care settings.In long-term care facilities, residents sometimes yell at or threaten one other, lob insults, invade fellow residents’ personal or living space, rummage through others’ possessions and take them. They can swat or kick or push.
The New York Times gave an example:
At an assisted living facility in New York State, a small crowd had gathered at the dining room entrance at lunchtime, waiting for the doors to open. As a researcher observed, one woman, growing tired and frustrated, asked the man in front of her to move; he didn’t appear to hear.“Come on, let’s get going!” she shouted — and pushed her walker into him.
Although not mentioned in the New York Times article, the social status in nursing homes tends to correlate with health status. Those in the best health with the best mobility tend to be the higher social status residents. That does not necessarily mean they are better behaved or the ones always instigating aggression. Agitation is common among dementia patients.
Only psychiatric hospitals and residential youth facilities have more aggressive behaviors among residents than nursing homes. One in five residents are involved in an aggressive act every month in nursing homes. Researchers then looked at assisted living centers with private apartments expecting to see much lower aggression in people with the mental capacity to live more independently. It was lower but still high. About 15% of assisted living residents were involved in an aggressive act each month compared to 20% in nursing homes.
There have even been deaths among residents caused by other residents. Between three and four deaths occurred yearly for the past 30 years.
“We have this extraordinary paradox: the institutions, nursing homes and assisted livings who care for the most vulnerable members of our society are some of the most violent in our society,” said Karl Pillemer, a Cornell University gerontologist who has studied resident-to-resident conflict for years.
Experts say that higher staffing levels would help alleviate some of the resident-on-resident aggression, but staffing is already a problem for nursing homes. Few people want to work in long term care and labor is the costliest part of running a long-term care facility. Another recommendation is better training among the staff to deal with residential aggression.
“We help people understand why this happens, the specific risk factors,” said Ms. Rorick, who directs the training program, which has been used in about 50 facilities nationwide. “They tell us the training helps them stop and do something about it. Things can escalate quickly when they’re ignored.”
I suspect the same training would work at a daycare, and possibly at a high school too. The nature of long-term care is that facilities are filled with people who cannot live independently. They are often a danger to themselves, whether that be from inability to feed themselves to burning the house down trying to feed themselves. That they can be a danger to others around them is not hard to fathom. The staff training that probably works the best is how to train the residents that bad behavior is unacceptable. However, it is unlikely not so simple. Before it was prohibited by state and federal laws, many facilities used so-called chemical restraints. Basically, they medicated residents to make them easier to deal with. That was not a solution either since groggy residents fell and hurt themselves more frequently.