Resident Aggression and Violence

January 3, 2019 | Aging Services Risk, Quality, & Safety Guidance

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Resident aggression and violence are pervasive in continuing care settings and put residents, staff, and the organization at risk. Some staff in nursing homes and other long-term care settings experience aggressive behavior from residents, ranging from verbal threats and taunts to physical assaults, on an almost daily basis. According to some estimates, up to 80% of nursing home staff experience aggression by residents (Zeller et al.). Ongoing aggressive behavior from residents prompted one nursing home staff member to comment, "There is probably a little bit of abuse going on all the time by these patients, whether it be verbal, manipulative behavior, sexual inappropriateness, or whatever" (Shaw).

Staff in continuing care facilities are at much greater risk of being assaulted than workers in most other industries. According to 2016 data from the U.S. Department of Labor, the rate of assaults on employees in nursing homes that lead to nonfatal injuries or illnesses and involve days away from work is more than eight times the overall rate for all industries and more than double the rate in acute care hospitals. (BLS "Table R8")

Resident aggression can also be directed at other residents. One in five residents experiences some form of resident aggression. Precipitating causes include invasion of a resident's personal space and communication difficulties. (Lachs et al. "Prevalence")

Home Care: Staff-Related Risks

Staff who provide home care are also at risk for resident assaults. In 2016, the rate of assaults that lead to nonfatal injuries or illnesses and involve days away from work on employees in home care settings was 4.6 per 10,000 full-time home health workers compared with 14.7 in nursing facilities (BLS "Table R8"). Although the incidence rate is lower than in nursing homes, off-site incidents may be underreported. Refer to the guidance article Home Care: Staff-Related Risks for more information on protecting home health staff from violence.

About 20% of residents exhibit aggressive behavior (Murphy et al.). Often, residents who behave aggressively with staff have a cognitive disorder. In one study, 87% of residents who assaulted staff had dementia (Robinson and Tappen), which can cause agitation, irritability, and restlessness. Other causes of combative behavior include physical discomfort; an undiagnosed medical condition; external stimuli, such as noise; and frustration and a sense of loss as dependence on others increases.

The many consequences from resident...

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