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Nursing homes not only can but must change the way they operate, becoming better places to live and work. Only then will they be able to reduce the epidemic of violence that currently plagues them, according to an article in the Journal of Gerontological Nursing, Vol. 34 No. 3.

CNAs often experience “harassment, threats, and assaults” from residents, and the number of those incidents is probably “seriously underestimated,” according to “Policy Recommendations on the Prevention of Violence in Long-Term Care Facilities.” (The article is free to subscribers only; others must pay.)

Those attacks cause emotional distress, which can lead to more confrontations. “Frustrated and fearful, CNAs’ voices might be louder and their movements rougher, causing residents to respond in an aggressive manner,” notes the report. A vicious cycle of abuse can also occur when, “in retaliation, such aggressive behavior results in staff-to-resident abuse.”

Low reimbursement levels lead to low staffing levels at most nursing homes, which is a major contributing factor, the report says. “CNAs are more apt to deliver care in a rushed, rough, and hurried manner when assigned a large number of residents. A hurried approach is likely to cause residents to become more aggressive, thus increasing the risk of assault.”

While research shows that behavioral treatment for residents and training for nursing assistants can reduce the severity or frequency of incidents, they cannot solve the problem, the report says. Instead, the authors recommend the following:

• Increase staff-to-resident ratios;
• Increase the supply of health care professionals with specialty training in mental health and dementia care;
• Require training about the causes, assessment, and management of resident violence for all direct-care staff;
• Increase reimbursement levels for care of residents who display aggressive behavior;
• Develop evidence-based guidelines for assessment and management of aggressive behavior;
• Require facilities to have policies and procedures to be followed when an episode of violence occurs; and
• Conduct more research on the sources and effects of aggressive behavior in long-term care settings, and identify the most effective behavioral and pharmacological strategies to manage aggression.

“Leadership, resources, and infrastructure are required to implement major workplace culture and organizational change,” the authors conclude. “It is imperative that the links between violence in LTC facilities and adverse outcomes, such as occupational strain, low job satisfaction, high staff turnover, anger, injury, and abuse, be adequately addressed. Policy makers need to understand that caring for LTC staff will result in better resident outcomes.”

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org