How to handle residents that bully staff
There's an image of a bully in our conventional wisdom: A meaty kid on a playground, harassing a skinny classmate wearing glasses over the latter's love of books.
In long-term care, that bully may be an elderly woman in a wheelchair forbidding another resident from a dining room, or a veteran struggling with mental health challenges yelling “Piggy!” at an overweight nurse. That's why “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” by Robin P. Bonifas, Ph.D., is an important reference in how to combat bullying*. Bonifas offers advice on empathy training and organizational interventions. The book is academic, but written in a way that you feel as if you're chatting with a friend.
I've written before about “mean girls” and their desire to exert control in continuing care retirement communities. But until reading Bonifas' book, it didn't occur to me that a specific area for improvement in nursing homes can relate to residents bullying staff. Bonifas says when that occurs, it's often with staff of color or those who are new to the United States, punctuated with dialogue such as, “We don't want your kind here.”
Bonifas illustrated a case for me: A resident makes the comment, “Go back to Africa,” to a black certified nursing assistant. The CNA responds, “That makes me uncomfortable. I am going to come back in five minutes and we can try again.” The resident runs to the administrator and says, “She didn't help me at all. She just left me alone.” The administrator takes the side of the resident and admonishes the CNA, without letting her tell the whole story.
“There must be good communication and the staff member must be supported in setting limits,” Bonifas said.
Addressing bullying starts with setting limits, she advises. That includes letting direct care staff set boundaries for what is appropriate dialogue.
Occasionally, administrators complain to McKnight's editors with comments such as, “We have to acknowledge resident choice” in letting residents make racial or ethnic slurs. Nope. Show me a surveyor who cites you for not letting a resident yell racist epithets at staff, or for not having an all-white staff, and I'll show you a reporter at their door. When dealing with resident rights, there is a difference between the resident being allowed to say, “I don't approve of homosexuality,” and insisting no one gay be allowed to sit near him in the activity room, or that all his caregivers be straight. It is a question of whether someone is, by stating their ideas, infringing on another resident's ability to live peacefully, without fear, and with respect from members of their community. It's a question of whether one person's rights infringe on someone else's.
What surveyors want to see are consistent guidelines and limits. What staff need to see is administration support.
While not an excuse, we can recognize many residents may have been raised not to associate with certain cultural groups. In the book, Bonifas walks a social worker or caregiver through a scenario where a resident vents about someone based on their ethnicity, and the caregiver responds with, “I'm hearing it's really uncomfortable for you to be living with people you were taught not to like.” The staff member goes onto say, “I'm wondering if it might be helpful to talk with me about how unpleasant and difficult it is for you to be living with members of [cultural group] rather than voicing those opinions publicly in a way that might be hurtful to others.”
Long-term care staff have to enforce clear policies and procedures with residents who bully either other residents or staff. We don't need to have all residents be nice all the time. But we do have to tell them what is acceptable — and what isn't.
*I'll randomly choose one commenter who writes in the space below to receive a copy of the book.
Follow Elizabeth Newman @TigerELN.