Men arguing on park bench

SAN DIEGO — If the response of attendees at a Tuesday session at the American Health Care Association / National Center for Assisted Living annual meeting is any indication, bullying is prevalent in senior living.

When speaker Tim Johnston, Ph.D., director of national projects at SAGE, asked audience members how many had witnessed bullying in their communities, nearly everyone raised a hand.

Johnston, whose presentation was part of the assisted living track of the meeting, shared tips that senior living professionals can use to prevent or address bullying, whether it involves staff members or residents. But first, he said, it’s important to understand what bullying is and what it isn’t.

“Having a strong, consistent definition of bullying is really powerful and really empowering,” Johnston said. “We talk a lot about bullying, but if we describe everything as bullying, we run the risk of diluting the term so it doesn’t really have meaning anymore.”

The three characteristics of bullying, he said, are that it involves aggression, violence, isolation or harm; that it involves a power imbalance between the aggressor and the target; and that it is repeated over time or carries the threat of future harm. A one-time hurtful remark or heated argument does not meet that definition, although such negative interactions can be addressed, Johnston said.

Older adults may bully fellow residents because doing so gives them a feeling of control or sense of identity at a time when they may believe that they are losing their independence, relationships, income and valued roles, Johnston said. They also may do it to gain social status or resources, he added. Or it could be due to underlying issues such as mental illness, dementia or physical discomfort. “But a bully can find any reason to bully someone,” Johnston said.

Senior living leaders may be tempted to try to implement a “zero tolerance” policy against bullying “because all the resource it takes is the paper to write down the policy” and because such policies appear to be neutral, Johnston said. Structural bias can be “baked into” them, however. Instead, Johnston favors an “ecological” approach that considers the cultural, social and historical context in which the behavior occurs.

“A lot of you work in environments where you just can’t kick somebody out,” Johnston said. “But an ecological approach stops to say, ‘We’re in it to win it. We’re a community. What can we do to get this person behaving in a more appropriate way?’ ”

Whether the bullying manifests itself verbally, physically, socially or online, similar tactics can be used to try to prevent or address the behavior, Johnston said. He noted that his recommendations are broad and that various state regulations may dictate responses as well.

  • Code of conduct/residents’ rights document. If you don’t have a code of conduct for your community/company, develop one. Review it with residents when they move in, and have them sign it. Go over it with residents and staff members every six months to ensure that their experiences are in line with the expectations established in the code. Make sure families see the code, and post a statement within the community that reflects its tenets. “Repetition is key,” Johnston said.
  • Training. Train staff members and residents — all of whom could be bullies, targets or bystanders — on how to recognize bullying and how to respond to it. Provide individual follow-up counseling and conversation as needed.
  • Respond to bullying behavior by critiquing the behavior and focusing on its impact, not the individual. “Having somebody criticize you is the worst feeling, and it immediately makes you defensive,” Johnston said. By concentrating on the behavior and its impact, however, “you’re triangulating your focus and [the bully’s focus] on this third thing” rather than appearing to be judgmental, he said. In your conversation, try to determine the underlying reason for the behavior so it can be addressed.
  • Discipline. Establish clear and multistep disciplinary procedures to be used if necessary, starting with verbal warnings and progressing to written ones so the bully understands the seriousness of the issue, Johnston said. “I do always want to keep our focus on rehabilitation and getting the bully to be a happy member of the community,” he said.
  • Anonymous reporting. Create a way for residents and others to anonymously report bullying behavior and to provide related feedback.

Johnston also recommended a book, “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” by Robin Bonifas, Ph.D., MSW.

NCAL also created a resource last year, “Bullying Among Seniors (and Not the High School Kind): A Prevention and Surveillance Resource for Assisted Living Providers,” that is downloadable as a PDF on the organization’s website.

In addition to educations sessions and expo hall hours, Tuesday’s annual meeting events included a ceremony honoring Bronze, Silver and Gold winners of AHCA / NCAL Quality Awards. The annual meeting concludes Wednesday with additional educational sessions, an AHCA / NCAL Awards ceremony and a closing keynote speech by motivational speaker Dan Thurmon.

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