How Should Nursing Care Homes Cope with Aggression and Violence?

Health Professional

A reader of OurAlzheimer' is very upset. A loved one has been asked to leave a care home because he is exhibiting challenging behavior. It is not an uncommon situation. There are however a number of things you can establish when trying to decide on a residential home for your relative. Aggression may be a problem of Alzheimer's but it may also be fostered in care environments for a whole variety of reasons.

Reasons for Resident Violence: Finding the Cause Leads to Best Treatment Plans

People with mid and later stage Alzheimer's can sometimes become aggressive and, on occasions, violent. There are a number of common reasons for this in care homes. These include:

  • Fear, confusion and misinterpretation of events.
  • Frustration about limitations on freedom.
  • Wish to leave the facility or area.
  • Feeling their immediate needs are not being met.
  • A response to a caregiver making them do something they do not want to do, such as go to bed, bath or toilet.

Sometimes however there seems no apparent reason or antecedents leading to an aggressive outburst.

Discovering the cause of aggression or violence requires a period of observation and analysis before a treatment plan is implemented. Relatives need to know what steps have been taken to find out the cause. Under the supervision of a doctor or psychologist, care home staff can use a simple form that records all aggressive and violent incidents. One of the most simple and effective is the ABC chart. This nursing care form records;

A ntecedent: What happened (if anything) before outbursts.

B ehavior: What behavior actually occurred e.g. shouting at someone, hitting a staff member.

C onsequence: What happened as a result e.g. was the patient removed to another area? Did a member of staff spend time calming them down? Did they go to bed?

The information is then analysed by the psychologist and/or doctor and a therapeutic treatment plan can then be implemented. Good staff communication is required to investigate the causes of aggression and violence and carry out therapeutic treatment plans. Policies and planning by care home managers need to be in place to deal with challenging behaviour by residents. When they are staff feel secure, listened to and valued and patients with Alzheimer's get the better treatments and better quality of life.

Here is a link to more about the A B C's of Managing Challenging Behavior in Alzheimer's Patients

A Common Response to Violence and Aggression in Care Homes is Increased Medication

Sadly, too often the first response to challenging behavior is medication. Tranquillizing medication quietens and subdues the patient with Alzheimer's disease but it can be very helpful used short term. Medication should be closely supervised by their doctor and regularly assessed to see if it is still required, to see if there are any unwanted side effects and to avoid overmedication.

Care Home Placement: Important Issues to Consider

When choosing a care home you can find out a number of things that may help difficulties later on such as being asked to find another home. Look for or ask questions about:

  • Staffing levels: some homes are often understaffed and have poor staff/patient ratios. Day levels may be far better than night levels. This is quite common as more work is undertaken during the day. Night levels however must account for patient needs.
  • Staff qualifications: Require balance of qualified and untrained staff.
  • Employment of caring male staff to help manage challenging behaviors, give female staff a feeling of security and be there should backup or retraint be required.
  • Ongoing staff education.
  • Stimulating theraputic programs for residents. All care home should employ  trained occupational therapy staff.
  • Safe, comfortable environment with access to garden area or to outside activities. Exercise activities should be matched to their likes and dislikes

Violence is difficult to deal with. It can be very frightening and staff can feel vulnerable unless they have proper medical and effective management backup.