Growing numbers of long term care workers are facing potentially aggressive situations on the job.
“Based on my experience, we’re seeing that resident aggression is growing,” says Karen Cody, CPCU ARM, director of risk management with Texas-based Preferred Care Partners Management Group (PCPMG).

The Occupational Safety and Health Administration (OSHA), which recently updated its enforcement procedures on workplace violence, defines it as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”

According to a member survey from the American Nurses Association, concerns about getting assaulted on the job have risen from 25 percent to 34 percent over the past 15 years.

Several reasons account for this: The population is continuing to age, producing more residents who suffer from progressive neurological conditions like dementia and Alzheimer’s disease. Long term care centers are also seeing more young people in their care who have disabilities as a result of drugs or brain injuries, observers say. Many are “a lot stronger and angrier” than older patients, Cody says.

In some cases, staff may also have to confront a resident’s disgruntled spouse, boyfriend, or family member in a nursing center.

“Health care is a strange environment because in facing the challenges of ill health and imminent death, it creates for families and workers a heightened emotional experience,” says Lyn Bentley, vice president of quality and regulatory affairs for the American Health Care Association. This is especially true in long term care centers, places where people may end their lives, and family members of residents are upset and concerned.

Experts in the field say that staff education and the proper safety controls at facilities can go a long way toward reducing workplace violence in long term care.

Patients often act out because they’re no longer able to express their needs or desires, Bentley says. If a staff member at a nursing center approaches a resident from behind, for example, it may end up surprising and frightening the resident, and they could lash out at the employee.

This calls for increased sensitivity in how workers approach and interact with patients with dementia, Bentley says.

For the 100-plus facilities she oversees, Cody has just finished work on an observation training tool that teaches new hires about safely interacting with and approaching residents. Through on-the-spot training, staff will learn how to knock on the door to a resident’s room and the ways in which they should talk to residents.

Cody has also been working with her chief nursing officer and PCPMG’s regional quality managers to reduce workplace violence. Through this collaboration, discussions can take place as to whether a certain resident should be discharged, or if additional staff training is necessary.

Ultimately, “we can’t train residents to be different, but we can certainly train staff on how to work with the resident and how to be safe,” she says.

Branford Hills Health Care Center located in Branford, Conn., has a zero tolerance for workplace violence. All employees are educated on how to handle various situations, says Administrator Janet Woxland, RN, BSN, MHCA, NHA.

The center has a number of safety features like panic buttons that can immediately alert the local police. Security cameras monitor the centers’ activities in all public areas. Unlike most facilities, Branford Hills has a 24-hour security guard at its front door as well as a security guard at its back door until 8 p.m. every day.
Branford Hills is looking into other entry systems as an added safety measure.

Preventing workplace violence not only involves the use of technical equipment, but also involves training of employees to identify signs of potential workplace violence. It’s about being in tune “with the mental health and well-being of your employees,” Woxland says.