How Can Nursing Home Staff Manage Poor Patient Behavior?

Assisted living facilities (ALFs) and long-term care providers like nursing homes face many risks as they deliver compassionate healthcare to America’s seniors. Over time, these risks have evolved, presenting new challenges for caregivers and facility staff members. One of the emerging risks is that of patient behavior due to an increase in residents with cognitive deficits like Alzheimer’s disease or dementia. Nursing home insurance is designed to provide protection for a wide range of expected and unforeseen risks in the long-term care sector. It can be considered the foundation of risk management in the nursing home environment. However, properly managing patients with dementia can help to reduce or eliminate the risks associated with their care, including injury, property damage, or unfortunate deaths. 

Dementia: A Growing Concern in U.S. Nursing Homes

As we age, many of us will experience changes in the way our brains process information. Collectively, these changes are referred to as cognitive declines. Some such declines are mild, including forgetfulness or a loss of problem-solving ability. Others, unfortunately, are more severe, and may include Alzheimer’s disease. Nursing home residents with Alzheimer’s may be unable to perform everyday activities, and may be at risk for wandering or elopement. Patients with dementia may also exhibit significant behavioral changes, including aggression or violence. Dementia patients in nursing homes, especially those with inadequate care or supervision, may be at risk of injuring themselves or others and may even die as a result of the disease. 

According to the Alzheimer’s Association, more than 5 million seniors in the United States are living with the disease. It is estimated that by 2050, more than 14 million seniors will be afflicted with Alzheimer’s. As such, it is a growing concern, and requires nursing home facilities to approach these patients with a higher level of treatment and protection. 

Acting Out: Bad Patient Behavior in Nursing Home Environments

Cognitive declines and disorders like Alzheimer’s are not the only reasons seniors may exhibit unwelcome behaviors. Some of these patient behaviors can be chalked up to natural human characteristics like disagreements or conflict avoidance. Seniors may act out for many other reasons, however, including:

  • Personality conflicts with staff members or fellow residents.
  • Naturally aggressive or bully-like tendencies.
  • Control issues.
  • Physical issues such as discomfort or pain.
  • Mental triggers not associated with cognitive deficits, such as past traumas or mental illnesses.
  • Reactions to or adverse side effects of certain medications.

Unwelcome or dangerous patient behaviors have led many nursing homes to evict those residents that exhibit these behaviors. Evictions or relocations of certain patients may run afoul of established transfer guidelines, but many nursing homes may justify evictions using a variety of means. It should be noted that penalties for unlawful evictions can be steep, and nursing home insurance may not cover these expenses. 

In 2013, the National Ombudsman Reporting System (NORS) collected over 7,000 reports of resident-to-resident conflict in America’s nursing homes. The following year, more than 11,000 reports were filed. Since then, the number of conflicts have grown, resulting in more long-term care facilities to modify their conflict resolution practices – or to implement these practices to protect the health and wellbeing of residents.  

Managing Unwelcome Resident Behaviors: Best Practices

Despite the growing number of reported conflicts within nursing homes, caregivers and facility managers have a variety of tools with which to control so-called “bad” behaviors. The first part of managing undesirable or unwelcome behavior, of course, is to understand the underlying factors. Caregivers who take the time to learn the personalities and behaviors of their residents are far more able to mitigate unwelcome outbursts. 

For many instances of bad patient behavior, nursing home staff can adopt practices like:

  • Conflict resolution training for caregivers and support staff
  • Conflict de-escalation training
  • Identifying and eliminating potential triggers within facilities
  • Addressing resident concerns with support and understanding

If a resident continues to exhibit unwelcome behavior, and eventually poses a safety threat to themselves, other residents, or staff members, that resident can be lawfully evicted. This should be considered a tactic reserved only for the most unruly residents – those who cannot be reached in any other way. 

For residents with dementia and other cognitive disorders, certain practices go hand-in-hand with nursing home insurance to reduce health and safety risks. Facilities that care for dementia patients should:

  • Monitor resident activities through the use of regular staff checks and closed-circuit video systems- if possible.
  • Install door alarms to help prevent elopement hazards.
  • Undergo specific training on caring for Alzheimer’s and dementia patients. 
  • Be willing to transfer patients to more specialized care facilities if those patients exceed the capabilities of nursing home staff. 

Bad patient behavior can pose significant risks to nursing home residents, staff, and facility assets. With conflict resolution training and improved monitoring of residents, healthcare facilities can supplement the protections afforded by nursing home insurance. The end goal is simple: to deliver compassionate care for seniors while providing safe accommodations. 

About Caitlin Morgan

Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.