Resident-on-Resident Violence in Georgia Nursing Homes

Abuse and neglect are a major problem in nursing homes and other long-term care facilities but abuse from staff to residents isn’t the only risk occupants face.  Resident-to-resident mistreatment (RRM) can include physical, verbal, emotional, or sexual violence, and nursing home facilities are responsible for managing and preventing incidents of RRM.

Resident-to-resident violence has a significant, negative impact on all residents and must be reported and investigated thoroughly to reduce this type of abuse. It causes fear and other emotional traumas for all residents at the facility – and all residents have a right to live in a safe and violent-free environment where they’re treated with dignity and respect.

Types of Abuse that May Occur

Physical: There are various forms of physical abuse that may occur in nursing homes including hitting, shoving, burning, or pinching, to name a few.

Verbal: Emotional and psychological abuse can be hard to identify. When a resident causes another resident emotional pain or suffering by their words, it’s abuse. Verbal abuse may include yelling or screaming, intimidation, name-calling, threatening, speaking to a resident in a demeaning way, causing a resident to feel guilty, ignoring them, restricting access to necessities, scapegoating, or withdrawing affection.

Sexual: Any type of initiated or physical touch by a resident that is sexual in nature, and is non-consensual or unwanted, is considered sexual abuse.

Learn more about various types of nursing home abuse here.

Why is Violence a Problem in Nursing Homes?

Typically, when aggression is involved, there’s an underlying cause or problem. It may be the result of a medical condition such as an infection, chronic illness like dementia, or even a reaction to foods or certain medications. It’s crucial that nursing home staff consider physical causes for aggression because an underlying illness or reaction to medicine may be easily treated.

Another major contributor to resident-to-resident violence is dementia and Alzheimer’s Disease. Symptoms such as memory loss, disorientation, and difficulty in communicating can lead to depression, fear, anxiety and panic. A study of residents with dementia revealed that 45 percent had at one time or another exhibited aggressive behavior.

Other contributing factors to violence in nursing homes includes:

  • Frustration
  • Fear
  • Confusion
  • Depression
  • Lack of sleep
  • Physical symptoms such as hunger or thirst
  • Anger
  • Cognitive Impairment

It’s also important to remember not all resident-to-resident mistreatment is considered abuse – it’s intent that determines whether mistreatment is abuse.

In Medicare or Medicaid certified nursing homes, if a resident acted deliberately, it’s considered abuse. Even if the resident might not have intended to inflict injury or harm, or they have a cognitive impairment, he or she “could still commit a willful act.” CMS SOM Appendix PP. F689.

Resident-to-resident aggression is an umbrella term that includes physical, verbal or sexual interactions that are negative, aggressive or intrusive. These behaviors can cause serious physical harm or psychological distress. Learn more about resident-to-resident mistreatment in the Long-Term Care Ombudsman Reference Guide.

Are Nursing Homes Equipped to Care for Residents with Mental Illness?

Many nursing homes and other long-term care facilities are accepting residents who suffer with psychiatric disorders like schizophrenia or bipolar disorder, who are prone to violence.

In a published study called “Mental Illness In Nursing Homes: Variations Across States,” the authors note that more than 500,000 people with mental illness (excluding dementia) reside in U.S. nursing homes, significantly exceeding the number in all other health care institutions combined.

In fact, the study suggests that mental illness is often the deciding factor when families choose to place their loved one in a nursing home. The question is, are nursing homes able to provide the necessary care for a resident with a chronic mental illness and if not, why do they continue to admit such patients?

“A key issue of importance for policymakers and mental health advocates is the appropriateness of nursing home admission for individuals with mental illnesses,” the study reads. “Nursing homes have become the de facto mental institution for many persons with mental illness as a result of the dramatic downsizing and closure of state psychiatric hospitals … However, it is questionable whether nursing homes are equipped to serve the unique needs of residents with chronic mental illnesses.”

A History of Results

We have an established track record of bringing nursing home abuse victims results they expect and deserve. We have recovered millions of dollars for our clients.

We have an established track record of bringing our clients results they expect and deserve. We have recovered millions of dollars for our clients.

Risk Factors of Resident-to-Resident Violence Include

  • Inadequate staff
  • Lack of staff training on abuse prevention, dementia, and cognitive impairment
  • A lack of engagement and activities
  • Crowded common areas
  • Excessive noise
  • Lack of proper procedures
  • Lack of awareness by staff of resident relationships (ie: Not paying attention to building tension amongst residents)

What Should Nursing Homes Be Doing to Prevent and Reduce Resident-to-Resident Violence?

Nursing homes and other long-term care facilities are responsible for protecting residents by incorporating proper management practice, prevention plans, and individual strategies for residents based on their history, patterns, and intake assessment.

The Centers for Medicare & Medicaid Services (CMS) State Operations Manual (SOM) Appendix PP, Guidance to Surveyors for Long Term Care Facilities, states that the “facility is responsible for identifying residents who have a history of disruptive or intrusive interactions, or who exhibit other behaviors that make them more likely to be involved in an altercation.”

The facility is responsible for identifying factors that may lead to the risk of violence, including environmental triggers, mental or emotional issues and underlying causes like dementia, so it can address the underlying reasons for the behavior and try to prevent altercations or violent outbursts.

Other important actions that long-term care facilities and nursing homes should practice that may prevent and reduce resident-to-resident violence:

  • Clean common areas and rooms
  • Reduce noise
  • Avoid overcrowding
  • Develop comprehensive care plans
  • Implement best practices for residents who may have behavioral issues
  • Share fact sheets about resident violence with potential residents and their family members
  • Implement proper policies
  • Ensure adequate staffing levels
  • Train staff properly
  • Implement meaningful social activities to avoid boredom, pain, and loneliness
  • Have protocol in place for violent incidents and respond appropriately
  • Provide proper supervision of residents

Any allegations or incidents of resident-to-resident abuse should be documented and immediately investigated. Once reviewed, if it’s determined one resident abused another resident, it must be reported to the state and handled appropriately.

Regardless of intent or whether the incident is considered abuse or a crime, “CMS expects long-term care facilities to take any necessary action to prevent resident-to-resident altercations to every extent possible.”

Staff should monitor for any behaviors that may provoke a reaction by residents, which include:

  • Verbal abuse or aggression like screaming, cussing, insulting, or bossing others around
  • Physical aggression such as slapping, hitting, pinching, biting, scratching, hitting walls, or throwing objects
  • Sexually aggressive behavior like making inappropriate comments, touching, or grabbing
  • Stealing or rummaging through another resident’s property
  • Invading another residents’ space by going into their room when uninvited

A resident-to-resident altercation should always be investigated.

How to Report Resident-to-Resident Abuse

If you suspect resident-to-resident abuse you should immediately report it to the nursing home staff, facility administrator, or a social worker. If you feel your loved one is in immediate danger, call 911.

The Georgia Department of Community Health, Healthcare Facility Regulation (HFR) is responsible for investigating reports of violence in facilities. Call 404-657-5728 or 404-657-5276 or the toll-free number 800-878-6442. Click here to learn more.

Federal laws are in place to ensure all residents have the right to live in a safe and violent-free environment where they’re treated with dignity and respect. If you or your loved one is a victim of resident-to-resident abuse, we can help you navigate the legal system and hold the correct person accountable. Contact us today for a free consultation by calling 706-354-4000 or filling out our case review form. We have recovered millions for nursing home abuse victims and we take cases across Georgia. There is no fee unless we recover money for you in your case.