Bullying in Residential Centres for Older Adults Gerard van Loon Manager European Projects National Ouderenfonds / National Foundation for the Elderly website: www.ouderenfonds.nl

What is Bullying? Bullying is the systematic practice of mental and/or physical abuse by one or more people of a person who is unable to defend him/herself. Sometimes it seems as if someone is capable of defending him or herself, or even provokes harassment by provocative behavior or comments. But this does not mean that it is necessarily this person’s fault. A victim of harassment may be anxious and withdrawn, or try to defend him or herself in other ways (which may not always be effective). Bullying is different from teasing. Bullying exists where there is an unequal distribution of power and the events are perceived negatively by the victim. Bullying is systematic and focused on one person, while teasing often occurs once, or is back and forth. In a study from Radboud University, Nijmegen (http://www.ncbi.nlm.nih.gov/pubmed/20924815), the language of bullying has been deliberately avoided, instead using the language of relational aggression. The reason is that bullying is associated with children's behaviour. However, in this article, we use the more common language of bullying. Bullying is usually a group phenomenon. For that reason, bullying more often occurs at sites where people are in close contact with each other for a long time, such as in schools and residential care centers. How often does bullying happen? The study by the Radboud University, mentioned above shows that 20% of older adults indicate they have experienced bullying. Nursing staff indicate that it could be as high as 40% of older adults. These figures are similar to those of children in schools, but it is surprising that virtually no research on bullying among older adults has been done. Moreover, no anti-bullying program for older adult residences is available, in spite of the fact that to a large extent, this problem exists in residential care and other congregate housing situations.

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How can bullying be recognized? Generally older people in residential care don’t pull someone’s hair. Examples of bullying behaviour among older adults include:  “saving places” for some residents and excluding others  ignoring each other  blocking each other's way, for example, or making it difficult to pass by with a walker  negative comments and glares  physical bullying can also occur in residential care centers. Usually victims of bullying are too intimidated to report this. It is therefore important to be alert for symptoms and patterns. Some symptoms and patterns associated with bullying are: - A person is almost constantly alone - Others do not listen to the person or s/he is ignored - The older adult looks frightened and unsure of him/herself. These behaviors are not evidence of bullying, but may be an indication. In these cases it is important to monitor the person closely or to ask, if you are unable to witness any behaviours. Exclusion can also happen accidentally. Someone may feel ignored, while in fact the other person has impaired eyesight or hearing, or other difficulties. What are the causes of bullying? In order to deal with bullying among the elderly, it is important to understand the root causes. There is virtually no research on bullying in residential care centers. Therefore we rely largely on research of bullying in schools. Similar group dynamics are at play, to a large extent, in schools and residential care. Behind every cause is a suggestion for change. Continuing upheaval in the group When the cohesion of the group is constantly disturbed the likelihood of bullying behavior may be increased as some members try to exert some form of control over an unstable situation. In residential or congregate care situations, the “group” may include residents, employees, volunteer caregivers and managers. Disturbances to group cohesion may be caused by the following situations: Conflict between the management of the residence and the family of the elderly: Unfortunately, there are many cases where a family member or members is in conflict with an employee or residence manager about their care for an elderly relative. The fallout from this conflict may easily be vented on the elderly relative or other people. This can negatively change the atmosphere in the group and 2

bullying can follow. It is therefore important to have a good complaints policy so that families are heard and older adults and employees are supported and feel protected. Authoritarian behaviour from employees and managers: Authoritarian behaviour is behaviour in which one person’s will is imposed on others without the participation of others in those decisions. This behavior may be deeply rooted in the organization and/or management of residential care or congregate housing centers, with negative effects on staff and residents as a result. Incidents of authoritarian behaviour, such as imposing too great a workload on staff, lead to abuse of the elderly. Abuse is not only a very serious form of authoritarian behaviour (i.e. abuse of power), but also a signal that something is amiss for the employee. This can be caused by both psychological problems and external factors. These external factors may be related to their own personal circumstances, but also may be related to unhealthy pressure or authoritarian behaviour by a supervisor. A good human relations/personnel policy can decrease bullying and other abusive situations. Continuous struggle for power within the group In a group, a hierarchy is created over time and this is a natural and normal group process. When new people join or leave the group it disturbs the equilibrium of the group, causing group anxiety and stress. Unfortunately, it is inevitable that there will be disproportionately large changes in group composition within congregate housing situations for older adults because of higher rates of sickness and death. The management of the facility has no or very little influence on this. Nevertheless, attempts can be made to limit group changes to a minimum. One can try to create a stable and cohesive group culture and maintain this as much as possible. Scapegoat Mechanism It is a common phenomenon among groups of humans and animals that the diseases and frustrations of the group may be projected onto one of the members of the group. If this ‘group scapegoat’ is removed, the problem will not be solved. The group will choose a new victim. In some congregate housing situations, the inevitable changes and losses that come with aging may cause frustration and tension among residents. Older adults may also be frustrated by their dependence on third parties, the care of the nursing home or a lack of attention by family members. The scapegoat mechanism can be reduced by educating residents about other ways to reduce their tension, such as by participating in discussion groups. 3

Heterogeneity of the group The National Foundation for the Elderly (of the Netherlands) has also received various messages about bullying between different groups in a nursing home. Elderly people from one neighbourhood or social class can exclude people from the other class or neighbourhood. Group formation is not bad; however it may be useful to the development of groups for them to look at as many similarities as possible between groups so that members do not feel too estranged from each other. Boredom Boredom can arise because everything is arranged for you (e.g., in hospital) or because daily events all are very similar and on a very regular schedule. Variety in the program helps prevent boredom. It is also important to provide opportunities for residents to participate in creating their own positive living environment and community as much as possible. Instead of always having to listen to dissatisfaction with living arrangements, a 'committee of elders' could be composed. This committee could be charged to come with proposals for improvements such as new layouts of space, seating arrangements, programming, etc. It may not always be possible to achieve the proposals, but it is recommended to look for ways in which the residents increasingly take responsibility for the quality of life in the residence. Older people may also be asked how they want to be more involved. Anonymity Group formation in itself is not wrong. It creates a bond and gives people the feeling that they belong somewhere. It is also important that people feel seen and acknowledged. In residential care this does not apply just for the residents, but also for the staff. When the people providing care change too often this will not only create unrest and insecurity, but also a feeling of anonymity. Older adults tend to appreciate feeling that the caregiver knows them and knows their preferences for receiving care. Personal problems An older adult can also become a victim of bullying because of personal problems. If someone is dealing with issues such as chronic pain, deafness or blindness, dementia, etc., this person may be seen by peers as annoying. Peers could decide the person is too much ´bother´ and exclude this person from the group. This attitude of peers may also arise from a projection of their own fears and frustrations (scapegoating). Conversations about complaints and frustrations, in a group or individually, contribute to mutual understanding and tolerance. History An older person may have been bullied previously at school or at work. This may have severely eroded his/her confidence in a group. It is also possible that 4

someone has not developed the social skills needed to properly and independently function in a group. Either situation may mean that someone is shy, hesitant, or behaves awkwardly in a group. In such cases, the staff can contribute to easing that awkwardness by accompanying an older adult when s/he first enters the dining room. In addition, the supervisor could previously have considered which group is most likely to be receptive to this person. The supervisor could then actively introduce the newcomer to the group. Social skills and assertiveness training may also still be fruitful in a residence for older adults. The Dutch National Foundation for the Elderly also found that elderly people who are bullied as children may encounter their former bullies again in a residential center. The bullying is then resumed, mostly because the same group patterns arise again. The risk is greater as the freedom of choice for a residential care center is less. What can be done concretely against bullying? 1. Designate a counsellor / mediator Both residents and staff of an institution need to know where they go with any complaints about bullying. It is important that a residential center appoints someone who is responsible for the prevention of bullying within the institution. 2. Establish a residents' committee against bullying Involve residents themselves in creating solutions to the issues around bullying by putting together a committee of older adults in each department. 3. Organize information sessions Educate staff, residents, their children and volunteers about bullying. Information sessions can describe the ways that bullying occurs in this context, and the serious implications it may have for one's wellbeing. An important first step is made by creating awareness of the seriousness of bullying. 4. Enlist the help of carers and volunteers In order to identify bullying behavior, it is important that carers carefully keep an eye on the atmosphere in the group. A negative atmosphere increases the chance of bullying. Because the carers often suffer from high pressure, volunteers can also be instructed to be especially alert for bullying signs and behaviours. 5. Enforcement of sanctions against bullying behaviours a. Clear sanctions against bullying behaviours need to be developed (perhaps with the residents’ committee members), and enforced. Having an unenforced 5

policy leads to recurrence and can also lead to feelings of insecurity. Therefore it is very important that proper action is taken against bullying. The policy may include speaking directly with the bullying older adult about his or her behaviour. Then, if someone persists in negative behaviour after being warned of the consequences, the stated measures need to be taken (e.g., excluding him or her from the next group activity). 6. Ensure a thoughtful introduction and orientation for new residents a. For a new resident the first period in an institution is often more difficult because he or she only knows a few people. It is therefore desirable that a newcomer is well supervised and introduced, for example, the first time he or she enters the dining room. Considering that the new resident may be entering the group during a period of grieving for a previous resident, it is even more important that a careful process be developed (perhaps with the residents’ committee) about how to handle that. 7. Involve relatives / partners of residents a. Often the elderly themselves are struggling to indicate that they are being bullied. It is therefore also important to involve partners and relatives in understanding and applying the anti-bullying protocol. What can you expect from the National Foundation for the Elderly (of the Netherlands)? Bullying Platform The National Foundation for the Elderly will soon open the Bullying Platform. This platform enables professionals of residential care centers to exchange knowledge and experience on this topic. The National Foundation for the Elderly is determined that in various residential care centers bullying is concretely addressed and considers it important that this information is shared with colleagues. In addition, professionals can also share their negative experiences with bullying and ask specific questions. The Bullying Platform also has a database where relevant, additional information can be found. New anti-bullying method for residential care centers Together with various experts in the field of bullying related to elderly, the National Foundation for the Elderly is developing a pilot. In some care centers a new method will be tested, which is specifically aimed at bullying in residential care centers. The effect of the method will be evaluated. The pilots will start after the summer. Afterwards, based on the learning and results, the methodology can adapted by other residential care centers. On the Bullying Platform, you can indicate whether you are interested in the pilots or the methodology. We will keep you informed.

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