The video clip I posted last week from the movie Alive Inside: A Story of Music and Memory has “gone viral.” There were well over 6.5 million views as of last Saturday, when I saw the documentary and post-film discussion and spoke with Dan Cohen, the social worker who started the ipod project. Here are a few points I took away from the experience that might be helpful for readers considering individualized music for their residents with dementia:
While all music can be beneficial, studies of the brain show that different parts “light up” when a person hears the music that is most connected to them. In other words, individualized music has a greater impact than the songs played for a group.
The music that tends to resonate most for people is that heard during their formative period of about 15-24 years old.
Dan Cohen’s Music and Memory organization has an 5-hour inservice that trains staff on how to use the devices with the residents, and answers common questions such as those regarding infection control and on securing the ipods so they don’t get lost or stolen.
The time spent by staff on the program is more than made up for in reduced time in other areas because the residents tend to be happier and more cooperative.
There have been people living with advanced dementia in every nursing home I’ve been in. They sit silently in chairs and recliners, lining the hallways or packed into the day room, where the TV creates the illusion of a pastime. This residents often seem unreachable, locked in their own private worlds, not responding to questions or efforts to involve them in activities. What if we could bring them alive again through music? In this video, Oliver Sacks, MD, provides commentary as music transforms a man with dementia. The clip is part of the documentary, Alive Inside: A Story of Music & Memory.
Potential Individual-Level Interventions to Reduce Bullying Among Seniors: Strategies for Bullies
By Robin Bonifas, PhD, MSW, Assistant Professor, School of Social Work, Arizona State University, Phoenix, AZ and Marsha Frankel, LICSW, Clinical Director of Senior Services, Jewish Family & Children’s Service, Boston, MA
Readers will recall some of the characteristics of bullies from our second blog,Who bullies and who gets bullied? These include:
Underlying need for power and control
Use power and control strategies at the expense of others
Often find it positively reinforcing to make others feel threatened, fearful or hurt, or to contribute to conflict between people
Difficulty tolerating individual differences
Lack of empathy
Very few positive social relationships
Low self-esteem with a tendency to put others down in order to build themselves up
In addition, the following complicating factors are important to consider in understanding where individuals who bully are coming from:
Losses associated with aging – may be seeking control at a time in life when they feel exceptionally powerless
Challenges of communal living – may be exerting control in attempt to change public space into private space
It is helpful to keep these characteristics and potential complicating factors in mind when designing interventions to reduce bullying behaviors because they can help us get at underlying issues that contribute to bullying. Approaches to address bullying will vary from individual to individual, but some initial strategies to try include the following:
Consistently set limits on bullying behavior – the individual who bullies need to hear the same message from everyone that his or her behavior is not acceptable. Here are two examples of setting limits, the first in response to a resident wanting the overhead light on in her roommate’s space and the second in response to a resident wanting a staff member to delay other residents’ care until she completes a phone call:
“Mrs. Jones, I know it’s difficult to adjust to a new roommate, but it violates her rights for your to have the overhead light on all night because it lights her side of the room, too; you’re welcome to have a night light for your side of the room instead.” “Mrs. Smith, I know you would like me to wait here until you finish your phone call, but I’m not able to do that, other residents are waiting for care and it’s not an effective use of my time. I’ll check back with you in 15 minutes and if you’re done with your call, I’d be happy to help you to bed.”
Offer an appropriate outlet to vent frustrations – sometimes individuals who bully have a difficult time tolerating others who they perceive as different or deviant. These are legitimate feelings and we can’t expect individuals to simply not feel what they feel; remember many older people have not been socialized to welcome diversity like people from younger generations have been. In keeping with social work’s values of beginning where the client is and working from the client’s world view, it can be helpful to offer a bully who is intolerant an alternative venue to talk about his or her difficulties. For example, meeting one-on-one with a social worker or psychologist to vent frustrations, have those frustrations acknowledged, and then slowly move toward developing strategies to manage frustrations in ways that don’t negatively impact others. For example, acknowledgement might look like this:
Resident: I really can’t stand individuals from that [cultural group]; I was brought up not to socialize with their kind and I’m not about to now. Mama always said those people were bad!
Helper: I’m hearing it’s really uncomfortable for you to be living with people you were taught not to like. You’re feeling put out that there’s an expectation to just get along with them when doing so has never been your way.
Resident: Damn straight! You know where I’m coming from…
Helper: I certainly want to respect your point of view.As you know, this is a place where we need to treat everyone respectfully even if they’re from walks of life we don’t approve of. I am wondering if it might be helpful for you to talk with me about how unpleasant and difficult it is for you to be living with members of [cultural group] rather than voicing those opinions in public? Might this be a way to compromise on this issue?
Later on, after rapport has developed and there is trust between the resident and the worker and the resident has had an opportunity to express his or her point of view and have the worker accept and understand that point of view without judgment, steps can be taken to help the resident develop healthier ways of managing negative feelings.
Identify alternative methods for individuals who bully to feel in control – we all want to feel in control of our environment and situations, so it is important to help individuals who bully to develop positive methods to feel like they are in charge. For example, one of Marsha’s colleagues used the following approach to manage bullying behavior that involved picking on others, bossing them around, and dictating who could sit where and who could participate in what. Marsha’s colleague addressed this resident by encouraging her to reflect on her feelings when moving into the residence and her difficulties in adjusting. She then asked for help to in creating a more welcoming environment for people who had newly moved into the facility. Playing up this individual’s potential leadership skills, Marsha’s colleague encouraged her to devote her energies to organizing a welcome committee. The individual was highly flattered, took on the task with relish, and bullying behaviors markedly decreased because of this empowering opportunity.
Foster the development of positive communication skills – sometimes people don’t know how to speak assertively, but only know how to speak aggressively; work with individuals who bully to enable them to express wants and needs without hurting others. This might be as simple as helping them practice making “I statements,” for example, they might learn to say something like “I feel frustrated when I can’t sit in my favorite chair; it reminds me of one my husband bought for me long ago. I’d like you to let me sit here during lunch, and perhaps you can sit here for Bingo” rather than “Get the hell out of my chair! I told you it was mine for lunch and you could have it at Bingo! Are you deaf or something?!”
Foster the development of empathy – empathy refers to the capacity to tune into another’s feelings, to understand the pain they may be feeling; individuals who bully often lack this ability. Fortunately, research suggests that empathy can be learned (Beddoe & Murphy, 2004; Siegel, 2007). Modeling is one method for fostering empathy and involves sharing your reflections on the victim’s feelings associated with a bullying incident and inviting the bully to elaborate on your reflections, for example by asking “What other feelings do you think may have come up for Mary when you said what you said to her?” Having the victim share how he or she felt directly to the bully, with someone from one of the helping professions there to provide support and safety for both individuals, can be especially powerful, but it is important to recognize that not all victims of bullies will feel up to such a challenging encounter.
Help them expand their social network – not surprisingly, individuals who bully have few friends, which can complicate matters. Why bother being respectful when no one likes you anyway? Helping bullies connect with others in positive ways can help bolster self-esteem and provide motivation for behavioral change. Introductions centered on shared interests or experiences can be a helpful way to begin.
Other potential interventions you may wish to explore further, but that are outside the scope of a short blog include conflict resolution methods and restorative justice approaches. Information on both of these methods is readily available by entering either term in Google.
Our final blog will address interventions that can help individuals who are bullied cope with the situation and take active steps to avoid being victimized.
Reducing Senior Bullying: Conversation with Bullying Expert Robin Bonifas, PhD, MSW
This 50-minute audio addresses how organizations can implement programs to reduce senior bullying, discussing in detail issues touched upon in Dr. Bonifas’ blog series on Senior Bullying. Listeners will learn:
How to discover the extent of senior bullying in your facility
Who should be involved in a task force to reduce senior bullying
How to distinguish between bullying and the problematic behavior of residents with dementia
Ways to create a positive environment that encourages caring behavior and thus reduces bullying
I read this worthwhile article by Susan Jacoby on the March 30, 2012 Opinion Page in the New York Times.
Susan Jacoby is the author of “Never Say Die: The Myth and Marketing of the New Old Age.”
I WAS standing by my 89-year-old mother’s hospital bed when she asked a doctor, “Is there anything you can do here to give me back the life I had last year, when I wasn’t in pain every minute?” The young medical resident, stunned by the directness of the question, blurted out, “Honestly, ma’am, no.”
And so Irma Broderick Jacoby went home and lived another year, during which she never again entered a hospital or subjected herself to an invasive, expensive medical procedure. The pain of multiple degenerative diseases was eased by prescription drugs, and she died last November after two weeks in a hospice, on terms determined by explicit legal instructions and discussions with her children — no respirators, no artificial feeding, no attempts to buy one more day for a body that would not let her turn over in bed or swallow without agony.
The hospice room and pain-relieving palliative care cost only about $400 a day, while the average hospital stay costs Medicare over $6,000 a day. Although Mom’s main concern was her comfort and dignity, she also took satisfaction in not running up Medicare payments for unwanted treatments and not leaving private medical bills for her children to pay. A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month. Those figures would surely be lower if more Americans, while they were still healthy, took the initiative to spell out what treatments they do — and do not — want by writing living wills and appointing health care proxies.
Today’s blog post is the fourth in a biweekly series on senior bullying, bringing research into practice. On Tuesday, 3/27, I’ll be recording an interview with Dr. Bonifas on the specifics of reducing senior bullying at the organizational level. If you have questions you’d like me to ask her, please email me via the Contact page, or leave your question in the comments section below. If your question gets asked during the interview, you’ll receive a FREE download of the recording, which will be available at the end of the Senior Bullying series. ~ Dr. El
By Robin Bonifas, PhD, MSW, Assistant Professor, School of Social Work, Arizona State University, Phoenix, AZ and Marsha Frankel, LICSW, Clinical Director of Senior Services, Jewish Family & Children’s Service, Boston, MA
Up until this point, our blogs have focused on the dynamics of bullying among older adults and the characteristics of individuals who bully and of those who are the targets of bullying. Now we would like to center our attention on promising strategies to minimize bullying behavior.
In keeping with the social work value of “beginning where the client is,” it’s useful to first consider what seniors themselves have to say about how to reduce bullying. Assisted living residents made the following recommendations to decrease bullying and other problematic behaviors (Bonifas, 2011):
Offer anger management classes
Set limits with people who bully or “pick on” others
Hold regular meetings to promote resident communication
Develop rules and expectations for resident behavior
Foster partnerships between residents and facility management
These recommendations reflect an important concept, namely that preventing and minimizing bullying requires multiple interventions targeted at each component of the bullying equation. Indeed there are three targeted intervention levels to consider, these include the organizational level, the bully level, and the victim level. Of these three, organizational intervention is the most crucial! This blog will focus on organizational approaches to minimize bullying; our next blog will address individual interventions for bullies and victims of bullying.
In approaching bullying prevention from an organizational level, the goal is to create a caring and empathetic community for residents and staff. Caring refers to feeling and exhibiting concern for others; empathetic refers to the presence of empathy – the capacity to recognize and share another’s feelings. Nurturing empathy is actually the best antidote to bullying! In an environment that promotes empathy, there is a pervasive culture of respect and trust where residents and staff are held accountable and responsible for their behaviors, which sets the stage for people being willing to take a stand in defense of themselves and others – a key intervention in putting a stop to bullying behaviors.
Of course, the primary question is “So how do we create a caring and empathetic environment?” The answer is to first strive to develop a culture of zero tolerance toward bullying. This mindset needs to be wholeheartedly embraced by the entire organization. Everyone – residents, staff, and management – must make a commitment to promoting and living by the tenets of equality and respect for all organizational community members. While overall efforts will vary across organizations, a universal component for creating a caring community is ongoing training and communication for both residents and staff.
To emphasize zero tolerance for bullying, we would suggest including the following elements:
Develop clear rules and expectations for resident and staff behavior; invite everyone to be involved in determining what these rules and expectations should be.
Hold regular group discussions about the challenges of communal living and possible solutions to those challenges.
Provide regular training around recognizing and responding to bullying and other difficult behaviors; include activities that promote the development of empathy.
Review policies for potential revisions that may reduce opportunities for bullying, for example, institute a “no saving seats” policy for group events and activities.
Encourage staff and residents to report incidents of bullying and take complaints seriously; staff must feel supported in making reports and in setting limits on inappropriate behavior.
To facilitate the development of caring and empathy, consider implementing strategies that promote such qualities. For example:
Acknowledge members of your community that go out of their way to welcome new residents and those who are perceived as “different.”
Institute a “Caring Squad” whose job it is to notice acts of kindness and reward them.
Nominate “Kings and Queens of Empathy” each month to recognize residents who have been especially caring.
Such activities send the message that caring and empathy are effective ways to achieve positive recognition, which is important for bullies who may seek attention through negative behavior.
It is important to recognize that developing a caring community is a process and organizational change is slow; improvements will not happen overnight, but gains can be made over time. A full description of these organizational interventions is not possible in the space of a blog, so Dr. El will be interviewing Dr. Bonifas regarding intervention details and will make the audio recording available for purchase to readers who would like more information. Readers are encouraged to list specific questions they have about organizational-level interventions that can then be addressed during the interview. As Dr. El mentioned, if your question is asked during the interview, you’ll receive the audio recording for free.
Our next blog will address interventions to address bullies and victims directly.
Reducing Senior Bullying: Conversation with Bullying Expert Robin Bonifas, PhD, MSW
This 50-minute audio addresses how organizations can implement programs to reduce senior bullying, discussing in detail issues touched upon in Dr. Bonifas’ blog series on Senior Bullying. Listeners will learn:
How to discover the extent of senior bullying in your facility
Who should be involved in a task force to reduce senior bullying
How to distinguish between bullying and the problematic behavior of residents with dementia
Ways to create a positive environment that encourages caring behavior and thus reduces bullying
Today’s blog post is the third in a biweekly series on senior bullying, bringing research into practice.
By Robin Bonifas, PhD, MSW, Assistant Professor, School of Social Work, Arizona State University, Phoenix, AZ and Marsha Frankel, LICSW, Clinical Director of Senior Services, Jewish Family & Children’s Services, Boston, MA
In our experience, it is common for various senior organizations to take a passive stance toward bullying. At times, a perception of “that’s just the way people are” or “there’s nothing that can be done” influences inaction, but at other times passivity is related to a belief that bullying is merely a social irritant and doesn’t really cause any lasting harm. However, nothing is farther from the truth! Research indicates that older adults experience a range of negative emotions and responses to bullying. For example, among assisted living residents the following reactions are often reported (Bonifas, 2011):
Anger
Annoyance
Frustration
Fear
Anxiety/tension/worry
Retaliation followed by shame
Self isolation
Exacerbation of mental health conditions
In addition, as described in our first bullying blog “What is Bullying?” the following ramifications have also been noted (Frankel, 2011):
Reduced self-esteem
Overall feelings of rejection
Depression
Suicidal ideation
Increased physical complaints
Functional changes, such as decreased ability to manage activities of daily living
Changes in eating and sleeping
Increased talk of moving out
It is also important to recognize that bullying behaviors can escalate to physical violence. For example, in September 2009, a 100-year-old nursing home resident was killed by her 98-year-old roommate over ongoing misperceptions regarding unequal sharing of room space.
The harmful impact of bullying is not exclusive to the recipients of such behavior: individuals who witness bullying also experience negative consequences. A common response is feeling intense guilt for not intervening, which can contribute to a sense of poor self worth. Furthermore, living an environment where bullying is allowed to occur creates a culture of fear, disrespect, and insecurity that can actually led to increased bullying as individuals retaliate against one another. Such environments also reduce resident satisfaction because residents feel that staff does not care about their well-being.
Up until this point, we have addressed bullying behaviors between seniors themselves, but bullying can also be targeted toward staff members of organizations serving older adults. Some residents or consumers may view certain employees as very different from them, creating an “us and them” mentality that can result in staff bullying. For example, in one of our cases, a resident repeatedly told a foreign-born worker that she couldn’t speak English properly and he would see to it that she was fired. As with seniors, such bullying behavior creates an environment of fear, disrespect and insecurity for staff, thereby decreasing their feelings of loyalty and commitment to the organization. These feelings have implications for retention and turnover. Furthermore, the possibility of staff retaliatory bullying and resident abuse also increases.
Our next two blogs will cover intervention strategies to help minimize bullying in senior organizations. We will begin with intervention ideas to create a caring environment at the organizational level, one that emphasizes respectful interactions among all individuals.
Reducing Senior Bullying: Conversation with Bullying Expert Robin Bonifas, PhD, MSW
This 50-minute audio addresses how organizations can implement programs to reduce senior bullying, discussing in detail issues touched upon in Dr. Bonifas’ blog series on Senior Bullying. Listeners will learn:
How to discover the extent of senior bullying in your facility
Who should be involved in a task force to reduce senior bullying
How to distinguish between bullying and the problematic behavior of residents with dementia
Ways to create a positive environment that encourages caring behavior and thus reduces bullying
Today’s blog post is the second in a biweekly series on senior bullying, bringing research into practice.
Who bullies and who gets bullied?
By Robin Bonifas, PhD, MSW, Assistant Professor, School of Social Work, Arizona State University, Phoenix, AZ and Marsha Frankel, LICSW, Clinical Director of Senior Services, Jewish Family & Children’s Services, Boston, MA
Individuals Who Bully
Readers will recall from our initial blog that bullying is defined as intentional repetitive aggressive behavior involving an imbalance of power or strength (Hazelden Foundation, 2008). Given this definition, the characteristics of most individuals who bully reflect underlying needs for power and control; the majority of bullies’ behaviors and social interaction patterns strive to achieve these aims. Although most people like to be in charge of their situation, they accomplish this in ways that do not negatively impact others. In contrast, bullies are more likely to use power and control strategies at the expense of others. Indeed, they often find it positively reinforcing to make others feel threatened, fearful or hurt, or to contribute to conflict between people. These tendencies are further complicated by difficulty tolerating individual differences, lack of empathy, and very few positive social relationships.
In our experience there are gender differences in bullying behaviors whereby women tend to engage in more passive aggressive behavior like gossiping and whispering, and men are more likely to make negative in-your-face comments.
In keeping with the social work profession’s strengths perspective, it is also important to acknowledge additional issues that provide insight into what makes older bullies tick. First, bullies put others down in order to build themselves up, suggesting low self-esteem plays a role in their behavior. Second, loss is ubiquitous with aging in Western societies; examples include loss of independence, relationships, income, and valued roles. Such losses are especially salient for seniors who move into assisted living facilities, nursing homes, and other long-term care settings: they may be seeking control at a time in life when they feel exceptionally powerless. Third, many long-term care residents may not have lived in a communal setting for years, if at all. Shared living requires adjustments around territory such that feelings of jealousy and impatience often arise. Bullying behaviors related to territoriality, as with selection of channels for shared televisions, dining room seating…etc., may involve attempts to exert control and change public space into private space.
Individuals Who are Bullied
In contrast to individuals who bully, individuals who typically fall victim to bullies have trouble defending themselves. They do nothing to “cause” the bullying, but passive social interaction styles make them ideal targets for bullies to overpower and control. Victims may also experience a sense of powerlessness, but in this case because bullying experiences are unpredictable and they have difficulty preventing them and removing themselves from bullying situations.
There are two types of bullying victims, those who are passive and those who are provocative. Passive victims tend to show a lot of emotion, are often anxious, and typically do not read social cues well. Others often perceive them as shy and insecure. Among older adults, such victims may have early dementia or a developmental disorder. Sadly, minority status based on race, ethnicity, or perceived sexual orientation can also contribute to individuals being targeted for bullying. Recall that bullies have difficulty tolerating individual differences.
On the other hand, provocative victims can be annoying or irritating to others, such as by intruding into others’ personal space. They are often perceived as quick-tempered and may inadvertedly “egg” bullies on. Among older adults, such individuals may have a dementia-related condition that is more advanced than that of passive victims.
Intersections Between Mental Health Conditions and Bullying
Both schizophrenia and dementia warrant additional attention in relation to bullying.
Individuals with schizophrenia experience disordered thinking, a distorted sense of reality, hallucinations, delusions, a limited range of emotional expression, and poor social skills. Such characteristics can make these individuals prone to both exhibiting bullying behavior and being victimized by others.
Similarly, individuals with dementia have cognitive deficits that can contribute to negative behavior, including aggression. Bullying behavior in this context does not involve a conscious, planned attack on another person, but is most often linked to decreased impulse control or distorted perception leading to a sense of feeling threatened. Dementia-related behavior can also trigger retaliatory bullying by cognitively intact peers as an attempt to control the individuals’ problematic behavior.
Our next blog will address common reactions to bullying behaviors.
Reducing Senior Bullying: Conversation with Bullying Expert Robin Bonifas, PhD, MSW
This 50-minute audio addresses how organizations can implement programs to reduce senior bullying, discussing in detail issues touched upon in Dr. Bonifas’ blog series on Senior Bullying. Listeners will learn:
How to discover the extent of senior bullying in your facility
Who should be involved in a task force to reduce senior bullying
How to distinguish between bullying and the problematic behavior of residents with dementia
Ways to create a positive environment that encourages caring behavior and thus reduces bullying
Today’s blog post is the first in a biweekly series on senior bullying, bringing research into practice.
What is Bullying?
By Robin Bonifas, PhD, MSW, Assistant Professor, School of Social Work, Arizona State University, Phoenix, AZ and Marsha Frankel, LICSW, Clinical Director of Senior Services, Jewish Family & Children’s Services, Boston, MA
Bullying, defined as intentional repetitive aggressive behavior involving an imbalance of power or strength (Hazelden Foundation, 2008), has been recognized for many years as a problem among children and youth in school systems. Recently “senior bullying” has also been noted to occur among older adults in many senior housing and senior care organizations, such as adult day health programs and assisted living facilities. What does bullying look like among the older generation? Surprisingly, in many ways it looks similar to bullying among younger age groups! For example, it includes verbal, physical or antisocial behaviors that occur in the context of social relationships, and, like youths, victims of senior bullying experience considerable emotional distress. Here are some specifics:
Verbal bullying involves name calling, teasing, hurling insults, taunting, threatening, or making sarcastic remarks or pointed jokes. For example, Mary was overheard at a Senior Center luncheon saying to Grace, “You don’t know what you’re talking about. Everyone knows you’re crazy!” Physical bullying involves pushing, hitting, destroying property, or stealing. For instance, two residents in independent senior housing got into an argument over control of the remote control in the community room. One punched the other in the face. This was not the first time these two men exchanged words, but the first time it escalated to a physical assault. Antisocial bullying includes shunning, excluding or ignoring, gossiping, spreading rumors, and using negative non-verbal body language. Such non-verbal bullying includes mimicking someone’s walk or disability, making offensive gestures or facial expressions, turning one’s head or body away when the victim speaks, using threatening body language, or encroaching on personal space. For example, John was relocated to senior housing in Massachusetts following the loss of his home in the New Orleans hurricane. Several residents began spreading rumors that he was a longtime homeless man and was the first in a deluge of formerly homeless people who were going to be “dumped” into their building. As a result, other residents began to avoid John.
Contrary to the childhood adage “sticks and stones may break my bones, but names will never hurt me,” individuals who are bullied are significantly impacted by their peers’ negative behavior. Common responses include (Frankel, 2011):
Reduced self-esteem
Overall feelings of rejection
Depression
Suicidal ideation
Increased physical complaints
Functional changes, such as decreased ability to manage activities of daily living
Changes in eating and sleeping
Increased talk of moving out
The situation and type of behavior often determines whether or not problematic behavior is actually bullying. An individual who yells and strikes out at everyone is not necessarily a bully; similarly, behavior may be inappropriate and violate community rules, but not truly be bullying because the dynamics of power and control are absent. It is important to keep in mind that some people exhibit verbal or physical aggression when they are frustrated or upset as a way of communicating their feelings rather than to usurp others’ power. The potential for this situation increases in the context of dementia, due to impulse control problems, communication difficulties, frustration regarding impaired task performance, and misperceptions of potential environmental threats.
At the same time, although some problematic behaviors may not meet the academic definition of bullying, such behaviors can still feel to those on the receiving end as if they were being bullied. For example, residents in assisted living report the following peer behaviors to cause the most emotional distress (Bonifas, 2011):
Loud arguments in communal areas
Name calling
Being bossed around
Negotiating value differences, especially related to diversity of beliefs stemming from culture, spirituality, or socioeconomic status
Sharing scarce resources, especially seating, television programming in communal areas, and staff attention
Being hounded for money or cigarettes
Listening to others complain
Experiencing physical aggression
Witnessing psychiatric symptoms, especially those that are frightening or disruptive
While only behaviors 2, 3, 6, and 8 really qualify as bullying, residents react or respond to such behaviors in the following comparable ways:
Anger
Annoyance
Frustration
Fear
Anxiety/tension/worry
Retaliation followed by shame
Self isolation
Exacerbation of mental health conditions
The similar reactions to both bullying and “bullying-like” behaviors implies that to understand bullying among older adults, it is necessary to develop knowledge about the individuals who exhibit bullying behaviors and individuals who are bullied. Our next blog will address this critical issue.
Reducing Senior Bullying: Conversation with Bullying Expert Robin Bonifas, PhD, MSW
This 50-minute audio addresses how organizations can implement programs to reduce senior bullying, discussing in detail issues touched upon in Dr. Bonifas’ blog series on Senior Bullying. Listeners will learn:
How to discover the extent of senior bullying in your facility
Who should be involved in a task force to reduce senior bullying
How to distinguish between bullying and the problematic behavior of residents with dementia
Ways to create a positive environment that encourages caring behavior and thus reduces bullying
According to their website, The National Consumer Voice for Quality Long-Term Care is “the leading national voice representing consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves.”
This Friday, February 3rd from 9am-3pm ET, The Consumer Voice is taking to Facebook to discuss mental health issues in long-term care. Be there to be part of the discussion.
How it works: Simply click on The Consumer Voice Facebook page any time between 9am and 3pm to find questions posed by The Consumer Voice and to leave your comments about issues related to meeting the mental health needs of those in LTC.
I’ll be dropping by periodically throughout the day. Hope to “see” you there!
I hadn’t been on the North wing of the nursing home in a while, and when I saw Juanita Johnson sleeping in a geri-recliner, I turned to the nurse, aghast. “I barely recognized her! She’s lost so much weight!”
“I know. It’s terrible,” the nurse replied. “We’re having her evaluated by hospice today.”
Ms. Johnson was accepted into the hospice program, and died two days later.
I’ve seen many late referrals to hospice in my years as a nursing home psychologist. It’s the rare older resident who wants every treatment possible late in life. Most of the time, the resident is going along with the program, waiting for the doctor to say that it’s time to rethink how we’re handling things. The resident is waiting for “the conversation,” but all too often the conversation doesn’t happen until it’s too late. The resident’s last days and months are ones of unpleasant medical interventions rather than a time of comfort and emotional support. This affects their family as well, with the emotional ripples of a “bad” death living on for years.
It’s not so easy to determine when someone is dying, but this week’s article by Paula Span in the New York Times, Interactive Tools to Assess the Likelihood of Death, discusses the use of interactive tools and how they can help us make better end-of-life medical decisions. The tools are posted at ePrognosis.org.
Coping with Grief, for Staff Members: Conversation with grief expert Courtney Armstrong, LPC
Beloved residents decline and then die, their families stop visiting the nursing home — coming to terms with these losses is an unacknowledged challenge of our work. Especially helpful for training directors, new employees, or those struggling with a current loss either on or off the job, this 20-minute audio will help staff members:
Understand their feelings
Recognize symptoms of grief
Identify coping skills
Assist each other in creating a supportive community
Includes FREE:
Signs of Grief checklist
LovingKindness Meditation Sign suitable for posting at the nursing station
Beloved residents decline and then die, their families stop visiting the nursing home — coming to terms with these losses is an unacknowledged challenge of our work. Especially helpful for training directors, new employees, or those struggling with a current loss either on or off the job, this 20-minute audio will help staff members: