Excessive bullying in Independent Senior Housing Living

[keolu hills]

Hi,

I was a primary care provider for a few years before I left medicine. Now a former colleague of mine has been mentioning that he has a new patient in Virginia experiencing excessive bullying in an Independent Senior Housing situation. The focus on bullying tends to be on children and adolescents. I have never heard of this happening in senior living centers. Have any of you come across any seniors with this problem?

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[WisNeuro]

I am not sure I understand this situation. Are children and adolescents bullying the seniors, or vice versa? Either way, 75%ish of my population is geriatric, and about 10-20%ish of that resides in Senior Living of differing levels of independence. I have never heard about any of this either way.

 

[bcliff]

I think OP means that discussion of bullying in general seems to focus on the experiences of adolescents, rather than older adults, adults living with disabilities, etc. — Not that older adults are being bullied by adolescents or vice versa.

I don’t have anything substantive to offer to this thread but am interested to hear what others think.


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[WisNeuro]

Have not heard about any bullying of gero individuals in senior housing, though I am sure that it exists. Just yesterday there was that report of those trash people running a fight club out of a nursing home.

That being said, what is more likely for me to hear is delusional content from patients, Capgras, or medications being poison, etc. Interested to hear more about the alleged bullying though.

 

[PsyDr]

I have.

And wasn't this on the Sopranos?

Old people housing is a lot like school. We just throw a bunch of people together based upon their age, and assume everyone is going to get along.

Old people have an incredible rate of STDs. Old people have their own fashion, looking at you Talbots. And by god, I'm positive that some of the stupid stupid stupid shows are created for the declining normal curve of the elderly.

People can be anything even when they're old. Except not old.

Some people are bullies. Some people get bullied. Some people are jerks that can give it but run to teacher and call people bullies when they get it back.

I will point out that there are sometimes class factors present in older people communities. Think Caddy Shack.

As for what you can do about it: sit them down and tell them to behave or you'll lose them as a patient. You could try to make them nicer, but when has that worked?

 

[Sanman]

Having worked with this population for years, I have seen it. I find it tends to be more relational aggression, more based on class, levels of independence, and cognitive functioning.

There are cliques and it can be a lot like school. People with cognitive deficits that present as socially inappropriate can be shunned by less accepting cognitively intact folks. New folks can be excluded from established groups. The guy that can still drive and has a car is popular with the older ladies...and it goes on.

 

[WisNeuro]

Having worked with this population for years, I have seen it. I find it tends to be more relational aggression, more based on class, levels of independence, and cognitive functioning.

There are cliques and it can be a lot like school. People with cognitive deficits that present as socially inappropriate can be shunned by less accepting cognitively intact folks. New folks can be excluded from established groups. The guy that can still drive and has a car is popular with the older ladies...and it goes on.

Curious, I'm wondering if this has lessened as more facilities have tiered areas now (e.g., independent/semi-independent/full memory care)? Also, at least in my experience, class (at least economically) generally seems to cluster as the cost of some facilities is only available to certain individuals with means. Are you aware of any research on this?

 

[Sanman]

Curious, I'm wondering if this has lessened as more facilities have tiered areas now (e.g., independent/semi-independent/full memory care)? Also, at least in my experience, class (at least economically) generally seems to cluster as the cost of some facilities is only available to certain individuals with means. Are you aware of any research on this?

It can be lessened in tiered facilities, but as cost goes up with care level, families are often loathe to move up. So many people appropriate for ALF level may still be in ILF and similar in ALF with a higher care level vs memory care if there is no elopement risk. However, in ALF level exclusion can be present due to hygiene and behavior more than social issues (this person smells due to lack of showers or incontinence issues, I dont want to sit at their dining table, etc).

Class can also present depending on the type of facilities (someone in a 1 bedroom or shared ILF apt qith a roommate is of different means than someone in a cottage or larger apartment in the same facility, etc). Shared vs separate dining room facilities can make a difference. Also, some have LTC insurance and pensions vs someone bankrolling from savings or the proceeds from a home can mean cash for restaurants or other trips vs not, etc.

I haven't looked at the research in this area in a while, but I feel like there were a few sparse studies.

 

[PsyDr]

@Sanman

I love that the oldest poster account here specializes in geriatrics.

 

[WisNeuro]

@Sanman What was Wundt like? And, what was it like to see the first electric light bulb, or the first talking picture show?

 

[Sanman]

@Sanman What was Wundt like? And, what was it like to see the first electric light bulb, or the first talking picture show?

Wundt? Nice guy, very smart, couldn't hold his liquor.

The first light bulbs? Great until the Phoebus Cartel ruined everything...look that up if you're bored.

Now get off my lawn, I've got to get ready for the early bird dinner...I've got a coupon!

 

[keolu hills]

Oh, I reread my post and realized it wasn't clear. I am talking about seniors bullying other seniors in independent senior housing situations. It has NOTHING to do with children and adolescents or the staff at these senior living centers. This elderly woman who lives in an independent senior living condominium is being bullied by other elderly women living there. Again, this has nothing to do with children or adolescents bullying seniors.

 

[keolu hills]

I think OP means that discussion of bullying in general seems to focus on the experiences of adolescents, rather than older adults, adults living with disabilities, etc. — Not that older adults are being bullied by adolescents or vice versa.

I don’t have anything substantive to offer to this thread but am interested to hear what others think.


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Yes, this is exactly what I mean!

 

[ClinicalABA]

Back when i was working in LTC and specialty geriatric psychiatric facilities, bullying was a common problem and, as the "behavior guy" it was my job to deal with it! It happened along the lines of cognitive abilities, medical or psych diagnosis, unit you lived on, who your charge nurse or CNA was on your unit, race, class, creed, etc.- just like with any involuntarily grouped population. Manifested itself how you would expect- seating at mealtime or rec activities, roommate selection, who you'd share your smokes with. I think bullying is a human phenomenon and no reason to think age has anything to do with it.
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As an off-topic aside, this thread has reminded me that there is a reverse relationship between my age and the age of the clients I work with. Being the stat geek i am (with a cancellation and being sick of writing reports), I did a regression analysis which produced the following equation:

My Age= -.25(median client age) + 45.66
(F=8.75, p=.04)

By the time I retire, I'll be assessing kiddos in utero!

 

[cara susanna]

I am NOT a geriatrics person so this may be way off base, but is it possible to get APS involved (if the facility itself won't do anything)?

 

[Therapist4Chnge]

Relational aggression is present at many age levels. Last I read it tends to skew female, though it t’s been probably 15 years since I looked at the research, which back then definitely looked at ‘mean girl’ ages and not older adults. I’m curious if/how the research has evolved since then.

 

[WisNeuro]

I am NOT a geriatrics person so this may be way off base, but is it possible to get APS involved (if the facility itself won't do anything)?

The bar to get APS involved is pretty high. It usually has to be a due to a fairly imminent danger posed to the physical safety of the individual. Even then, really hard to get any kind of meaningful action. I would have to imagine that there is nothing that they can do about relational aggression or other similar types of bullying if there was no physical harm involved.

 

[ClinicalABA]

The bar to get APS involved is pretty high. It usually has to be a due to a fairly imminent danger posed to the physical safety of the individual. Even then, really hard to get any kind of meaningful action. I would have to imagine that there is nothing that they can do about relational aggression or other similar types of bullying if there was no physical harm involved.

Also- statutes may specifically reference harm/threat from caregivers. Peer to peer stuff causing harm/harassment may be more appropriate for the local PD to handle (or mishandle-whatever the case may be)

 

[WisNeuro]

Also- statutes may specifically reference harm/threat from caregivers. Peer to peer stuff causing harm/harassment may be more appropriate for the local PD to handle (or mishandle-whatever the case may be)

even so, I can't imagine the local PD wanting to get involved because no one wants to sit next to someone in the cafeteria.

Better bet would be staff trainings and activities geared at more interaction between peers to increase empathy. But, given the low pay for many of these places, good luck with getting staff on board for extra programming.

 

[Sanman]

even so, I can't imagine the local PD wanting to get involved because no one wants to sit next to someone in the cafeteria.

Better bet would be staff trainings and activities geared at more interaction between peers to increase empathy. But, given the low pay for many of these places, good luck with getting staff on board for extra programming.

Yeah, PD involvement is rare. Building management and staff is usually the best intervention bet. Staff pay may be low, but I often worked with staff higher up (facility directors, SW and nursing staff, etc) under the guise of customer service as these places cost a pretty penny.

 

[Spydra]

Yes I have heard of this, in fact I attended a talk on this very subject and the presenters ended by saying it'd be great if academics would start to look at this so that there's more literature available. A quick google scholar search of "senior bullying in assisted living" pulled up a few citations you may find helpful.

 

[PsyDr]

Relational aggression is present at many age levels. Last I read it tends to skew female, though it t’s been probably 15 years since I looked at the research, which back then definitely looked at ‘mean girl’ ages and not older adults. I’m curious if/how the research has evolved since then.

Both genders engage in relational aggression at equivalent rates. The method by which it is expressed substantially differs by gender. The method of expression is likely mediated by socioeconomic, cultural, and small group politics.

This is one of those areas where people get all upset and have difficulty in logical discourse.

 

[GradStudent2020]

I am NOT a geriatrics person so this may be way off base, but is it possible to get APS involved (if the facility itself won't do anything)?

Similiar to CPS, APS has a hotline you can call and determine if a situation is reportable. I’ve worked with colleagues that did APS evaluations. The bar didn’t seem that high to me. Often a neighbor would call concerned an elderly person was unable to care for themselves alone. Or that a family member was hoarding resources from the elderly person. The police in our area did not take those calls, APS did.

No clue about how they would handle peer on peer elderly bullying, but I imagine they would investigate if concerns fell within their six categories of abuse/neglect. My experience with APS is that the bar is much lower and their resources are spread less thin than CPS. My exposure is limited to only one major metro area, though.

 

[Action_Potential]

 

[AcronymAllergy]

In my experiences where I am now, as with GradStudent2020, the bar to report to APS and have them investigate is not particularly high (although this varies by profession). However, the bar for them to actually determine something to be actionable does seem pretty high.

 

[WisNeuro]

In my experiences where I am now, as with GradStudent2020, the bar to report to APS and have them investigate is not particularly high (although this varies by profession). However, the bar for them to actually determine something to be actionable does seem pretty high.

Yeah, having them "investigate" is not that hard. Having them actually do a good investigation and do something is pretty high. One example, back on internship in the VA, HBPC social worker reported a pt living in apartment with feces, rotting food and things piled high on the stove to APS. They went to the complex, Vet came down and talked to them in the lobby, because he told the APS worker that everything was ok, they dropped the report without actually looking at his residence.

Last year, pt in and out of inpt units for kidney issues (failure to comply with dialysis). Family reports she is unsafe in the home, utilities have been turned off, not eating, etc. APS talks to pt, says she's fine. We finally get her deemed incompetent after she lands in the hospital again by going through the courts.

Sure, the bar for APS to listen to a report is low. The bar for anything to come of a report, is high. In lieu of any actual physical harm, fat chance that they will do anything about bullying in a senior living situation, nor should they.

 

[GradStudent2020]

In my experiences where I am now, as with GradStudent2020, the bar to report to APS and have them investigate is not particularly high (although this varies by profession). However, the bar for them to actually determine something to be actionable does seem pretty high.

In my area they seemed to take the results of the investigation and recommendations from the evaluator seriously, but I imagine there’s a lot of variability in resources for these offices.

 

[WisNeuro]

In my area they seemed to take the results of the investigation and recommendations from the evaluator seriously, but I imagine there’s a lot of variability in resources for these offices.

Huge amount of variability. Overall, not great in most places I have lived and worked. Washington state probably had the most responsive of the 5 jurisdictions I have experience with.