Research details extent of aged care workplace violence

An RMIT University report is calling attention to the high level of violence and aggression directed at aged care workers.

A new report from RMIT University calls attention to the high level of violence and aggression directed at aged care home workers by residents.

Having interviewed managers, nurses and personal care staff, researchers found that 93 per cent of respondents had experienced physical violence at work, with the majority reporting being attacked at least twice, and some, four or more times. As well, 44 per cent reported being threatened with a weapon and 87 per cent of staff recorded being sexually harassed.

“It was quite shocking hearing some of these stories,” Dr Jillian Cavanagh told Australian Ageing Agenda. “Everyone told us they had experienced violence and aggression.”

The independent report – funded by the Victorian branch of the Australian Nursing and Midwifery Federation and launched at the ANMF OHS online conference last week – is based on more than 800 surveys conducted in 2020 and 60 interviews with managers, registered nurses, enrolled nurses, endorsed enrolled nurses and personal care workers.

He hurled a pot plant at the wall

Endorsed enrolled nurse Alicia told researchers of the time she was assaulted by a resident with dementia. “She punched me repeatedly in the face. She was gripping me, punching and pinching,” Alicia said. Manager Rita has also been physically assaulted in the workplace. “He’d been lashing out … hurled a pot plant at the wall,” she recalled to researchers. “He grabbed me by my right arm and twisted it so hard I had instant bruising. I thought it was broken.”

Dr Jillian Cavanagh

Such incidents are neither new nor rare, said Dr Cavanagh – senior lecturer at RMIT’s School of Management. “This has been an issue for a long time. It’s happening on a daily basis,” she said.

And it’s the frontline staff that suffer the most abuse. “Residents are very violent with nurses and PCAs,” Yasna, a manager, told the researchers. “They threaten the staff every day. They punch and shout at staff. In some cases, we’ve got to go into a lockdown and isolate residents who are causing the problem.”

It’s not just residents who kick off and hit out. “Family members get quite angry and aggressive about the care their loved ones receive. But they should talk rather than yell,” said personal care attendant Revoreda. Manager Rosaura told researchers: “Relatives say horrendous things to the staff. I always try to support my staff as much as I can but dealing with people is very hard. As a manager, you’re in the middle.”

The 10-point plan

To help managers deal with violent and aggressive behaviour in residential aged care facilities, the ANMF developed a 10-point plan in 2014. However, very few managers seem aware of the document. “There is very little known about the 10-point plan,” said Dr Cavanagh.

The plan provides employers with practical systems, processes and changes they can implement in 10 areas to prevent and reduce the opportunity for violence.

They include:

  • improving security
  • identifying risks to staff and others
  • reporting, investigating and acting when an incident happens
  • providing education and training to healthcare staff
  • applying an anti-violence approach across all disciplines
  • empowering staff to expect a safe workplace.

However, rather than empowering staff, Dr Cavanagh said that management often blamed their workers for residents’ bad behaviour. “There are poor relationships between managers and their staff,” she told AAA. “What we found is that there is a culture of blame against the nurses and personal care assistants.”

The blame culture needs to stop, enrolled nurse Julia told the researchers. “Instead of managers saying, ‘What did you do [to the resident]?’ They should say, ‘What happened? How can we do better?’”

A number of factors exacerbate the situation on the ground, said Dr Cavanagh. Such as off-site human resource management. “This means a big disconnect between HR and staff,” she said. Staff-resident ratios were also “problematic”.  

It’s happening every day, I feel helpless

The levels of violence have a negative effect on workers’ mental health. “Violence impacts a lot – physically, emotionally and mentally,” manager Alejandra told researchers. “I’m always stressed. It’s happening every day, I feel helpless.” Another manager Fanny echoed the feelings. “Workplace violence stresses everyone: managers, staff and residents,” she said. “It’s a stressful environment. I’m drained and fatigued because of this chronic situation. Sometimes I take a day off.”

Others resign. “They told us they were considering – not only leaving a particular facility – but leaving their nursing careers completely,” said Dr Cavanagh.

For Yasna it was the job versus her mental health. “I left my job because I had enough,” she told researchers. “I came to the realisation that nothing was going to change, so I had to make the change.” Alejandra also told researchers she intended to quit. “I just can’t do it anymore,” she said. “I’m physically and mentally very tired. You just fight a losing battle every single day.”

Although dated 24 February 2021, the report’s release was delayed due to pressures of the pandemic.

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Tags: anmf, dementia, featured, residents, staff, violence,

7 thoughts on “Research details extent of aged care workplace violence

  1. Yes this does occur and management do not support workers when required.
    In aged care staff are not trained appropriately and put themselves in positions waiting to get hit by the resident. Dementia Training and awareness should be upfront to minimise this from occurring. I have seen too many care staff stand face to face with a person and stop a person from moving etc. Family member emotion/stress should be recognised and supported. Do not argue or disagree, as you are asking for retaliation. Most of this is caused by the resident not getting urgent or immediate assistance when needed. This is where appropriately skilled staffing levels (or lack) cause the problems.

  2. I agree with Anthony – its about training and educating staff about behaviours to mitigate potential threats before they happen. Clearly there will still be incidents that require escalated action from management.

  3. Absolutely no surprises there. Tells us what we have known for years. The elements required to change this include:
    -Staff learning about the client and the client’s condition, ability etc (e.g. dementia, depression, arthritic pain etc)
    -Supervisors who help and insist that staff can answer the question “Because the client has/is like this, what is it that we need to do to take that into account? What needs is this client likely to have?
    -Supervisors who have training in providing supervision and who have skills in reflective practice that they can share
    -Staff who have the necessary language and cultural knowledge and skill to match the needs of their specific client/s
    -Staff who have learned how to practice (do their work) in a way which is least likely to see them injured
    -Managers who have undertaken the same training and who understand that before they advise a staff member that they must cease a particular practice must first advise them of a different practice which is at least as effective, safe and acceptable.
    -Families etc should be as involved as they wish and should be seen as sources of intelligence about the specific person who is the client. In order for them to argue for the cessation of a particular practice that they are uncomfortable with, must provide staff with an alternative, safe and effective strategy.
    -Management to provide staff with the support resources necessary to provide post-incident debriefing, support etc. Most supervisors have this expectation but have no training in this area.
    -Families need to understand that these are the conditions of placement of the client.

  4. There is always the unpredictability of residents with dementia who just lash out without any provocation, and this is how many incidents happen.
    Decent staffing levels with mandated ratios would help to reduce the violence against staff and including other vulnerable residents.
    Training alone without staff ratios cannot fix the problem

  5. I have heard from and seen work colleges bitten,slapped, choked, scratched and the like, and these are very experienced workers who have worked in age care and dementia specifically for a long time. More and more we are seeing many people come into care with different mental health issues, as well as the different sorts of dementia . Management are not supportive saying it is lack of training, possibly with some staff but not those who I above mentioned. Every time they did an incident form involving resident violence to staff, they were told off by management. As if the conditions already facing the age are workers left now is unexceptable they are attacked on almost on a Daily bases. New staff with very little training are put down in the dementia specific ward and are often traumatised by responsive behaviours and do not want to go back there and work. I say yes to more training, yes to taking this more seriously, and yes to more support. One work colleague got slapped across the face and has had no real support from the company and she now has a permanent disability and she can not work anymore. we have the 8 standards for our customers but what about a safer and more supportive work place.

  6. I have recently retired at 71 from working in aged care due to violence everyday from people in care, and management just see it as part of the job no support at all. The no restraint policy to medications keep these people in high anxiety which living in confined spaces with 20/30 others experiencing the same makes for a volatile work place along with never enough staff, can only get worse.

  7. Families expect aged care staff to be empathetic, understanding, patient and trained to deal with elderly patients who who possibly are suffering from dementia or other mental health conditions and physically and/or verbally abuse staff. These families are incapable of caring for their ageing parents themselves due to the high care needs and the obviously stressful nature of care. However instead of being supportive of staff who are doing their best to provide a decent level of care, they are attempting to find excuses and justify the abuse as a reaction to not receiving suitable care.
    No matter the intent or lack of thereof abuse is never okay and should not be normalised or justified.

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