Addressing Resident-to-Resident Aggression in Nursing Homes for Improved Safety

Resident-to-resident aggression is a common challenge in nursing homes, involving unwelcome harmful interactions between residents that may include physical, verbal, or sexual behavior. Often misunderstood, this aggression typically does not stem from malicious intent but from factors such as cognitive impairments like dementia. Recent investigations, including an inquest by the Coroners Court of Victoria, highlight the tragic outcomes of such incidents, including deaths resulting from physical altercations.

Research estimates that up to 20% of aged care residents may experience episodes of resident-to-resident aggression each month, although underreporting is likely. The consequences range from minor privacy invasions to severe injuries, such as fractures or head trauma, and, in some cases, fatalities, especially among residents with frailty and cognitive impairments.

Historical cases, like the Oakden facility closure in South Australia, have brought heightened awareness to the severity of the issue, emphasizing the importance of regular clinical reviews, accurate incident documentation, and effective risk management strategies. Authorities now require facilities to report all incidents involving unreasonable use of force through systems like the Serious Incident Response Scheme, with ongoing monitoring by the Australian Aged Care Quality and Safety Commission.

As the prevalence of dementia increases, so does the likelihood of resident-to-resident aggression, complicating care strategies. Interventions include creating calm environments, maintaining familiar routines, and deploying specialized behavior support teams such as Dementia Support Australia’s 24/7 Response Team. Effective management also involves multidisciplinary approaches that encompass mental health, disability, and aged care sectors.

Family members play a crucial role by maintaining open communication with care providers and advocating for their loved ones. External support organizations like the Older Persons Advocacy Network can assist in ensuring proper care and addressing concerns.

Legal proceedings, including police investigations, are generally limited to cases of severe injury or death, with many residents deemed unfit for interviews or trial due to cognitive decline. Prevention efforts focus on systemic changes, staff training, and ongoing risk assessments at facility, provider, and national levels. As society ages, the need for targeted interventions and better safety protocols becomes increasingly urgent.

Continuous improvements in behavior management, staff training, and advocacy are essential steps toward safeguarding the wellbeing of aged care residents and reducing the incidence of resident-to-resident aggression.