Recognizing & Responding to Bullying in Supportive Living FacilitiesPresented by Kellie E. Branch-Dircks, LCSW & Sarah Jackson, LCSW

Disclosure

There are no known relationships or conflict of interests regarding the information being presented.

Learning Outcomes for Today’s Event:

´ Participants will be able to identify different types of bullying behaviors

´ Participants will be able to identify the different types of bullies

´ Participants will understand the psycho-social impacts of bullying behaviors

´ Participants will be able to identify organizational interventions that may help minimize bullying among older-adults

´ Participants will be knowledgeable of tools to share with older adults to help them avoid being targets of bullying

What We Know About Late-Life Bullying:

´We know bullying in Assisted Living and other senior living environments occurs

´ Awareness of bullying and its effects has gained more awareness in recent years, but little research has been done in the area of bullying in the senior populations.

´ The most well known study of bullying among residents in an Assisted Living Environment was in 2015 by Dr. Robin Bonifas, Associate Professor, School Of Social Work, Arizona State University.

´ Dr. Bonifas study estimated 10-20% of older adults experience some type of senior to senior aggression, usually verbal abuse.

Tough to tease out precise numbers because these acts often go unreported.

Barriers to reporting the bullying include:´ Lack of education regarding what

constitutes bullying for the resident or staff.

´ Staff members may be unsure of the correct protocol or would prefer the situation to resolve itself.

´ Victims are often too ashamed and fear retaliation.

Definition of BullyingAccording to the federal government, bullying is defined with the following core elements:

unwanted aggressive behavior; observed or perceived power imbalance; and repetition of behaviors or high likelihood of repetition.

Bullying can be: direct (e.g. bullying that occurs in the presence of a targeted

individual) indirect (e.g., bullying not directly communicated to a targeted

individual such as spreading rumors).

5 Types of Bullying

´ Verbal Bully: Uses their words, starts rumors, uses sarcastic, or demeaning language to embarrass, dominate and humiliate another person.

´ Physical Bully: Uses physical aggression.

´ Narcissistic Bully: self-centered, need for power and control, does not share empathy with others.

5 Types of Bullying

´ Impulsive Bully: Spontaneous, plans their bullying out less. Even if consequences are likely, they have hard time restraining from bullying behaviors.

´ Secondary Bully: Does not initiate the bullying, but joins in so that they do not become a target down the road. May feel bad about what they are doing, but are more concerned about protecting themselves. (self-preservation, survival of the fittest)

Where Bullying for Seniors Occurs

´ Senior living communities, senior centers, adult day health centers, rehab facilities, assisted-living facilities, and nursing homes.

´ During community events and activities where seniors spend a lot of time together and share resources e.g. chairs, tables, and TV stations. (elevators & stairwells)

´ Technology, including email, social media, email, text messages, etc.

´ Senior environments with higher functioning residents or participants tend to have more problems with bullying

Types of Bullying Behaviors

´ Verbal: name calling, teasing, insults, taunts, threats, sarcasm, and pointed jokes targeting specific individuals

´ Physical: pushing, pinching, biting, punching, hitting, hair pulling, destroying property, and stealing

´ Anti-social: shunning, excluding, gossiping, mimicking, spreading rumors, using offensive gestures and negative nonverbal body language.

´ Relationship-centered: ostracizing during meal times, activities or forming social cliques.

´ Damage to property: stealing items from another resident, breaking another residents items

Why Do Older-Adults Bully?

´ Some people who were bullies when they were younger often continue to bully into their golden years.

´ Some people do not adjust well to the aging process so they take out their frustration on others.

´ Some people experience emotional problems. ´ Some people have an underlying need for power and

control. ´ Some people with dementia might misunderstand things

as threatening and react with more primitive responses.

Why Do Older-Adults Bully?

´ Some people feel the need to assert their will to intimidate, embarrass or humiliate others.

´ Some people have a difficult time transitioning into senior living communities due to loss of independence, relationships, income, valued roles, and social support networks.

´ Some people have difficulty tolerating individual differences, lacks empathy, and has few positive social relationships.

´ Some people have insecurities about themselves and enjoy making others feel bad to raise their own self-esteem/worth.

Who gets bullied?

´ Individuals who have difficulty defending themselves (vulnerable, disabled, and disenfranchised)

´ They generally do nothing to cause the bullying´ Two types of people often targeted with bullying:

passive targets and provocative targets

Who gets bullied?

´ Passive targets ´May be highly emotional´Have difficulty reading social cues´May be shy and insecure´May experience anxiety´May have early stage dementia´Have racial/ethnic, spiritual beliefs, or sexual

orientation perceived as “different”

Who gets bullied?

´ Provocative targets ´Can be annoying or irritating to

others´Quick-tempered´May unwittingly “egg on” bullies´Intrusive into others’ space´May have mid-stage dementia

Gender differences of a Bully

Women usually utilize more passive behaviors:

´ gossips ´ snipes´member of a clique´ passive-aggressive

behavior ´manipulates emotions ´whispering

Men usually utilize more provocative behaviors:´ verbally or physically

aggressive´ negative comments´ direct´ spontaneous´ superiority complete´ overly protective

What You Need to Know

´ Bullying is Not a Function of Aging ´ Bullying is a function of psycho-social pathology. ´ Bullying is the human phenomenon of the strongest

picking on the weakest. (Survival of the Fittest) ´ Bullying is just as much a Behavioral Health Problem of

Older Adults as it is any other generation.´ 10-28% of older adults have mental health conditions

serious enough to need professional care ´ 80% of older adults in need of mental health services do

not get the treatment they need.

Senior to Senior Bullying Warning Signs:What to Look for in a Bully

´ Intimidates staff and others ´ Tells others what to do using a bossy style/tone ´Criticizes others ´ Lacks empathy ´Makes repeated complaints about others. ´ Be aware that individuals who complain in

a powerful, outraged style about others’ picking on them are often bullies themselves.

Senior to Senior Bullying Warning Signs:What to Look for in the Target

´ Self isolation ´ Avoidance of events and activities. ´ Take long and often out of the way routes to get to and

from communal areas. ´ Vague complaints, “They don’t like me” or “They won’t

let me_______ .” ´ Depressed mood (acute onset)

Most Distressing Behaviors reported by the Targets of Bullying

´ Loud arguments ´ Verbal abuse: naming calling and teasing´ Hurtful actions: gossip, spreading rumors´ Being bossed around ´ Being hounded for money or cigarettes ´ Listening to others complain ´ Experiencing physical aggression ´Witnessing mental health symptoms (decompensation

symptoms)

Common Reactions of Bullying by the Target

´ Withdrawals socially/self isolation

´ Increased physical complaints/symptoms (i.e. migraines, GI complaints, high blood pressure)

´ Feels rejected ´ Speaks about moving out

or requests transfer ´ Become depressed or

suicidal ´ Exacerbation of other

mental health symptoms (i.e. anger)

´ Creates an environment of fear and disrespect

´ Creates insecurity ´ Anger´ Annoyance´ Frustration´ Retaliation followed by

Shame´ Stress, anxiety, tension, and

worry´ May escalate to physical

violence

Skills to share with the Targets of Bullying

´ Speak up and Report the abuse per the facility policy´ Let it go or tune it out´ Avoid contact´Walking Away´ Engage in positive self talk (mantra) ´ Pursue off-site activities

Skills to Share with the Targets of Bullying

´ Seek to see the other person’s point of view and show empathy

´ Learn and use de-escalation skills. ´Get a pet or spend time with pets. ´ Form relationships with other supportive individuals. ´Counseling/professional support

What Facilities Can Do´ The best way to deal with bullying is to have an all-

around culture where bullying is unacceptable -Robin Bonifas, PhD, MSW, School of Social Work, Arizona State University

´ Prevent bullying by educating people on the ways it occurs and encourage onlookers to intervene.

What Facilities Can Do

´Create, implement, and disseminate zero tolerance policies and procedures on bullying, including channels for reporting incidents and resolving them.

´ Educate and offer support to residents who exhibit bully behavior. It may be necessary in cases to make them aware that if their behavior does not change, their behavior may result in an eviction.

´ Intervene: If you see something, say something and do something.

´ Support the target. ´ Encourage staff members and residents to report

bullying behaviors.

Three Tier Intervention Model

Preventing and minimizing bullying behavior requires intervention at multiple levels:

´Organization´Target ´Bully

Three Tier Intervention Model: Organization Level Interventions´Create caring communities for all residents and staff

members. ´ Prohibit the use of obscene language, name calling,

gossiping, etc. ´ Use empathy as an antidote to bullying. ´Creating environments that promotes empathy requires

that: ´All members are treated with consideration, respect

and recognition of each individual’s dignity. (Tenets of equality and respect)

´Everyone is held accountable and responsible for their behaviors.

´Everyone is encouraged to stand up for what is right.

Three Tier Intervention Model: Organization Level Interventions´ Facilitate on-going conversations about bullying with

residents. ´ Provide on-going training opportunities for staff

members. ´ Implement and enforce Zero-Tolerance Anti- Bullying

Policies & Procedures ´ Transparent process for responding to reports

(Grievance procedure) ´Anti-bullying pledge ´ Publicly acknowledge members of your community

that go out of their way to make others welcome. (Ambassador/Ombudsman)

Three Tier Intervention Model: Organization Level Interventions

´Pre move-in or new resident orientation which includes information on living peaceably together

´Provide support or self-help groups for targets in your community.

´Seek legal consult, have legal services send target a letter

´ If all else fails, issue lease violation notices ´Proceed with eviction process when you have

collected evidence and supportive documentation

Three Tier Intervention Model: Target Level Interventions

´ Focus on skill development to help them avoid being targeted.

´ Encourage and support them to stand up for their rights. ´ Foster their self worth and dignity and bolster self

esteem. (past successes) ´ Refer them to mediation training ´ Refer them to de-escalation or other direct

communications skills training.

Three Tier Intervention Model: Target Level Interventions

´ Refer them to a self-help group or counseling´ Encourage them to continue to report instances of

bullying´ Encourage them to call 9-1-1, if needed´ If appropriate to do so, refer them to obtain a restraining

order against the bully.

Three Tier Intervention Model: Bully Level Interventions

´ Do not avoid or ignore the behaviors´ If you see something, say something and do something.´Consistently set limits with the bully. ´ Refer the bully to mental health provider. ´ Assist the bully to expand their social support networks. ´ Assist the bully in identifying appropriate outlets and

alternative methods to manage anger, frustrations, etc. (refer to anger management classes)

Resources

´ Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemicby Bonifas PhD MSW, Robin (can be found on Amazon)

´ Bullying Among Seniors (And Not The High School Kind Anymore): A Prevention and Surveillance Resource for Assisted Living Providers National Center for Assisted Living https://www.ahcancal.org/ncal/operations/Documents/Bullying Among Seniors.pdf

´ AHCA/NCAL. (n.d.). Fast Facts: What You Need to Know About Antipsychotic Drugs for Persons Living With Dementia. Retrieved from National Center for Assisted Living: https://www.ahcancal.org/quality_improvement/qualityinitiative/Documents/Antipsychotics%20Consumer%20Fact%20 Sheet%20-%20English.pdf

´ Bonifas, R., & Frankel, M. (2012, February 8). Senior Bullying Blog Series. Retrieved from My Better Nursing Home: http://www.mybetternursinghome.com/senior-bullying-guest-post-by-robin- bonifas-phd-msw-and-marsha-frankel-licsw/

´ Botek, A.-M. (n.d.). Things People With Dementia Say: Common Phrases and How to Reply. Retrieved from AgingCare.com: https://www.agingcare.com/Articles/communicating-with- dementia-patients-150914.htm

´ Senior Bullying. (2015, June 4). Retrieved from Retirement Living Sourcebook: https://www. retirementlivingsourcebook.com/articles/senior-bullying-233

´ U.S. Department of Health & Human Services. (n.d.). Facts About Bullying. Retrieved from StopBullying.gov: https://www.stopbullying.gov/media/facts/index.html#ftn1

Thank You