Violence in senior care facilities is on the rise.

In March 2020, an attorney wrote about an incident in a senior care home. An “agitated” resident had been diagnosed with Alzheimer’s and was becoming increasingly abusive, both physically and verbally, toward the nursing staff in the home.

The nurses working in the home were well aware of his aggressive behavior at other senior care facilities where he had lived. Because of his reputation for aggressive behavior, they requested that administrators not allow the man to be admitted into their facility.

They were overruled.

One day, while using the bathroom, he soiled the bathroom walls and floors. A nurse came in to clean the bathroom, but when she did, he started hitting her with soap bottles. He then grabbed her hair and slammed her face into the door frame repeatedly.

That’s not all. Then the resident grabbed the nurse’s stethoscope and began to choke her, causing her to lose consciousness. When other nursing home staffers realized what was happening, they called 911. An ambulance took the nurse to a hospital. Police soon followed to arrest the assailant and remove him from the facility. *

Is This an Isolated Incident in a Senior Care Facility?

We might think this is an isolated incident. However, violence against nurses in all types of healthcare settings, including nursing homes and long-term care facilities, is a growing problem. That is one of the conclusions of a study published in the January/December 2021 issue of the Journal of Occupational Health.** This study found that:

  • Approximately 25 percent of registered nurses around the world and working in all types of medical care facilities report being physically assaulted by a patient or member of the patient’s family.

  • More than half reported verbal abuse or bullying by patients or family members.

  • In the U.S., it was estimated there were two violent events in a hospital per 100 beds in 2012; that number increased to three per hundred beds a decade later.

Furthermore, we should add that the pandemic has only made things much worse. In fact, in some medical facilities, administrators are now installing panic buttons in discreet locations. This allows nurses to call for help should a patient become physically or verbally abusive, unruly or threatening.

Definition of Terms

Before we go further, let’s clarify a couple of terms. Physical abuse, according to the researchers, refers to “being pushed or hit.” It can also be much more serious, as happened in the incident above. A patient or resident may use an object to harm a nurse, staff member, themselves, or another resident.

On the other hand, verbal abuse characteristically involves swearing, shouting, or cursing. But here is something more we need to know. The two types of abuse, physical and verbal, are frequently interconnected. All too often, when a patient or resident becomes verbally abusive, it is a precursor to much more serious physical abuse.

Helping to Ensure Safety in Senior Care Facilities

With this situation in mind, what steps can nurses and administrators in senior and long-term care facilities take to help ensure safety for both staff and residents? I must note, there is a reason for saying “help ensure safety.” 

There is no way to prevent all types of violence from occurring. If someone is determined to cause harm, they will find a way to do it. All we can do is minimize the possibility of violence and, should it happen, be prepared to address it as quickly and effectively as possible.

The first step in the process is to conduct what is termed a risk assessment. A risk assessment can be defined as:

A program conducted by security and risk assessment professionals designed to identify risks and assess defects and vulnerabilities in a facility. The assessment then suggests processes, systems, and procedures administrators can take to ensure the safety of people, places, and data.

Many administrators of long-term care facilities may not have heard of a risk assessment before. This is understandable. While violence and crime have always been issues in all types of medical facilities, in the past few years, they have become much more frequent and much more serious.

The pandemic, as we’ve mentioned, has made situations worse. A professionally conducted risk assessment allows administrators to proactively address this situation and help prevent incidents from occurring.

Another step that administrators and staffers can take is to know what to do when a dangerous situation is actually occurring. It’s a drill called “Run, Hide, Fight,” and in today’s world, especially in the medical care industry, it is something all administrators and staff members should know.

In Run, Hide, Fight, if nurses, staffers, and patients are in the unfortunate situation where an attack is occurring, they are advised to first run for safety; or if they cannot run, hide somewhere in the facility for safety and, when possible, call 911. As a last resort, nurses and staff may have to fight. 

So we are clear, to fight, means to:

  •       Disable the attacker
  •       Recruit others to ambush the attacker
  •       Be prepared to cause harm to the attacker.

The Run, Hide, Fight drill may be something we have never considered before in a senior or long-term care facility. Administrators in senior care facilities may feel it’s not and should never be necessary, and certainly “not in my facility.” 

I wish that were true. But the unfortunate reality is that violence is escalating in all types of medical facilities. Further we must know, if violence happens anywhere, it can happen in your facility as well.

Johnathan Tal is Chief Executive Officer of TAL Global Corporation, an international investigative, risk assessment, and security-consulting firm. He is a licensed investigator, former President of World Association of Detectives (2000-2001) and holds a Bachelor of Science degree. He can be reached through his company website at


© TAL Global, 2019