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When you find a nursing home for a parent, you do so thinking they’ll be safe. However, sometimes the move doesn’t always go as well as you’d hope.

Sadly a common problem that may arise is resident on resident assaults or abuse. According to the National Center for Victims of Crime they make up 22% of all abuse cases in nursing homes, and it’s expected that many more are left unreported.

The abuse can be physical, sexual, emotional, material, or verbal. It may be a one-off assault or ongoing abuse.

This article will help explain what causes it and what nursing homes must do to manage it.

What causes resident on resident assaults?

There have been multiple studies into resident abuse and assault. Although the causes will vary in each situation, common contributors include:

  • Dementia
  • Patients in pain
  • Patients with mental illness (Schizophrenia, depression, bipolar, etc.).
  • Certain medications
  • Post-Traumatic Stress Disorder
  • Substance abuse

Often, the victims will have cognitive difficulties or be vulnerable in other ways. The victim may not always recognize it as abuse or is unable to communicate there’s a problem.

There can be many other contributing factors too. Including:

  • A resident feeling their space is being invaded, or the stress of feeling confined.
  • Racial conflicts
  • Previous conflicts or disputes
  • A one-off argument that leads to violence
  • The overall environment) too much noise, crowding, sudden noises, other resident’s behavior, overstimulation).

Nursing Home Contributing Factors

Another reason for abusive/aggressive behavior is the failures of the nursing home. The home should have adequate measures in place to prevent such behavior. These should include:


  • Care plans: Each patient must have a care plan designed to meet their individual needs. This is vital to all patients but it’s especially important to patients with dementia. Dementia patients need routine and they may be prone to violence or anger if it’s disrupted.
  • Failure to act on warning signs: There may have been early signs there was a problem between two patients. The resident may have had minor conflicts or shown controlling behavior towards another resident.
  • Poor training: Nursing homes must equip staff to manage or recognize resident on resident assaults/abuse and to control the situation when a resident is at risk of assaulting someone.
  • Low staffing: Low staff levels can mean poorer care. And limited staff capacity means staff are less able to monitor and protect vulnerable patients.Federal law sets staffing levels for Medicare and Medicare levels.

In nursing homes, a licensed nurse must always be on duty, while a registered nurse should be there a minimum of 8 hours a day, for seven days a week. Aside from this, Arizona doesn’t set out the standards required for nursing ratios

Preventing resident nursing home assaults

Nursing home staff should have plans in place to manage incidents and to prevent them. These plans should include:

Care Plans/Medication Review

The first step is a review of the care plan and medication. For example, psychotropic drugs can cause patients to become violent, meaning the resident may be more likely to attack another.

Nursing homes should also review care plans regularly to ensure each resident’s care needs are met. Frustration at unmet medical or emotional needs can be a major trigger in some patients.

Understanding triggers

There are many triggers for violent attacks or abusive behavior and it’s vital staff are properly trained to identify and understand individual triggers and manage them.

Avoid overstimulation

Overstimulation like violent TV shows can contribute to an assault. Nursing homes must manage the content residents watch.

Analyze the situation

Nursing homes can use their records to spot patterns. When they see patterns they should act. This may mean changing the environment to avoid overstimulation, or sitting the resident in quieter, less crowded areas of the room.

If the resident has specific needs the nursing home should ensure they’re met. For instance, with dementia patients, routine is critical and they may be better with familiar faces, rather than too many changes in staff. has many more tips for managing and preventing assaults/abuse.

Background checks

Prior to accepting a resident, the nursing home should carry out background checks for a history of abusive or violent behavior so they can put a plan in place to manage it.

Keeping Dangerous Objects Out of Reach of Patients

Store objects that could be used to assault another resident safely to prevent them from being used in an assault.

Use Aversion Techniques

This may involve distracting a resident if they are showing signs of abusive behavior or violence. Changing seating arrangements may help. Or walk with the resident to calm them down.

Resident on resident sexual abuse in nursing homes

Sexual abuse doesn’t just mean physical contact. Sexual abuse also means being forced to:

  • Undress
  • Watch pornographic content
  • Witness sexual acts
  • Take images

Most victims are female and vulnerable or frail in some way. Sometimes, the perpetrators of the abuse will have dementia, which may drive their sexual urges.

What should nursing homes do to prevent sexual abuse?

A nursing home should have preventative measures in place. Further, they should report the incident/s to:

  • Law enforcement
  • The State Survey Agency
  • Any other relevant state officials

In an article in the Journal of Gerontological Nursing, Professor Sandra P Hirst details the steps the nursing homes should implement to prevent and stop the abuse. They are:

  • Educate staff: Homes must train staff to recognize resident on resident abuse/assaults, When it occurs, they must act on the nursing home guidelines.
  • Draw up guidelines: Each nursing home should have established guidelines in place for managing resident-on-resident abuse.
  • Keep records: For the purposes of reporting, managing, and preventing abuse.
  • Deliver a person-centered approach: This means nursing homes should have a plan designed to meet the individual needs of the residents.
  • Assess potential triggers: As detailed earlier in this article, there are many factors that can trigger resident on resident abuse.

Resident on resident abuse FAQs

How do I identify resident on resident abuse?

Assaults or abuse don’t always happen in front of other people. For many victims the abuse will be hidden and the resident will be reluctant or unable to talk about it. However, there are indications you can look out for.

One of the most common signs is a change in your relative’s behavior. They may become withdrawn, depressed, and seem anxious. They may also have lost weight because of a poor appetite. Another thing you might notice is lost possessions or money.

There are also physical signs, like bruises, cuts, and scratches. In cases of sexual abuse, they may have STDs.

What should I do if I suspect a relative is being abused?

Tell the staff, administrator or manager. They should investigate and get back to you. If they find there is a problem, they should put a plan in place to prevent future issues, or review their current plans.

Contact State Regulators

If you’re not satisfied with the outcome, there are a few state agencies you can contact. The Arizona Department of Health Services Division of Licensing is responsible for care home licensing in the state. You’ll find a complaint form here.

You could also file a complaint with Adult Protective Services (APS). This is the agency responsible for preventing vulnerable adults. You can file a report online, or call (877)-SOS-ADULT or (877)-767-2385, or (877)-815-8390 (TDD calls).

When you file a complaint, they will assess it to see if it meets the criteria for abuse/neglect and they’ll send it on to a local APS office for investigation.

Alternatively, you can call the Department of Health Services at (602) 364-2536.

If the nursing home doesn’t satisfactorily respond to your concerns, seek legal advice. A lawyer can help by:

  • Investigating whether the nursing home followed procedures and carried out checks.
  • Seeing the nursing home held an adequate investigation into previous allegations
  • Requesting documents from the nursing home
  • Creating a sturdy case against the nursing home
  • Filing court documents
  • Issuing Letters before action to the defendant/s

Contact the Thompson Law Firm

When you help your parent choose a nursing home, you do so expecting the environment to be safe for them. Sadly, this won’t always happen and resident on resident abuse can occur.

The effects of resident on resident abuse are not just physical. It will also have a psychological impact. The victim is likely to feel stressed and anxious, and they feel unsafe in their environment. Ultimately, this may mean the patient has to move, which brings additional anguish and distress.

If a relative of yours is the victim of a resident on resident attack or abuse, it’s vital you understand your legal rights and the obligations of the nursing home.

While compensation cannot undo the effects of the assault or abuse, a legal case can have other positive effects. This may include the home being forced to put preventative measures in place to prevent similar attacks. Or helping to facilitate a relocation to alternative nursing accommodation.

For an expert, compassionate service, contact Thompson Law today.

Our experienced attorneys offer comprehensive guidance on all personal injury matters by phone or video conference call.

Our team of lawyers work closely with their injury clients across Arizona, communicating clearly whilst offering reassurance and empathy through an often very difficult and emotional process. During the free consultation, our lawyers will discuss your concerns before creating a comprehensive plan for you, while also assessing the strength of your claim.

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