Aggressive Behaviours: How Many Stories Like These? Blog Banner
In response to my recent blog Aggressive Behaviours: Just part of the job for aged care workers?, personal experiences of aggressive behaviours were shared. I was both disheartened by their experiences and uplifted by their overwhelmingly positive attitudes – caring, passionate, committed, perseverant, frustrated, perhaps undervalued.
 

I am pleased to see you mentioned the need for better training. Staff need to be aware of the reasons for aggressive behaviour from residents.

I am totally against medicating residents to keep them cooperative or quiet or for any other reason.

When staff are appropriately trained and the ratio of staff to residents has been improved, there will be less incidents of aggression.

Government funding for these residents needs to be increased and monitored. You don’t want a situation where a facility is receiving extra funding and it’s being siphoned off for some other activity.

I find the biggest reason there are issues in the aged care sector is staff who have a “we have always done it this way and we will continue to do it this way” attitude and management who have no control over the decisions being made by staff and are not prepared to put their foot down on the behaviours of staff. Then you have existing staff training new staff and passing on bad habits. The cycle goes on.

Thank you for your article. I know there will be many many staff who will say no this doesn’t happen but believe me it does.

Emily *
 
 


The aged care sector was my passion. It was often a sad environment, an aggressive environment and often a watch over my shoulder environment.

I kept advocating right through my journey in aged care. I wrote to the relevant authorities, I wrote to the organisations.

Like Mother Teresa said, “we can make a difference one step at a time”. The difference I made was to and for the individual people without a voice. I listened. I held their hands and looked into their eyes. I held my ethics and encouraged others to do so.

The corporatisation of aged care has brought terrible changes to aged care – for the workers, for the residents and for their families.

I can only do what I can now and that is to continue to advocate as best I can.

Mary *

 
We know there is a tremendous amount of good work being done. However, representing more than 20 years working in aged care and disability, these personal anecdotes raise significant concerns.
 

5 questions your strategy to manage challenging behaviours should answer:

1. How are you supporting significant lifestyle change?

The nature of residential aged care alone will present challenges for some residents. Most people in Australia have spent very little, if any, of their lives living in what amounts to dormitory style accommodation.

At a stage in life when most people would not choose to make lifestyle changes nor choose to relinquish significant levels of control over their life, new residents are required to rapidly adjust to significant change where daily activities, including toileting, are run to a schedule.

This context provides a myriad of triggers for aggressive behaviours: the physical environment, frustration, boredom, food preferences, deteriorating health, clinical conditions, pain, living with other residents who you may not like, the number of people in the dining room, being asked to do things you may not like to do by staff who you may not like, and the list goes on.

Some care recipients are not able to effectively communicate their needs, wants or dislikes. Their advocates may also be unaware of their struggles.

When needs and wants are better met challenging behaviours tend to decline.

Looking for the function behind the behaviour may lead to a care recipient being better understood.

As Emily attests to, staff are known to request that care recipients be medicated because they are non-cooperative or frequently in a challenging mood. Understanding the function behind these behaviours will in many cases remove the need for overuse of medication.
 

2. How active is active ageing?

Is active ageing not practiced as actively as it could be?

Are residents, particularly new residents, only given limited opportunities to do things that they would have otherwise been doing unsupervised in their own homes?

More independence. More participation. Less aggression.

What are your care recipients, who are capable of walking, also capable of doing?
 

3. Are current incentives driving sufficient change?

Even for the most well-meaning care providers, person centred care is at odds with the economic realities of running aged care services that need to minimise costs in order to survive and perhaps make a profit.

Staff are commonly drawn into providing time-based task-focused care rather than wellbeing-focused care. Would smaller groups of care recipients produce better care outcomes? Or as Emily suggests, is this simply a question of ratios and staffing levels?

Most will agree that when the ratio of staff to care recipients drops, so too does the level of care provided. I would suggest that when the level of care decreases, aggressive behaviours increase.

Organisations that successfully decrease aggressive behaviours enjoy increased wellbeing for all involved. Other benefits include savings in time and resources utilised to manage incidents, absenteeism, presenteeism, medical treatment, lost time, sick leave, staff retention, workers compensation claims and workers compensation premiums. Despite this, many organisations are still using more reactive rather than proactive approaches.

If Mary is right, not only is the level of care not improving, it is actually on the decline.

How can we place more “value” on these known benefits in order to prioritise and incentivise positive change?

 

4. Does training achieve a level of competence?

As Emily has highlighted, training provided to staff to prevent and manage aggressive behaviours needs to achieve a level of competence, and not just compliance. Some organisations find it difficult to provide adequate ongoing training. The result is senior staff who may not have been adequately trained themselves, and who are already short of time, being asked to provide on the job training for junior staff. Unfortunately this can result in bad habits being passed down the line.

Promoting participation in the prevention and early management of aggressive behaviours will reduce risk and the associated costs.

Face to face training provides an optimal framework for maximising individual participation and peer to peer learning, and enhancing learning retention. Rostering, logistics and budget related hurdles can make this difficult for some organisations.

Alternatively, well-designed eLearn programs offer an effective pathway to increase awareness and knowledge across your workforce, and improve attitudes and behaviours. Providing consistent, mobile, and self-paced content, eLearn programs help overcome the practical limitations of speed and ease of delivery associated with face to face workshops.

How are you enhancing staff skills and improving levels of care in the next 12 months and beyond?
 
 

5. If we know the challenges, why aren’t we making the changes?

If Emily and Mary’s stories are more common than we’d like, it raises another question:

If those in management see the need to change yet do not change, then where will the drive for change come from?

 
 

Image of Travis Holland presenting

Travis Hol­land
Man­ag­ing Direc­tor
Hol­land Thomas
Travis Holland email address

M.A.B. Staff Safety Training. Find out more.

* Names have been changed.
 
Should you wish to discuss strategies to improve your staff’s safety in their work environment, please feel welcome to contact Holland Thomas.
 
Our goal at Holland Thomas is to create safer workplaces that enhance wellbeing for all concerned whilst also delivering improved operational and financial performance.

This blog draws on our years of experience delivering our M.A.B.™ Staff Safety Training (Contextualised Prevention and Management of Aggressive Behaviours) across Australia and the development of My Safety Buddy, our smartphone app and web portal based lone worker safety solution.

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