Senior Living LIVE! Senior Bullying

Video Transcription

Hi everybody. Hello and welcome to Senior Living Live. I'm Janae Sherman and I wanna thank you for joining us today for the webinar on senior bullying. Today our special guests, Mary DiDia and Rita Grandlis are from Unicity Care, will be speaking to us about recognizing and preventing bullying, as well as how to create a safe, inclusive environment for everyone. Ladies, thank you so much for joining us today.

Before we begin on this important topic, I just wanna remind you that this a perfect time for you to get your questions answered by the experts. So make sure you click the Q & A button at the bottom of your screen to submit any questions you have throughout the presentation. And when the ladies are finished presenting, I'll make sure to get your questions answered live. We'll also give you some more information at the end about how to get a replay of this webinar. So with that, let's get started. Ladies, the floor is all yours.

Thank you, Janae, and thank you everyone. Good morning or good afternoon depending upon where you are time zone wise. I just wanted to thank you guys for all taking time out of your busy schedule to join us, on this very, very important topic. So I am Mary DiDia. I am the director of business development for Unicity Care Management, and we have Rita Grandlis who will be our presenter today. Rita Grandlis is our director of care management.

So a few of you may be wondering how we are experts in senior bullying and who we are today. So I just wanted to take a moment to introduce ourselves, of course, but most importantly, Unicity Care Management.

So Unicity Care Management consists of all a team of licensed social workers and registered nurses. Our team of care managers helps our clients, their families if they're lucky enough to have family members, in a nutshell, navigate the complexities of aging, the health care industry, and most importantly, answering those difficult questions of what's next, what's going on, and how do we get to that most important next step. We've worked very closely with our assisted living affiliates like yourselves and The Arbor Company to identify those next step solutions of having those difficult conversations of, okay, you no longer can safely live in your home.

What's going on next? And that move and that difficult move to an assisted living and broaching that topic of how to even start that conversation of that move. And then, of course, working with your lovely team at your communities to make sure that move and that transition's going smoothly and that, you know, your staff isn't overwhelmed. If we can ever offset anything, we are here as a solution. So many communities have brought us in to talk about this very difficult topic that is affecting many assisted living communities.

Unfortunately, bullying doesn't stop in grammar school. It doesn't stop in high school. It continues to assisted livings. So this is why we are here today.

We've done a lot of support groups. We've done a lot of social work sessions in communities where the communities bring us in to help their residents with difficult scenarios, bullying being one of them. So I think utilize this as a resource. As Janae said, ask the questions.

We are here to help you. And if I wanna welcome, you know, I, myself, Rita, and our team of care managers into your communities too if there is ever anything that we can be boots on the ground resource to you. So please, again, take our contact information, and we are here as an added support layer. So and we are in, I'm not I'm not sure where everyone is joining us on this call today, but our footprint that we cover is predominantly Northern New Jersey, Central New Jersey.

We teeter the border into New York, and we are also in Palm Beach and Broward County of Florida. So if you guys are in those areas, you may know us. If not, get to know us. So I will hand it off to Rita.

She will be, presenting today. So, again, any questions, please, please, feel free to ask. We like this to be conversational. So, Rita, the floor is yours.

Thank you so much. And, yes, to piggyback off Mary's, statement, we'd like this to be interactive. I don't like, just kind of, relaying all the information to you. I love it when we actually talk about scenarios or real life vignettes.

Mary and I both come from working in varied health care settings. Myself, I have experience working in the hospital, skilled nursing facilities, Mary assisted living, and now working as a care manager in multiple communities, and we see the bullying on a regular basis. So we'll start with the slides, but if anyone has questions, you know, as we're going, please raise your hand. We can kind of address it as we're going through it.

But to Mary's point, normally, when we think about the word bully, we relate it to our children, our teenagers, but the reality is that bullying is a very real issue, among the adult older adult and senior population.

Seniors can be either the, you know, the target of a bully or be responsible for the bullying themselves.

We see it can happen one time. It can be an ongoing, issue, and I think we really need to talk about it more and have these conversations because as the senior population continues to grow, this is gonna become a larger, problem. And I think just like with, children, teenagers, you know, young adults, you know, bullying is wrong. It's not to be tolerated, and it's not accepted regardless of, what age we're talking about it occurring.

So when Mary and I give this presentation, I always ask everybody just to take a moment, do a little exercise. Think about a time in your life where you felt like you were bullied, and how did that make you feel?

Did you report it? Did you speak to somebody?

Did you speak to the person that was bullying? Or perhaps you witnessed somebody else being bullied.

How did you respond? Did you intervene?

Did you report it?

Or how did it make you feel? And then in some cases, people have admitted to me that they've been the bully, sometimes in their younger years, and kind of talking that out, like, why did you do it? How did you engage in that behavior? How did that make you feel?

So I always just ask people to kind of take a few minutes. We don't have all that time today to kind of just think about this as a self reflection exercise. Because all of us at some point in our lives have either been a victim or perhaps seen it occur, and that will help us kind of in our work here, working with our seniors and addressing the bullying issue.

Really, people ask me, what is bullying? Right? So that's what I like to do first is actually define it. So again, different organizations such as the APA, Dr. Maria Leon, who is an elder bullying expert, defines it as there's a distinct pattern of deliberate, harmful, and humiliating acts or behavior. The APA defines bullying as a form of aggressive behavior in which individuals are intentionally and repeatedly causing another individual discomfort or injury.

Again, just to give you another example, the Haslin Foundation, which focuses on bullying, again, states it's an intentional, repetitive behavior, and it really has to do with an imbalance of power and strength. So the common points throughout all these definitions. Right? It's a repetitive, aggressive, controlling behavior that is causing harm to another individual.

And we have to remember that the target who's being bullied is not looking to be bullied. Right? It's unsolicited by the target. The bully has found somebody that they're going to target and display that behavior. So when we talk about older adults and bullying, some key points is we don't hear a lot about it or have discussions a lot about it because the percentage of people actually reporting it is so low.

Those working within the senior population feel that that ten to twenty percent of reporting of seniors who've experienced bullying is actually very low. We really do believe that most seniors, are not reporting the bullying, and it could do to that could be due to embarrassment.

It can be due to stigma attached to bullying.

They may be completely unaware or a lack of understanding what bullying truly is, and they may not even be aware they're being bullied. They may just think this is the normal process of living in a senior community and just interacting with the residents.

A lack of understanding that bullying can be a onetime occurrence, but primarily, it usually is a continuous pervasive pattern of behavior.

There's also the false assumption that if you ignore the behavior, it will go away. So a lot of seniors figure if, oh, I don't say anything, they'll eventually stop. And ninety nine percent of the time, that's not the case.

Also, there's a lot of our seniors or clients who have spoken to us about bullying report that there there's a fear of retaliation, that if they report on their friend or their resident or, you know, the other attendee at a senior center, they feel like if they report the behavior, then the behavior is going to become worse, or there may be retaliation by the bully. So there's many reasons that the bullying isn't reported, but we definitely know it occurs. And we anticipate those working in the industry an increase from that ten percent to twenty percent to more likely a thirty percent to forty percent number within the next years as people keep talking about it and we kind of put the topic out there and educate both health care providers as well as our seniors on bullying.

So for seniors, we see the bullying occur when the seniors have to share spaces. Right? They have to share spaces. They may have to share resources.

They may have to share seats, or staff attention. We really see the bullying occur when it's in shared spaces for seniors who spend a significant amount of time together, whether it's forced or voluntary. So, attendance at a senior center, sometimes you'll see the bullying incidences occur there. Same with adult day care centers.

Same with independent or assisted living communities. Same with independent, inpatient skilled nursing or nursing home communities, and then the same with fifty five plus communities. So it's any environment where seniors are spending a significant time together, whether, again, they're choosing to be there or whether they're a resident and living there. So this is commonly where we see the bullying, occur.

So I'm sure all of you guys know this. If you're working in seniors in health care, the most common place we see this is in the dining room. Tables heating is the bane of most people's existence who work in assisted living and memory care community. Mary is shaking her head because she she formerly is from the assisted living world.

That is a lot of where the issues come with the dining room. And if anyone would like to share a story about that, we're open to it. We also find that it also is in the seating for activities in the theater in in the communities, whether it's at a movie theater, it's in the activities room, who's gonna sit next to who for the art therapy program, or if it's for the games, if you're playing trivia, sitting on a bus to go out to an activity, sitting in the community room watching TV, you know, anything that involves, like, seating or seating arrangements, we we find those are where most commonly the, bullying occurs.

Also, we have found and it's very interesting when you sit back and just observe. We also find that it happens when the seniors or the residents at these communities are vying for the staff attention. And if they feel that a staff member is paying more attention to somebody else more than them, it can trigger feelings of jealousy and resentment, which then can lead to to bullying as well.

And then we also kind of need to realize that senior bullying can also occur on social media. So many of our seniors, our older adults, are text are are tech savvy. You know? They're on their phones. They're texting. They're on Facebook or possibly Instagram, or there could be a shared site for the senior living community that they're in. So we have to be cognizant of the fact too that the bullying can occur, via social media as well, which I think a lot of us don't think about for seniors, but it's a very real, occurrence as well too.

Mary loves to tell a story about when she worked in the assisted living with bullying. Right?

Yes. So, when Rita and I, we were sitting down and we were making this presentation, you know, we're like, what do we call it? What do we call it? And, you know, this slide really drives home why it's called bullying.

You can't sit with us. Because as Rita beautifully said is a lot of the bullying does take place in the dining room. I myself some days felt awkward walking through the dining room because people had you know, the seniors often, they would bully. They would, you know, have certain comments that they would share about, you know, they didn't like the color of my shirt or something.

And they they voiced that opinion, which is fine. I have a thick skin. But when we see it amongst the residents to resident, that's really where we need to do something. So I myself used to work as a, director of sales in an assisted living, and I remember this one woman.

She was so excited to move in. She was excited to be with a friend of hers that she had a few years ago when they lost touch. And she's like, she lives here now. You know, I I just wanna be with her, you know, presume resume our friendship.

And I said, this is great. You know? And I was talking to, our assisted living coordinator about, you know, where she's gonna sit in the dining room. You know?

So I said, let's put her with that resident that she's that they were previous friends with. And, so I said something to the resident who was living there, not the new move in. And I said, oh, your friend's moving in. And she's like, she's no friend of mine.

And so then I had to navigate those difficult orders of, okay. Where is she gonna sit? And we had them sitting at the same dining time, the same seating time, rather, but they were at separate tables because the bullying got to be so bad. So the staff had to intervene.

Apparently, they weren't friends, but it was a one-sided friendship where this poor woman did think that she could resume this friendship, but the bullying continued. And since that resident was there longer than the new move in was, she had her friends, and then the friends kinda ganged up on each other. So with staff intervention, we were able to dissipate the situation, but the it's just building the awareness, you know, to the these topics and where they where they can occur.

So Correct.

And then also understanding what types of of bullying are out there. You know, obviously, you know, some of this is very obvious information. There's the verbal abuse. Right?

Verbal bullying. Maybe picking on people's outfit, their appearance, you know, negative comments to them on a regular basis. I know working with older adults and seniors in the skilled nursing facilities or assisted living communities, sometimes when a person transitioned to using an assistive device, Right? Whether it be a cane or a walker or a wheelchair, sometimes they'll be picked on for that.

I've heard stories that, you know, people can tell when somebody starts wearing incontinence briefs because they could see the change in maybe how their outfit looks or the noise of the swish going by and maybe picking on them then because they suddenly have an incontinence issue.

So, obviously, verbal bullying. Then there's physical bullying where sometimes they're actually laying hands on each other, which oddly enough, several years ago in a community up here in Bergen County, I had a man and a woman literally fighting over space in the dining room. Verbal you words were expressed. This was a con consistent issue over seating in the dining room, And it got to the point that the woman actually physically put her hands on the gentleman. So we don't necessarily think that it'll get to a physical level, but in certain situations, our seniors can really still be physically aggressive.

We touched on cyberbullying before between texting, perhaps posting messages on Facebook or Instagram. I mean, most commonly for us working with our senior older adult population, really, most verbal the most common form of bullying we see is the verbal abuse. And behaviors can range from being very subtle, you know, to being just outwardly aggressive. So it's just being on the lookout and and being aware that sometimes it starts off very slowly and then can build up to a very aggressive level.

We also find there's a difference between men and women and their billing their bullying behaviors. We find that women are more verbal, you know, more with the negative commentary, the negative tones, you know, getting their friends to gang up, talking about them, those kind of verbal behaviors. And we see men, it's more of, physical, like kind of entering people's personal space without permission, getting more up into people's faces. And I've had it happen actually down in Florida where we also cover care management.

I had a resident, at a facility one of the first times I was giving this presentation talk about how one of the gentlemen in the community was very sexually aggressive to her. And even though she was denouncing you know, denying his advances and told him he had no interest, he was very physical and sexually aggressive towards her every time that they saw each other and even was knocking on her apartment door unsolicited to the point that she didn't even wanna leave her apartment and go down to activities or the dining room because his behavior was becoming so aggressive.

So, I mean, that may not be a high occurrence as the verbal bullying, but it does happen.

We were brought in to an assisted living too because the bullying amongst the women got to be so bad that they formed their own clique. And the way that they identified themselves, if you were a member of this clique, is you wore horizontal stripes. So no one else in the assisted living was allowed to wear horizontal stripes unless you were, involved in, you know, a member of this clique. And the women were so verbally, abusive towards others that they tried to intervene amongst the staff, but then they had to bring us in, to really resolve the situation. So it it can be verbal and and even look out for those nonverbal signs of why are there so many stripes around the community? So just looking out for everything.

Yeah. So, I mean, obviously, we know pretty much what verbal abuse entails. It's criticizing or ridiculing someone for their clothing, their hair, perhaps their race, perhaps their religion, perhaps their economic status, sexual orientation. Like I touched on before, suddenly, maybe they were walking independently. Now maybe they need a cane or a walker.

So due to the change in their medical condition, now they're being criticized or ridiculed.

Oddly enough, spreading rumors or gossip. I mean, we joke about it. It's like being back in high school sometimes when you're in these senior living communities, but spreading untrue rumors or gossip about fellow residents, making inappropriate sexual comments among the residents, verbally hounding another resident for something they want from them. Like, you know, I want that beaded necklace.

You I wanted that, and I didn't win it at bingo. And I should have had it, and I want it. I want it. I want it.

So kind of harassing or hounding someone for something else that they want from them. Making hurtful jokes.

Person making the joke may think it's funny, but the recipient may not.

And then, like I talked about, insults about your change in health or conditions such as using a cane, rollator, or wearing oxygen, or perhaps you know, having a stroke and then having, you know, aphasia and not being able to communicate. So those are kind of the common ones we see in the verbal abuse.

Physical abuse, I mean, obviously, those are pretty obvious too.

Hitting, pinching, pulling hair, pushing, kicking.

Some of the other ones are stealing or damaging the other person's property, making obscene gestures, which one of my back to that client up in in Bergen County a couple years ago, she loved to give to the finger to anyone who possibly aggravated her, and that offended a lot of other residents.

As we touched on inappropriate sexual advances or sexual behavior, Invading one's personal space, and that's kind of a very interesting one because I think everybody has a different definition of their personal space. But really entering into somebody's you know, they're right in their perimeter and not understanding that personal space and that physical boundary, And that really is a trigger for a lot of people as well too. And I'm actually currently dealing with that in a facility here in Bergen County, and we keep trying to address with the resident who doesn't have dementia that he makes the other residents uncomfortable when he invades their personal space, when he touches them without their permission, when he joins them at the table and they haven't asked, you know, or given permission to have them join there.

He thinks he's helping people. He thinks he's being friendly. He's not understanding his physical presence is actually making people uncomfortable. The big one we see, obviously, as we talked about, is the exclusion, not allowing one to sit with them at your table or saving seats for your friends and excluding other people from sitting with you.

And as Mary touched on briefly, we do realize that flicks do occur in most senior communities at a senior center, adult day cares. So it's just being aware, of the physical signs here.

The other key thing I'd like to talk about is knowing the difference between bullying or a change in behavior. So we need to be aware that sometimes one of our residents or seniors may be acting differently and displaying new behavior, but it's not necessarily bullying. They may become aggressive. They could become easily agitated.

They may be verbally inappropriate, but sometimes it may be due to a change in a medical condition versus bullying, intentional bullying. So we all have to be aware of working in the senior communities with our seniors in health care, assessing the new onset of this behavior. Right? Is it related to an acute health or mental health condition?

And once we rule all of that out, then maybe it is a bullying behavior, But, really, we we need to rule out any medical conditions such as a UTI, chronic pain, which I think a lot of us take for granted that if somebody's in pain, they may not be in the best mood on a regular basis and may not be easy to engage or interact with. Do they have a fever? Do they have some sort of infection such as sepsis?

Are they using alcohol, or is there drug interactions between their medications if they're drinking alcohol?

And dementia, obviously, we know the different stages of dementia. You could start off as mild, moderate, you know, to severe.

But is there a change in cognitive status?

And if there is a change in their cognitive status, is this why now nonverbal behaviors, maybe such as hitting or, you know, being more aggressive, are now arising because that's the only way they can communicate? So I think just being aware of the difference between a change in either acute physical or mental health versus bullying. So some behavior may be inappropriate and may violate some of our community or social rules, but it's not due to bullying.

So people always ask what's the common reasons for bullying? And I think a lot of us kind of, in our minds, know what they are, but it's usually fear, a big feeling of insecurity.

Especially moving into the senior communities, it's a loss of control, a loss of their freedom and independence.

For some individuals, it could be a lack of social skills that's been with them their whole life, but it's now exacerbated as they're aging.

Low self esteem, which goes into the feeling of insecurity, but, you know, low self esteem, so I feel bad about myself or I'm not feeling good about myself, so I'm going to make others feel just as bad as I do.

Sometimes we say sometimes a person has just been a mean person, and they just have a bad personality.

So that can be one of the reasons too we see for bullying. Sometimes it's just situational. It could be the trouble adjusting to moving to a new senior living community or adjusting to the aging transition and adjusting to the changes in their mental as well as physical health or now maybe needing to attend an adult day care or senior center when they were independent at home. So a lot of times, it could be the adjustments and the difficulty adjust adjusting to the transitions as we age.

Sometimes it can be side effects from medications, you know, which changes their personality or their emotional and mental health. It could be grieving. Perhaps they had a recent loss of a spouse or a partner, and that's created a change in their behavior.

Obviously, you know, underlining psychiatric diagnoses.

Sometimes those psychiatric or mental health diagnoses have been untreated and undiagnosed, and nobody's ever addressed them with it. And now we're seeing these behaviors in a senior living community, and they've been there for years, but nobody's ever addressed it before. So it's been undiagnosed and untreated. And as we touched on, it could be a cognitive and neurologic decline. And then also a lot, we see a lack of empathy with our seniors as they're aging as well too.

So those are kind of the common reasons we see for the bullying occur.

So, again, we're talking about the reasons for the bullying, but then we need to look at the side effects, right, the effects of being bullied. And we need to realize these effects can be very harmful, long lasting, and the effects then can be for the victim is low self esteem, feelings of rejection, depression, anxiety, an increase in social isolation or withdrawal, avoidance. And I will tell you to the woman down in Florida who is, you know, very upset over the unwanted sexual advances from that other resident, she then was choosing to stay in her room as opposed to participate in the community and all these activities and go down for meals.

And she really her life was impacted more than his because she was choosing not to engage in any of the activities. And meanwhile, she's a very social woman, had a lot of good friends, enjoyed living in the community until this gentleman moved in, and the staff slowly started to see her kind of become so socially withdrawn.

And then finally, you know, it came out. It was due to this resident's particular behavior. Suicide is an extreme example of one of the effects of bullying. I have not experienced it with any of my clients, but when you review the data, we do see that sometimes people have thoughts of wanting to harm themselves, or have harmed themselves, and we see that more common in men than we do for women.

Some of the mental and physical effects of bullying we see is, you know, moody, irritable. They could have physical complaints such as headaches, abdominal pain, loss of appetite, panic attacks, request or inquiring about moving elsewhere.

Some residents who have access to alcohol, you know, admit to using alcohol to help deal with their depression and anxiety.

And then in some instances, I've seen it where it goes to extreme anger where they wanna retaliate, and they're becoming aggressive in response to the bullying, which, again, is gonna escalate the situation. It's not necessarily the best answer for retaliation to the bullying.

So, really, people ask, how do we cope, or how do we prevent bullying? As we all know, this is very difficult, whether it's for, like, we talked about children, teenagers, young adults, older adults. But the key is education. Education, education.

The more we talk about it, the more it raises awareness among health care staff, among our seniors. And it's the simple expression, if you see something, please say something. You have to report it. Bring it to staff.

We also not only need to educate our health care staff, we need to train our seniors as well.

You know, providing interventions that are necessary to minimize and prevent senior bullying, asking our senior centers, our ILAL communities, and nursing facilities to take an active role in educating, intervening, and preventing senior bullying. For my client that was the bully up in Bergen County up here a few years ago, everyone's like, oh, that's just her. That's been her personality her whole life. Well, that's not an acceptable excuse.

She's making other residents uncomfortable to the point that they don't wanna sit in the dining room with her, and she wasn't taking any accountability for her behavior. So it was really a lot of work. We partnered with the facility staff. We had meetings with the client.

We had to get her family involved. We got her psychiatrist to see. Medication was added. Then we did a lot of support for the other residents in the community, you know, listened to their frustrations.

We talked about how they can cope and, you know, respond when they felt like they were being bullied by her.

It took a lot of work, persistence, and it did pay off in the long run. Things things really did work out. A lot of it was her lack of awareness. Again, everybody said she was just feisty, that was her personality, not realizing that the aggressiveness, and her persistent, aggressive, rude behavior was actually bullying.

So for the victims, obviously, like we talked about, it's just education too, reassuring they're not at fault or they shouldn't take the blame, and help develop techniques to deescalate the situation, which is hard for any of us when somebody's kind of coming at us, right, or being aggressive towards us. It's very difficult to try and stay calm to deescalate the situation, but truthfully, that's the best approach.

So there's a delicate balance between deescalation and developing techniques to assert oneself but without being overly aggressive.

Getting everyone mental health support, whether it's the bully, the victim, other residents, the staff. Also encouraging relationships with friendly, more supportive seniors. So maybe the bully has never really been taught appropriate behavior. So a lot of times, there is an ambassador or somebody at the community who's really such a great overall resident and such a picture of, like, a great personality and somebody we would want them to to kind of aspire to act like. So kind of partnering them with other residents to encourage those friendlier, more supportive relationships.

Remind them that they are not alone. That's a key thing. A lot of people, there's so much shame and stigma to being the victim of being a bully, of being bullied. So reminding them that they're not alone and that they need to talk to us. They need to talk to the staff. They need to talk to their family, their friends, perhaps their power of attorney to not keep it inside, to remind them that they do have a village of support around them and that we can help guide them through this this difficult situation.

We've talked a lot. Does anybody have any kind of questions or incidences or anything they'd like to bring in?

Thank you, Rita.

But I mean, have more slides, but if anyone wanted to ask questions.

You still have more. Okay. Well, if you're trying to ask a question, please, you can use the chat or the Q & A. I will find them and make sure that we can get them to Rita to answer. So if you have anything, please jump in and get those in there.

Okay. Perfect. And as we talked about interventions directed toward the bully is please do not ignore or avoid the behavior. Please report it immediately, whether it's to staff at a senior community, an adult day care, a day care center, wherever the behavior is occurring, please report it to somebody.

It's important that's the only way we can address it.

Consistently the key is the consistency. Right? When we're working with anyone who's been bullied or is the bully, it's the consistency, setting limits, setting boundaries, clear limits and boundaries, even having to write it out more than just having that verbal discussion with them of expectations of behaviors. I definitely am a big proponent for mental health intervention.

Sometimes it's hard for them to agree, but as far as the care plan or an intervention plan, a lot of times we mandate that as part of our intervention that they need to either speak with a licensed clinical social worker or psychologist and or a psychiatrist. Sometimes the the behaviors may be due to depression, and sometimes getting a mood stabilizer or medication can can help improve their mood, which may reduce the bullying. So it could be one on one therapy, could be group therapy. For one particular client, we did specific anger management classes, identifying more appropriate outlets to release their anger and frustration.

Again, it's always very difficult for all of us, but really trying to address the situation calmly. The more we stay calm, the more the other people involved stay calm. We try not to agitate or elevate the bully. That helps everybody.

Again, on both ends, whether it's the bully or the victim of the bullying, really always involving families, friends, the power of attorney. If we don't address it in, like, two years you know, I'm being extreme, but two years later now, this has been a pervasive pattern where the resident at the senior living has been bullying people, and it's never been brought to the family or friend's attention. And now it's to a point that you may be wanting them to leave the community, where the family is gonna be like, well, I never heard about this before. Why is this the first time I'm hearing about it?

So really making sure we have clear, concise communication, specific examples of what has happened.

And, again, I'm dealing with that right now in the community here in Bergen County where I asked the residents to write the letters, tell me exactly what happened, put it in writing. So then when I bring this to the to the person, you know, I have concrete facts. It's not hearsay. I'm not naming the name of the person who wrote the letter, but at least I have particular hard evidence of the situations where their pervasive inappropriate bullying behavior is happening.

So that way, when we meet with the bully and their family and their support, they they have a clear understanding of what we're talking about and what interventions we're recommending based on that.

A lot of times, we see when it becomes such a a problem. Like I said, senior communities may ask the resident to leave. I've had clients being asked to leave a senior center or a senior activity due to their inappropriate behavior. So we can kind of skip over this a little bit, Mary.

I feel like we touched on that. So the other thing we need to realize, and we see our clients as care managers in their home, in independent living, in assisted living, in memory care, in nursing homes, at the hospital. So we kind of touch all along the continuum of where the seniors live. But I think a lot of us need to realize too that it's not caregivers need to realize it's not one size fits all for all of our seniors.

The key is to offer a motivation and support. Right? There's not one solution that's gonna fit for every senior, so we need to look at everything. But we have to remember that caregivers can be the bullies as well too.

And I see this more commonly at home when it's the senior alone one on one with a caregiver. So we always the key is to offer our motivation and support. We want the the senior to feel empowered, to feel independent when they can with activities and decisions.

We want them to openly communicate with us, discuss expectations of their care, whether it be at home, whether it's in a facility.

We solicit their feedback, on a regular basis.

We need everybody to understand that the ends don't justify the means. So if a caregiver is being overly aggressive, like, you need to do this, you need to take a shower, or otherwise you're going to smell and no one's going to want to hang out with you anymore.

That verbal abuse on a regular basis by a caregiver to a senior doesn't justify the means. So maybe the senior will get in the shower because they've been bullied too, but that's not acceptable behavior by a caregiver to encourage a senior to engage in an activity. So there's a term that's been coined called creeping bullying, where it's this slow trend where caregivers use sheer force and pushy behaviors to get the senior to complete the task and get them to complete their tasks. Right?

Because a lot of caregivers, whether it be at home or in a facility, have a checklist of tasks they need to complete for their shift with seniors. And if the senior's not agreeable to doing that task, sometimes the caregivers will resort to, you know, verbal or physical behaviors, which are inappropriate to get the senior to engage in their tasks. So, you know, it's tough. Caregiving isn't about efficiency, excuse me, but actual caregiving to the client.

So, I think we just need to realize that caregivers can also, be the bullies.

The other thing when I've sat and actually talked to a room full of seniors, even just recently, it was very interesting. They were reporting to me that sometimes they don't feel like it's actually, like, in the facility or, you know, residents or friends or that they feel like they're bullied through the health care system, which was an interesting perspective to hear them report to me, that they feel like they're bullied by their health care providers, that they feel like their opinion is not considered or respected, that they're rushed through the visit, that it's only five or ten minutes, and their wishes, their thoughts are not honored or listened to, that they're just kinda rushed through the office visit, rushed through the ER visit, rushed through the hospital stay, and they feel like they're just being pushed through the system and that it's a pervasive pattern that's going on in the health care world and by health care professionals.

And they feel like they're they're being biased against and getting sub par care or attention due to their age. It was a very interesting discussion when Mary and a couple of my other colleagues have heard this feedback from our seniors. And then sometimes I do sit back and watch it when we go to the ER or, you know, I'm at a doctor's appointment, and I may not say anything right away, and I watch the process. And it's true.

Sometimes they can't even get a word out of their mouth before the doctor's kinda shushing them and moving on to the next issue. So we spend a lot of time as our care managers kind of making sure we're advocating for our clients, speaking up on their behalf, and making sure their needs and concerns are being addressed, whether it's in an office visit, an ER, or a hospital stay.

So we really for the next slide, we encourage our seniors not to feel intimidated or afraid to speak up when they're going to meet with their health care provider. We encourage them to ask those questions.

We encourage I always before I take one of my clients to a doctor appointment, we'll make notes together.

Questions? What are your concerns that you wanna address before you go see your health care professionals? Sometimes we'll take notes. I have one client who loves to record the conversation because he can't write as well anymore, but he's very good with his smartphone, and he likes to record then the information that him and the doctor have discussed. And then he can review it at a later date. And we always encourage having a health care advocate, a family or friend, a care manager be there so they don't feel like they're being pushed through or bullied by their health care professional.

The other thing is too I find a lot, and I'm sure some of you do too, there's a loyalty for a lot of our seniors to physicians maybe they've been seeing a really long time.

And they're actually unhappy with their provider, but they're fearful of leaving, because of retaliation, or they just, feel like they'll offend them if they choose to go to another provider. So we always encourage our clients to talk with us to express their thoughts and concerns, and you can always switch to another provider if you're unhappy. And a lot of times, if we're working as the care manager, sometimes we'll take, you know, on that burden for them of relaying that information to the provider that we're switching. I also remind our clients and our seniors on a regular basis, it's okay to say no or ask for a second opinion.

So, again, at an organization level for all of us, it's really educating our staff. It's educating our residents. Intervention. Early intervention and prevention are the key. You know, not disregarding incidences, reporting it as soon as the incident occurs via clear, easy process, at your facility, through your company, wherever maybe you are working.

If you don't have that in place, then working with your team, your facility, your community, your company to create and implement and inform all staff and residents of the zero tolerance policies and procedures on bullying.

And these need to include instructions, clear instructions and channels on how to report the bullying incidents, how to address them. You know, the goal for all of us is to create an empathetic caring community for all of our residents and staff to work and live in.

So that's the key. It's working together. It's partnering between the residents and the staff at the community. At a few communities, I've seen them institute, an anti bullying agreement or pledge, and they will have their residents sign that, that they understand that that's not acceptable behavior, and they're gonna pledge to, you know, act appropriately.

At a lot of the communities we know, there is the ambassador and mentor program, and that goal is to make others feel welcome. And that's a lot I find I see it a lot with newer residents coming into, an existing community with residents that have been there for maybe five, ten years where the group of friendships there, that cli for lack of a better word is there. So making sure for the newcomers that their transition into the senior community is as smooth as it can be and using your members and your residents as ambassadors and mentors to help make that transition easy. You know, code of conduct.

We all have a code of conduct at our jobs. Right? We're held accountable for our behavior. So making sure our residents and our seniors are held accountable, for their behavior as well.

And the key to that too is providing mental health support. So if you can't provide that within your senior center, your, senior living community, making sure you make a referral out. Maybe create a support group, which we provide at a lot of our communities. And it's important to keep the bullying conversation going. Just having one in service or one conversation one time a year for the residents or your staff is not going to help. It needs to be consistent and on a regular basis, these conversations and training.

You know, really sitting back and evaluating when bullying occurs in your community, you know, and then coming up with specific strategies to address it if it happens more so in the dining room. What's that because? Is it because of set seating times? Is it because, it's open seating times? Is it because maybe the table setup isn't right? Like, just trying to figure out little nuances to how you can address it better.

And keep in mind, ultimately, you know, when they're living in a senior community, we are responsible for both the target, like the victim of the bullying, as well as the bully. So that puts us in a very delicate situation because we need to make sure we're protecting the rights of all the residents, right, be it whether they're the victim of bullying or the bully itself too. So it puts the facility in a a delicate situation.

But we really need to understand that bullying is a function of a true deeper, you know, mental health kind of psychosocial pathology.

Bullying is an example of survival of the fittest at its best. Right? It's the human phenomenon of the stronger individual picking on the weaker one.

And while we may never eliminate it completely just by education, addressing, providing coping strategies and interventions for our seniors, we hope that we can at least reduce the incidences and, you know, assist our seniors and our facilities with dealing with it.

I've shared a couple of the story. I've shared a couple of those vignettes already. But so currently, on the gentleman that right now is causing an issue in one of the facilities here in Bergen County, we today, actually, one of my care managers is meeting with the staff, and he not only is a bit on the younger side to be living in an assisted living community, he also has a history of a developmental disability.

So we're dealing with something different more than a dementia or just a typical, you know, senior aging. So, really, our interventions and our approach is gonna be different. So we had to solicit the help of a specialist who works with DDD adults.

And so we're realizing we can't approach the bullying and his behavior in the same way we would somebody else because of his intellect and his disability.

So part of our intervention was researching and bringing in somebody to educate not only myself, the staff at the facility. Yes. He may have these medical issues, but approaching him the same way you would approach an eighty year old is going to be completely different. So this afternoon, we're doing a DDD education class for my team, for my for the staff at the facility. And then from that, we're gonna create a plan to work with him because, basically, she educated us. It's very interesting to kind of work on, like, positive reinforcement, giving him incentives and actual concrete I don't wanna say prizes, but concrete rewards when he displays good behavior.

We also have referred him to mental health professionals. He's agreeable to seeing the the clinical social worker in the building through his insurance. We have the psychiatrist assess him. He's refusing medication at this point in time, but at least he's speaking to the psychiatrist, so it's small steps.

And then we're offering a support group to the residents that are, you know, kind of feeling bullied by him and also meeting with their families as well too. So, again, it's an ongoing process. It's not one size fits all. It's trying to understand the individual that's being that's performing the bullying and then understanding the residents who are being bullied and figuring out, you know, how we can create interventions and mediate and support both the bully and the victims as well too.

Okay. So anybody have any thoughts, questions, comments?

Yes. Thank you. That was that was great information. I'm sure everybody's very appreciative. So if you have any questions, make sure you get those in. We still have a few more minutes, so we wanna get your answers live.

But I did have a couple of things I was thinking of that I would love for you to help me with. So you discussed the effects of bullying. Are there any warning signs, like early warning signs that are often missed because they might look like normal social behavior or something that people could be looking out for?

Yes.

That's a great question. And I think for us working in the senior communities, it's really trying to understand your residents and their personalities.

Because and Mary can attest to that and probably speak to it a little bit better. You kind of know eventually over time who kind of are the residents that are consistently displaying the behavior. Correct, Mary? Yeah. So kind of getting ahead of that when we start to see them being a little aggressive of activities, you know, trying to get ahead of it as early as possible. But Mary can speak to that a little bit better having worked in.

Yeah. No. I totally agree. And it's really just looking at you know, we have the gift of being or you guys have the gift of being in front of your residents on a daily basis.

So you understand who they are on a daily basis, you know, oftentimes more so than their families. So understanding who they are on a day to day basis. You know, if someone is being bullied, you know, seeing that change in just not their physical condition, you know, as we do. We always look at things so clinically.

But, you know, if someone seems a little bit down, you know, if they might seem a little bit, you know, not take not partaking so much in activities, you know, understanding those changes in their their normal day to day.

So how can we intervene? What's going on? Kind of just doing that friendly check-in, you know, making sure that they are comfortable. You know, this is their home setting, and it comes down to communal living.

Communal living is often difficult. You know, people are, you know, coming from their forever homes that they've lived in independently, and now we're putting a bunch of people in that same scenario living together. So they're gonna there's gonna be issues that come about it, but it's really what we do with it. But, yes, keeping an eye out for, those changes too, I think, is the most important.

Yeah. And we know the residents that have a stronger personality versus not.

You know? But you can see the ones who agitate or get triggered easily. You know? So really kind of making a conscious effort to keep your eye maybe on that person versus not.

But it's hard. Sometimes people surprise you. I was so surprised my client was. I mean, she was a strong personality, came from Brooklyn, you know, ninety six years old.

She was, like, appropriate with me. So to hear her behavior in the dining room, I was shocked. So I had to show up a couple times and hide and sit and watch her at mealtime just to witness it myself because I never witnessed it. I was just told it.

So it's really you know, as soon as we see something, we need to say something so we can get ahead of it sooner rather than later before it escalates.

That was actually a great lead into our our first question from a viewer. Who should be contacting you guys? Should it be the individual, the, community themselves, the senior community, or even the family of the bully or the bully themselves? How do we make that connection?

Correct. That's a great question. So it could be any of the above. We are a fee for service. We're private pay as care managers.

So, usually, the facility may contact us or they may call Mary and say, hey. We have a prospective client. Would you reach out to either speak to the resident directly or perhaps it's a family member or a friend or power of attorney? So it could be the facility.

The facility may give our information to the actual residents or their family. They can connect with us. So there's many ways. A lot of times, the bully isn't really aware of their behavior.

Right? Nine times out of ten when I'm giving this presentation, there's the person the most vocal, and they're the bully. Like, everyone around them is like, they're the problem, not me. So it could come from from any of the above.

Yeah. But we are a private pay service, so it's just making sure they can afford to have that.

Yes. And that's, you know, bringing them on as a client. So if you guys do identify that they do need those resources, you know, as being brought on as one of our clients where we could be that added benefit to them and properly intervene.

But we have worked with many communities too where they bring us in, and they pay for our service. It's two hundred an hour to so that we can do a complimentary support group for their community. So we would work in a group setting, or we can cater it to you guys know your communities the best, so, you know, your residents the best. So we would work with you to come in and intervene with residents either in a group setting, a one to one setting, two on two settings, and we can, you know, be that intermediary. But we have done that in the past where communities pay for us to come into. So, you know, those are the two primary options. But, you know, if you are referring to someone, and I hope that you do, it's over to Unicity, you know, doing that handoff, you know, providing either myself or Rita with the information of why you're referring them over to us just so that we can pick up the conversation and roll with it.

Yeah.

Well, thank you. That sounds good. I hope that answered your question.

And sometimes it's easier for us as a third party that isn't invested in the community or doesn't have a relationship with the resident to kind of help mediate the situation because we do find, you know, there's a lot of hurt feelings. There's a lot of emotions. People get defensive.

So sometimes it's nice to have somebody independent, you know, kind of come in and and help alleviate the situation.

Well, just thinking ahead and trying to be proactive. If there are families who are helping a parent transition into a new community, what can they do early on to help their loved one build positive connections or avoid social isolation or exclusion so that we kind of avoid these kind of things happening. Do you have any suggestions?

Correct. That's a great question. And we we do have another presentation that's talking about, like, how to start the discussion about senior living with your loved one and then kind of expectations.

So, you know, a lot of it is managing expectations. I think a lot of people have their, their thoughts on what senior living is gonna be like, and then the reality of it is two different things. So we work very closely with our clients and families to educate them on the reality of what it's like in senior living. Everyone thinks it's gonna be sunshine and roses moving in, and there are some hiccups along the way.

So when we work with our clients and families, we're very open and honest about expectations, what's gonna happen. This may happen at this point. You know, there's residents that have lived there for five, ten years. There's other residents moving in who are newcomers like you.

It's gonna be a transition. You're gonna have some missteps along the way. The staff may have some missteps along the way. You know?

So really communicating and being clear about what the transition to a senior community is, expectation of now sharing living space that when they ring the pendant, they may have to wait a little bit because the caregiver is providing care to other residents, so they may not be on demand service.

Expectations of what it's like in the dining room at activities. So we really walk through with our clients and their loved one and staff family members, power of attorney, guardian, whoever it may be, the expectations of what it's like to live in senior community. We always encourage them to then even go for lunch one or two times a week one or two times, excuse me, a week. One or two times before they transition, kind of engage in the community as much as they can so they can see and get familiar with the routines. Because a lot of times, some of the seniors, they're family toured, and they never did. So they're moving in and seeing a community that they've never even been part of before, and that's very scary and overwhelming. So encouraging them to be a part of the process as they can so they can physically see the environment they're moving into as well.

So I just wanna piggyback on Rita's, managing expectations and what she said too.

Oftentimes when, you know, I would communicate with families and, you know, I talk to our clients who are making that transition and their family members, You know, they may be picking up the phone, talking to if there's directors of sales on the on the call today, talking to you and going through, oh, my mom's so lonely. My dad's so lonely. They've been widowed for years. They just need to make more friends.

They you know, they're gonna go to all these activities, and they're gonna meet all those friends. And I say to them, I said, okay. Well, that's a goal, but was your parent social, you know, in the past? Or were they more, you know, an introvert?

You know? So it's managing those expectations too. Like, do your communities offer wonderful activities that can fill their days, but also knowing, is this an individual that would enjoy these activities ten years ago? So, you know, and if they're not the most social one, they probably aren't gonna change.

So you know? And managing those expectations with the friends. And that's where we come in. We've known our clients, you know, prior to moving into the assisted living as well, and we can be involved in that process too.

But also to communicating with you and your staff being that, okay. If we have someone who's more introverted, working with your beautiful activities coordinators and saying, hey. How is there another introvert that we might be able to partner with? Or they love mahjong.

Do you have a mahjong group? You know, it's something that's not as prominent and prevalent as participating from ten thirty to four thirty, you know, so with these activities. So, you know, how do we manage those? So and and that's a big thing with communication.

Yeah. And to Mary's point too, and I'm working with a family now that we're gonna either most likely transition to memory care. But, like, when they're like, oh, great. So at AL, they'll force them to go to every activity.

I'm like, it doesn't work like that. The activity schedule is there. Nobody can force somebody to go to an activity. They encourage their residents to and, you know, to go, but they can't physically force your mom or dad to go to the activity.

So, again, it's a lot of managing the expectations, having those conversations in advance of what it's really like in the day to day. So, you know, hopefully, we can avoid some of those hiccups and speed bumps along the way. Exactly.

Anything else?

Thank you, ladies. I don't see any other questions from anybody watching.

And you did you already showed your contact information. Correct?

Yeah.

Yeah.

So we'll be sending this webinar, a video, a recorded webinar to the email that anyone used to RSVP very shortly so that you'll be able to view this again, see how you can connect with them, and you can share that link with family or friends to rewatch as needed. So we definitely thank you. his hour just flew by.

Thank you guys so much. This was a pleasure.

No. Thank you so much for sharing your expertise with all of us today. And so for all of you watching, you'll be getting that link very shortly. And also we have a lot of videos and webinars just like this one all about every senior living topic on our website at www.seniorlivinglive.com.

So all of that content is available for free and on demand. This will be part of that library soon, and of course, you'll be getting the link. So thank you both so much for joining us today. Thank you for everyone on the call for us today.

Any anything else or are we ready to go?

I'm good. We're good. Happy Thursday everybody.

Yes. Thank you all for joining.

Part of our conversation today.



Bye. Thank you for having us.