“Elder Bullying Strategic Interventions ”

1. “Elder BullyingStrategic Interventions” Leading Age New Jersey Annual Conference Harrah’s Atlantic City New Jersey June 3rd 2016 Mary Anne Ross Victor Miranda Coordinator Training & Consultation Service Coordinator Rutgers COPSA Institute Woodmere Senior Housing For Alzheimer’s Disease Spotswood, New Jersey

2. Goals of this Workshop After attending this workshop, you will: • Know the definition, and understand the dynamics of bullying. • Recognize how it is manifested in older adult communities. • Understand the impact of bullying on individual residents, bystanders, your community and agency. • Develop a bullying prevention program for your own community.

3. Bullying Defined It is aform of aggressive behavior that involves an imbalance of social or physical power. verbal harassment physical assault psychological coercion .

4. People Who Are Different Race Religion Sexuality Immigration status Ethnicity Dementia Disability Psychiatric Illness Odd, lacking social graces

5. Whose involved Bully Victim Bystander Organization or group

6. Examples of Bullying • School yard bullying • Cyber bullying • Work bullying Possible Exercise - Provide examples and ask audience to identify, bully victim, passive bully, bystander ,

7. Impact of Being Bullied On children People at work  serious and lasting effects. Debilitating Anxiety (80%) Panic Attacks (52%) Clinical Depression: new to person or exacerbated condition previously controlled (49%)

8. Impact of Being Bullied 2 Post-traumatic Stress (PTSD) from deliberate human-inflicted abuse (30%) Shame (the desired result of humiliating tactics by the bully) - sense of deserving a bad fate Guilt (for having "allowed" the bully to control you)

9. Impact of Being Bullied 3 Overwhelming sense of Injustice (Equity - the unfairness of targeting you who works so hard; Procedural - the inadequacy of the employer's response to your complaint)

10. Ageism Any issue that impacts older adult must be understood within the context of ageism Older adults are thought of as a burden or irrelevant When your over 50 you are not over the hill you are on top of the mountain

11. Bullying is different as we age • Older adults are often experiencing losses • loss of independence, relationships, income, and valued roles. • seniors who move into assisted living facilities, nursing homes, and other long-term care settings.

12. Demographics of Bullying • Has not been studied in this population as much as with youth but beginning to receive more attention. • Increased awareness of this occurring as it closely relates to a form of elder abuse • About 10-20% of older adults are experiencing some form of Bullying Bonifas, 2011 • Estimated about 1 out of 5 adults • 10% of elders experience some type of abuse.

13. What senior bullying looks like Resident to Resident Resident to Staff Resident to Family Member of another resident These should fly in and we can pull from the audience. Give them a chance to speak about being bullied by seniors

14. Why Do They Bully? • Control-Bullies who get away with this as children often grow into adults who bully in social groups when they feel threatened or competitive. • Coping Strategy Bullying can be a way to deal with the anxiety that comes from life changes due to age. • Continuation of a Role -The person who was always the boss may want to keep being the boss. They look for attention and respect as a “Leader” from the “Followers”. • Dementia - Some bullying behavior may be related to dementia and other cognitive deficits that may cause disinhibition. The adult bully may not be aware or acknowledge that they have these issues.

15. The Targets of Bullies: Their Characteristics Person may be confused and not clear about what is going on They may ask the same question over and over or tell the same story. History of being bullied Not used to having to defend themselves Socially Isolated Lack of Social Skills

16. Psychological Impact of BullyingCommon Reactions to Bullying Experience • Anger • Fear • Anxiety/tension/worry • Retaliation followed by shame • Self isolation • Exacerbation of mental health conditions • Reduced self-esteem • Overall feelings of rejection • Depression • Suicidal ideation • Increased physical complaints • Functional changes, such as decreased ability to manage activities of daily living • Changes in eating and sleeping • Increased talk of moving out

17. Bullying “ By-Standers” • Identifies with bully and may help. Enjoys the bullying. • Identifies with victim and feels immobilized • Avoids the situation or tries to minimize it. • Has mixed feelings and can see the problem, but may fear to actively intervene. • Feels guilty about not intervening

18. Bystanders This group includes everyone — other than the bully and victim. Bystanders can be staff too. Often feel afraid to associate with the victim Often feel afraid they will be the next victim Generally tend not to report to management May feel diminished empathy for the victim

19. Bullying “Hot Spots” • Senior Centers • Nutrition Centers • Adult Day Care Centers • Senior Housing Buildings • Assisted Living • Retirement Communities • Nursing Home Facilities • Senior Clubs

20. Research Study Arizona State University • Seniors may identify the following as examples of bullying • Loud arguments in communal areas • Name calling • Being bossed around • Negotiating value differences, especially related to diversity of beliefs stemming from culture, spirituality, or socioeconomic status ????? • Sharing scarce resources, especially seating, television programming in communal areas, and staff attention • Being hounded for money or cigarettes • Listening to others complain • Experiencing physical aggression • Witnessing psychiatric symptoms, especially those that are frightening or disruptive

21. These are some hurtful actions of “Mature” bullies: • Block off seats for their little cliques at mealtimes and events. • Criticize, ridicule, and lie about those who don’t meet their standards of acceptance regarding race, ethnicity, sexual orientation, religion, economic background, and any other criteria they condone. • Steal and destroy property to flaunt their power and harass victims • Physically abuse victims by pushing, hitting, punching, or kicking them. They sometimes justify this as an “accident.” • Yelling in the middle of a dining room • Speaking out loud to others about dislike of others so that they can be heard.

22. Creating a Bully Free Environment Change must occur on the organizational, community and individual level. It takes a village to create a bully free environment. All staff, from housekeeping to management must understand what bullying is and how it impacts the residents and their own jobs

23. Creating a Bully Free Environment Organization must have written policy This should be given to all residents It should be explained at a community meeting.

24. Organization Level Interventions • Goal is about preventing and minimizing bullying. • The goal is to create a caring and empathetic community for residents and staff. • Caring refers to feeling and exhibiting concern for others; empathetic refers to the presence of empathy – the capacity to recognize and share another’s feelings. • Nurturing empathy is actually the best antidote to bullying! • In an environment that promotes empathy, there is a pervasive culture of respect and trust where residents and staff are held accountable and responsible for their behaviors, which sets the stage for people being willing to take a stand in defense of themselves and others – a key intervention in putting a stop to bullying behaviors.

25. Administration must be seriously involved. These guidelines can help eliminate bullying: • Commit to and promote a culture with principles of equality and respect for everyone. • Do a confidential needs assessment on bullying to determine severity of the problem. • Have ongoing discussions involving residents/members, staff, and community members about bullying, its causes, and solutions. • Consultants with expertise in bullying, conflict resolution, and diversity can be especially helpful. • Provide ongoing staff training in how to handle bullying among themselves and those they serve. • Review and change procedures that can decrease the power of bullies. • Create and disseminate a zero tolerance policy on bullying, including channels for reporting incidents and resolving them.

26. Developing a Zero Tolerance To emphasize zero tolerance for bullying, we would suggest including the following elements: • Develop clear rules and expectations for resident and staff behavior; invite everyone to be involved in determining what these rules and expectations should be. • Hold regular group discussions about the challenges of communal living and possible solutions to those challenges. • Provide regular training around recognizing and responding to bullying and other difficult behaviors; include activities that promote the development of empathy. • Review policies for potential revisions that may reduce opportunities for bullying, for example, institute a “no saving seats” policy for group events and activities. • Encourage staff and residents to report incidents of bullying and take complaints seriously; staff must feel supported in making reports and in setting limits on inappropriate behavior.

27. Exercise Develop a bully prevention program for your community.

28. Assessment - He said She Said Interventions for assessing bullying incidents

29. Assessment of Bullying Incident Look at the person in the context of their Environment and Surrounding

30. Additional Factors/Issues • First, bullies put others down in order to build themselves up, suggesting low self-esteem plays a role in their behavior. • Second, loss experienced: • loss of independence, relationships, income, and valued roles. • seniors who move into assisted living facilities, nursing homes, and other long-term care settings. • they may be seeking control at a time in life when they feel exceptionally powerless. • Third, Shared living requires adjustments around territory such that feelings of jealousy and impatience often arise. • Bullying behaviors related to territoriality, as with selection of channels for shared televisions, dining room seating…etc., may involve attempts to exert control and change public space into private space.

31. Process of Working With the Bully 1. Develop Rapport 2. Once developed and there is trust, between the resident and the worker. 3. Give the resident an opportunity to express his or her point of view 4. Have the resident accept and understand that point of view without judgment 5. Suggest steps to help the resident develop healthier ways of managing negative feelings.

32. Working with the Bully  – • the individual who bullies needs to hear the same message from everyone that his or her behavior is not acceptable. – • For example, meeting one-on-one with a social worker or psychologist to vent frustrations, have those frustrations acknowledged, and then slowly move toward developing strategies to manage frustrations in ways that don’t negatively impact others.

33. Intervention Strategies for Senior Bullies Consistently set limits on bullying behavior Offer an appropriate outlet to vent frustrations Provide Opportunities to build sense of control/mastery Foster Development of positive communication skills – “I” Help them expand their social network

34. Strategies for Targets of Bullies • Bullying victims can be helped by learning ways to prevent others from dominating them. Assertiveness training is a best practice approach for gaining such abilities and emphasizes the following: • Standing up for one’s rights • Seeking respect and understanding of one’s feelings regarding the impact of the bully’s behavior • Managing feelings of anger • Using direct communication strategies • Using “I” statements • Setting boundaries • Creating win-win situations • Assertiveness Training

35. Working with the Bullied • Talk with the senior on a regular basis. The person may be afraid of reporting an incident. Make ongoing communication a habit. • Document all incidents. Keep a log of any and all bullying incidents including names of those involved, times, and dates. In health care facilities follow state regulations. • Never dismiss the incident or blame the person for being bullied. • Help facilitate healthy peer relationships. Work with the senior on forming good friendships and help them connect with these folks. • Help the individual develop effective strategies for dealing with the bully. You can role play scenarios that can help the senior ignore the comments or tell a trusted staff member. • Help the individual value his or her natural strengths and remind them of those strengths.

36. Help Regain Sense of ControlRemind the Individual of the following: • They are not to blame • Must not feel that it is acceptable behavior • They have a right for Bullying to stop • They have right to complain • Right to confidentiality • Right to dignity and respect • Right to be Empowered

37. How to Help Regain Control • Help individual recognize that it is the Bully who has the problem • Speak up and verbalize clearly that the behavior is not acceptable • It is OK to go and seek help from others • Keep a journal or a diary or a pad of paper • Build a network of support

38. Other Facility Interventions • Offer anger management classes • Set limits with people who bully or “pick on” others • Hold regular meetings to promote resident communication • Develop rules and expectations for resident behavior • Foster partnerships between residents and facility management • Seek Professionals to provide “talk therapy”- Clinical Social Worker, Clinical Psychologist, Psychiatrist etc..

39. Other Interventions: • Establishing ‘Code of Conduct” • Forming a “Civility Group” • Ombudsman Office in NJ • Reporting and Tracking Incidents • NJDHSS Reporting of Abuse & Neglect • In-Services & Training For Staff on Bullying • Education for the Seniors to raise awareness • Zero Tolerance Rules • Mediation • Involving Family Members • Office on Aging Case Worker

40. Bibliography http://www.violencepreventionworks.org/public/bullying_effects.page Bullies in older adult communities by Frances Shani Parker on August 4th, 2011in Patient http://www.lifeafteradultbullying.com/ http://dspace.uta.edu/handle/10106/6207 www.stopbullying.gov http://www.bullyingstatistics.org/content/why-do-people-bully.html www.netplaces.com/.../history-of-bullying.htm http://en.wikipedia.org/wiki/Anti-bullying_legislation http://www.fyiliving.com/health-news/bullies-grow-up-to-become-disturbed-adults/ http://blog.medicare.gov/2012/06/28/how-we-can-stop-older-americans-from-being-bullied/