Why are violent assaults against healthcare workers on the rise?

Carer and resident

In NSW, The Australian has reported that Bureau of Crime statistics show assaults against healthcare workers increased 55% over the last five years. In Queensland, violent assaults rose 50%, and in Victoria, assaults increased by 34% over the same period.

Lauren Hutchens, Health Services Union (HSU), NSW manager of the aged-care sector, told HelloCare that most of the reports the union receives from aged care workers about assaults relate to staff being assaulted by residents who are living with dementia.

“We get reports of it quite frequently … generally it’s from residents who have dementia and generally they’re known [by staff] to act violently.”

Hutchens said it was well-established that staff shortages “make the situation worse”.

“If you have enough staff and consistent staff on, you can start to pick up the behaviours, so you can say this person is about to act out. 

“And if you have enough staff on, a carer can work one-on-one to try to de-escalate [the situation].”

Another serious assault the HSU is often informed of is residents inappropriately touching staff. 

This issue has occurred “to the point we’ve had people leave the sector because they’re quite traumatised,” Hutchens said.

Hutchens believes having more male carers on staff in aged care would help to prevent these situations from arising.

“If someone is known to act in that way, one of the first things we ask for is if there are male carers who can be directed to do that work. Or in the absence of that, there are two carers allocated to work with that particular resident. But if you have staffing issues or you don’t have male staff on your roster, that can be quite an issue.”

Sometimes violent or aggressive behaviour can be the result of a change in medication, and having access to a good physician can be helpful in these circumstances, Hutchens noted.

“Our members know that if you have more staff on who can identify behaviours, who can look at implementing de-escalation strategies, then you can actually stop violent behaviour. But in the absence of that, and when you’re already stressed, people get slapped … or punched.”

Hutchens said the HSU does not generally receive reports of family members being violent or carrying out assaults. 

“There is verbal abuse, but that’s generally due to frustration. More often they’re feeling that their family member’s needs are not being met.”

A senior emergency nurse based in Melbourne, Helen Dannefaerd, told The Australian that assaults occurred daily at work.

“I’ve been called every name under the sun,” she said. 

“Other times it escalates and becomes physical. I’ve been spat on, kicked, bitten. I have friends who have been punched in the face.

Melbourne emergency nurse Jackson Campbell, who founded nursing platform and support group The Nurse Break, told The Australian, “I’ve heard all kinds of abuse. People being kicked, punched, strangled and worse,” he said.

Mr Campbell said Victorian nurses received inadequate training on how to deal with violent patients, and there were not enough security guards to help when situations escalated.

“We get two-day courses on how to retain people, but there’s not enough training on how to hold people down,” he said.

“With the aged-care system failing in regards to its management of medical issues, dementia people can become quite violent,” Campbell said.

The Royal Commission into Aged Care Quality and Safety noted there was a “high incidence” of assaults by residents on staff, as well as by staff on residents, and residents on residents. 

Better reporting of assaults might help with the new SIRS, but – as with so many of the problems in aged care – the answer really lies in having more staff on the ground in aged care homes and more staff with better dementia training who can ward off problems before they escalate. 

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  1. Yes it’s true that Resident to Staff assaults are escalating, but not only is the staffing an issue. The Government is decreasing the medication that doctors and trained staff are able to use. If it is noted that a Resident has been settled, decisions will be made to reduce then stop said medication that has been working and so the vicious cycle begins again. It is always so much easier to have a necessary medication ceased, but try and have it restarted is impossible. In the mean time, staff and other residents are used as avenues for that Resident to express themselves, and not with a happy outcome.

  2. From personal experience with my husband who was in care because he had Alzheimer’s , they were well and truly understaffed, especially at night , two PCA’S and one RN for a minimum of 72 residents, the locked dementia area was left unattended most of the time at night, I was always more relaxed when I knew certain RN’s were on duty who made certain there was a PCA in the dementia unit at night so tended not to medicate, I visited every day for at least five hours and stayed until past 2.30 am on one occasion because I knew he’d been given benzo’s far too much and didn’t want him medicated ( because he was really aggro after having benzo’s) which nobody except me picked up on , and I also wanted to see if I could work out why he was waking up , it was because he was snoring , long story which I won’t go into except to say when I turned him onto his side at around 1am he slept soundly without snoring and was told he slept until 7am the next morning so I’m more than experienced with how they can affect these poor souls.
    I did my own research and found they can have the opposite effect and indeed make people aggressive especially those over 55 and more so people with dementia , and people with dementia can’t articulate how they feel ( especially when their Alzheimer’s is as far advanced as my husband’s was.
    My brother who was around 55 at the time ( super fit and not suffering from dementia ) was prescribed Temazapam for insomnia , he only took it only twice because surprise surprise it made him extremely hyper and slightly paranoid , he said if someone was behind him he became very alert and felt they were going to do something to him , so imagine having any kind of dementia and not actually knowing what is causing you to feel like that when they drug you, its a disgrace , the answer to most people with dementia is more and also better trained staff , I also wonder how many people are also on Aricept , my husband was prescribed that when he was first diagnosed and the longer he was on it the more paranoid delusional and aggressive he became ( we were only told it may cause stomach upsets) the geriatrician told me it was his dementia , his memory did become better but he was like a person with severe mental illness, ( I was so frightened of him and concerned I made an appointment with my GP , she looked up possible side effects and there it was ) I then stopped giving it to him, I should have trusted my own instinct rather than the geriatrician and taken him off it then instead of thinking maybe he’ll settle down after being on it for longer, again in my opinion because he couldn’t really articulate anything my guess is the Aricept was giving him nightmares and to him it was reality because not long ago I was chatting with an acquaintance whose husband was diagnosed much earlier in his illness than my husband ( he was proactive because his Mum and sisters had Alzheimer’s ) he was still capable of articulating and understanding things and after being on Aricept for not very long said he wasn’t taking it anymore because it was giving him horrific nightmares .
    In my opinion drugs are rarely the answer , its listening to them giving them comfort and reassurance and not having TV and radio’s on really loud, also having documentaries and calming things on the TV , the dementia unit he was on often had Rage on on the weekend and violent tv shows at other times , their brains can’t take too much noise also conflicting noises like radio and TV on in the same lounge area .

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