"You're bleeding, Mr. Ramsey! Go upstairs with your aide!" The nurse's well-meaning directive was falling upon deaf ears.
"I ain't goin' nowhere until I get my money!" Mr. Ramsey clutched a tissue to his bloody lip with one hand and waved his other hand around in a fist.
The aide took hold of the handle bars of his wheelchair. "Come on, Mr. Ramsey. Come with me."
Mr. Ramsey swung his fist around in an attempt to hit the aide.
"Mr. Ramsey! Stop it! Calm down! You've got a bloody lip! You've got to get cleaned up!" The nurse turned to the aide. "I'm going to page security."
It was clear to me the staff had escalated the resident to the point of aggressive behavior. It was equally clear they had no idea they'd done so. I debated the pros and cons of intervening and perhaps undermining staff authority versus a showdown between Mr. Ramsey and the security guard.
"The social worker will be back in just a minute with your money, Mr. Ramsey. Just let him get his money and then he can go upstairs calmly." They looked at me like I was speaking a foreign language.
Luckily, the social worker, who'd realized Mr. Ramsey was adamant in his position, rushed back from the business office with his funds. Immediately mollified, Mr. Ramsey went upstairs without further incident.
Psychologists spend years examining the nuances of human interactions and are trained to de-escalate situations like this, which happen every day, in the nursing home and out. While many nursing homes have psychologist consultants who work with the residents and provide an occasional hour-long staff training on communication skills, very few have psychologists on staff. A psychologist on staff at least part-time could provide intensive interpersonal training to reduce resident/staff conflict, increase resident, family, and staff satisfaction with the nursing home, reduce time spent on incidents, and increase the quality of care.
Dr. Barbera is an author and a licensed psychologist consulting in long-term care facilities in the New York City area. She frequently lectures on subjects related to psychology, aging, and nursing homes. Dr. Barbera is available for private consulting with organizations, institutions, and individuals around eldercare issues. Visit her personal blog at www.mybetternursinghome.blogspot.com.