Confronting Bullying with Caring and Empathy

Review of Bonifas on bullying

Robin P. Bonifas et. al., Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic, (Baltimore:Health Professions Press, 2016).

We urgently need to study Bullying Among Older Adults to extract ideas that can be tested in multifamily housing. I will focus on the valuable lessons that Bullying Among Older Adults can offer in multifamily subsidized and public housing for elderly and disabled. In multifamily subsidized housing for the elderly and the disabled, bullying is nearly everywhere, but in only a few cases do we find a bullying-free environment. Typically there may be a mixture of ages and backgrounds, and very limited support services, and sometimes lax management. Worse, at times management and staff, including social workers, may themselves bully residents, allow and enable residents to use bullying tactics, and even join in mobbing by collaborating actively with residents.

Bullying Among Older Adults covers residential institutional settings with professional staff such as nursing, social work, gerontology, and psychology. Bonifas is a leader in the understanding and prevention of bullying among elderly patients, based on her many years of service in chronic care and psychiatric facilities, focused on improving the psychosocial care of patients and their families. Bonifas presents a comprehensive overview of the subject—how to recognize bullying, how to understand the causes of bullying behavior, how to intervene, and how to enable staff and residents to work together to create a healthy community. She has assembled a group of contributors with expertise and together they present a useful overview of current understanding of bullying and a variety of intervention approaches to address a problem that affects so many elderly residential settings. Based on this book, an infographic presents some of the evidence on the epidemic prevalence, reality, and impact of elderly bullying. http://www.healthpropress.com/pdf/wp-content/uploads/2016/08/Bullying-A…

Bonifas presents "a framework for anti-bullying interventions" that is informed by the need for staff to engage with residents as partners in developing a program that addresses their expressed needs. She shows the value of designing a program that addresses the organization, the perpetrators, the targets, and the bystanders. She recognizes that this is a challenge for staff, who may believe that only the perpetrator needs to change. To create a caring and empathetic organizational culture, staff as well as residents need to take part in training. Everyone must work together to create a caring community. The essential components are caring, empathy, accountability, and trust. The book provides an excellent overview and much practical advice, with extensive examples of bullying and intervention techniques.

An attitude of caring and empathy must be embraced by the entire organization; residents, staff, and management must make a commitment to promote and live by the tenet of equality and respect for all members of the community. p.45

In her research at two assisted living facilities, Bonifas studied the emotional impact on wellbeing related to bullying among residents, shared her findings with the residents, and helped the residents to devise solutions. Based on her experience, Bonifas asserts,

Care providers can be trained to recognize and minimize bullying behaviors, and those who are bullied can be taught effective skills to address and even prevent such behaviors. p. xvii

Bonifas notes the range of bullying behaviors among residents, ranging from one person targeting another, to social bullying to exclude a target, and cliques seeking to oversee and control others, and even affecting the whole insitution, with the potential for staff to be affected or bullied, and even for staff to use bullying tactics in the attempt to restore peace. Bonifas proposes that training of staff is needed so they can effectively prevent bullying.

For many people, living in a communal setting is a challenge, requiring adjustments to sharing common areas with people of various other backgrounds. Claiming a territory or control over social activities is one way to resolve the frustrations of adjustment, converting "public space into private space."

Targets of bullying may disturb or annoy other people, or just be different in some way. How can a person who is targeted for bullying respond in a resilient manner? Coping strategies suggested by Bonifas can include ignoring the bullying, avoidance, keeping busy with individual activities or with supportive people and pets, understanding the perpetrator, and seeking to influence others. However, I am concerned because these strategies must be monitored lest they put the burden on the target, and also cause them to restrict their social interactions in communal activities, so that they display "warning signs" of being bullied. pp. 36-40

Engaging bystanders is essential. If bystanders don't intervene, the perpetrator will continue; but bystanders can learn how to break the cycle. Residents need to see that it is the perpetrator who has a problem, they need to stand up to the perpetrator, and then walk away.

While this approach with a focus on bystanders may prove effective to deal with an individual perpetrator, it may fail when there is a situation of group bullying. I have observed how a group of perpetrators can impose pyschological and social sanctions not only on a target that resists, but on their friends and bystanders, so bystanders will likely not dare step forward in the absence of support from management and staff. In multifamily housing, I have identified such situations as institutional mobbing, where the authority figures do not intervene, allowing a group of perpetrators to intimidate and punish targets at will. (1)

Bonifas asserts that a written policy, developed with participation by residents, can facilitate creating a caring culture. She provides ideas about how to carry out surveys to identify problems and to elicit suggestions from residents, and a model bullying policy statement. This section alone is worth the price of the book, providing a useful guide to creating a bullying policy. pp. 56, 66 Other approaches include a "peace learning circle" to learn how to respond to situations of conflict and turn them into peaceful situations; and encouraging civility in daily life. Residents need to learn to tolerate people who are different, learn to communicate without hostility and anger, encourage empathy, and more. But if these efforts fail, and the perpetrator is causing harm or violating the rights of others, they may have to leave the facility. I caution that helping a perpetrator to have more control or to gain more friends must be done with caution, lest this expand the circle of perpetrators.

Bonifas considers several ethical issues, problems that may be difficult to resolve. When the organization does not try to deal with bullying, it is bad for the organization and creates a situation that I have identified as institutional mobbing, where perpetrators have freedom to use bullying. Unfair treatment of residents can be avoided by careful investigation and hearing all sides. The rights of residents must be protected, so if a perpetrator harbors prejudices against classes of people, the staff needs to set limits and prevent such feelings from expression in public areas. Some residents who use bullying tactics may pose very difficult problems for staff. It is then most important to do a careful analysis of the underlying causes of the bullying behavior. Is it from substance abuse? dementia? a mental health condition? a need for power? Only after a careful diagnosis of the problem can action be determined.

The most effective interventions for elderly residents to forsake bullying as an answer include providing other ways for them to feel personal power and control, to deal with feelings of loss, and to learn how to understand and respect the feelings of others. Intervention begins with setting limits and enforcing boundaries. Targets can learn to protect themselves, stay out of harms' way, and to advocate for themselves. And support groups can be helpful. Even staff can become targets of bullying by residents. They need training and support from the organization.

Eleanor Feldman Barbara discusses methods to assess the prevalence of bullying and proposes strategies for intervention. The main method is to train residents and staff to recognize bullying and to be "upstanders," people who will speak out or act to stop the bullying and protect the target. Another intervention is to recognize and reward residents who have acted on the core values of the community. Finally, when residents engage in activities outside of the residence to do good in the community, they feel better about themselves, enhance the reputation of their residence, and bullying tends to diminish.

Alyse November discusses a method of empathy training called "different like me." There are many aspects of this program, which has approaches to several aspects of communal life that can be made more open and accepting of all persons.

Catherine Parker Cardinal proposes the goal of creating a positive community environment in order to prevent bullying, because it is much harder to act against bullying directly for social and legal reasons. Confrontational approaches might drive the bullying underground and result in a worse situation. Elderly people living independently may resist change, and unlike teachers of children, the housing provider and staff have limited options for enforcement. Thus, the goal of creating a culture of civility and social wellness is indeed a good idea. Can this gentle approach work in the face of determined resistance by an entrenched group that uses bullying tactics? What are the conditions to make this approach feasible? Is it possible in subsidized housing? Does it need more staff? New legislation? How to eliminate the harassment and serious bullying that would inhibit and defeat efforts to create a positive community?

Policy and legislation

Contributors Alyse November and Stephanie Langer address the social and policy issues that must be addressed to protect the elderly from bullying. While elder abuse is already a major problem which is bound to grow as the elderly population grows, there are almost no legal protections against bullying of the elderly. They present an excellent consideration of how to adapt laws protecting school children from bullying, and raise important questions about how to define and implement new legislation. They mention Massachusetts legislation, including the bills proposed by the Stop Bullying Coalition, which has now led to the creation of the Massachusetts Commission to Study Ways to Prevent Bullying of Tenants in Public and Subsidized Multi-Family Housing, pursuant to Chapter 2 of the Resolves of 2016. (2)

Alyse November and Stephanie Langer advise,

Any proposed legislation must include staff administration trainings on the importance of building caring communities, creating a congruent climate (everyone is in agreement or harmony), identifying and addressing inappropriate behaviors, and addressing bullying behaviors. There must also be ongoing programming for residents on issues such as prevention, managing bullying issues as they arise, and creating committees that include stakeholders.p. 147

And in Missouri, legislation recently passed because of vigorous advocacy by Edie Potts, a resident, making elderly bullying a form of abuse subject to the established elder abuse protective agency. (3)

Strongly recommended

I strongly recommend Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic, a timely and important resource. There is much of value which could be adapted to settings with diverse clients including independent-living elderly and younger people living with disability, so it could be very helpful for managers, staff, and resident service coordinators working in multifamily subsidized housing. The primary audience consisting of administrators and professional staff in residential environments providing assistive, supportive, or nursing services will find this an essential guide to enhancing the quality of life and work in their residential communities.

Notes

(1) Halberstadt, Jerry, Stop Bullying: Creating Healthy Communities for the Elderly and Disabled, (Peabody: Togethering Press, Forthcoming, 2017.)

(2) Chapter 2 of the Resolves of 2016—S1984 189th An Act Resolve creating a commission to study ways to prevent bullying of tenants in public and subsidized multi-family housing. https://malegislature.gov/Bills/189/Senate/S1984 also http://stopbullyingcoalition.org/signed

(3) Missouri SB732 Modifies numerous provisions relating to public safety. It includes a definition of bullying of elderly or disabled persons, creates a mandate to require making a report of suspected bullying to the Missouri Department of Health and Senior Services, Division of Senior and Disability Services, lists specific professions and roles that are mandated reporters, and sets penalties for a failure to report in a timely fashion.

Any other person who becomes aware of circumstances that may reasonably be expected to be the result of, or result in, abuse or neglect of a person sixty years of age or older may report to the department.

Abuse, Bullying and Eligibility are defined:

"Abuse", the infliction of physical, sexual, or emotional injury or harm including financial exploitation by any person, firm, or corporation and bullying;

"Bullying", intimidation or harassment that causes a reasonable person to fear for his or her physical safety or property and may consist of physical actions including gestures; cyberbullying; oral, electronic, or written communication; and any threat of retaliation for reporting of such acts;

"Eligible adult", a person sixty years of age or older who is unable to protect his or her own interests or adequately perform or obtain services which are necessary to meet his or her essential human needs or an adult with a disability, as defined in section 192.2005, between the ages of eighteen and fifty-nine who is unable to protect his or her own interests or adequately perform or obtain services which are necessary to meet his or her essential human needs;

Reports are to be made to the Missouri Department of Health and Senior Services, Division of Senior and Disability Services. An abuse hotline is open from 12AM to 7PM daily. Failure to report is a class A misdemeanor.