How to Reduce Bullying Between Older Adults AiA18 Conference

Bullying Elimination Training Program for Staff and Older Adults
Aging in America 2018 conference hosted by American Society on Aging.
Session 2pm March 29, Golden Gate 6, Hilton Union Square, SF
Patrick Arbore, EdD
Director and Founder, CESP and Grief Related Services, Institute on Aging
Valorie Villela
Director, 30th Street Senior Center (SF)
A member of the On Lok family of Senior Services

This was the last session on the last day with twenty other sessions competing in the same time slot. Yet the room was full. Professionals attending this conference have a very high interest in the topic of bullying between older adults.

I present here, a video of the session, the full transcript of the session, the reading list distributed by the presenters, my comments on the topic, and something about the conference. This article is one in a series of articles I am writing covering this conference for Boomer Tech Talk. There was a also a poster session by Eilon Caspi called, “Death of Elders Due to Resident-to-Resident Incidents in the Context of Dementia in Long-Term Care Homes” on March 28th which I share at the end of this article.

Transcript: Bullying Elimination Training Program for Staff and Older Adults

Valorie: Patrick and I were just curious, we’re not getting into any questions or answers yet. How many of you; you just show your hands, can tell us if you have seen it or experienced it [bullying between older adults] where you are working or in a community. Just show your hands. [Most of the people in the room raise their hands]. Well it’s real, so I’m going to turn it over to Patrick at this point.

00:36
Patrick: I’ve been working in this arena now for quite a few years talking about bullying behavior and years ago when I would get these talks, I would be happy if five people showed up. What I got from that is people either were not recognizing what was going on or were just looking the other way, and that’s one of the big barriers to the whole issue of bullying is that you know, staff, family members don’t want to acknowledge what’s really going on and then if you dig into that a little more deeply what you find is part of the reason they don’t want to notice it, is because they don’t know what to do.

01:30
And so as I was saying to Valorie and probably Kathy at the staff training is that, one of the issues that comes up with staff; and this is a real incident that happened at a kind of a rehab center that there was an episode of bullying and one of the women at this table for four people, had been bullying this other woman who was frail, disheveled because she just had surgery and the taller woman just went after her you know and in a very bullying way, telling her, ‘how dare you come to lunch looking so disheveled, and how would you ever leave your room looking the way you did’, just kept pounding at her and she left crying to her room. One of the women sitting there said to this woman that was doing this she said, ‘you know I think that you’re bullying her and this is really not okay’ and she said, ‘you know you can’t bully me because I’m standing up for myself, so I’m not the least bit worried about you.’ But this other woman just could not handle that, it was just too much because she just had surgery.

02:44
And so Liz, the person who was there, went to staff immediately which was really wise and she said, ‘the first comment from the nurse on the floor was “oh you know with these kinds of things, we just let the girls work it out.” Now there’s so much wrong with that sentence [laughter] we could spend an hour debating that and just how wrong that was.

3:07
But Liz said, I know Liz very well, she knows what I do; and she was like, ‘Patrick this is exactly what you said would happen; that people do not want to look at this.’ And she said and I was not going to let this lay there. And I was not going to let that happen.’ So she talked to the social, and she said that nobody wanted to do anything.

03:31
And finally she said, maybe day four, when the lady who had sat at her table would not come out at all for any of the meals with people because she was afraid. And finally a social worker said to her, this is after Liz caught the ombudsman, I said to her, you have to do something, she didn’t have to but she wanted to; and so that was really very important that the social worker finally said, we are going to work on this situation; which they did. And so the lady who had done the bullying wound up sitting with people like Liz who were not going to tolerate that kind of behavior. And that had a better ending, and then Liz also ate with the woman in her own room and so that was good.

04:24
You see the thing is when we rely only on seniors themselves to manage this, there is a lot at stake for them you know, because of their own health conditions and you know not wanting to be retaliated against; and that’s why I think it’s so important that we really think about the roles of staff.

04:41
And so in terms of the scope of the problem, when we realize that only and there’s not much data as Valorie said but rather Bonifas from Arizona State University has been one of the researchers whose been really kind of a pioneer trying to gather data and she estimates that it’s about between 10-20% of older people experience this type of relational aggression or bullying behavior and it’s just hard to get these numbers accurate because they are ignored, nobody’s really talking about it and so there is a stigma here; so Coloroso, we see that some researchers have been really trying to you know pull away the blinds and really trying to look at this and Coloroso describes bullying behavior as a “conscious willful and deliberate hostile act intended to harm, induce fear including the threat of further aggression and really create terror”.

05:48
Liz was telling me when she met with this woman who had been harassed; the woman said that she feels she’s terrified to go out into the hallway if she sees this woman, even though there’s staff there; you know staff are plentiful there. But there was a lack of recognition in terms of what should we do and ‘letting the girls work it out’ I think is really crazy.

06:12
So the American Psychological Association also chimes in on that as well; in terms of trying to define what this behavior looks like and is again a form of aggressive behavior in which someone really intentionally – you see that’s the thing; this is not unconscious, you know the person really believes that they are entitled to behave that way. And that they are going to do that because they feel that they can and oftentimes they can, they will; “bullying can take the form of physical contact, words or subtle behaviors” and “the bullied individual typically has trouble defending him or herself”; they don’t know exactly what to do and particularly when they feel frail themselves, that if they say something they really worry that someone’s going to knock them over or whatever and so there’s a real concern that something more violent might happen if they try to stand up for themselves and so people keep it quiet.

07:26
And I have met with so many older people in some of these facilities – assisted living or senior housing or whatever it might be; and what I find is that they are terrified. One woman had been living in assisted living and she had been there for maybe a year and you know it was hard for her family to support this move but she couldn’t really take care of herself and she was in this facility which she really liked but she had been bullied there and it was so unrelenting that she convinced her family that she really needed to move; so she moved to another facility in a different county and really liked it. And I happened to be there to do a talk on bullying with participants and I noticed like where that door is, there was a window and I could see that there was an older person there and I finally went to the door and said do you want to come in and she said I do but I have to look inside first to see who’s in there because she was worried that the bully would be in there.

08:29
And she wasn’t and so she came in and she said, ‘I can’t even believe to tell you this’ because she was starting to cry, and she said, ‘I’ve been here about three months I think and she said within the first month, I was getting bullied and it has been again unrelenting and I can’t tell my family because they’d think I’m crazy and I can’t even imagine moving again to another facility because it was hard to get into this one’.

09:02
And she said, ‘I live everyday in fear’ and she talked to the administration and you know what they said to her? ‘Work it out’, that ‘we’re not in the business of these petty conflicts’. It’s not petty, this woman was terrified, and I am sure with the hands that went up, you are aware of this.
And it’s really – when you think about what happens to people – it’s really difficult.

09:28
And then the other thing we want to talk about is, we were – Valorie and I – were talking about how words matter. We need to call things by what they are. And so on this continuum [chart shows incivility, bullying and violence continuum], what we see instead is that where there is incivility, where there is a lack of respect for whether it’s residents or participants or you know staff, because staff can also be bullied but don’t mess with Kathy [laughter].

10:05
And it really does take standing up but it also takes staff involvement and it really means we all have to be on the same page. But where there is a lack of respect you know for residents or participants, that can easily lead as you can see into bullying behavior; and people have said to me oh Patrick you’re just talking about abuse; no, up further upstream. I want to talk about let’s prevent abuse from happening you know, but we’ve got to pay attention to what leads us to elder abuse; this is just you know when you think about elder abuse as a pie that we want to pull out a wedge of that. That wedge is bullying and there is another wedge which is incivility and if we can reduce incivility and reduce bullying behavior that’s going to have an impact on a certain type of elder abuse and I think that that’s really well worth this project that we’ve been involved in.

11:35
Valorie: So this is all new to us, we designed as we went and we actually divided our project into phase one and phase two. Phase one was really about increasing the opportunity to understand why staff, what were the obstacles for staff actually taking action. So what we did in the first phase was we focused on staff training and awareness and I took the executive decision to make all staff do it.

12:07
So we had social workers, we had health promotion managers, we had activity managers; everybody that was in the team was expected to be in these sessions. We had nine sessions of two hours each; and we really learned a lot, but one of the unintended consequences also was the intimacy that grew among my team.

12:33
So they all learned a lot, and then we also had a group facilitator, the training as we wanted to get the seniors to talk to us about what they thought about that and then we also worked on elements of communication; how are we going to get this word out in signage and in other ways so that the whole community could benefit even though not everybody would go to the training.

12:57
And then we wanted to develop the senior presentations. So then year two was the senior trainings and we’ve also in the midst of all of that had our partner meetings, which I will get into a little bit more. So we are on the list of—so the types of our curriculum guru was Dr Patrick Arbore, but these are some of the topics that we dealt with; first of all just defining bullying and leading staff through experiences of remembering when they were first bullied if they were; and also to understand from an empathy way because a lot of the staff when seniors are bullied, one of their reaction is ‘let’s just suspend them’. But that’s not what we want do, we want to see if we can understand and help these people because the bullies were bullied probably in their lives and so how can do that. Again nine sessions of two hours each and the staff all reported, how much that meant to them, and how much they learned.

14:10
We also realized that there were clinical issues that come up so we had a clinician work with us, she provided the staff support, so staff could sign up for a session to just talk about what was coming up for them in terms of transference or countertransference or just wanting to talk about a case that was just really bothering them.

14:35
Or in some cases, she would do some mini trainings on de-escalation and some other types of training. This is a picture, a moment in time and these are all the staff that participated; again you can see diverse seniors and diverse staff from all kinds of different backgrounds and we were very proud that staff engaged.

We also worked with our community to come up with a facilitator training because we want to make sure we got information from seniors so we have colleagues from different agencies that work here in the city and Patrick trained us on how to facilitate appropriate focus groups. Amazing stuff, (I’m not sure you can see these charts from back there) but we asked all seven focus groups of different folks in the city about what is bullying and what does bullying behavior look like in the center.

15:36
The comments were: it’s a part of our society, going with it; I’m only here for six more weeks, and resentment of older people; these were their thoughts when we asked them what is bullying. What does it look like: many people said ‘I haven’t noticed any bullying here’ which surprised us. And then some folks said gossip, people talk about others, isn’t that normal; and another one mentions jealousy and then somebody mentioned about the more vulnerable you get the more apt people are going to pick on you.

16:24
And other couple of questions that we asked: describe at least three ways in which bullying behaviors can be prevented; they really didn’t come up with a whole lot of specifics but I thought that that first one, there was a woman who pushed her way in front of a line as they were going to lunch while others stepped up and stopped her; so not really prevention but definitely not taking it from a bully.

16:42
Another, define the consequences, some people just said throw them out, awareness or let’s give them a chance; and so we really just wanted to listen and see what the experience of the people that were coming to the center were saying to us.

16:58
As I said, we did seven focus groups, we actually talked to about 41 seniors; English, Spanish, LGBT, male English, male Spanish and also mixed crowd. Again the demographics of our groups reflect a lot of what the seniors have already seen in terms of age and ethnicity.
This is just an example of one of the staff who was leading a focus group and so while we were doing that, we were already looking for materials like; how can we get some signage, what kinds of things can we come up with that we would take this and make sure that’s it’s not just people who are in the presentations but that the center becomes more aware.

17:47
Online, we found a lot of things but most of it was geared towards kids or adolescence and that just didn’t seem right, we didn’t want something cute but also something that older adults could relate to.

18:02
So myself and the activities manager came up with this one and the partnership felt that was better, and this is kind of our logo and our signage and our materials and also at the center where we are talking about it and we have this in English and Spanish; we had it translated to Cantonese at this point, that may be the next language that we go to. So we have other materials you know fliers inviting people to the trainings, we tried using the same message at lunch and on the placemats that created an interesting lunch conversation; to try to see if we could keep people paying attention to it.

18:51
And I think we were successful, it’s an ongoing process; it’s not done, but I think we are not trying to have it stay the same all the time. This is our flat screen TV, another one rotates through all day long; a lot of people had felt that that was colorful and got their attention. We’re still looking at other ways of message it and get people to pay attention.

19:21
This was the list of the scheduled presentations for seniors; the first one of course is what is bullying. This is all done with Patrick as the lead presenter and Kathy or Sochi following up with Spanish as well. Another one is why do people bully – how does bullying affect our Center?

19:48
And what would be a healthy response? For a Center of 300 people, we don’t have enough staff to monitor every space they go to, so we also want seniors to also know how to respond to bullying behavior with a healthy attitude and not take it.

20:02
So we are trying to empower them to take responsibility for people – for themselves if people are bullying them. When we get to the end, we are going to have a graduation on May 15th or 18th. Again this is Kathy leading one of the senior presentations, and I just wanted to show again, the diversity of folks at 30th Street Center, we have the East Indians, Thai, Filipinos, Latinos, Americans and that’s our life; so understanding the difference and appreciating and celebrating it, is something what we’ve really tried to do.

20:44
We are not going to be able to read the next one but every single session had a very simple handout, translated in English and Spanish. The seniors loved that and then they really love walking away with something. And then we found out that when we printed too may, we put them out on the hospitality desk and they disappeared; although again, people are eager to read and so we are excited right now; I think the font size is a little bit too small for us, but again empowering them also to take ownership of the environment at the center.

21:22
Another teaching moment with Patrick.

21:30
So how did we come up with this? Who are the key partners in this? Both of us have full time plus jobs; so there is no way we are going to pull this off without some help. So again with Patrick’s background in this area, he was the lead in the content in educational materials, my staff, mostly Spanish translators; all the senior center staff were in some way stakeholders in this project.

22:05
The clinical support for staff – Kathy and I were just talking it about it – we had an amazing project manager, I mean she kept us on target the whole time and that was not easy with Patrick and I. So we needed somebody to really keep us on track and ensure that we delivered on all the different timelines.

22:24
So, what did we learn so far, again we are not finished. This project ends in June 30th or at least the funding for this time.

22:33
You have to have coffee and cookies that is a plus and a must; reminder calls, seniors are busy and this was once a month, it wasn’t every week so we did have to spend staff time reminding, they were so grateful because they were really disappointed if they missed it. And we wanted to have a dynamic, an easier way of conversation, discussing so we worked really hard to have at least eight people in a session. We always put up the ground rules, confidentiality and respect at every session and it took three people to pull that together. So it took the trainer; Patrick, my staff and then the logistic people to make it happen.

23:20
Another part of that is we did a lot of debriefing, what did we learn. Every session brought up some interesting issues. Even to where there was an actual bullying incident within one of Patrick’s presentations that we had to quickly de-escalate and my staff member with Kathy’s; she’s great, she came up with this way to handle these behaviors. There’s the yellow, the red, the green card. So if you are a sports fan, soccer; if you are already a yellow, you better be on your best because red is just around the corner; and this particular gentleman had been on yellow for a while, so both Kathy and Sochi escorted him out to have a conversation. In that particular case we just think there was definitely some dementia because it’s gotten worse. And then again the handouts are essential and then of course we want to have a graduation at the end.

24:21
Challenges, so again, we’re learning. We decided at the beginning that it would be one session a month and then of course some of the seniors are saying it would’ve been better if we do it weekly. Some people said no its better to do it monthly because it keeps it on our raider longer, some people said it loses continuity when you extend it so far; so I don’t know what the real answer on that one is. The other thing that we had to do is rethink is the idea of graduation like how many sessions and all that because was it more important the cohesion and the relationships that people formed to let them talk or was it more important to expose as many people as possible. So we loosened our rules a little bit to maximize the amount of people that we might be able to be exposed to the bullying.

25:21
And the other certain challenge we’re still dealing with is staff turnover; so you saw all those beautiful faces in the beginning; in our workforce these days, young people don’t stay as long as they used to. I’m one of them, I started when I was 26 and still here but they move on; so how do we build into culture as an organization and awareness about this because we don’t want to go backwards, we’re not going back, but how do we get the new people in and up to speed within our training in our orientation to these staff.

26:00
The other thing that we have that some Centers may not have to deal with is literacy issues. We have people that don’t read and write and so they have can’t just write for the readers. Some folks do not read. So we are looking at our materials and are deliberating around that. So future, we have been so busy we really haven’t had time to think too much about the future. Patrick do you want to say something?

26:27
Patrick: Because we have fortunately have time [today in this session]; I wanted to deepen some of the comments that Valorie was making particularly for those of you that might be thinking about maybe we could do something like this in our company or organization and I want to go back for a moment to the focus group; and we have all participated in one or more focus groups and listen, for those of you that have done focus groups, you probably know this; but I think for those of you that haven’t, what happened was just so interesting and perfect in its own way. I was doing a group of male English speakers with Sochi but they were people who are bilingual and they were all men. As you know with focus groups, you just want to encourage conversation and then we are writing like mad to get exact comments, trying to get exact comments and so some of the comments by most of the men in that group.

27:36
Well you know they could say that this is interesting and important but of course bullying doesn’t happen here. And they were all in unison about that; bullying doesn’t happen here and they were like very gracious, they said this it was great and blah blah blah. But you know, it doesn’t happen here; so when we finished, it was an hour and we were very good about time after an hour that’s done, and as they were wrapping up and Sochi was doing whatever and one by one the men came by to me and said, “well I didn’t want to say anything in front of the group, but this guy over there, he is a bully.” And then this guy would say “this other guy over there; he is a bully, I didn’t want to say anything in front of him.”

28:18
Each one of them said the same thing and you know that was the most important part of that focus group was their hesitation and reluctance to acknowledge that bullies were there including the person who was saying this is a bully, somebody was saying he is too. So it was just really fascinating, we just learned so much from that and just how challenging it is to try and help people just simply tell the truth.

28:58
With this, it’s very tough; you know Kathy knows this from the trainings too; we would have them talk about, was there ever a time just like we asked you [in the AiA18 session]; ‘have you witnessed bullying or whatever’ and so many answered and practically the whole room or at least 90 percent of us; and we would encourage them in the beginning to share if they could; if they have ever been bullied you know, had that ever happened to them.

29:37
We also did the same thing at some point in the staff training; it was really very profound for both groups and I think that’s so essential that staff have to go through a similar type of training maybe on a different level but in terms of counter transference, they have to face whether or not they have been bullied and how does that get resolved; usually not you know, it usually was never resolved. It’s just that people thought that they grew out of it.

30:06
Well one of the fascinating things about bullies that I want you to think about this for a minute; when you were in grammar school or high school, had you ever been bullied or were you aware of what that group was that did bullying behavior. There was a quote, “what do you think happens to mean high school girls, they become mean older girls” and that’s the thing, if there is no intervention, you know what do you think happens to people who bully, who get older well they get better at it and you know they really start to believe that nobody is going to interfere with me and if you have been bullied and I know in a room this size, there are those in this room who have been bullied and you know how painful that is.

30:53
You know, I had this one gentlemen who is 60 something and he’s one of the grievers at my office and he said he has been a trigger for him with this devastating loss he had is how he was treated as a kid from about 6th grade to about 10th grade and how he lived in fear every day of his life at school and to this day, he’s in his 80’s, he says, I still have nightmares as a result of this bullying that happened to me as a kid and he said and he still—this person that did that to him has found him on Facebook and just continues the harassment on Facebook and it’s just amazing to him. And he’s very embarrassed to talk about it because he feels so ashamed that this is still happening.

31:58
And so I think that’s the thing that we’ve got to be able to help staff you know really get a hold of that counter transference, what’s going on inside of them and I think that contributes to this barrier which is staff would prefer to look the other way. And I understand that and I think that’s where we have to really support staff by saying; ‘we get how painful that is, now just imagine that you are 80 or so and you have a cane or whatever and just trying to live your life and have some quality of life and then have somebody who is you know gossiping about you or you know rolling their eyes when walk in or you sit down on his chair where the sign says well “ No Reserve Seating” and I sit down here and you say to me, get out of here, yeah that right. I am saying and for somebody who must be a spirit because we can’t see them [laughter].

33:01
And if you’re new at the center or new in the facility that is confusing; I’m reading a sign that says “Sit where you want, its okay” You know that’s what I mean by the loss of civility rather than saying ‘hey sit down, what’s your name’ you know just that respect just common courtesy; where is that going you know and I don’t think, I don’t want to use the “T” word but I think it’s been being eroded for quite a while.

33:32
And you know again we see it with kids as Valeries said in the beginning and we usually associate bullying with kids but that’s not… from your show of hands, I really see that you know you’re aware that something’s happening with the seniors themselves but I think that staff training is so crucial in terms of being able to help the staff really dig into that and see, did they just avoid it, deny it or just grateful they got out of high school and who wasn’t grateful they got out of high school.

34:11
And to, it’s tough to kind of revisit but I think it’s so important that they see that oh yeah, this was hard when I was 16 let alone 76 you know and I think it’s really crucial. And also when Valorie referred to that incident in the participant training and that was really quite a lovely, you would have loved it in terms of a the mobilization of Sochi, Kathy and myself because the person who was doing the bullying – and he had a cane too – was in there and he got right up this guy was talking about something that was 20 years ago–

Valorie: He blamed this guy for the reason that poolroom was closed; that happened 20 years ago and he was still holding on to that.

35:13
Patrick: He was the wrong guy, he wasn’t the right person. But he got up and then Sochi was teaching and so Kathy came up on one side of the room because we had like four rows of people and I went in on the other side because we didn’t want him knock the guy on the head. He was just relentless. And so it was really good because we kind of wedged our way in there and then Kathy was able to pull him out. It took a while to get him out the door. But it was so interesting to see even in a bullying prevention training; which I thought was the irony of ironies, that he was exhibiting this aggressive behavior and it was I know, it was difficult for you to kind of debrief with him and calm him down.

36:07
But as Valorie said, we think there’s something else going on with him too. You know I think this is where staff have to be trained and have to be prepared to work together you know and then the problem is, as you were saying Valorie, is that our of that great picture of staff, about half of them have moved on. So now we have this other half and then what we what we do with them.

36:35
Valorie: We started to dabble a little bit. Patrick has come and done some refreshers and intro’s to kind of get some of the new staff to at least understand some of the vocabulary that we use but it’s definitely something that we’re looking at. There’s no way to do this training quickly, you can’t go the two hour thing and you’re done. It’s has to somehow be built into your staff life in a different way because it’s the depth that you go to explore this issue with your staff that I think is so powerful but it also takes time and trust building.

37:13
Another couple things that I wanted just to mention when Patrick was talking; so when you’re in a senior residence, you don’t have anywhere to go; you live there. What we were concerned about at 30th Street is that we heard people would leave and we would never hear from them again. So we were lucky to have a couple people re-engage with us and tell us a little bit about that and almost always it had to do with some kind of verbal thing; gossip being one, this gentleman was so excited about meeting his wife in later life and there’s a group of women who when she was not with him would say to her, ‘You can’t be with that guy, he’s terrible’ and on and on; and so she felt really bullied and certainly her husband who had been a long term member of the senior center said, ‘we are out of here’.

38:03
They’ve come back but it’s been very gentle and not very consistent. And I think the other one which was really painful for us but again we’re trying to do something about this. Some people said well, do you really want to talk about 30th Street and we said yeah we are doing something. So we had a woman who’s blind and had her service dog with her and she looked Anglo, she looked white and so there’s a Spanish speaking senior who said ‘oh she’s probably just pretending’ in Spanish and this woman heard it.

So I think again, we’re trying to figure out whether it’s behavior or whether it’s some other mental health stuff going on but at the end of the day, we are not going to stand for this kind of behavior at 30th Street.

38:56
Patrick: So when we look at the future. You know there are a lot of things that we’re thinking about that because we are still in the thick of it, we haven’t really been able to sit down and really look at what has happened over these two years but that is something that we’ll be doing with Kathy and Kathleen and Valerie and myself; but the thing I want to really emphasize, which is hard for a lot of the seniors to swallow is that there are two victims here, well actually three. One, is that the person being bullied obviously is a person for whom we are very concerned and want to see how we can help that person feel more comfortable or safe; then there’s the bully him or herself, which is very easy for any of us to say, ‘ay yai yai – this person is trouble’.

39:57
Then there are the bystanders who are also victims and it’s very difficult and the thing that Valorie had said earlier which I think is really worthwhile for all of us keep thinking about if you’re going to do a program like this; is that the seniors themselves are very quick to say, terminate, get rid of him’, or they have a very pessimistic view of rehab, you know. So I believe that people can change, people can learn; we can teach them, we can help them; you know we need to have some outcomes, we need to have some consequences but not ones that are going to re-shame the bully because that’s why they became a bully in the first place; because they had been bullied by somebody.

40:54
You know Robin Bonifas said, “bullying is a learned behavior” they learned it somewhere, and I know you know this. I know that some of you might have had … I had a father who was really outrageous and cruel and mean and a bully. I can see with my one older brother that he has just you know that’s what he has absorbed and he’s very much a bully even at the age of 75. And he would be after me in a second if he walked into this room; and I would leave quickly. I can see where he got it from, he acts just like my dad.

41:31
So we know that bullying is a learned behavior; and as Valorie said there are other causes of it that we have to really be aware of; oh and Judy has been in some of our classes that we are teaching. And so it’s important to have a plan in terms of how does staff at this facility, try to have some consequences that won’t shame the person who bullies but sends a message that we will not tolerate this. You know, of course our aim, which is a very ambitious, is to eliminate bullying behavior at 30th Street. But that’s not necessarily an easy goal to achieve and it really takes the investment of a whole lot of stakeholders to really come to grips with the fact that empathy, compassion are teachable concepts that can help bridge this gap between those who engage in these aggressive behaviors and the people that could stand up, so we don’t need to have a baseball bat; what we have to have is empathy, but that’s what we’re trying to do through these trainings.

43:00
Questions (summarized)
Q: We’re from Chicago Housing Authority. Our residents can’t leave, they live there.
I want to know more about your Red, Yellow, Green
A: Used on a number of occasions for limit setting
Kathy: Since we have a lot of Latin participants, they understand the soccer reference
It’s done privately.
If you get a yellow card, warning, red card means suspension.
We explain if they have a yellow card, if it happens again you can’t come to the center for a month.
45:11
Q: This is such an important topic. You can tell by the attendance today that so many of us have been touched by bullying in our adult lives. I am participating in a Womens Empowerment Group teachers, lawyers, doctors, and there is bullying in there. We meet once a month. No one knows what to do about the bullying so it continues. I wish you had a training that could be taken back to civic groups.
46:13
A: We long to do that. The question is what the that would be.
46:26
Q: Perhaps you could offer a training at next year’s conference?
46:40
A: Patrick: ThWell if we can find our way to New Orleans. We’ll do a GoFundMe page to get there. But this is something we are thinking about. We did intend to write this up in a publication that people might read.
47:14
Q: We are interested in what kind of data analysis you have from this. We assume that is what you are going to write up.
47:30
A: We are going to look at many things and one of the things we did with the staff and with the participants was a pre and post test so we have some data that we can quantify. One thing that we discovered in the senior group is that not everyone could read. That was challenging. We didn’t want to embarrass anybody. Kathy was very good about addressing this especially with the Spanish speakers. The other think we are aware of is just keeping track of what is happening in the trainings. So we have some more qualitative data which we think will be helpful.
48:40
A: Valerie: It’s all about data, I hear that almost every single day.
It’s challenging in this environment. We did get increased number of reports we think that is caused by awareness. It has been a struggle to keep even the same people in the senior group to do the pre-test and the post-test. They come and go as they wish.
49:48
Q: I’ve been in some bullying workshops and I think it would be great if you could join forces. Your logo for your sign is the best one I’ve seen in all the workshops.
50:35
Q: Given how reluctant people are to disclose that they’ve experienced bullying, do you do any anonymous reporting?
A: Valerie: We certainly do everything confidentially.
A: Patrick: We try to validate their feelings and allow them to not disclose if they don’t want to. Shame is the biggest feeling.
51:36
Q. There is a senior bullying group in Boston that has been working on this for five years.
The Marshall Franklin group. If you join forces …
A. Patrick: I agree. I don’t feel that I have to reinvent the wheel. There is a lot out there. [Note there is a reading list in their handout included with the Boomer Tech Talk article. ]
Q. More of an observation, there is such value in identifying the behavior.
A. Patrick: Yes making the distinction between bullying and elder abuse is important
A. Valerie: Intent is so important. Giving it a name really helps in dealing with behavior

Reading List Distributed at the Senior Bullying Elimination Training Session

B. Coloroso: The Bully, the Bullied and the ByStander
C. Dellasega: Mean Girls Grown Up
T. Harbin: Beyond Anger: A Guide for Men
K. Pillemer et al Resident to resident aggression in nursing homes. The Gerontologist 52(1), 24-33
R. Potter-Efron: Rage: A step-by-step guide to overcoming explosive anger
T. Rosen et al: Resident to Resident Agression in Long-Term Facilities
David R. Brubaker – Promise and Peril
O. Puccioni, A. Valliesi (2012): Conflict resolution and adaptation in normal aging. Psychology of Aging 27(4), 1018-26
Marshall B Rosenberg: Nonviolent Communication: A Language of Life
William Ury: Getting Past No: Negotiating in Difficult Situations
Robin Bonifas: “The prevalence of elder bullying and impact on LGBT elders” Handbook of LGBT Elders, Harley & Teaster (eds)

Bullying Elimination Training Program for Staff and Older Adults Event Description from the ASA AiA18 App:

“It is estimated that 10-20% of older people have experienced some type of senior-to-senior aggression in an institutionalized setting. Because bullying behavior is underreported, it is hard to find exact numbers on this public health problem. We will describe how one center is confronting this social problem through a bullying prevention training program for staff and participants of the senior center.

When we think of bullying behavior, we generally think of students on a playground or cyber attacks by adolescents or young adults on the internet. We rarely think of older adults who engage in bullying behaviors with other older adults. What do we think happened to the adolescent bully who tormented us in high school? The adolescent bully got older and has gotten better at the practice of bullying behaviors. Mean young people will grow up to become mean old people unless there is some intervention.

After a 2-hour staff in-service on the problem of older bullying behavior, the staff at a senior center reviewed their critical incident report. What they came to realize was that a number of these incidents had the hallmarks of bullying behavior. These behaviors included: repetitive, negative behavior towards another older person or “target;” verbal intimidation of someone; disruptive behavior during the lunch time meal; gossip; and other behaviors toward another person that violates standards of civility.

Through a series of discussions with the Senior Center Director, it was decided that there was enough data to support the creation of a training model, which would prepare staff to recognize bullying behavior and intervene effectively to halt this negative behavior. Educating center participants was another facet of the model.

A funding proposal was written to support a two-year project to create a partnership team consisting of the Center Director, a Psychological Consultant, an Admin Support person, a Staff Liaison, and a Trainer. A staff training curriculum and a Senior Center Participant training curriculum was created. Six focus groups had been initiated in order to include information from a diverse group of older people, some of whom are participants of this senior center and some were not. These focus groups yielded compelling data on the way in which older people understand, observe, and define bullying behavior. A proposal was submitted to the San Francisco Department of Aging and Adult Services Fall of 2016. With funding approval the project officially began with the first of monthly partner meeting on September 19, 2016. Based upon research conducted by the trainer, nine, two-hour staff trainings began in October 2016; the final training was June 2017.

A pre-test on bullying related issues was completed by the staff prior to the beginning of the first training. Topics related to bullying behavior were introduced on a monthly basis. Each training began with a didactic section followed by role plays, Each training session ended with staff comments about the application of theory to practice. After the final training, a post-test was distributed to staff to evaluate whether there were changes in knowledge about bullying after the 18 hours of training. Certificates of Completion were distributed to staff who completed the training course followed by refreshments. Center participants were encouraged to participate in the.participant bullying behavior training, which began August 2017.

To determine changes in knowledge regarding bullying behavior, a pre-test/post-test will be distributed to the participants prior to the initial training and after the last training. Certificates of Completion will be distributed to the participants at the end of the training course followed by refreshments. Throughout the second year of the project, the partners will meet on a monthly basis to review progress. Decisions about signage will be made so that “Stop Bullying Behavior” will be prominently displayed throughout the center. Changes in signage will occur frequently so that participants and staff do not become habituated to the signs and disregard them. Policies will also be formulated that will carry the message that bullying behavior is not welcomed at this center. Discussions about future trainings will also occur for new staff and participants.

The project partners anticipate positive responses to the bullying elimination program. Staff have verbally shared helpful comments regarding their training. Center participants of focus groups also made helpful comments about their experience in these groups. Preliminary data will be shared for participants who attend this session at the conference.
Questions include:
1) Based upon the pre-test/post-test scores, did staff show an increase in bullying behavior knowledge?
2) Based upon the pre-test/post-test scores, did center participants show an increase in bullying behavior knowledge?
3) Did critical incidents reflect a decrease in bullying behaviors since the project began?
4) Was the signage helpful?
5) Overall, do staff and participants experience a greater sense of acceptance and respect for one another since the project began?”

Personal Comments on the AiA Senior Bullying Session:

I have seen resident to resident aggression during my many visits to see my father in two different residences in the Davie, Florida area over a four year period until he died at 91 in December. The second facility used the same technique that was mentioned in the presentation. They could see he could take care of himself, so they put him with the worst offenders in the facility except when I intervened.

Related Research

About the Aging in America Conference hosted by America Society on Aging.

This is the first of a series of articles that I am writing from what I learned at the Aging in America Conference.

I highly recommend this conference. The next one is April 15 – 18 in New Orleans. Locations through 2023 have been decided so that you can plan ahead. Thousands of dedicated professionals attend the conference. Their desire to do good and better for the older adults they serve is palpable. There are ten+ concurrent sessions during five time slots for four days, a feast of information sharing. “Over 3,000 attendees from across the nation and abroad attend the annual ASA Aging in America Conference conference to learn, network and participate in the largest multidisciplinary conference covering issues of aging and quality of life for older adults.”