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Just because individuals get older doesn’t mean they get any nicer, and when professionals begin working in congregate settings they are surprised to see bullies, mean girls, cliques, and the same dynamics many may remember from high school.

For most adults, the only time they are forced to live, eat, and socialize with a single group of people for an extended amount of time may be on a cruise ship. The rest of life is often spent traveling between family, work, social circles, and community activities. This all changes when a person moves into a long term or post-acute care (LT/PAC) setting, and socializing with the same people all day, every day, means that conflict and tension are inevitable. How can staff know if the conflict or negativity they are seeing is just the normal bumps and bruises of community living, or if it is bullying?

Most researchers and activists agree that bullying has three characteristics:

1. There is an intentional harm.

2. A power imbalance exists between the bully and their target.

3. There is a threat of future or continued harm.

If Joan pinches her roommate every day, that is bullying. It is a harm; Joan is probably stronger than the roommate, and it happens daily. Her roommate may start avoiding her, become afraid of her, and withdraw. If, on the other hand, Joan is frustrated and pinches her roommate one time out of anger—this may be an assault, but it is not bullying because it is not repeated.

If a resident accidently tells a secret that ends up embarrassing a friend, the resident has hurt her feelings, but it was not intentional so it is not bullying. Intentionality and repetition are key aspects of bullying, in part because it is that future threat that leads the target to change their behavior or avoid the bully.

There are four major types of bullying. Physical bullying involves bodily attack or intimidation. Verbal bullying includes things like name calling and harassment. Social bullying relies on manipulating social relationships to isolate, embarrass, or ridicule a person. Lastly, cyber bullying is bullying that happens over the internet or social media, and can include harassment, intimidation, and spreading hurtful information or rumors.

There is no one motivation for bullying, but a common theme is seeking control. People moving into an LT/PAC setting may be facing health challenges, mourning the loss of a significant relationship, or feeling depressed, anxious, or less independent. They might be feeling invisible or marginalized, and be missing valued professional and personal roles. When this is the case, bullying can be a way to feel powerful, in control, or to get resources and attention.

Bullying behavior might also express an undiagnosed or undisclosed condition, such as chronic pain, depression, anxiety, or unprocessed grief. When someone starts bullying, a good first step is to have conversations with that person to see if perhaps the real problem is one of these underlying conditions. Once these are treated, the bullying might stop.

People living with dementia may do hurtful or disruptive things, but it is not bullying if the person cannot understand the long-term impact of their actions. That is not to diminish the harm or the need to address the situation, but agitation in a memory care community requires different interventions than bullying in other settings.

So what can staff do? While this is not an exhaustive list, here are some things to consider.

Once bullying is spotted, it is important to intervene in the moment. Separate the parties involved, make it clear that bullying is not okay, and then have one-on-one follow-up conversations with everyone present. 

When speaking with the person who is bullying, focus on the impact of their behavior (“That comment made people feel uncomfortable”) rather than focusing on them (“You are a bully”). Focusing on the person may make them defensive, whereas focusing on the impact can help everyone keep an eye toward solutions and creating a friendly community.

Another action that staff can take is to share the three-part definition of bullying with residents to start a dialogue about their experiences. Many residents may be experiencing bullying but not understand that they are being bullied, dismissing it by saying things like “It’s okay. It’s always been like this, why should it be any better here?” This is particularly true for residents who are part of other minority groups (for example, people of color or those in the lesbian, gay, bisexual, and transgender community) who may have internalized stigma and a lifetime of confronting discrimination and abuse. Sharing this definition can empower residents to realize if they are being bullied and feel empowered to ask staff for help.

Lastly, ask everyone in the community to discuss and sign a letter defining bullying and agreeing not to do it. This gives staff something concrete to come back to when talking with the person who is bullying and reminding people of community norms. Follow this up with more discussions and training for staff and residents. Many organizations, including SAGE, provide training for staff, and another good reference is Dr. Robin Bonifas’s book, “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic.” Share these resources, and once people can identify bullying it is easier to know how and when to intervene and help create a bully-free atmosphere.

John is an openly gay man who recently moved into the community. He has a slight tremor and drops food during meals. Other residents refuse to eat at his table and say that he is “dirty” and that they “don’t like people like that.” John is increasingly isolated.

This is an example of social bullying. The other residents have isolated John repeatedly, and John is new so he has less social standing and support. A good first question to ask is when residents say John is “dirty” do they mean because he sometimes drops food, or because he’s gay, or something else? Likewise, who are they referring to specifically when they say “people like that?”

If it is about John’s sexual orientation, this is an opportunity to discuss community norms around inclusion and nondiscrimination, as well as dispel myths and stigma. The residents may incorrectly believe that all gay men are promiscuous and that is at the heart of the “dirty” comment. Once that myth is cleared up, they may feel more comfortable together.

If the root of the “dirty” comment is the food, assistive technology or different food that is easier to eat are good solutions. The other residents may see John’s reduced dexterity and be afraid that will happen to them, and this is an opportunity to have conversations about their fears related to aging, ability, and capacity. If the other residents can help to make John feel at home and included, it will also show them that even if they, too, start to have a hard time eating, it does not mean they will be excluded in the future.

Finally, be sure to check in with John. Maybe he is legitimately fine eating alone and prefers to socialize outside of meals, in which case the goal can be to make sure he is integrated into other parts of the day.

There is no one solution to bullying. Each situation is as unique as the people involved, but generally, staff can focus their efforts on stopping the harm when they see it, keeping the focus on the community, and having conversations to build empathy.