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Angry statements made by residents. We have all heard them at one time or another. Accusatory, mean, sarcastic, or loud angry words. And we ask: Why are they so angry? That’s a good question. Are they angry at you personally? What are they really trying to express? And what can we do about it? Are they upset because this is the first time in their lives that they need the help of others? When you observe angry comments or actions it is important to identify the cause.

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Indirect care providers are often the first to be exposed to a resident’s anger. Being able to recognize when a resident is becoming upset and angry is your first step in addressing the problem. Try to understand why some residents are so easily angered. Most people who are newly placed in long-term care or assisted living are coping with the loss of their independence. They are nervous in a new strange place. Many also have dementia or medication side effects. All of these things put residents at risk for angry behaviors. Your first reaction to an angry confrontation can mean the difference between successful resolution and further escalation. Calm interactions will help the resident to calm down. There are specific actions you can take to manage these difficult situations successfully. We will discuss them here. Your supervisors and your facility’s policy and procedure manual should also outline clear expected courses of action. They outline the lines of communication for support and for reporting incidents.

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Anger is often misplaced. For instance, a resident who is screaming at a staff member might really be upset about something that happened with his family or something else entirely. But the anger boils over in the wrong place. Moving into a long-term care facility is a stressful, major life change. Many new residents have also lost a spouse or a child. They may have health or financial problems. Many are also slowly losing the ability to care for themselves independently. Having to depend on others to take care of us is one of the hardest life changes we face as we age. This difficulty can lead to expressions of anger misplaced at people who are trying to help. Many older people find it hard to socialize. Meeting other residents and engaging in activities might not be as easy as we think leading to social isolation. Some medical conditions common to this population are neurological and memory changes and emotional effects of stroke. These conditions put residents at risk for anger and agitation. Anger can be a symptom of many mental health issues, such as depression and anxiety.

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All people experience feelings like frustration or helplessness. These feelings can lead to aggression. When we are well, we find socially acceptable outlets for aggression – such as work, play, or sports. When life changes with aging or when entering a long-term care facility aggressive tendencies can occur. Aggression might be exhibited in socially unacceptable ways. Residents who don’t normally yell might raise their voice.

Not all angry or aggressive residents will become abusive, but some might. Abusive residents are very often those who are confused. Other factors that put residents at risk for being abusive are pain, depression, and things in the environment. Tell the supervisor if you notice irrational or sudden changes in a resident’s behavior. This might require that the resident undergo a medical examination. Medications can also play a part in aggression and abuse. Residents who seem unusually angry, are acting irrationally or appear confused may be experiencing more than anger. They could be physically or mentally ill, or be experiencing side effects from medicine. If you encounter an irrational or confused resident, or if a resident you know has a sudden change in behavior, alert a nurse or a doctor. The resident might need a medical examination.

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Many things that happen in long-term care settings can trigger anger and aggression in residents. The most common triggers include being crowded or touched by other residents. This can be annoying, or even feel threatening. Noise coming from the television or a noisy roommate can cause problems. People that enter the resident’s room uninvited and who touch the resident’s belongings can cause angry feelings. This includes wanderers. Remember, the room is the resident’s home, and they need to have some control over who enters it. Arguments can take place with others about issues like the room temperature or noise. Dealing with a difficult roommate who might often be confused and irritable can be upsetting. Group areas crowded by objects and people can cause frustration.

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It is important to know your own response to the anger. Each person has their own response to anger based on past experiences and current emotions. Avoid reacting with your own anger. Instead, note that the resident is having a hard time. Always be respectful to the resident and do not take it as a personal attack on your. Feeling personally attacked or feeling fear and anxiety cause us to react in a bad way. You might feel like the resident’s anger is your fault. This can prevent you from finding out what is really going on with the resident. Feeling powerless or unprepared may prevent you from responding. Be aware of your own angry response to feeling unfairly treated or unjustly accused.

Letting your own anger show can make the situation worse. It can lead to shame and guilt for losing control. This might result in trouble with supervisors. Remember, your role is to give assistance to the resident and not to become personally involved with whatever is creating the anger in the resident.

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When anger makes you feel badly about yourself and the job you are doing, it is easy to overreact and get angry in return. Do not let the angry resident get to you personally. Think about the resident’s situation. Are they having a hard time? Remember that the resident has anxiety or fear. They may take it out on others. As difficult as it may be, the caregiver has to stay indifferent to any personal attack aimed at them by the resident. It takes self-confidence to put the anger aside. Respond with care and understanding. Then you can resolve the issue. Knowing the triggers will help you recognize and address situations before residents get angry. Alert other employees who are in a position to help. Your facility has policies addressing these situations. If you recognize problems that you cannot address yourself, your supervisor should be able to help.

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When a resident’s anger is not managed well, they might feel a loss of control or guilt. Staff may be scared and not want to care for the resident. This leads to more stress and changes the quality of care. Angry outbursts are upsetting to other residents. They can disrupt the routine of the community. Anger aimed at other residents puts them at risk of psychological or physical injury.

Unresolved anger can lead to blame for misconduct or abuse against the staff.

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When a resident is very angry, staff members must be aware of their own emotional reactions and work to stay calm. Signs of anger are often seen as reactions like tense body language, pacing, clenched fists or clenched jaw, or any behavior unusual for the individual. Do not avoid a resident who is becoming angry. Remember this is not a personal attack on you. Stay near but avoid touching the resident. Touch can be easily misinterpreted. Speak in a calm steady tone. Allow the resident to talk about what is wrong. Even if he or she is yelling, listen to everything they say. Answer directly and honestly. Acknowledge and validate the resident’s feelings. Honest attempts to resolve problems may prevent the anger from rising to a crisis. If you can fix the problem, fix it.

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The cause of a resident’s complaint might be about a specific situation. For example is could be that the room isn’t clean enough, the meal did not come fast enough, or the hallway is too crowded. The problem may seem larger than it really is and the resident may be over-reacting. The resident has other problems that are combined to make this situation worse. The anger might be misplaced, but the resident’s immediate concern is valid. Don’t respond to the angry feelings. Instead, remain calm. Remember that no concern is trivial, and take care of the issue as best you can. Sometimes, it seems that there is nothing you can do to help an angry resident. You may feel helpless if a resident is screaming at you and you can’t fix the problem. You are not helpless. Avoiding the resident will only make him or her angrier. Engage the resident. Let them explain the problem. Listen with attention and eye contact. It is OK to say that you don’t know the answer, or that you are unable to fix it. Explain that you want to help. The important thing is that you let the resident know you are trying.

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Resident and staff safety is always the first priority. You may be with a resident who is very angry. They could be yelling, hitting, walking fast, running, hurting themselves or hurting others. They could be out of control. Get help before approaching the resident. If the resident becomes physically abusive, call for assistance immediately to reduce the chance of the resident injuring you or themselves. Fall prevention is a priority. Follow your facility’s policies for alerting others. Call 9-1-1 when it is needed. Outbursts and resident complaints should always be reported to the supervisor. Make sure that an incident report is filled out in a timely manner as soon after the incident as possible. Your facility should also have clear outlined policies for these situations. Always follow policy and procedure.

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It is worth repeating that the first and best thing you can do when encountering an angry resident or family member is to take charge of your own angry response. When you don’t take things personally, you are better able to maintain control of the situation. Staying in control is far more rewarding and less stressful than showing anger or letting anger control you. If you lose control, the situation will remain out of control.

Remember that frustration is expressed by residents in many ways and quite often long-term care staff will be the object of that frustration. Personal attacks are more often an expression of fear, anxiety, or frustration. You show empathy and understanding when you can look at the whole person, recognize their stress, and respond in a productive way. If an incident occurs report it in a timely manner and always follow policies and procedures of your institution.

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“This place is awful. It’s your fault I’ve been waiting half an hour! You should have called sooner.” Becky, the admissions clerk, had been checking Mrs. Smith into the long-term care facility. She also wondered what was taking transport so long. It was time to move this process along and get the brand new resident to the unit, where the nursing staff would orient her to her new home. She had met Mrs. Smith once before, when she and her daughter toured the building together. Mrs. Smith was irritable then, too. Becky didn’t want to spend any more time with her. She had a full busy day ahead of her, and Mrs. Smith’s anger was starting to affect her own mood. Becky wanted to excuse herself and avoid the situation, but she knew she should not. Although she knew that transport’s delay was not her fault, she resisted the urge to defend herself. She knew that would only make the situation worse. Instead, she gathered all of the patience she had left and said, “You are right, Mrs. Smith, you have been waiting too long, and I apologize for that.” And added with a smile, “Transport never takes this long. They are an excellent team. If they ever arrive, I think you will like them! I’ll call and find out why they have been delayed.” This response made Mrs. Smith stop complaining, as her frustration had been validated. After calling, Becky was able to explain the reason for the delay to Mrs. Smith, and

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remembering what a hard day this must be for her, offered to sit and wait with her in the lounge. She asked Mrs. Smith about her daughter, and before she knew it, Mrs. Smith was going on and on about her family. She laughed and cried. It was so hard to be left alone by them, and to move out of her home. The remaining time flew by and it seemed only a minute before transport was there to bring Mrs. Smith upstairs. Before Mrs. Smith left, she grabbed Becky’s hand and with a tear in her eye said, “I’ve been so lonely. You‘re a lovely girl. Thank you.”

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