How to Keep Older Adults in Care Facilities Safe From Abuse

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When a loved one reaches the point where they need round-the-clock care, most people assume that assisted living facilities and nursing homes are safe places to provide that care, especially from violence and assault. A research team—led by Cornell gerontologist Karl Pillemer, Jeanne Teresi from Columbia University, and Mark Lachs from Weill Cornell Medicine—set out to measure how often residents of assisted living facilities are aggressive toward one another.

In a study published in JAMA Network Open, the researchers tracked 930 residents across 14 New York State assisted living facilities for one month. They found an estimated 15 percent of residents experienced verbal, physical, or sexual aggression from another resident during that period. Nursing homes had a similar rate; according to a related Cornell study, roughly one in five residents experience an altercation each month.

The similarity surprised the researchers. Assisted living residents tend to be more independent and mobile, and they have more privacy than nursing home residents, factors that might be expected to lower the risk of conflict. Instead, aggression between residents turns out to be common across long-term care.

“These findings point to the need in both settings to understand risk factors, train staff in appropriate interventions, and engage the residents and their families in individual-level solutions,” Pillemer said.

Why Dementia Raises the Risk

Verbal conflict was the most frequent type of incident, but physical assaults affected roughly 4 to 5 percent of residents in a typical month. Related research shows residents with dementia are disproportionately involved in these altercations, as both the aggressor and the victim.

That’s likely because of how dementia affects the brain. As the disease progresses, it can erode connections between the prefrontal cortex, which supports judgment and self-control, and deeper regions tied to fear and threat response. Residents may lose the ability to explain that they are in pain, frightened, or overstimulated, and that distress can surface as shouting, grabbing, or hitting. Crowded common areas, unfamiliar caregivers and disrupted routines can all become flashpoints.

These incidents are warning signs usually present well before an altercation turns serious: a resident who has hit staff before, one repeatedly moved between roommates, or one whose family has flagged unsafe behavior.

What Families and Facilities Can Do

The Cornell researchers offer a training program for staff designed to help caregivers recognize risk and intervene before conflicts escalate. Broader recommendations from researchers and geriatricians include:

• Providing each resident an individualized care plan that identifies known triggers.
• Supervising higher-risk residents more closely, including rooms near nursing stations.
• Separating residents with a history of repeated conflict, and reassessing roommate and seating arrangements when problems arise.
• Training staff specifically on de-escalation, not just general dementia care.
• Treating a family's reported concerns as clinical information, not just complaints.

The take-home message: Resident-to-resident aggression in long-term care is far more common than most families realize, and dementia significantly raises the risk of both being involved in and being harmed by these incidents.

If you have a loved one in assisted living or a nursing home, don't hesitate to ask directly about the facility's care planning process, staff training on aggression, and how they respond to reported concerns. Early warning signs are often visible — the key is making sure they are acted on.