Resident-to-Resident Mistreatment in Nursing Homes
Author: Weill Cornell Medical College
Published: 2014/11/11 - Updated: 2026/02/25
Publication Type: Research, Study, Analysis
Category Topic: Rehabilitation - Related Publications
Contents: Synopsis - Introduction - Main - Insights, Updates
Synopsis: This research, conducted by Dr. Karl Pillemer of Weill Cornell Medical College and Cornell University and Dr. Mark Lachs, and funded by the National Institute on Aging, is the first study to use direct observation and resident interviews to measure the prevalence of elder mistreatment between nursing home residents. Presented at the 2014 Gerontological Society of America Annual Scientific Meeting, the study found that 19.8 percent of residents across 10 randomly selected New York State skilled nursing facilities experienced at least one negative encounter with a fellow resident in a four-week period - including verbal abuse, physical aggression, sexual incidents, and invasion of privacy. The findings are critically important for seniors, people with disabilities, and families with loved ones in long-term care, as they reveal that the most frequent threat to nursing home residents may come not from staff but from other residents, a problem that remains vastly under-reported and inadequately addressed by current intervention strategies - Disabled World (DW).
- Topic Definition: Resident-to-resident Elder Mistreatment
Resident-to-resident elder mistreatment refers to inappropriate, aggressive, or hostile behavior occurring between individuals living in the same nursing home or long-term care facility. It encompasses verbal abuse such as cursing and screaming, physical aggression including hitting, kicking, and shoving, unwanted sexual behavior, and invasion of privacy such as entering another resident's room or going through personal belongings without permission. Research has established that these incidents affect roughly one in five nursing home residents over any given four-week period and are significantly under-reported to facility administrators and regulatory agencies. Residents most commonly involved tend to have some degree of cognitive impairment while retaining enough physical mobility to move freely through the facility, and effective intervention requires staff training, clear reporting guidelines, and individualized approaches that account for each resident's cognitive and behavioral profile.
Introduction
Mistreatment Between Nursing Home Residents
A study found that nearly one in five nursing home residents were involved in at least one negative and aggressive encounter with one or more fellow residents over the previous four weeks. These included acts of verbal or physical abuse, inappropriate sexual behavior, or invasion of privacy, among other incidents, known collectively as resident-to-resident elder mistreatment. Researchers discussed the findings today at a press briefing at the 2014 Gerontological Society of America (GSA) Annual Scientific Meeting in Washington. They will present the full study results at a GSA symposium on Nov. 8.
Main Content
"This is the first study to directly observe and interview residents to determine the prevalence and predictors of elder mistreatment between residents in nursing homes," said Dr. Karl Pillemer, a professor of gerontology in medicine at Weill Cornell and the Hazel E. Reed Professor in the Department of Human Development at Cornell University.
"The findings suggest that these altercations are widespread and common in everyday nursing home life. Despite the acute urgency of the problem, resident-to-resident mistreatment is under-reported. Increased awareness and the adoption of effective interventions are greatly needed."
Over the past two decades, researchers, policymakers, and the public have become increasingly concerned with the problem of elder abuse. However, most of this research has been conducted among community-dwelling older adults, that is, those who live someplace other than a nursing home, and focused on mistreatment perpetrated by family members. In recent years, research and clinical experience have shifted the focus to abuse by nursing home staff against vulnerable residents, such as elderly dementia sufferers. But the new study, funded by the National Institute on Aging, suggests that a more frequent threat to residents is aggression committed by other cohabitants.
Dr. Pillemer and his co-author, Dr. Mark Lachs, randomly selected 10 skilled nursing facilities with more than 2,000 residents in New York state. The facilities were comparable in size and classification to other large nursing homes at the state and national level. The researchers used multiple data sources and methods--including staff interviews and reports, direct observation, and a research-based questionnaire for both residents and staff--to record the total number of incidents of mistreatment between residents.
They determined that resident-to-resident elder mistreatment affected 19.8 percent of residents over a four-week period. Specific types of mistreatment included verbal incidents, such as cursing, screaming or yelling at another person (16 percent); physical incidents, such as hitting, kicking or biting (5.7 percent); and sexual incidents, such as exposing one's genitals, touching other residents, or attempting to gain sexual favors (1.3 percent). A fourth category, which involved 10.5 percent of people, included unwelcome entry into another resident's room or going through another resident's possessions.
The research also suggests that individuals who are most likely to be involved in a mistreatment incident are younger, less cognitively and physically impaired, and prone to disruptive behavior, compared to fellow residents. There was no significant difference between men and women, and African Americans were less likely to be involved than non-Latino white and Latino residents. The investigators noted that the study did not distinguish victims from perpetrators of resident-to-resident elder mistreatment.
"People who typically engage in resident-on-resident abuse are somewhat cognitively disabled but physically capable of moving around the facility. Often, their underlying dementia or mood disorder can manifest as verbally or physically aggressive behavior. It's no surprise that these individuals are more likely to partake in arguments, shouting matches, and pushing and shoving, particularly in such close, crowded quarters," Dr. Pillemer said.
Dr. Pillemer and Dr. Lachs, who is the medical director of the New York City Elder Abuse Center, believe intervention should be targeted toward these individuals. They recommend programs that educate and train nursing home staff to recognize and report resident-to-resident elder mistreatment; provide guidelines for staff to follow when incidents occur; and use an approach that considers the needs and abilities of individual residents.
"We urgently need strategies to address this under-recognized problem, which affects fully one-fifth of all residents, erodes their quality of life, and is stressful for staff to manage," said Dr. Lachs, co-chair of the Division of Geriatrics and Gerontology and the Irene F. and I. Roy Psaty Distinguished Professor of Clinical Medicine at Weill Cornell.
Collaborating on the study was Dr. Jeanne Teresi, Research Division, Hebrew Home for the Aged at Riverdale. The study was funded by grants from the National Institute on Aging (RO1 AG014299), the New York State Department of Health (# C-022657), and the National Institute of Justice (IJ 2009-IJ-CX-0001).
Insights, Analysis, and Developments
Editorial Note: For decades the conversation around nursing home abuse has focused almost entirely on mistreatment by staff, and while that remains a serious concern, this study makes clear that the person in the next room or down the hallway may pose a more common daily threat. When one in five residents experiences some form of aggression from a fellow resident in just four weeks, the problem is not isolated or rare - it is woven into the fabric of everyday institutional life. Residents with dementia or mood disorders who remain physically mobile are particularly likely to be involved in these incidents, yet most facilities lack formal protocols for identifying, reporting, or intervening in resident-to-resident conflicts. For families trusting nursing homes with the care of elderly or disabled loved ones, these findings underscore the need to ask hard questions about how a facility monitors and manages interactions between residents, not just between staff and patients - Disabled World (DW).Attribution/Source(s): This quality-reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Weill Cornell Medical College and published on 2014/11/11, this content may have been edited for style, clarity, or brevity.