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Violence in Care: "It Starts with a Mean Word and Ends with Murdering“

Violence in Care:

"It Starts with a Mean Word and Ends with Murdering“


Senior citizens in need of care become more and more often victims of violent encroachments. Potential culprits are informal caregivers or the nursing staff. What affected people should do and how such situations can be avoided – the experts of a Germany-wide emergency call advice centre in Bonn know it.

Photo: Rolf Hirsch

Rolf Hirsch; © private

Rolf Hirsch is the chairman of the crisis and emergency call advice centre „Acting instead of mistreating Initiative against violence in old age Bonn“. Together with ten volunteers (social workers, psychologists, doctors, nursing staff) he attends to the emergency call phone of the advice centre two hours per day. talked to him about alarm signals, interpersonal tensions and forms of assistance. There are hardly official figures, the estimated number of unknown cases is huge: According to the World Health Organization WHO about four millions older people in Europe suffer from maltreatments. Mr. Hirsch how many cases of violence in care do you get to know on the emergency call phone?

Rolf Hirsch: We have about 300 to 400 incoming telephone calls per year – relatives as well as affected persons and nursing staff. During the last years especially the visits on our website and the inquiries via e-mail have strongly risen. Many estimate and use it that one doesn't need to mention one’s name and can remain anonymous therefore. A frequent complaint is: „Finally, somebody listens to me and tries to understand me“. At least, violence is a precarius subject. Where does violence in care begin at least?

Hirsch: Basically one can say: Violence begins with a mean word and ends with murdering And of course, the bad word is a very subjective thing. But all statements which are very insulting, discriminating and grieving as well as they attack the sense of shame, are a form of violence. Violence does not only mean physical encroachments. Which forms do also exist?

Hirsch: Also psychic violence is spread very much. Besides, nursing staff or informal caregivers show up the patients, threaten them, handle them disrespectfully or manipulate them by wrong or omitted information, for example. But also financial exploitation and mobility-restricting devices are often appearing forms of violence in care.

Photo: Old man on the phone

Affected people get helpful tips at the German emergency call phone;
© Werner Nick/ What can one do as an affected person?

Hirsch: Because a huge number of the affected people is demented, especially the relatives and responsible persons are asked here. Depending on in which facility it came to actions of violence, the relatives should turn to the station management or the service management. Those who do not dare to do this step directly, can of course also call our emergency call phone. Then our volunteers speak with the relatives, give tips for the further approach, try to appeal to the home and service management and also provide with pleasure other contacts with regional other places. Why does it generally come to actions of violence?

Hirsch: As a main cause a large part of the nursing staff calls the excessive demand in the job. If in one shift only two instead of five planned employees supply the patients and in the night shift maybe even only one nurse is working, however, it is also no miracle that the staff is demanded too much just by the pressure of time. Here those responsible for the personnel and also the politics are in the duty to change something. Since excessive demand should be perceived as an alarm signal by everybody. Are there still other causes for violence in care?

Hirsch: Other reasons are personal or informal conflict situations, psychic crises of the staff, to stiff timings and deficient education and advanced training. Also our culture partially favours the origin of violence. Certain forms of violence are accepted extensively or at least nobody speaks about it – because of fear and shame of the public. For informal caregivers the relations with each other play a crucial role.

Photo: Old and young woman look at each other angry

Old conflicts among relatives boost the readiness to use violence;
© ginasanders/ To what extend?

Hirsch: Let’s fancy the following situation: The parents-in-law were never really satisfied with the choice of her son and also let this feel their daughter-in-law. Thereby a very tense relation has been established with the years on both sides. Now, however, the parents-in-law become care-dependent, maybe caused by dementia, and the daughter-in-law is supposed to look after them at home. The obligation and the existing tensions between all involved parties are the conceivably worst conditions for a non-violent nursing situation. Whether at home or at the nursing home – how can one avoid violence?

Hirsch: By offering advanced trainings for the nursing staff and doctors. Prevention of violence and de-escalation strategies should come first. In bigger institutions this is used increasingly, at smaller homes, unfortunately, less. Here it is often argued with the absence of the staff. Besides, those responsible lose sight of the long-term use for everybody. Often they are not aware of their responsibility that they are somehow in charge for the balance of their employees and have to act. Only complaining about staff shortage is not sufficient. What do these so called de-escalations training look like?

Hirsch: Mostly these trainings last about one week. The programme is well structured. In form of role plays all participants act from different positions and go through the typical situations in which violence can originate. From the changed perspective one learns to question oneself and to recognise personal triggers. In the following discussion about that, one appropriates tactics to prevent such situations. This has to be put into practice and should be discussed continuously in the team. Is there a sort of a patent remedy against violence?

Hirsch: Let’s say it like that: Often it is sufficient to change just little things – in the cooperation, in communication or concerning the working conditions. Many are very surprised about that. But, in principle, it is quite easy: More transparency and more openness between all involved parties are de-escalating.

This interview was conducted by Nadine Lormis.


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