Violence and Security in Skilled Nursing/Assisted Care Facilities


Ensuring an adequate security posture in a skilled nursing or assisted care setting can be challenging for the security director or administrator in charge of security. Although these facilities do not have some of the security sensitive areas of an acute care hospital such as an emergency department or nursery, many of the security concerns are similar. Unfortunately, many of these facilities do not have a dedicated security department and rely on personnel who are not trained in security measures to provide this important service.

In an IAHSS survey the top four security and safety concerns from security directors and managers who have responsibility for long term care facilities were:

  1. Resident aggression/violence
  2. Public aggression/violence
  3. Theft from residents and staff
  4. Elopement/wandering[18]

Mitigation – Mitigation of these security concerns includes various techniques and will require a collaboration between security, facility administration and facility staff with reasonable and appropriate measures being considered based upon the issue.

Resident aggression/violence- Several mitigation options should be considered here. Some facilities have begun approach utilizing a broad-based approach by implementing a disruptive patient and visitor program. As part of the program, patients and visitors who repeatedly cause disturbances or commit egregious acts of violence are flagged in the electronic medical record. Alerts are accompanied by tips from previous caregivers on how to reduce risk, such as entering the resident’s room slowly. On an individual level, staff should be trained to recognize and eliminate any potential weapons available such as items that may be thrown or used to strike someone. De-escalation training should be provided, although this may be of limited use when interacting with residents with cognitive impairment.[19]

Public aggression/violence- Some mitigation techniques may need to be based on the design of the facility. As discussed earlier, on a large CCRC with hundreds of residents scattered over hundreds of acres, security can be more challenging due to the sheer size of the campus and with most proprietary security forces being unarmed. Ensuring the ability to effectively patrol the campus, transportation for the security officers is vitally important. Based on the facility design this may be either automobiles, SUVs, or even golf carts. Mitigating this broad category also includes considering threats from the public such as an armed intruder. Modern facilities which use the Crime Prevention Through Environmental Design principles understand how specific design and placement of features can enhance security. While these are valid principles it is important to augment them with additional measures such as an electronic access control platform, campus wide video surveillance, panic buttons and an effective mass communication system.[20]
Another important yet often overlooked mitigation tool for the security officer is customer service training. As with training programs in de-escalation techniques and conflict resolution, customer service skills can pay off by preventing complaints, and diffusing potentially hostile encounters before they escalate.

Theft from residents/staff – Mitigation here begins with a good physical security program which includes visitor management/access control and video surveillance. As someone who oversees security in a CCRC or nursing facility, the security leader should be asking “who is on my campus”? When implemented correctly modern visitor management systems interface with access control and video surveillance platforms to enhance the overall security posture of the facility. This gives the security director and administrators various options such as the ability to identify who is coming onto the campus. Through this system, the visitor may be allowed access to only a specific area or even no access at all. Video surveillance allows tracking in real time the movement of visitors, staff and residents. Even though video is not in resident’s rooms, the ability to review recorded footage can be crucial when investigating a theft or other incidents that occur on property.
Educating not only residents but their family is an important step that should not be overlooked when discussing the importance of safeguarding valuables. While residents who live in an on- campus house or apartment may be able to limit who comes inside of their residence, some residents may share a room with another and therefore be more vulnerable to theft. Staff should also be educated and be encouraged not to bring valuables to work. The facility should provide an area with lockers for staff to secure valuables inside and encourage staff to utilize their own lock as well. Some staff may prefer to leave valuables secured in the trunk of their locked vehicle if they have one.

Elopement/Wandering- Mitigation of this event will depend upon processes and procedures in place at a facility. Security should ensure the administrators are utilizing industry standard technology to help prevent elopement. Electronic patient monitoring systems sometimes referred to as anti-wandering systems should be a part of all modern facilities. These systems consist of a sending unit such as a bracelet that transmits a signal to a receiver, which can prevent residents from accessing or exiting certain areas. Various brands are available, and features can include alarm activation, door locking, and other notifications such as to a computer or cell phone.[21]


[18] OIAHSS Long Term Care Task Force. (2013):6. IAHSS Long Term Care Safety & Security Management Guide. Bayside, NY: Rusting Publications

[19] Durkin, M. (2017, December). Hospitals Fight Back Against Violence. ACP Hospitalist, (), . Retrieved from

[20] IAHSS Council on Education. (2016):32. IAHSS Toolkit For New Security Managers In The Healthcare Environment. Glendale Heights, IL: IAHSS

[21] IAHSS Long Term Care Task Force. (2013):20. IAHSS Long Term Care Safety & Security Management Guide. Bayside, NY: Rusting Publications

[22] CNA Aging Services 2016 Claim Report (2016). Retrieved from

[23] OSHA Adopts Expanded Enforcement Against Hospitals, Nursing Homes, and Residential Care Facilities. (2015). Retrieved from