Violence and Security in Skilled Nursing/Assisted Care Facilities

Facility mitigation against wandering or elopement should include:

  1. Ensuring that staffing levels are sufficient and reflect resident acuity.
  2. Perform comprehensive elopement risk assessments.
  3. Place new residents in rooms closer to nursing stations and away from exits.
  4. Conduct routine safety rounds inspecting door locks, alarm systems and camera surveillance.
  5. Conduct routine elopement drills and educate all staff about emergency response.[22]

The Occupational Safety and Health Administration recently announced a stricter enforcement policy for the healthcare industry, including nursing homes and residential care facilities. One of the five specific hazards OSHA promised to monitor closely is workplace violence. To protect against violence, the OSHA recommended industry best practices include developing an effective workplace violence prevention program with key components such as:

  1. Management commitment to supporting and funding the program and providing training and safety devices;
  2. Employee participation through safety committees and surveys;
  3. Worksite and job analysis with a focus on areas and tasks that may expose employees to potential violence, such as transferring patients and providing intimate care;
  4. Tracking and trending workplace violence complaints, injuries, and near misses for purposes of identifying patterns and new controls.
  5. Safety and health training of all employees on how to recognize the potential signs of violence, how to defuse a situation and defend against an encounter, and how to use the controls and safety devices.[23]


Providing safety and security to residents of a skilled nursing or assisted care facility can be challenging yet rewarding. Personnel at these facilities provide protection for a vulnerable population who are dependent upon others for their safety and security. While crime and violence may occur in all types of healthcare facilities, assisted care and skilled nursing facilities are unique due to the many residents who may suffer not only from physical disabilities associated with aging, but also from differing degrees of cognitive impairment. It is imperative that facility administrators and those that are responsible for security, recognize the threats and vulnerabilities associated with these facilities and ensure proper prevention and mitigation steps are in place.


Dean Conner is a corporate security manager for Atrium Health based in Charlotte, N.C. with direct security oversight for two behavioral health hospitals. He holds a bachelor’s degree in Social Science and a master’s degree in Administration of Justice and Security. Previously Mr. Conner was an investigator assigned to the corporate security investigations and training unit. He is also a retired detective sergeant who specialized in use of force training and is a former federally certified bomb technician. Mr. Conner may be reached at

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