Combative Behavior

For nurses working in assisted living facilities, dealing with all types of patients is a day-in, day-out expectation. Having to handle patients with combative behavior within nursing homes is not ideal, but it is crucial to handle appropriately.

It’s best to de-escalate a scenario before it becomes physical through combative patient management in an Assisted Living Facility. However, this isn’t always possible. Despite a nurse’s best intentions, some patients may come with the job. Understanding how to efficiently deal with an aggressive patient helps keep everyone involved safe.

What is Combative Behavior?

Combative behavior refers to a display of aggression from patients toward nurses and other assisted living facility staff. Patients who display combative behavior are quick to fight and create a confrontation, and can potentially become physically or verbally aggressive.

The kinds of patients who are mostly combative are elderly patients with dementia and a history of mental illness. Memory loss and confusion are among the most common triggers as to why someone with dementia would display a form of combative behavior. Often not able to recognize their nurses and caretakers, it’s understandable why someone with dementia may react in a defensive manner. However, if someone acts combatively, they can find themselves being moved out of an assisted living facility.

Understanding the Issue at Hand

Patients may be combative for a variety of reasons including stroke, head injury, and dementia, as noted above. These can lead to personality changes and make patients more aggressive than before. Medication side effects can also play a role in affecting someone’s mind and temperament.

Understanding the possible underlying cause of combative behavior can be useful to provide a possible solution. If there are issues with medication causing unwanted side effects, changing the medication or switching to a different dose may end up decreasing aggression.

Remain Calm


When a patient becomes aggressive, combative patient management and combative patient training needs to kick in, even though it can be difficult to remain calm. Nurses should keep from becoming irritated or taking out their irritation on a patient as this only makes the situation worse and sets them up for potential liability issues. In most cases, patients are not intentionally being disruptive. They are often combative due to a certain cognitive impairment or a neurological problem.

Remaining calm helps nurses keep the scenario from becoming even worse. Once a patient becomes combative, a nurse’s main job is to keep them from hurting anyone including themselves.

Calling for Help


If someone becomes physically combative, it’s important to call for help. Hospitals have security in place to respond to combative patients. Nurses and assisted living facility staff should follow their protocols for getting support with combative patients. Hospitals usually have a “code gray” system in place to call for help with a combative patient. In some instances, security may be called for help. Ideally, nurses should seek assistance before the scenario becomes physical

Always Have Personal Safety at the Forefront


Patients may exhibit combative behavior in a number of ways. Some patients may become abusive verbally. Some may end up kicking or scratching. Keeping safety in mind is essential for nurses and caretakers. They should remember to put some distance between themselves and the patient and not allow themselves to become cornered or alone. Nurses should stay close to an exit or door and never turn their back to the patient.

While these tips may not completely eliminate all aggressive patient scenarios, they can reduce the chances that they will escalate to physical problems and major safety issues.

About Highland Risk

At Highland Risk, we use our expertise and experience to provide insurance information and programs to those who serve long-term care and senior living facilities. Since 2007, we’ve been offering insurance and risk management plans designed to help our agents give their clients the ability to achieve continued growth while simultaneously protecting against loss, containing costs and increasing profitability. With three offices to serve you in Chicago, Illinois; Phoenix, Arizona; and Burlington, Connecticut, we do everything we can to make your experience with us as professional and transparent as possible. To learn more, contact us at (877) 890-9301.