Preventing and Responding to Resident-to-Resident Harm in Residential Long-Term Care in Viet Nam: Early Recognition, Individualized Risk Assessment and Proportionate Protection

Preventing and Responding to Resident-to-Resident Harm in Residential Long-Term Care in Viet Nam: Early Recognition, Individualized Risk Assessment and Proportionate Protection

Two older residents have shared the same dining table for months. Recently, one has become visibly upset whenever the other approaches. Care workers have noticed raised voices and occasional arguments, but the disagreements usually end quickly. One afternoon, the situation escalates. One resident pushes the other, who loses balance and falls.

The immediate priority is to ensure that the person who fell receives appropriate assessment, care, and protection. But the incident also raises questions about what happened beforehand. Were there warning signs? Did staff recognize that tensions were increasing? Could changes to seating arrangements, daily routines, supervision, or the care environment have reduced the risk?

There is another difficult question. How can the facility protect the person who experienced harm without automatically treating the other resident as someone who must be punished, isolated, or removed?

These situations illustrate a challenging aspect of residential long-term care. Residents share living spaces and daily activities while having different health conditions, communication abilities, personal preferences, and levels of independence. Disagreements are sometimes unavoidable. Harmful interactions, however, should not be dismissed as an inevitable consequence of communal living, aging, or cognitive impairment.

For organizations providing residential long-term care in Viet Nam, preventing and responding to resident-to-resident harm requires early recognition, individualized assessment, timely protection, and appropriate organizational oversight.

The aim is not to eliminate every disagreement between people who live together. It is to recognize when interactions become unsafe, understand the circumstances contributing to harm, and protect the rights, dignity, and wellbeing of everyone involved.

Understanding Resident-to-Resident Harm

Resident-to-resident harm is a broad term describing situations in which the actions of one person receiving residential care cause, or create a meaningful risk of causing, harm to another resident.

Such harm may be physical, psychological, or sexual. It may also involve violations of privacy, personal boundaries, or property.

Some incidents are immediately recognizable. A resident may strike, push, threaten, or intimidate another person. Other situations are less visible. Someone may repeatedly enter another resident's private space, interfere with belongings, engage in persistent verbal harassment, or make unwanted sexual contact.

Not every disagreement or unpleasant interaction constitutes abuse. People living together may disagree about noise, shared facilities, seating arrangements, or personal habits without engaging in abusive conduct.

Nevertheless, repeated intimidation, serious threats, unwanted contact, and behavior that causes significant distress should not be minimized simply because there is no visible injury.

International research commonly uses the terms resident-to-resident aggression and resident-to-resident elder mistreatment. The Social Care Institute for Excellence (SCIE) uses the broader expression resident-to-resident harm and highlights an important conceptual distinction.

The World Health Organization's definition of elder abuse refers to harmful acts or omissions occurring within relationships where trust is expected. That expectation cannot automatically be assumed between two residents of a care facility.

This distinction is useful when considering terminology used in international literature. It does not mean that harmful conduct between residents cannot constitute abuse or another unlawful act under applicable national law.

For organizational quality and safety purposes, the term harm allows facilities to recognize concerning interactions without prematurely determining whether an event constitutes abuse, a criminal offense, or behavior associated with a particular medical condition.

This approach is particularly important when one or both residents have cognitive impairment, communication difficulties, or conditions that may affect their understanding and behavior.

The initial responsibility of the organization is to recognize the concern, protect those involved, and obtain appropriate assessment. Determining the clinical or legal significance of an event may require qualified professionals or competent authorities.

Why Resident-to-Resident Harm Deserves Attention

Residential care brings together people with different backgrounds, personalities, expectations, and support needs.

Some residents remain relatively independent and value privacy and control over their daily activities. Others depend on staff for personal care, communication, mobility, or supervision. Shared living can provide companionship and meaningful social participation, but it can also create circumstances in which personal boundaries are crossed or tensions develop.

A person sensitive to noise may become distressed in a crowded communal area. Someone living with dementia may enter another resident's room while searching for a familiar place. A resident who has difficulty communicating discomfort may react physically when another person approaches unexpectedly.

These situations require understanding, but they should not lead to assumptions that dementia or disability inevitably causes harmful behavior.

Cognitive impairment does not, by itself, establish that a person is dangerous. Equally, the absence of cognitive impairment does not prove that harmful conduct was intentional.

Resident-to-resident harm may involve several interacting factors, including individual health conditions, communication difficulties, interpersonal relationships, environmental pressures, staffing arrangements, and inadequate recognition of changing care needs.

A scoping review published by Bremer and colleagues in July 2026 examined risk factors for violence and institutional approaches to risk assessment in residential long-term care.

The review included 64 publications and identified four broad areas of concern: work organization and facility structures, resident-related factors, staff-related factors, and characteristics of the built environment. It also highlighted the limited evidence available for validated institutional risk assessment approaches.

These findings reinforce the need to look beyond individual labels. Knowing that a resident has previously been involved in a harmful interaction may be relevant to future assessment, but that history alone does not explain why another incident might occur or which preventive measures will work.

Understanding risk requires attention to the individual, relationships with others, the environment, and the way care is organized.

Recognizing Warning Signs Before Harm Escalates

Some serious incidents occur without obvious warning. In other cases, smaller changes suggest that an interaction is becoming unsafe.

A resident may begin avoiding particular communal spaces, become distressed when another person approaches, or withdraw from activities they previously enjoyed.

Care workers may notice repeated arguments, unwanted approaches, interference with personal belongings, or reports that someone has been threatening another resident.

Changes in sleep, unexplained distress, reluctance to leave a room, or fear associated with a particular person may also deserve sensitive inquiry.

None of these observations proves that abuse or violence has occurred. Similar changes may result from illness, pain, anxiety, grief, or other unmet needs. They should nevertheless be taken seriously rather than dismissed as ordinary behavior or inevitable consequences of aging.

Some residents cannot easily explain their experiences. Cognitive impairment, hearing difficulties, limited speech, fear of retaliation, or dependence on others may make disclosure difficult. Distress may be expressed through changes in behavior rather than a clear verbal account.

Care workers therefore need opportunities to share observations, particularly when several apparently minor events suggest a recurring pattern.

Families and visitors may also notice changes that are not apparent during routine care. Their observations can provide valuable information, although concerns should be assessed fairly rather than accepted or rejected solely because of who raises them.

Residents and staff should be able to report suspected harm without first having to prove what happened.

Early recognition does not mean monitoring every conversation or treating ordinary disagreements as serious incidents. It means understanding residents well enough to recognize when relationships, routines, or behavior may be changing in ways that affect safety.

Immediate Protection Comes Before Determining Responsibility

When one resident appears to be harming another, the immediate response should focus on preventing further injury and ensuring that anyone affected receives appropriate assistance.

Staff may need to interrupt the interaction, create safe distance between those involved, obtain additional help, or arrange urgent medical assessment.

The response should reflect the seriousness of the situation, the abilities and condition of the people involved, and the safety of staff and others nearby.

A resident who has been pushed, struck, or otherwise injured may require assessment by a qualified healthcare professional. Suspected fracture, head injury, loss of consciousness, significant bleeding, or other signs of serious deterioration require urgent attention.

The absence of visible injury does not necessarily mean that no harm occurred. Threatening or unwanted encounters may cause fear, humiliation, anxiety, or other psychological distress.

The affected person should receive reassurance, privacy, and an opportunity to communicate what happened without pressure.

The resident whose actions may have contributed to the incident also requires an appropriate response.

That person may be frightened, confused, injured, or experiencing an acute medical problem. Staff should avoid unnecessarily escalating the situation through confrontation, humiliation, or force.

Calm communication, reducing environmental stimulation, allowing appropriate personal space, and obtaining assistance from trained colleagues may help when circumstances permit.

However, workers should not attempt unsafe physical interventions or use restraint techniques beyond their lawful authority, training, and competence.

Protective action may need to be immediate, but conclusions about intent, diagnosis, or legal responsibility should not be made without an appropriate basis.

Once the immediate danger has been addressed, the organization can examine what happened and determine what further protection is needed.

Assessing the Needs of Both Residents

Resident-to-resident harm presents a particular challenge because both individuals may depend on the same facility for care, support, and protection.

The person who experienced harm may need medical assessment, emotional support, changes to daily arrangements, or reassurance that further unwanted contact will be prevented.

The resident whose behavior created a risk may need clinical assessment, communication support, environmental adjustments, or changes to their care plan.

These needs should be considered separately while recognizing how they affect one another.

Assessment of the person who experienced harm should consider physical injury, psychological distress, ongoing fear, personal preferences, and circumstances that might make recurrence more likely.

For example, someone who has experienced repeated intimidation may prefer to avoid a particular shared area temporarily. Another resident may wish to continue ordinary activities with additional staff support.

Their preferences should be taken seriously, alongside the facility's responsibility to prevent further harm.

Assessment of the resident whose actions may have caused harm should examine what happened before, during, and after the event.

Relevant information may include usual behavior, recent changes in health, communication abilities, previous interactions, personal preferences, possible unmet needs, and environmental conditions.

The review should not begin with an assumption that the resident is simply difficult or aggressive.

At the same time, understanding why harmful behavior occurred does not remove the need to protect others.

A person experiencing cognitive impairment may have difficulty understanding the consequences of certain actions. The facility nevertheless remains responsible for identifying and addressing resulting safety concerns within its legal and service obligations.

A fair response protects both residents without treating their needs as identical or allowing one person's difficulties to invalidate another person's experience.

Individualized assessment is generally more useful than applying the same disciplinary or restrictive response to every incident.

Considering Clinical, Cognitive, and Communication Factors

A new or escalating behavioral change may reflect an unmet need or an underlying health problem.

Pain, discomfort, infection, dehydration, medication effects, sleep disruption, sensory difficulties, and acute cognitive changes can sometimes contribute to distress or unusual behavior.

Delirium deserves particular attention because it can develop suddenly and may involve changes in attention, awareness, activity, or behavior.

An unexpected change should not automatically be attributed to dementia, personality, or a longstanding mental health condition. Appropriate clinical assessment may be necessary, particularly when behavior is new, severe, or accompanied by other changes in health.

However, medical explanations require careful interpretation. A diagnosis does not establish why a particular interaction occurred, and it should not be used to dismiss serious concerns.

Communication is equally important.

Someone with hearing impairment may misunderstand another person's words. A resident with poor vision may become startled by an unexpected approach. A person who cannot express discomfort clearly may become distressed when their personal space is entered.

The Queensland Health residential aged care clinical pathway on Behaviours of Concern, updated in July 2026, provides a useful example of an approach that considers physical health, cognitive functioning, emotional wellbeing, communication, environmental conditions, and personal circumstances together.

The pathway emphasizes identifying possible underlying health problems and unmet needs and developing individualized behavioral support.

These principles can inform local practice, but clinical assessment and treatment must remain within the responsibilities of appropriately qualified and authorized professionals.

For Vietnamese residential care providers, this highlights the importance of establishing reliable arrangements for obtaining healthcare advice rather than expecting care assistants to diagnose complex behavioral, neurological, or psychiatric conditions independently.

Understanding the Influence of the Care Environment

Not every harmful interaction begins with a problem involving one resident.

The way a facility organizes its environment and everyday activities can influence whether disagreements develop or escalate.

Crowded communal areas, excessive noise, limited privacy, poorly coordinated activities, and competition for shared resources may contribute to distress or tension.

The timing and location of activities can also matter.

A dining room may become stressful when several residents require assistance simultaneously. A narrow corridor may create difficulties for people using mobility aids. Confusion about private and communal spaces may lead to repeated unwanted encounters.

A study by Yan and colleagues, published in the December 2025 issue of the Journal of Environmental Psychology, examined resident-to-resident aggression and environmental characteristics in residential care facilities in Hong Kong.

The study analyzed cross-sectional information from 412 personal care workers across 29 facilities. It found strong associations between reported aggression and residents' behavioral disturbances. Among the environmental variables examined, indoor cleanliness was the only factor showing a statistically significant association in the adjusted analysis.

Most other environmental characteristics examined were not independently associated with aggression in that study.

Because the research was observational and relied on staff-reported information, its findings do not establish that environmental cleanliness or any other factor directly causes or prevents resident-to-resident aggression.

Nevertheless, the study illustrates the value of examining organizational and environmental conditions alongside individual needs rather than assuming that harmful interactions arise solely from residents' characteristics.

In practice, a facility may need to review how communal areas are used, whether supervision is sufficient at particular times, and whether residents have opportunities for privacy and meaningful activity.

Changes should be intended to improve safe participation, not simply keep people apart.

Removing residents from communal life whenever difficulties arise may reduce opportunities for companionship without addressing the underlying problem.

The aim is to create an environment where people can live together more safely while retaining choice, independence, and social connection.

Protecting Personal Boundaries and Responding to Sexual Harm

Some resident-to-resident incidents involve unwanted touching, sexual behavior, intimidation, or violations of personal privacy.

These situations require particular sensitivity because they may involve questions of consent, individual rights, cognitive functioning, and potentially serious unlawful conduct.

Older people retain rights relating to privacy, personal relationships, intimacy, and lawful personal choices. Living in a care facility or having a diagnosis of dementia does not automatically remove those rights.

At the same time, sexual interactions must be considered in light of consent, the person's ability to understand and make the relevant decision, freedom from coercion, and applicable law.

Unwanted sexual contact, intimidation, coercion, and suspected sexual assault must not be dismissed as harmless behavior or an ordinary consequence of cognitive impairment.

The facility's immediate responsibility is to protect anyone who may have experienced harm and arrange appropriate medical or psychological assessment when indicated.

Where serious sexual harm or possible criminal conduct is suspected, staff should follow applicable reporting and competent authority pathways. Relevant information and potential evidence should be handled appropriately without delaying necessary healthcare or protective action.

A person's ability to make a particular decision cannot be determined solely from a diagnosis.

Someone living with dementia may retain the ability to make certain personal decisions, while difficulties with understanding, communication, or coercion may affect the circumstances of a specific interaction.

Clinical decision-making abilities, civil legal capacity, legal representation, and consent to sexual activity are related but distinct questions. They must not be treated as interchangeable or determined solely by care workers' informal judgments.

Where legal capacity or representation is relevant, the applicable Vietnamese legal framework, including the Civil Code, must be considered.

Care workers should not attempt forensic interviews, make unsupported determinations of criminal responsibility, or resolve potentially serious sexual harm through informal mediation between residents.

Clear procedures are needed for protecting privacy, recognizing concerns, documenting relevant facts, and obtaining qualified assistance.

Respect for personal relationships and protection from sexual harm are both essential elements of dignified residential care.

Using Proportionate Protection Rather Than Automatic Restrictions

After a harmful incident, a facility may feel pressure to separate the residents permanently or restrict the movements of the person perceived as responsible.

Sometimes temporary changes to supervision, activities, or living arrangements are necessary to prevent further harm.

But restrictions should not become the automatic response to every event.

The appropriate approach depends on the seriousness of the risk, residents' needs and preferences, available alternatives, and the organization's lawful authority and capabilities.

For example, adjusting meal seating or providing additional supervision during a particular activity may reduce recurring tension.

Another situation may require a more comprehensive care plan, specialist clinical assessment, or changes to the care environment.

Where serious or persistent harm continues, management must consider whether existing arrangements can adequately protect everyone involved.

Measures involving physical restraint, involuntary treatment, isolation, or substantial restrictions on movement require particular scrutiny.

A resident should not be physically restrained, indefinitely isolated, or given sedating medication solely because their behavior is inconvenient or difficult for staff to manage.

Medication decisions require appropriate clinical assessment and authorization. Restrictive interventions, where legally permissible, require their own safeguards and cannot be justified simply by referring to a general need for safety.

Proportionate protection does not mean delaying action when immediate danger exists.

It means selecting measures justified by the circumstances, supported by an appropriate legal and professional basis, no more restrictive than reasonably necessary, and reviewed as conditions change.

The facility must protect the person exposed to harm without imposing unnecessary harm on another resident.

Making Individual Care Plans Responsive to Interpersonal Risks

Care plans can help translate individualized assessment into practical arrangements that staff can follow during everyday care.

Where harmful interactions have occurred, the plan may need to identify situations associated with distress, preferred communication approaches, appropriate supervision, environmental adjustments, and circumstances requiring further assessment.

For the resident who experienced harm, the plan may address emotional support, personal preferences, monitoring, and steps to reduce the likelihood of further unwanted contact.

For the resident whose behavior created a risk, the plan may focus on possible unmet needs, changes in health, communication support, environmental factors, and suitable preventive strategies.

These plans should not reduce people to labels such as aggressive resident or vulnerable victim.

Previous involvement in an incident may be relevant to future assessment, but it should not permanently define someone's identity or justify indiscriminate restrictions.

A useful care plan explains what staff are expected to do, who is responsible, and when the arrangements require review.

Instructions such as "monitor closely" or "avoid conflict" may be too vague to support consistent practice.

Equally, plans should not become so rigid that they fail to account for changes in a resident's abilities, preferences, or medical condition.

Where several staff members or service providers are involved, relevant information should be communicated appropriately between shifts and teams, with suitable confidentiality safeguards.

Review is particularly important after another incident, a significant change in health, or evidence that existing arrangements are not working.

The value of individualized planning lies in whether it supports safer everyday interactions, not merely in whether a document has been completed.

Listening to Residents and Families

Older people should have accessible ways to raise concerns about interactions with other residents.

Some may feel comfortable speaking with a familiar care worker. Others may prefer a manager, a family member, or someone they trust outside the immediate care team.

A concern should be taken seriously even when staff did not witness the event.

A resident may have difficulty describing what happened, particularly if they are frightened, have communication difficulties, or are living with cognitive impairment.

Staff should listen respectfully, avoid leading questions, and document relevant information accurately.

They should not promise absolute confidentiality where lawful reporting, investigation, or protective action may require information to be shared.

The affected person's wishes should be considered, but the facility may also have responsibilities to protect other residents or notify competent authorities in particular circumstances.

Families can provide useful information about usual behavior, preferences, communication needs, and recent changes.

However, being a family member does not automatically establish unrestricted access to another resident's health information or personal circumstances.

A relative whose family member has been injured may understandably want to know what happened and what the facility intends to do.

The organization should communicate appropriately about the affected person's care, protective arrangements, and follow-up while avoiding unnecessary disclosure of another resident's confidential information.

The resident whose conduct is under review also deserves fair treatment. Their account, communication needs, and legally relevant representation should be considered as appropriate.

A trustworthy process does not automatically accept the account of the more articulate resident, favor the family that complains most strongly, or dismiss concerns because someone has cognitive impairment.

The aim is to understand the circumstances as fairly as possible while maintaining appropriate protection.

Reporting, Documentation, and Legal Escalation

Resident-to-resident harm should be addressed through the organization's overall safety and incident management arrangements, with specific attention to interpersonal circumstances and the rights of everyone involved.

Staff should know how to report events they witness, concerns raised by residents or families, and situations in which harm is suspected but not yet established.

Immediate protection must take priority over documentation.

Once urgent needs have been addressed, relevant records should describe what was observed, what individuals reported, the condition of those affected, actions taken, and any continuing risks.

Firsthand observations should be distinguished from information provided by others. Where facts remain uncertain, that uncertainty should be stated rather than concealed.

Documentation should avoid premature conclusions about intent, clinical diagnosis, or criminal responsibility.

Serious incidents may require additional clinical assessment, management review, protective measures, or notification to competent authorities.

Internal reporting and external legal notification are not interchangeable.

Where serious violence, sexual harm, abuse, or potentially criminal conduct is suspected, the organization should follow appropriate legal pathways rather than treating the matter solely as an interpersonal disagreement.

An internal quality review must not obstruct lawful investigations or necessary protective action.

The absence of a formal complaint should not automatically end the matter. Some residents may be unable or unwilling to complain, particularly when they fear retaliation or further contact with the person involved.

Organizations need reporting arrangements that allow significant concerns to be recognized and addressed through more than one channel.

Legal and Regulatory Responsibilities in Viet Nam

Resident-to-resident harm must be considered within the Vietnamese legal framework relating to older people, social assistance services, healthcare activities, individual rights, and protection against unlawful conduct.

The Law on Older Persons No. 39/2009/QH12, as amended and reflected in Consolidated Document No. 23/VBHN-VPQH dated February 26, 2026, provides an important foundation.

Article 9 prohibits several acts against older people, including insulting, mistreating, humiliating, abusing, and discriminating against them, as well as certain infringements of their lawful rights.

The Article also prohibits retaliation or threats against people who assist older persons or identify, report, or prevent violations of the law against them.

These protections are relevant to residential care. However, Article 9 should not be interpreted as establishing a complete specialized reporting or investigation system for every incident involving two residents.

The appropriate legal response depends on the circumstances and the applicable provisions of civil, administrative, criminal, healthcare, and social assistance law.

For organizations legally classified as social assistance establishments, Government Decree No. 103/2017/ND-CP, as amended, remains part of the regulatory framework applicable as of November 2, 2026.

A new framework has been issued.

Government Decree No. 395/2026/ND-CP, dated October 23, 2026, regulates the operation and management of social assistance establishments and is scheduled to take effect on December 7, 2026.

From its effective date, the new Decree replaces Decree No. 103/2017/ND-CP. It also contains transitional provisions for facilities established and licensed under the previous framework.

Under Article 21, qualifying existing facilities may continue operating without completing the new initial activity notification procedure. They are given two years from the Decree's effective date to review their operations, ensure compliance with the new operational requirements, and report the results to the competent management authority.

These transitional arrangements must be read in conjunction with the Decree's applicable conditions and procedures. They should not be interpreted as a general exemption from other legal obligations or from the responsibility to protect people receiving care.

Facilities within its scope should review the new organizational, service, and resident protection requirements and prepare for implementation. Its provisions should not, however, be treated as already effective before December 7, 2026.

The legal classification of each provider remains important. A private residential accommodation business, a social assistance establishment, and a licensed healthcare facility may have different obligations depending on their actual activities and applicable regulations.

Where medical examination and treatment services are provided, the Law on Medical Examination and Treatment No. 15/2023/QH15 and relevant implementing regulations may also apply.

Clinical assessment, diagnosis, treatment, and medical decisions must remain within the responsibilities of appropriately qualified and authorized professionals.

The Civil Code No. 91/2015/QH13 may also be relevant to questions concerning civil legal capacity, representation, personal rights, and lawful decision-making. These matters should be assessed under the applicable provisions rather than inferred solely from a diagnosis or a resident's age.

Potential criminal conduct may be subject to the Criminal Code No. 100/2015/QH13, as amended, including Law No. 86/2025/QH15, depending on the facts and the relevant legal provisions.

A care organization should not attempt to determine criminal liability through an informal internal process. Such determinations belong to the competent authorities and legal procedures.

The facility's responsibility is to take appropriate protective action, document relevant information, cooperate with lawful investigations, and fulfill applicable notification duties.

Internal policies should support legal compliance, not imply that the organization possesses powers to investigate criminal offenses, detain, restrain, or impose sanctions beyond its lawful authority.

Protecting Privacy and Personal Information

Managing an incident involving two residents may require information about both individuals.

Care records may contain health conditions, cognitive assessments, medication details, personal histories, and other sensitive information.

The organization must handle these records carefully.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Government Decree No. 356/2025/ND-CP, both effective from January 1, 2026, are relevant to the lawful processing of personal data.

Facilities should establish appropriate legal grounds, access controls, security measures, and procedures for collecting, using, storing, retaining, and sharing incident-related information.

Information should be disclosed only where there is an appropriate lawful basis and to the extent necessary for legitimate care, protection, investigation, reporting, or other authorized purposes.

The use of cameras and digital monitoring systems also requires attention to privacy, lawful processing, proportionality, and resident dignity.

Monitoring should not become unrestricted surveillance merely because the organization wishes to prevent interpersonal harm. Private spaces and intimate care activities require particular protection.

Information shared with families must reflect the relevant person's rights, the recipient's legal authority, and the purpose of communication.

Confidentiality must also be managed alongside lawful reporting obligations and the need to protect people from serious harm.

The aim is to ensure that staff and authorized professionals have the information necessary for safe care without unnecessarily exposing residents' private lives.

What Recent Research Tells Us About Prevention

International research increasingly recognizes resident-to-resident harm as an important quality and safety concern in long-term care.

However, the evidence supporting specific prevention programs remains limited.

A systematic review by Falardeau and colleagues, published online in December 2023 in the Journal of Elder Abuse & Neglect, examined practices intended to prevent or respond to resident-to-resident aggression and promote wellbeing in congregate residential facilities.

Of 6,196 records initially identified, 28 studies met the review's inclusion criteria.

The authors found that relatively few practices were supported by sufficient evidence for widespread implementation. They emphasized the importance of continuing staff education, person-centered approaches, and organizational support.

More recent research offers additional insight.

A cluster-randomized trial by Teresi and colleagues, published online in January 2026 and in the March 2026 issue of the Journal of the American Geriatrics Society, evaluated a staff education intervention in 14 assisted living facilities in New York.

The study included reporting data concerning 930 residents and found improvements in staff knowledge, recognition, documentation, and reporting of resident-to-resident aggression.

These findings matter because incidents that are not recognized or documented may remain unaddressed.

However, an increase in reporting does not necessarily mean that harmful behavior became more frequent. Equally, improved reporting should not be interpreted as proof that the intervention reduced the true incidence of harm.

The July 2026 scoping review by Bremer and colleagues further highlighted the need for stronger evidence on institutional risk assessment methods.

Only three of the 64 publications included in that review focused on validation of risk assessments, illustrating the limitations of the available evidence.

Taken together, these studies support a practical but cautious conclusion.

Organizations do not need to wait for a universally validated prediction tool before addressing evident risks. They can strengthen recognition, communication, individualized assessment, staff competence, and organizational oversight using evidence-informed care principles.

At the same time, the effectiveness of local interventions should be evaluated rather than assumed.

Building Staff Competence Without Reinforcing Stigma

Care workers are often closest to the interactions occurring between residents.

They may notice small changes in behavior, recurring tensions, or situations that repeatedly cause distress.

Their observations are valuable, but preventing harm should not depend entirely on individual intuition or experience.

Staff need appropriate education and supervision to recognize concerning interactions, communicate respectfully, respond safely, and understand when additional support is necessary.

Training should distinguish ordinary disagreement from behavior that creates a meaningful risk of harm and from situations requiring urgent protective action.

It should also clarify the limits of staff responsibilities.

A care assistant should not be expected to diagnose the cause of complex behavior, conduct a specialist psychiatric assessment, or independently investigate a suspected criminal offense.

Workers should learn to consider possible unmet needs, communication difficulties, and environmental factors without allowing those explanations to minimize harm.

The language used in training and documentation matters.

Describing people living with dementia as inherently aggressive or dangerous reinforces stigma and may lead to inappropriate care.

Likewise, treating every resident with cognitive impairment as an unreliable witness can cause serious concerns to be overlooked.

A balanced approach recognizes individual differences without reducing residents to diagnoses or behavioral labels.

Training also needs organizational support.

Even well-trained workers may struggle to implement appropriate care arrangements when staffing is insufficient, supervision is inconsistent, or access to professional assessment is limited.

Managers should respond constructively when employees report that existing arrangements are not sufficient to protect residents.

An effective prevention system requires both staff who can recognize concerns and an organization capable of acting on them.

When Existing Care Arrangements Are No Longer Sufficient

Some situations remain difficult despite careful assessment, environmental changes, and individualized support.

A resident may continue to experience serious harm, or repeated incidents may indicate that the facility cannot reliably protect everyone under its current arrangements.

These circumstances require management review and, where appropriate, consultation with healthcare professionals, relevant social assistance services, families, legally authorized representatives, and competent authorities.

The organization may need additional staffing, changes to supervision, specialist clinical input, or different care arrangements.

In some cases, transfer to another suitable setting may need to be considered.

However, relocation should not be used automatically as punishment or simply as a convenient way to remove a resident whose needs are difficult to manage.

Any proposed transfer must consider the person's needs and preferences, the risks to others, the capabilities of the current and receiving facilities, and applicable legal, contractual, and care requirements.

Where legally required, appropriate representatives must be involved.

The receiving organization must be able to provide suitable care and manage the relevant risks.

Moving someone without understanding their underlying needs may simply transfer the problem to another location.

Equally, maintaining an unsuitable arrangement without adequate safeguards may expose residents and staff to continuing harm.

Responsible decisions balance the safety of others with individual rights, service capability, and lawful continuity of care.

Measuring Whether Residents Are Better Protected

The number of incident reports alone cannot establish whether a residential facility is safe.

An increase in reporting may reflect greater staff awareness, improved recognition, or more confidence in the reporting process.

Conversely, very few reports may indicate underrecognition, fear of speaking up, or inadequate documentation.

A more useful quality approach examines whether the organization identifies concerns, responds appropriately, and demonstrates improvements in residents' safety and wellbeing.

Facilities may review whether significant concerns are escalated promptly, whether affected residents receive appropriate assessment, and whether individualized risk assessments are completed when necessary.

They may also examine whether preventive actions are documented, communicated across care teams, and reviewed for effectiveness.

Repeated harmful interactions involving the same individuals, locations, or circumstances may indicate that earlier measures have not addressed the underlying problem.

The experiences of residents are particularly important.

Someone who continues to avoid a shared area because of fear may not feel safe even when no additional physical incident has been reported.

Likewise, a resident whose behavior has been associated with repeated conflict may experience unnecessary isolation or loss of meaningful activity if the facility responds poorly.

Quality evaluation should therefore consider safety, dignity, participation, and wellbeing for everyone affected.

Staff observations and family feedback can provide additional information, but they should be interpreted alongside direct assessment and other available evidence.

Comparisons between facilities require caution because residents' needs, service models, staffing arrangements, and reporting practices may differ considerably.

The objective is not to reward organizations for reporting fewer incidents. It is to determine whether important risks are being recognized and addressed effectively.

Making Resident-to-Resident Protection Part of Everyday Governance

Preventing resident-to-resident harm is not solely the responsibility of the worker who happens to witness an incident.

Facility leaders need to establish reliable arrangements for recognizing concerns, protecting affected residents, obtaining appropriate assessments, reviewing recurring risks, and making decisions that can be explained and justified.

This includes accessible reporting channels, practical staff training, appropriate supervision, and care planning processes that reflect changing resident needs.

Managers should also consider whether environmental conditions or work arrangements contribute to recurring problems.

If conflicts repeatedly occur in one communal area, the facility may need to examine how that space is used.

If several residents frequently need assistance at the same time and staff cannot respond adequately, the problem may involve work organization rather than one person's behavior.

Governance also requires fair treatment.

The organization should not automatically accept the account of the more articulate resident, favor the family that complains most strongly, or dismiss concerns because a resident has cognitive impairment.

All relevant accounts and evidence deserve appropriate consideration.

When an event involves serious harm or possible unlawful conduct, management must ensure that the necessary clinical, protective, and legal processes are followed.

Internal incident review, medical assessment, safeguarding activity, and formal legal investigation may overlap, but they serve different purposes.

Leadership must also examine whether protective measures create unintended harm.

Additional supervision may reduce risk, but excessive monitoring can undermine privacy. Temporary separation may be necessary, but prolonged exclusion from ordinary activities may contribute to loneliness or distress.

Good governance requires continuing attention to both protection and individual rights.

Building a Practical Approach for Viet Nam

Residential long-term care in Viet Nam includes organizations with different sizes, service models, workforce capabilities, and regulatory arrangements.

Some facilities provide nursing or clinical services through appropriately authorized professionals. Others primarily offer accommodation, personal assistance, and social support, relying on external healthcare providers when medical assessment is needed.

Their approaches to resident-to-resident harm should reflect these differences.

A smaller facility may not need a sophisticated behavioral risk assessment platform or a dedicated safeguarding department. It does need clear procedures for recognizing serious concerns, responding to immediate risks, obtaining professional support, and communicating relevant information between staff.

Larger organizations may require more formal multidisciplinary arrangements, particularly when residents have complex needs or repeated incidents involve several care teams.

Regardless of size, every provider needs a reliable way to determine whether its protective measures remain appropriate and effective.

International frameworks can help inform local implementation.

The Social Care Institute for Excellence provides useful analysis of resident-to-resident harm, including the importance of recognizing interpersonal, environmental, and organizational factors.

Australia's Serious Incident Response Scheme offers examples of how serious incidents involving older people can be addressed through provider accountability, reporting, and regulatory oversight.

However, the Australian framework operates under its own legislation. Its reporting categories, notification deadlines, and regulatory requirements should not be interpreted as automatically applicable in Viet Nam.

ISO 25557:2026, Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities, provides a broader international reference for person-centered care quality, individual preferences, participation, safety, and organizational responsibility.

These resources may help Vietnamese organizations develop quality improvement processes, staff education, and internal governance arrangements.

They do not establish a mandatory resident-to-resident harm reporting system for every residential care provider in Viet Nam or replace the requirements of applicable Vietnamese law.

For HLVN, the opportunity is to encourage care organizations to recognize interpersonal harm as a meaningful safety and quality concern rather than an unavoidable feature of communal living.

Protecting Residents Without Losing Sight of the Person

Residential long-term care should provide an environment where older people can live with appropriate support, security, and dignity.

Living alongside others can offer companionship, meaningful relationships, and a sense of community. It can also create situations in which different needs, preferences, and communication abilities lead to conflict.

A care organization cannot guarantee that residents will never disagree.

It can, however, recognize when interactions become harmful, respond promptly, and take reasonable steps to reduce the likelihood of recurrence.

A resident who has experienced harm deserves to be heard, assessed, and protected. A person whose actions have created danger also deserves an individualized response that considers their health, circumstances, abilities, and rights.

These responsibilities must be addressed together without allowing either to be overlooked.

For residential long-term care providers in Viet Nam, a reliable approach connects early recognition, individualized risk assessment, proportionate protection, appropriate professional involvement, and organizational accountability.

The measure of success is not whether a facility can claim that disagreements never occur.

It is whether residents can continue to live with reasonable safety, meaningful choice, and confidence that concerns will be addressed fairly.

High-quality care means protecting people from harm while continuing to recognize them as individuals, not simply as risks to be managed.

Key References and Regulatory Context

National Assembly of Viet Nam. (2009). Law on Older Persons No. 39/2009/QH12, as amended. Consolidated Document No. 23/VBHN-VPQH, February 26, 2026. Particularly Article 9 concerning prohibited acts against older people.

Government of Viet Nam. (2017). Decree No. 103/2017/ND-CP on the Establishment, Organization, Operation, Dissolution and Management of Social Assistance Establishments, as amended and applicable on the review date.

Government of Viet Nam. (2026). Decree No. 395/2026/ND-CP on the Operation and Management of Social Assistance Establishments. Issued October 23, 2026; scheduled to take effect December 7, 2026. Particularly Articles 20 and 21 concerning effectiveness and transitional provisions.

National Assembly of Viet Nam. (2023). Law on Medical Examination and Treatment No. 15/2023/QH15 and applicable implementing regulations.

National Assembly of Viet Nam. (2015). Civil Code No. 91/2015/QH13, as applicable.

National Assembly of Viet Nam. Criminal Code No. 100/2015/QH13, as amended, including Law No. 86/2025/QH15.

National Assembly of Viet Nam. (2025). Law on Personal Data Protection No. 91/2025/QH15. Effective January 1, 2026.

Government of Viet Nam. (2025). Decree No. 356/2025/ND-CP Detailing Certain Articles and Measures for Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

World Health Organization. (2024). Abuse of Older People. Fact sheet updated June 15, 2024.

Social Care Institute for Excellence. (2021). Resident-to-Resident Harm in Care Homes and Residential Settings.

Falardeau, M.-C., Beaulieu, M., Carbonneau, H., & Levasseur, M. (2023). Practices Countering Resident-to-Resident Aggression and Promoting Wellness Care for Older Adults in Congregate Residential Facilities: Results From a Systematic Review. Journal of Elder Abuse & Neglect, 35(4–5), 174–211. DOI: 10.1080/08946566.2023.2283746.

Teresi, J. A., Silver, S., Boratgis, G. D., et al. (2026). A Staff Intervention Targeting Resident-to-Resident Aggression in Assisted Living: A Cluster-Randomized Trial. Journal of the American Geriatrics Society, 74(3), 695–704. DOI: 10.1111/jgs.70268.

Bremer, L., Haeger, M., Eggert, S., Köpke, S., & Bergmann, A. (2026). Risk Factors and Risk Assessments for Violence in Residential Long-Term Care: A Scoping Review. Trauma, Violence, & Abuse. Published online July 21, 2026. DOI: 10.1177/15248380261462170.

Yan, E., Ng, H. K. L., Lai, D. W. L., et al. (2025). Living Environment and Resident-to-Resident Aggression in Long-Term Residential Care Facilities. Journal of Environmental Psychology, 108, 102822. DOI: 10.1016/j.jenvp.2025.102822.

Queensland Health. (2026). Behaviours of Concern. Residential Aged Care Clinical Pathways. Updated July 23, 2026.

Australian Aged Care Quality and Safety Commission. (2023). SIRS Insights Series — Unreasonable Use of Force: Notifications of Resident-to-Resident Incidents.

Australian Aged Care Quality and Safety Commission. Serious Incident Response Scheme. Current provider guidance and incident management information.

International Organization for Standardization. (2026). ISO 25557:2026 — Ageing Societies — Care Quality for Older Persons at Home and in Care Facilities.

About Healthy Longevity Vietnam

Healthy Longevity Vietnam (HLVN) is an independent initiative focused on advancing quality, safety, and implementation in age-friendly, integrated, and long-term care for older people in Viet Nam. Through evidence-informed approaches, quality improvement, measurement, and collaboration, HLVN supports healthcare and care organizations in developing safer, more coordinated, and person-centered care across settings.

Disclaimer

This article is intended for general education, quality improvement, and organizational development. It does not constitute individualized medical or psychological advice, behavioral treatment guidance, legal advice, authorization to use restrictive interventions, an official safeguarding protocol, or a mandatory national standard for residential long-term care in Viet Nam.

Resident-to-resident incidents require responses appropriate to the circumstances, including immediate protection, clinical assessment where indicated, lawful reporting, and involvement of competent authorities when necessary.

The presence of dementia, cognitive impairment, mental illness, or behavioral symptoms does not automatically establish that an individual is dangerous, lacks decision-making ability, or is legally responsible for a particular act.

Organizations must not use this article to justify inappropriate restraint, involuntary treatment, unlawful isolation, unnecessary relocation, or other unjustified restrictions on residents' rights.

Clinical assessment and treatment must be undertaken by appropriately qualified and authorized professionals. Suspected criminal conduct, sexual violations, serious abuse, and other legally significant events must be addressed through applicable legal and competent authority procedures.

Organizational duties depend on the provider's legal status, licensed activities, service arrangements, and the laws and regulations applicable to the circumstances.

Decree No. 395/2026/ND-CP was issued on October 23, 2026, and is scheduled to take effect on December 7, 2026. Its provisions must not be treated as already effective on the review date of this article. Organizations within its scope should also examine the relevant transitional arrangements.

International research, standards, and regulatory examples are provided as reference points. They do not replace Vietnamese law or establish automatically applicable reporting obligations, clinical procedures, or safeguarding powers.

Healthcare and long-term care organizations should develop locally appropriate policies with input from qualified clinical, social care, legal, and other relevant professionals, and seek direction from competent authorities where required.

Information and regulatory context reviewed as of November 2, 2026.