Long-Term Care

Tip of the week: Take necessary steps to prevent resident suicide

Contemporary Long-Term Care Weekly, October 23, 2008

Nursing home resident depression can lead to thoughts of dying, attempts at self harm, and, in some unfortunate cases, suicide. And the downward cycle can happen quickly. For example, consider an active, social, working woman. At 76-years old, she gets up every morning and walks two miles before driving herself to her job as a secretary for an oil company.

One day, the woman has a debilitating stroke. Now she must rely on another person to bathe, feed, and toilet her. She feels that she has lost her dignity and spirals into a deep depression. The joyous life that she once knew is gone.

Your nursing staff are the first line of defense against depression, which might lead a resident to attempt suicide. These are the same staff who must develop a care plan to prevent suicide, according to Holly Sox, RN, RAC-C, MDS coordinator at NHC Lexington in West Columbia, SC, and clinical services manager at Robintek in Worthington, OH.

Be a good detective

There is one type of resident who talks about killing him- or herself and actually has a plan to do so. There is another kind of resident who is depressed, but doesn’t have the ability to commit suicide, explains Carol Maher, RNC, RAC-C, director of clinical reimbursement for Ensign Facilities, Inc., an extension of the Ensign Group in Mission Viejo, CA. It takes good assessment skills to determine whether a resident is suicidal.

Make note that many elderly don’t like to complain about their situation or health problems, so staff should look for other warning signs, including



  • sitting in a dark room
  • talking to anyone about suicide
  • collecting items with which to commit the act, (e.g., cutlery, glassware, or medication)
  • asking guests to bring in weapons or items that could work as weapons (e.g., a knife with a loaf of bread)
  • stopping eating or taking medication


    “It’s always important to keep in contact with families of residents,” Maher says. Families often notice first when their relatives’ eating habits, moods, or sleeping patterns are different.

    Prevention is key

    Providing the safest environment possible is the first step to suicide prevention, says Sox.

    Once a resident expresses a desire to commit suicide, possible approaches to ensuring the resident’s safety are

  • providing a closely supervised atmosphere along with one-on-one care
  • removing harmful objects (e.g., cutlery, glassware, ballpoint pens, plastic bags, items with cords, shoelaces, etc.)
  • ensuring that the resident has swallowed all administered medication, so he or she can’t use it to overdose


    Get social services involved right away if you sense that a resident’s thoughts are veering toward suicide. Nursing and social services are the best departments to deal with suicidal residents, Sox says.

    Care plan particulars

    Both Maher and Sox agree that the goal of a suicide care plan is to minimize the risk for residents to hurt themselves.

    Be aware that there are different guidelines available when developing a care plan. If your facility has an accepted clinical practice policy or a plan in the policy and procedures manual, always turn to it first to develop your formal plan, recommends Sox.

    When documenting the problem in the care plan, Sox suggests stating that the resident has “the potential for harm to self—related to depression, bipolar disorder, etc.—as evidenced by a suicidal statement, repetitive suicide attempts, or a history of suicide attempts.”

    Once a resident exhibits suicidal tendencies, provide immediate and frequent evaluations. If the resident is actively suicidal, he or she needs to be evaluated daily to assess his or her status. Once the resident is out of immediate danger, you can spread out the time between evaluations to see how he or she improves, Sox says.

    Sox advises that nurses recognize when they are in over their heads. When one-on-one care with a potentially suicidal resident lasts for more than 24 hours, the resident should be admitted to an inpatient psychiatric unit.



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