Diana believes that the key to behavior management lies in the ability to determine the resident's motivation for their actions, i.e. striking out at staff. Only when healthcare providers understand that motivation and then see their role as assisting the resident to reach their goal will success in reducing challenging behaviors, without the use of antipsychotics, be realized.
Diana offers many practical and immediately useable tips for behavior management of individuals with dementia.
Although each recommendation is priceless (just ask Diana!) here are a few that Diana would suggest that you commit to memory:
ALL BEHAVIOR IS MOTIVATED.
1. Freedom from the use of antipsychotic medications to manage a resident behavior will occur only when facility staff are empowered to look at the person's motivation for their actions.
Unless and until the staff address the person's motivation for their actions, managing challenging behaviors will continue to be seen as a failure to staff members. Although it is a well-known fact that antipsychotics are not indicated for use with individuals with dementia, lack of alternative interventions continues to plague long term care professionals.
HOW WOULD YOU MANAGE THESE BEHAVIORS?
1. The resident strikes out at caregivers. This is one of the "reasons" we used to support the use of antipsychotics.
Diana suggests often the behavior is motivated by the staff's approach and conversation. Learning what the striking out behavior means coupled with appropriate communication techniques will lead to determining the root cause and providing vital information on how the staff can alter their approach. This results in a successful outcome for both the person and the staff member.
2. A resident likes to sit on the floor instead of sitting in a chair.
There is a faction at the facility that believes she should not sit on the floor and have instituted restraining shoulder harnesses to keep her sitting in a chair instead.
Diana suggests let her sit on the floor! Care plan it. Have a Physical Therapist perform an assessment on her ability to get on the floor and then get back up to determine where she will need help. Then outline a plan to help her to meet her goal successfully.
3. A resident gets very upset when we try to bath her. Currently we have quite a "battle" with her. Not only is it challenging for her, it is very challenging for staff.
Diana suggests several alternatives. Consider rinse-less soap; changing the words you use from "shower" to "bath"; reducing bathing from a total bath to washing body areas that cause odors such as hair and perineum; involving her is an activity where she gets "dirty" such as kneading bread or replanting a plant.
1. The five hundred pound gorilla in the room is the percentage of residents in a facility with Cognitive Loss.
The national average is approximately 80%. There is no diagnosis, syndrome or symptom that affects any where near that many residents. Long term care staff members must become dementia experts if care is to meet the unique needs of this population.
2. Knowing a resident’s cognitive functional age is vital.
Two standardized and validated tests are: ALLEN COGNITIVE LEVELS www.allen-cognitive-network.org and RCCT www.clocktestrcct.com. For more information on these tests, please visit these two websites.
Want to ask Diana a specific question? Visit her Contact Us page and ask away!