Tuesday, May 14, 2013


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:


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. 


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!

Monday, April 22, 2013

WHAT DO I SAY? - I’m good for nothing!

A family member recently asked me how in the world to respond to this comment made by her loved one with memory loss:  “I’M GOOD FOR NOTHING ANYMORE.”

Comments such as this are troublesome and very frustrating for both of you.  The initial, and normal, reaction is to disagree with them with a response such as “Oh no, that’s not true.  You’re still valuable to me.”

Unfortunately that doesn’t sit well!  It sounds like you are denying their feelings at best or arguing with them at worst.  The reaction often is increased frustration for all.

There IS a more successful approach.

Begin by meeting them where they are and showing you understand their feelings.  Remember with me a time in your life when you offered information to someone and they immediately told you that you were wrong.  Didn’t feel good I’ll bet.  Now add the dimension of memory loss.  The individual already feels a loss and a reply that doesn’t acknowledge that their information had value quickly heads the conversation south!

Sometimes your body language speaks louder than your words and will tell them you disagree with them.  Try using a caring, warm facial expression coupled with leaning toward them to demonstrate you heard them and do care what they are saying.

The next step is to make a comment such as “That must make you feel sad”; or “That’s got to frustrate you.”; or “Sounds like you are feeling really down.”  No need to rush, simply allow your concern to show.  Many times they will tell you more of what they are thinking.

I know you then want to say something.  Try a comment such as “I was thinking of the time you taught me to make perfect pie crust,” or “I was thinking how you held my hand when I was learning how to fish.”  Sit quietly and allow them to “feel” your support.

Your goal of course is calm, enjoyable conversations and going where they are is often the key.