Conflict and disagreement exist in all relationships. For the elderly living in long term care facilities there is no exception.
When you have a community of people with a progressive cognitive disorder such as dementia living together, it is to be expected that unpredictable and difficult to control behaviors will arise.
Most nursing homes and other long term care facilities will face behavior management problems at one time or another.
Behavior Management is a process that guides people to change their actions within a specific time frame. This article offers suggestions for Leisure Coordinators and Activity Staff on how to cope with behaviors in the recreation area where many residents spend a good part of the day.
Disruptive behavior refers to inappropriate, vocal, and sometimes hostile behaviors. Whether it is intentional or not, it is a concern that impacts on everyone's quality of life. It can distress relatives, carers, friends, other residents and contribute to staff burnout.
Sometimes the cause of problem behavior is not related to any of the above. Instead, poor day-to-day interactions between clients and peers/staff/family/friends may prompt the undesirable behavior through misunderstanding, miscommunication, and unnoticed upsets such as:
A considered assessment may give you an understanding of the meaning of the behavior. Find out what may have happened a few hours ago or the previous day to identify early symptoms or triggers so that you can alter their course in the future.
Identify the behavior patterns in terms of frequency: every half hour, all day long, only when family visits, and how long the behavior lasts. Be objective in the description of a client's actions, and avoid vague terms, such as 'annoying' or 'strange behavior'.
There is no 'one size fits all' solution. Non-pharmacological interventions are the preferred approach. Use strategies that increase positive behavior and reduce negative behavior.
Related: Person-Centred Care
Related: Goal-Directed Behavior
Planned Ignoring is an intervention where attention is withdrawn until the behavior has improved. Staff should seek the authorization of Management or Senior Staff before implementing this intervention. It is combined with positive reinforcement for the desired response.
Planned Ignoring is used for repetitive questioning and other problem behaviors. 'Resident Behavior Charts' are used in conjunction with the 'Planned Ignoring' Intervention to monitor behavior over a period of weeks.
It is important that the relevant 'Resident Behavior Chart' (sample provided) is regularly updated so that a unified approach is possible among relevant staff.
Staff on all shifts should be made aware of problem behaviors so that they can work in unison. If choosing a 'Planned Ignoring' intervention; download the instructions provided and make available to staff from all shifts.
Be patient, sometimes the client has been behaving in this way for many months, or years, and it will take a few weeks or months for change to be noticed. Of course sometimes nothing works and you may have to ask assistance from clinical staff/management/doctor or attending psychologist.
Related: Difficult Behavior Care Plan
We'd love to hear your feedback!
How do you approach Behavior Management at your facility?