Conflict and disagreement exist in all relationships. 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.
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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.

Related: How to Respond to Challenging Behavior

Behavior Management for Activity Coordinators

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

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.

Related: Sundowning: Symptoms, Triggers & Strategies

Common Factors Influencing Behavior in Dementia Care

  • Functional losses, handicap
  • Physical health (pain, discomfort and/or infection)
  • Cognitive deficit deterioration

Communication Strategies for Dementia Care

Possible Reasons for Problem Behaviors

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:

  • Ineffective use of discipline (harsh reaction to crisis, staff inconsistencies)
  • Ignoring or rewarding poor behavior
  • Perceived escalation of triggers (from the point of view of clients and others)
  • Overlooked body language
  • Guilt inducing message from family and/or peers
  • Antagonism between client and others
  • Environmental factors
  • Conflicting instructions (too many, too quick, too vague)

Related: How to Respond to Challenging Behavior

Assessment of Behavior

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'.

Managing Disruptive 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

How to Increase Positive Behavior

How to Reduce Disrupting Behaviors

Related: Goal-Directed Behavior

Positive Reinforcement Intervention

Tuning into desirable behaviors is an intervention that can increase positive behaviors and decrease negative behaviors.
  1. Observe client closely and when the opportunity arises, comment on positive behavior:
    • Describe the approved behavior – “Oh my, Betty, I really like the way you are cutting these pictures” - “This is wonderful Joe, please show me how you do it!”
    • Be enthusiastic and sincere
    • Smile and maintain eye contact with client at all times
  2. During activities and conversations and whilst doing chores or playing games, reward the client with social approval and attention e.g. asking questions related to the activity, and complimenting them on performance as above.
  3. Take an interest in what clients are doing. Clients usually appreciate your attention and this can be a powerful motivator.
  4. Initially, attend to clients immediately and often when reinforcing positive behavior.
  5. Remember that non-verbal behavior can convey a great deal of meaning to clients. e.g. sitting by client or standing nearby, touching, joining in activity, smiling.

Planned Ignoring Intervention

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.

A Unified Approach is Important

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?

Files included:

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Planned Ignoring Intervention PDF

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Resident Behavior Chart PDF

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Comments   Post a Comment

Sharon Gronow 28th Nov 2016
I feel the topic of "Behaviour Management" and the approaches recommended are quite sad and very out of date. I would suggest reading the books written by Dr Allen Power and Dr William (Bill)Thomas from the organisation The Eden Alternative . Also check out the work of Dr David Sheard (Dementia care matters UK). It should never be about Behaviour Management but Trigger management and knowing your person well in as many aspects of their past and present life . Repetition comes with Alzheimer's Disease and often boredom. Repetition and other responses to people or situations are sometimes the only way the person can communicate. David Sheard suggests looking upon it as the person lodging a complaint. I would suggest that when the person smiles or interacts in a happy contented way that can also be considered an approval. To ignore another human being who is not aware they have already asked you something is cruel. I work for one of the peak bodies in dementia in Australia and this would not be considered best practice. I would also suggest that when you have tried working through a variety of positive strategies without success that the (unfortunately named) Dementia Behaviour Management Advisory Service (DBMAS) be contacted. They work with a non pharmacological approach and are now situated within Hammond Care across Australia. Finally rather than 'planned ignoring' we would suggest 'prescribed regular attention'. Shaz
Solange 28th Nov 2016 Diversional Therapist
Hi Sharon, thank you for your input. It is comforting to know that new approaches to Dementia Care is constantly being sought. With a little education and consultation these new principles and practices will replace the old fashion method to support the unique needs of clients living with dementia. Best wishes!
Joy 3rd Aug 2016 Diversional Therapist
Your information on "Ignored Behaviour" was very interesting and are now applying this to our Dementia Wing with some difficult residents.................this has worked with two of our residents so far..............of course not every time.
Talita 4th Aug 2016
That's really great to hear Joy! Thanks so much for your feedback.
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