- Is the behavior truly a problem?
- Whose problem is it: the resident’s, other residents’, the staff?
- Is it a matter of safety to the patient or to others?
- Most of the time, it’s not a problem, it’s just not “normal” behavior
- Is there actually meaning to the resident’s behavior?
- Are they reacting to someone else’s bad behavior? When they start the behavior (yelling, crying, etc.), ask yourself, “What did I (or someone else) do that might have initiated this?”
- Most of the time, the resident is simply reacting to us
- What has changed that might be contributing to the person’s behavior?
- Explore the “whys” of actions. The resident’s behavior could be related to many things – emotions, environment, unmet needs, or even you, the caregiver
- Be aware. If the resident is confined to a wheelchair, for example, think about how it feels to no longer be able to move around on their own. How might that influence their actions?
Changing Our Behavior: Help Improve CMS Survey Compliance and Quality of Life through Enhanced Dementia Patient Care
Current reports indicate that 60 percent of nursing home residents1 and 42 percent of assisted living facility residents have Alzheimer’s or another form of dementia.2 Nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias, and these costs are expected to increase more than 400 percent by 2050.1
Alzheimer’s and dementia are often viewed as strictly medical problems, with the need to find a medical solution. While there are conditions that can increase the symptoms of Alzheimer’s and dementia – medications, UTI, constipation, dehydration – it’s important to see this not as just a medical problem. In working with patients suffering from Alzheimer’s or dementia, improving care giving and communication are of parallel importance.
Behavior is a form of communication
The term “behavior” in Alzheimer’s or dementia patients is often associated with negativity. The behavior of patients with these conditions is frequently viewed as challenging, and clinicians often feel the need to manage them. But patients are often acting quite normal for the situation they are in. For example, when someone says they want to go home, some people in the early stages of Alzheimer’s or dementia are literally thinking about the home they just left. But people in the next stage may be thinking about the home where they grew up in Germany, “I want to go to that home.” They can’t necessarily verbalize what has happened.
CMS expanding use of the Focused Dementia Care Survey
In 2015, CMS expanded the use of the Focused Dementia Care Survey in select states, which looks at compliance with federal requirements related to dementia care practices in nursing homes. As a result, CMS revised the survey materials and tools based on surveyor feedback and data analysis. The following care tips for persons with Alzheimer’s and dementia go beyond compliance of the federal requirements with ideas that will also enhance the quality of life for these patients.
1. Be a detective – look at what you can change.
- Huddle with staff. Talk about what has been noticable – are there observable patterns? Same time, same person, same room?
- Educate the team, including residents and family, to help them understand that expressions of distress are often a form of communication for a person with dementia.
2. Being a model can make a huge difference.
- Consistently practice the right approach – really listen, without jumping to conclusions. What is this person trying to tell us?
- Encourage maximal independence; try to refrain from performing activities/care routines that the resident could perform alone if given adequate time and task segmentation
3. Find a response that is not “NO.”
- Think about ways to instead to give a “YES.” Use the “yes” to validate and empathize with the request and then use “and” to redirect. Example: “I want to go home.” “Okay, tell me about your home. And let’s get a sweater because it’s cold in here.”
- Redirect the resident away from a high-stress environment
4. Make eye-to-eye contact.
- Sit down to talk with the person instead of standing over them – be at their eye level. Use a soft, low voice and speak where the resident may read your lips/see your face clearly
- Don’t approach a resident from behind, which may startle them. Ask permission to talk with them; ask if they would like to do something you want them to do, instead of just doing it
5. Work on building more trust with your residents.
- Allow a resident to remain in a preferred location/environment (e.g., to remain in bed) if safe, and recognize this as a preference/choice, even in someone who has dementia
- Appropriately limit choices to avoid frustration and confusion and build understanding and trust to help minimize potential issues
Products for Alzheimer’s and dementia care
The below suggested products and routines can help improve care and quality of life for residents with Alzheimer’s or dementia.
- Hand massages or back rubs with scented lotions such as THERATM Moisturizing Body Cream or BOA VIDA Recovery Cream
- Sensory Stimulation Tray – bright stars in water-based gel helps calm agitated residents by providing tactile and visual stimulation
- Activity pillow – designed especially for Alzheimer’s and dementia patients; staff engages residents in activities such as zipping, buttoning, hook & loop fastening and buckling
- Fleece/lambskin/soft flannel vest or “snuggy” for non-verbal, non-ambulatory residents
- Glow-in-the-dark strips for flooring on path to bathroom for nighttime visits
- Bathing products to ease the distress or trauma of bathing, such as calming aromatherapy misters (particularly lavendar), warming bath mats, bathroom screens that project calming images (nature scenes, colors, favorite hobbies)
Related Clinical Connection Webinar
1: Alzheimer’s Association 2015 Facts & Figures Report, www.alz.org; www.alz.org/join_the_cause_special_care_units.asp
Changing Our Behavior: Being With Persons Who Are Living With Dementia, Karen Stobbe, McKesson Clinical Webinar, February 11, 2016
2: Dementia Survey-and-Cert-Letter-16-04, Centers for Medicare & Medicaid Services, November 27, 2015.
Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.