1. Managing Difficult Behaviors in a Dementia Care Setting Alison L. Ray Divisional Dementia Care Manager Brookdale

2. It’s a Need, Not a Behavior Objectives: What are our “perceived challenging behaviors” we face as caregivers? Are they behaviors or communication? What can we do to manage the behavioral expressions of the person with dementia and still provide safety for all residents? 2

3. Behavioral Expressions verses Difficult Behaviors Need verses an initial negative word of behavior Can we manage difficult behaviors or should we be proactive prior to the “expression/behavior”? –What does this look like to be proactive or person centered prior to the behavioral expression 3

4. What are behavioral expressions we face? Yelling Hitting Eliminating in inappropriate areas Refusing care Wandering Spitting Eating/drinking non- food items Inappropriate sexual behaviors Swearing Repetition Restlessness/Agitation Suspiciousness Sleep disturbances 4

5. What is the need behind the behavior? Stop judging and become curious: Who? What? Where? When? Why? Need to develop a detective mentality… 5

6. Questions to explore: Is it an unmet physical need? Hungry? Thirsty? In pain? Looking for a bathroom? 6

7. Questions to explore: Is it the environment? Too loud or noisy? Too hot, too cold? Distracting visually? (Shadows cause distress) 7

8. Questions to explore: Is it the task they have been asked to do? Physical challenges? Unable to decide/understand what to do next? Are they frustrated? (can’t express themselves, don’t understand what you want them to do.) Expressive aphasia Receptive aphasia 8

9. Questions to explore: Is it how we are communicating to them? Speaking too fast, not loud enough Using too many directions Non-verbal appearance doesn’t match with what is being said Is there a language/accent barrier? 9

10. So how to get to the need behind the behavioral expression? Be a detective Ask basic questions, look for common patterns Ask yourself, what would I feel? What would I feel and what would I need? How could you meet my need? 10

11. How do we utilize person centered interventions once we know the need behind expressions? Identify patterns/share them with others. Then, intervene BEFORE the expression emerges – You must redirect the resident to “something purposeful”, not just move them to a different place. Use their history as a means of refocusing their thoughts. Create a program box with their “special items” in it to use during challenging times. Give resident favorite food or drink as part of their daily routine not when resident is upset 11

12. If the behavior expression emerges, now what? Change the scenery Go to another room turn on soft quiet music and discuss new things in the room Ask someone else to step in: a fresh face. Take a walk, a drive Meet basic needs: offer coffee and cookie, juice, water, ice cream (comfort foods), offer the bathroom Validate the persons feelings Offer your hand 12

13. If the behavior emerges, now what? Assess for underlying pain: Look at footwear, denture fit, clothing fit, diagnoses…administer pain meds as ordered. Initiate a new activity: give something purposeful to do which has meaning to them. Evaluate the behavior: Is it dangerous? Who is it bothering…you? The person with dementia should be able to display their dementia. 13

14. Other ideas of interventions Ask permission from person with dementia for all tasks Write a letter for the person who has dementia reassuring them (can be from family or doctor) Video/audio tape family members telling a story or reassuring the resident. DVD of the grandchildren, spouse or friend Encourage meaningful/purposeful activities (meaning must be created in the present moment) Provide meaningful things for them to do Slow down and listen (allow the person with dementia time to respond) Focus on abilities (repetitive, sorting, etc) 14

15. It’s a Need not a Behavior Summary Ask questions and get to the need behind the behavior. –Who, what, where, when, why? –Is it an unmet physical need? Environment? Task too hard? Communication? Pain? –Use knowledge of their history. –Ask what would “I” feel, need, if I were in their shoes. –Look for warning signs and patterns and intervene before the behavior emerges. –Give yourself a break, use respite, ask help from other caregivers. 15

16. Questions? 16