Coping with Challenging                 Behaviors–     It’s How You Do What You Do that            Makes a Difference!    ...
What behaviors are we talking           about?• Examples…                                 2
What Are the Most Common Issues            That Come Up???•   Not going to the MD         •   Shadowing•   ‘Losing’ Import...
Why Do These Things Happen?• EVERYTHING is affected         • Dementia is predictable   –   Thoughts                     –...
Why Might These Things NOT             Happen?•   Dementia is individualistic•   The person ‘doesn’t have it in them…’•   ...
What Makes ‘STUFF’ Happen?• SIX pieces…  – The type & level of dementia … NOW  – The person & who they have been    • Pers...
What Can YOU Control? OR NOT! CONTROL…                    NOT CONTROL – The environment –         – The person & who   set...
For your persons with  problem behaviors…What are the behaviors that    ‘challenge’ you?                              8
But the REAL question        should be…Is this behavior dangerous?                              9
Does this behavior               create danger               for the person          or others in the setting?• YES –     ...
THEN…Use a Problem Solving ProcessKnow the personBuild Caregiver Skills & EducationCreate & Control the Environment       ...
How to Help withDangerous Behaviors?    Identify the behavior… Make sure – Is it dangerous?                               ...
Building                  Caregiver             Skills & Knowledge•   Understand dementia & its progression•   Know how sy...
What Do They Do?•   Question•   Refuse•   Release – verbal•   Intimidate – physical•   Tension reduction                  ...
What Should You Do?•   Be supportive•   Offer choices & be directive•   Set realistic limits•   Act – Take control•   Re-c...
Why will they do them?•   Physiological factors•   Physical factors•   Psychological factors•   Social factors            ...
Brain atrophy• the brain actually shrinks• cells wither then die• abilities are lost• with Alzheimer’s area of  loss are f...
Memory Loss   • Losses     –   Immediate recall     –   Attention to selected info     –   Recent events     –   Relations...
Understanding•   Losses     – Can’t interpret information     – Can’t make sense of words     – Gets off target•   Preserv...
Language    • Losses       – Can’t find the right words       – Word Salad       –    Vague language       –       Single ...
Impulse & Emotional Control• Losses  –   becomes labile & extreme  –   think it - say it  –   want it - do it  –   see it ...
Self-Care Skills• Losses  – initiation & termination  – tool manipulation  – sequencing• Preserved Abilities  – motions an...
Factors to Assess…• Level of dementia• Personal history• Health history• Caregiver approach &  assist• Environment• Schedu...
Progression of Cognitive Loss      •   What is lost      •   What is retained      •   What is typical behavior      •   W...
Give information• Keep it short and simple  – “ It’s lunch time”  – “Let’s go this way”  – “Here’s your socks”• Use famili...
Encourage Engagement• ask a person to try        •   use props or objects• ask a person to help       •   gesture  you    ...
Environmental Factors &       Changes   • Setting   • Props   • Programming                          27
Environmental Aids• Setting  – familiar  – friendly  – functional  – forgiving (safe)                                 28
Environmental Aids• Props  – visible & invisible  – timely  – available  – matched to ability  – matched to interests     ...
Daily Routines &      Client-Centered Programming•   Old habits and routines•   Patterns during the 24 hrs•   A time to re...
To Intervene…• Where will you start???  – An idea –     • caregiver education     • caregiver skill building              ...
Then…• Observe & document the risky behavior  thoroughly  – what is the pattern  – when does it happen  – where does it ha...
Is it really a problem?              … A danger• If NO - leave it alone• If YES - its time to problem solve  – call the te...
Explore all of the following -•   Type & level of dementia•   Personal background information•   Health information•   Car...
Re-look at the problematic    challenging behavior…• What does the person need?• What is the meaning of the behavior?• Do ...
Make a PLAN!•   Who will do what•   When will it be done•   How will it work•   What environmental change is needed•   Wha...
Implement your plan!  • Keep track of progress  • Document what is happening  • Communicate among the team members  • Reth...
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  1. 1. Coping with Challenging Behaviors– It’s How You Do What You Do that Makes a Difference! TeepaSnow.com© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County 1sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.
  2. 2. What behaviors are we talking about?• Examples… 2
  3. 3. What Are the Most Common Issues That Come Up???• Not going to the MD • Shadowing• ‘Losing’ Important Things • Eloping or Wandering• Getting Lost • No solid sleep time• Unsafe task performance • Getting ‘into’ things• Repeated calls & • Threatening caregivers contacts • Undressing• Refusing • Being rude• ‘Bad mouthing’ you to • Feeling ‘sick’ others • Striking out at others• Making up stories • Falls & injuries• Resisting care • Infections & pneumonias• Swearing & cursing • Seeing things & people• Making 911 calls • Not eating or drinking• Mixing day & night • Contractures & immobility3
  4. 4. Why Do These Things Happen?• EVERYTHING is affected • Dementia is predictable – Thoughts – Specific brain parts – Words – Typical spread – Actions – Some parts preserved – Feelings• It is progressive – More brain dies over time – Different parts get hit – Constant changing• It is variable – Moment to moment – Morning to night – Day to day – Person to person 4
  5. 5. Why Might These Things NOT Happen?• Dementia is individualistic• The person ‘doesn’t have it in them…’• The situation doesn’t come up• Other conditions keep it from happening• Caregivers have great skills• The dementia isn’t bad enough yet• You get LUCKY! 5
  6. 6. What Makes ‘STUFF’ Happen?• SIX pieces… – The type & level of dementia … NOW – The person & who they have been • Personality, preferences & history – The environment – setting, sound, sights – Other medical conditions & sensory status – The whole day… how things fit together – How the helper helps - • Approach, behaviors, words, actions, & reactions 6
  7. 7. What Can YOU Control? OR NOT! CONTROL… NOT CONTROL – The environment – – The person & who setting, sound, sights they have been • Personality, – The whole day… how preferences & history things fit together – The level of dementia … NOW – How the helper helps - • Approach, behaviors, words, actions, & – Other medical reactions conditions & sensory status 7
  8. 8. For your persons with problem behaviors…What are the behaviors that ‘challenge’ you? 8
  9. 9. But the REAL question should be…Is this behavior dangerous? 9
  10. 10. Does this behavior create danger for the person or others in the setting?• YES – • NO – – Then further – Give it up… – Don’t sweat it assessment and – Learn to live with it problem solving is – It’s a ‘So what?’ behavior – needed! different, but not dangerous! 10
  11. 11. THEN…Use a Problem Solving ProcessKnow the personBuild Caregiver Skills & EducationCreate & Control the Environment 11
  12. 12. How to Help withDangerous Behaviors? Identify the behavior… Make sure – Is it dangerous? 12
  13. 13. Building Caregiver Skills & Knowledge• Understand dementia & its progression• Know how symptoms affect behavior• Describe needs connected to behavior• Optimize interaction skills 13
  14. 14. What Do They Do?• Question• Refuse• Release – verbal• Intimidate – physical• Tension reduction 14
  15. 15. What Should You Do?• Be supportive• Offer choices & be directive• Set realistic limits• Act – Take control• Re-connect 15
  16. 16. Why will they do them?• Physiological factors• Physical factors• Psychological factors• Social factors 16
  17. 17. Brain atrophy• the brain actually shrinks• cells wither then die• abilities are lost• with Alzheimer’s area of loss are fairly predictable• … as is the progression• BUT the experience is individual… 17
  18. 18. Memory Loss • Losses – Immediate recall – Attention to selected info – Recent events – Relationships • Preserved abilities – Long ago memories – Confabulation! – Emotional memories – Motor memories 18
  19. 19. Understanding• Losses – Can’t interpret information – Can’t make sense of words – Gets off target• Preserved abilities – Can get facial expression – Hears tone of voice – Can get some non-verbals 19
  20. 20. Language • Losses – Can’t find the right words – Word Salad – Vague language – Single phrases – Sounds & vocalizing – Can’t make needs known • Preserved abilities – singing – automatic speech – Swearing/sex words/forbidden words 20
  21. 21. Impulse & Emotional Control• Losses – becomes labile & extreme – think it - say it – want it - do it – see it - use it• Preserved – desire to be respected – desire to be in control – regret after action 21
  22. 22. Self-Care Skills• Losses – initiation & termination – tool manipulation – sequencing• Preserved Abilities – motions and actions – the doing part – cued activity 22
  23. 23. Factors to Assess…• Level of dementia• Personal history• Health history• Caregiver approach & assist• Environment• Schedule & flow of the day 23
  24. 24. Progression of Cognitive Loss • What is lost • What is retained • What is typical behavior • What helps & works • Levels 5-1 24
  25. 25. Give information• Keep it short and simple – “ It’s lunch time” – “Let’s go this way” – “Here’s your socks”• Use familiar words and phrases• Use gestures and props to help 25
  26. 26. Encourage Engagement• ask a person to try • use props or objects• ask a person to help • gesture you • demonstrate• give simple positive • guide directions - 1 step at a • distract time • redirect 26
  27. 27. Environmental Factors & Changes • Setting • Props • Programming 27
  28. 28. Environmental Aids• Setting – familiar – friendly – functional – forgiving (safe) 28
  29. 29. Environmental Aids• Props – visible & invisible – timely – available – matched to ability – matched to interests 29
  30. 30. Daily Routines & Client-Centered Programming• Old habits and routines• Patterns during the 24 hrs• A time to rest, work, play…socialize• Your needs… my time 30
  31. 31. To Intervene…• Where will you start??? – An idea – • caregiver education • caregiver skill building 31
  32. 32. Then…• Observe & document the risky behavior thoroughly – what is the pattern – when does it happen – where does it happen – who is involved – what is said, done, attempted – what makes it better… worse 32
  33. 33. Is it really a problem? … A danger• If NO - leave it alone• If YES - its time to problem solve – call the team together – put on the thinking caps 33
  34. 34. Explore all of the following -• Type & level of dementia• Personal background information• Health information• Caregiver approach & assistance• Environmental issues• Habits, schedules & time of day 34
  35. 35. Re-look at the problematic challenging behavior…• What does the person need?• What is the meaning of the behavior?• Do you understand the behavior better? 35
  36. 36. Make a PLAN!• Who will do what• When will it be done• How will it work• What environmental change is needed• What props are needed - where will they be 36
  37. 37. Implement your plan! • Keep track of progress • Document what is happening • Communicate among the team members • Rethink - if it isn’t working…. • CELEBRATE - if it is!© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County 37sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.

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