Long-Term Care Survey Alert

Combine data analysis, creativity to improve resident well-being.

Understanding residents' behavioral symptoms and intervening in a helpful way can be a tall order. But you can make short work of it by using these two strategies.

1. Try to identify specific triggers for a behavior. Keep tracking records of the person's behaviors and what happened before the behavior, advises Christine Twombly, RN, a consultant with Reingruber & Company in St. Petersburg, FL. Also document and track what interventions the staff have tried -- and what's worked, she adds. That information is "very helpful in care planning," she says.

For example, you may see a resident's behaviors occur at the same time of day. If so, "the person may have an unmet need -- such as pain relief -- that has accumulated all day until he can't manage it anymore," says Twombly. If the resident tends to try to leave the facility at a certain time, "do a history to see what the person typically did at that time of day," Twombly suggests.

Example: One resident tried to leave each afternoon to meet her grandson at the bus, which she used to do when he was school-aged. "Engaging the resident in an activity around that time of day" can help eliminate so-called wandering behavior that actually is purposeful from the resident's point of view.

2. Step into the resident's reality, if possible, to understand the meaning of a behavior that doesn't appear to make sense. Twombly notes that experts in long-term care "used to talk about reality orientation but that's for people who are confused -- not for people with ongoing dementia. The focus in dementia care is now on entering the person's reality" to figure out what's going on with the person, she says.

A resident-centered solution: Twombly recounts how one resident -- a former nurse who worked in the era of starched white uniforms -- would get agitated at the sight of Twombly's nursing shoes "which weren't perfectly white due to the winter weather." So the staff care planned an activity where they gave the resident an opportunity to polish the white shoes each evening with supervision. The resident "appeared to enjoy the task and it eliminated her agitation. Each morning she'd proudly hand over the polished shoes," relays Twombly.