MDS Alert

This simple approach can provide the answer to why a resident is behaving aggressively.

If a resident's behavioral symptoms don't seem to have any clear-cut cause, you may be able to pick up clues by looking at when they tend to occur.

To do that, use a scatter plot to analyze a resident's behaviors, advises Michael Partie, a behavioral expert and director of Therapeutic Options in Newark, Del. Start by identifying the behavioral issue you want to examine -- "for example, Joe becoming verbally aggressive with others."

Next step: Make a chart of each day by the hour. "When the incident you're investigating occurs, put a dot," Partie advises. Then "over a course of a week or two, look at where the dots cluster."

You may find a concentration of dots at certain times of the day, which narrows your focus, Partie says. If so, take a look at what's going on at those times that could "lend themselves to the behavior." For example, "maybe people are always entering the dayroom and residents have more free movement while staff passes meds and gets meal trays out."

More possibilities: Does the resident always become irritable a few hours after lunch? "In that case, he might have low blood sugar and need a protein snack and more protein at meals." Did the person change his medication schedule so the medication disrupts his sleep at night? Perhaps he's exhausted and competing for access to things when there's less supervision, Partie points out.

You can also use an Antecedent-Behavior-Consequences approach to analyzing behaviors, Partie suggests. That's where you identify the patterns involved not only in the conflict itself, but also in events leading up to it, he explains.

Example: Suppose you see that certain residents get angry at Joe because he takes too long to select his food in a cafeteria line, Partie says. You could "orchestrate when Joe enters the line," he advises. For example, perhaps Joe can come after others or a little before they get in line.