Category: Resident care

Using Humor to Reduce Agitation in Dementia Residents

A 2011 study by Australian researchers focused on the use of humor to reduce agitation in nursing home residents with dementia.  The Sydney Multisite Intervention of SmileBosses and ElderClowns (SMILE) study investigated the effect of providing humorous interactions with residents through the use of a character dressed like a bellhop, who kindly jokes with participants.  Residents who were initially silent and withdrawn became animated and engaged.

The researchers found a 20% reduction in agitation during the 12-week program, as compared to a control group.  Once the humor therapy concluded, happiness and positive behaviors returned to previous levels, but agitation levels were lower at the 26-week follow-up point.  The Arts Health Institute is training nursing home staff members in Australia to act as humor practitioners to continue this work.

For a more detailed article on the “humor doctors,” click here: The Arts Health Institute makes people with dementia SMILE.  To see a short trailer of the movie, click here: The Smile Within.

For Dr. El’s suggestions on reducing resident agitation, download my free report, “Stop Agitating the Residents! 17 Secrets from Psych That Will Transform Care on EVERY Shift.”

Depression Treatment in a Snap

“I watched them take my father into the ambulance on a stretcher, and it was then I realized that my mother didn’t make it.”  The TV was blaring as I entered the room for my session with Grace, who was being treated for depression.

“WHAT are you listening to?” I asked Grace incredulously, feeling my mood dip from 30 seconds of viewing the show.

“It was on,” she replied.

“Grace, you’ve got to be careful.  I don’t know if you’ve noticed, but living in a nursing home can be a little bit depressing.”  She smiled at my intentional understatement.  “You’ve got to balance life here with happy things.  I never watch shows like this because they make me depressed.  Although…there was the time when I was feeling sad after the breakup of a long relationship and I rented the movie Alive.  You know, the one where the airplane crashes and the people have to eat each other to survive.”

Grace nodded.  “I remember.”

“Yeah, I figured, by comparison, my life was going great.”

Graces’s laughter filled the room, and I shut off the TV to take it in.

Agitation and Dementia: Tips to Calm Residents

I read some helpful ideas on working with residents with dementia in the most recent Psychologists in Long-Term Care newsletter (Vol. 25, Issue 2-3).  Psychologist Nancy Hoffman, PsyD, discusses research findings and her interview with Lucy Andrews, RN, MS, owner of At Your Service Homecare in Santa Rosa, California.  The main points to consider:

• Agitation often reflects underlying physical needs such as thirst, hunger, or pain, or an undiagnosed infection such as a Urinary Tract Infection (UTI)
• Many LTC residents suffer from sensory deprivation, boredom, and loneliness
• Behavior interventions aim to treat to underlying needs that are causing inappropriate behavior
• We should provide positive attention when residents are calm so they don’t need to become agitated in order to gain attention
• It works better to distract agitated residents rather than to reason with them
• Soothing music, toys, gentle touch, or favorite personal items can be helpful coping tools for residents with dementia
• Asking closed questions is more effective than open-ended questions that can leave the resident struggling for an answer
• Reminiscence therapy focused on pleasant and meaningful experiences can address underlying emotional needs, as can therapeutic activities such as art, exercise, and music

Behavioral Geography: What Does Your Nursing Home Map Look Like?

When I was in college at the State University of New York at Albany, I took an intriguing course called Behavioral Geography. The professor taught us that how we used a place affected the way we mapped it in our brains. One of our assignments was to ask people we knew from different groups to draw a map of the city of Albany. The students I asked invariably featured the University prominently, and included lots of details like the apartments of friends, well-known downtown buildings, and favorite watering holes. My other group of maps came from patrons of the local Woolworth’s lunch counter where I served up coffee and tuna melts to pay for college expenses. (Yeah, this was back in the days of Woolworth’s, a now-defunct Walmart-ish store.) The people who frequented the lunch counter were mostly working class locals and outpatients from the local psychiatric center, and this really fun homeless guy who rolled cigarettes in the paper napkins, which let out plumes of smoke. (Yeah, this was in the days when you could smoke at a lunch counter in New York.) The maps drawn by my lunch counter friends were devoid of details such as street names and landmarks. My homeless man drew a single line with an X to represent the Woolworth’s on Central Avenue. I was shocked, and fascinated, by the disparity between the groups.

Now imagine drawing maps of the nursing home. My map, and those of staff members who work on many units like I do, would show lots of details – we get around the place. Other staff members, with specific floor assignments, might show the lobby, the lunchroom, and their particular floor. And what about the residents? The lucky few with motorized scooters or the ability to wheel themselves around might show their floor, the recreation area, rehab, and the backyard. Those with limited mobility might draw their floors and the recreation area if they attend scheduled activities. But I imagine others, if they could, would draw only their rooms, the shower room, and the dining area. Just a line with three Xs. What can we do to enlarge their worlds?

Nursing Home Bathing Transformed: Dr. El in Long-Term Living magazine

Check out my article in Long-Term Living Magazine this month: Resident Bathing Transformed: From Endurable to Enjoyable.  Interestingly, the perspectives of the residents and staff members I interviewed about showers in the nursing home corresponded with research on providing good customer service.  Click on the link, or paste this into your browser — http://tinyurl.com/5u757n2 — to read about the inexpensive and easy to implement suggestions for improvement.

Hearing Loss and Depression: Good News!

Me:  Mrs. Jones, Where Is Your Hearing Aid?

Mrs. Jones:  What?

Me:  YOUR HEARING AID!  WHERE IS IT?

Mrs. Jones:  The nurse has it in her closet.

Me:  I’LL BE RIGHT BACK!

Research shows that people with untreated hearing loss have a higher risk of depression than those wearing hearing aids.  I believe it.  Imagine sitting in the hallway and you can’t hear a thing your neighbor is telling you, while everyone around you is laughing at the joke.  Imagine the aides and the doctors talking to you and you realize it’s important, but have no idea what they’re saying.  So you ask again, still can’t hear, and then fake it, pretending to understand.

If our residents can’t hear, let’s put in an ENT consult and get the hearing aid process started.  And if they’ve got hearing aids, let’s take them out of the closet.

The good news is that a recent study showed that within three months of hearing aid use, residents showed a significant improvement in cognitive and psychosocial functioning.

Call Bell Crazy? 6 Tips for Taming Overuse

“Tired CNA” posted a comment on my blog, saying she wished there were something that could be done about alert residents who ring their call bells 30 times a day.  And there is.  Here are some suggestions:

1. Residents who ring their call bells frequently are often anxious, needing what seems like constant reassurance.  Quell their anxiety by visiting with them at the beginning of each shift, telling them who you are and when you’ll be by again next.  Check in on them when it’s relatively convenient for you so they don’t have to call and interrupt you when it isn’t.
2. Answering the call bell right away reduces resident anxiety and decreases the frequency of calling.  Ring, answer, ring, answer, even if it’s to say that help will be there in ten minutes.  Then show up in ten minutes.
3. I used to wait tables and there’d always be that group of diners who would wait until I’d returned from one request to give me a second, and then a third when I returned from the second.  I learned to ask “Is there anything else you need right now?”  Try this.
4. I provide “Call Bell Education” on the theory that the residents, most of whom have never been in a nursing home before, have no idea how much bell-ringing is considered “too frequent” by the staff (and some of them don’t use it when they should).  It’s better to do this in a calm, informative manner when the residents first arrive rather than waiting until everybody is aggravated.  As a CNA you could give them a ballpark figure of what’s considered reasonable during a shift, while assuring them that you’re there to meet their need for care.  Part of the education process is helping them to identify when it’s important to let the staff know they require assistance (for example, they need oxygen or to be changed) and when it might be better to “group” requests (for example, if they want the window closed and the TV station switched, and meds are coming in ten minutes, they might as well wait for the nurse).
5. If a resident continues to need a lot of assistance, consider moving them to a room closer to the nursing station, where staff members are more likely to pass by easily rather than having to walk all the way down the hall.
6. Consider a referral to the psychologist.  My residents know they will see me each week and can ask me for assistance with a wide variety of matters.  This significantly reduces their anxiety.  This week someone said to me, “I don’t know what I’d do without you.  I really feel like you’re listening to me, taking my concerns seriously, and getting things done to fix them.”  And I am.  Include the psychologist on your team, and any other staff and family members you can enlist to improve the situation.

Room Changes in the Nursing Home: A Customer Service Opportunity

“What the f***!”  Ms. Webster was red in the face, shouting at the nurse who’d just arrived for the evening shift.  “The day nurse told me I was moving to the third floor — now you tell me I’m not?  You people better get your s*** together!”  She began hurling onto the bed the belongings she’d gathered into a giant trash bag earlier in the day.  She muttered profanity as she did so.

“I’ll make some phone calls and find out what’s happening,” the evening nurse said nervously and then rushed out of the room.

There’s been a lot of attention paid recently to transitions in nursing care: moves between the hospital and nursing home, and moves between home and the hospital or nursing facility.  Another transition that deserves attention is room changes within the nursing home.  The importance of this passage is often overlooked, resulting in confusion, anxiety, and distress.  Properly handled, room changes are an opportunity to create a positive customer service experience within your facility.  Here are some points to consider:

• Prepare the resident (and family) for the change by informing them as far in advance as possible.
• Attend to the emotional reaction to the move, especially if it signals a shift from being a short-term resident to becoming a long-term resident.  Consider a psychology referral to facilitate adjustment to the new floor rather than waiting until problems become entrenched.
• Try to make room changes early in the day so that one shift handles the entire transition.
• Do an “idiot check” to make sure all property is transitioned to the new room.
• Label clothing quickly and make the resident aware of the reason the clothing is missing.
• Provide an introduction of staff and a pleasant welcome to the new unit to reduce anxiety.
• Introduce the transferred resident to another resident or two with whom they might get along.
• Ask a long-time resident on the floor to welcome the new resident.
• Create a policy that guides transitions so that “short-term” floors stay short-term, avoiding the resentments that crop up when one resident is reluctantly moved while another resident who has been there longer remains on a supposedly short-term floor.

Elderspeak and Resistance to Care

“Come on now, Vera, honey,” the nurse said in a high-pitched, sing-song voice, “be a good girl and take this nice candy.”

Vera swung her arm and knocked the tiny cups of pills to the floor.

In their 2009 study, Elderspeak Commnunication: Impact on Dementia Care, Kristine N. Williams, RN, PhD, and her colleagues report that resistiveness to care increases nursing home costs by 30%.   They examined the way nursing staff speak to residents and its impact on the level of cooperation of residents with dementia.  They found that residents became significantly more resistant to care when nursing staff used elements of elderspeak such as:

• simplistic vocabulary or grammar
• shortened sentences
• slowed speech
• elevated pitch or tone
• inappropriately intimate terms of endearment
• collective pronouns (“Are we ready for our bath?”)
• tag questions (“You want to get up now, don’t you?”)

Health Researchers: Call for Papers on Person-Centered Care

Call for Papers: The Clinical Gerontologist (Special Issue)

Person-Centered Care: Measurement, Implementation, and Outcomes

Person-centered care incorporates the unique life history of older adults and emphasizes relationships and communication. The past two decades has seen a rise in a desire to transform care of older adults from a task-centered to person-centered. However, there is a dearth of empirical research on measuring and implementing person-centered approaches, in addition to assessing the impact of person-centered care on mental health outcomes. In an effort to advance the existing literature on person-centered care, we invite authors to contribute original research papers that:

• Address issues surrounding defining and measuring person-centered care,

• Include empirical findings on the impact of person-centered care, and/or

• Address issues related to implementing person-centered care in long-term care settings

Manuscripts must include mental health implications. Authors are strongly encouraged to address how the findings might relate to diverse ethnic/racial groups. Multidisciplinary contributions are welcome.

Please send completed manuscripts to Associate Editor, Marie Savundranayagam at maries@uwm.edu.

Author Guidelines for The Clinical Gerontologist can be found at:

http://www.tandfonline.com/action/authorSubmission?journalCode=wcli20&page=instructions.

Associate Editor: Marie Y. Savundranayagam, PhD, Associate Professor
University of Wisconsin-Milwaukee
Submission Deadline: September 30, 2011
Print Publication Date: March 2012
Marie Y. Savundranayagam, Ph.D.
Associate Professor of Social Work
Associate Editor: The Clinical Gerontologist
Hartford Geriatric Social Work Faculty Scholar: Cohort VII
University of Wisconsin-Milwaukee
Helen Bader School of Social Welfare
1059 Enderis Hall
P.O. Box 786
Milwaukee, WI 53201
Phone: (414) 229-6034
Fax: (414) 229-5311
maries@uwm.edu
uwm.edu/hbssw/Faculty_Staff/savundranayagam.cfm