Behaviour Management Support for Long Term Care


As life expectancy extends, so does the time spent in a less functional body.  Long term care homes like Centennial Place seek ways to help their residents as they adapt to the inevitable physical and mental decline as centenary birthday celebrations become more common.

While there are many challenges facing caregivers for elderly residents, one of the more perplexing one is dealing effectively with erratic and sometimes inappropriate behaviour which is particularly difficult in a communal living setting.  Actions such as hitting, yelling, wandering, performing repetitious mannerisms and destroying property are ways to communicate an unmet need for an older adult dealing with dementia, complex mental illness, substance use and/or other neurological disorder and are referred to as Responsive Behaviours.  The term describes how these actions, words and gestures are a response to something important in the person’s personal, social or physical environment and often stem from changes in the brain affecting memory, judgement and mood.

After research into the problem in 2010, the Ministry of Health and Long-Term Care launched a program to enhance the availability of supports and services to persons living with responsive behaviours called Behavioural Supports Ontario (BSO), to find ways to improve health care services for older adults in Ontario with complex and responsive behaviours for professional caregivers as well as family members.

Photo Karen Graham

After a brief pilot program, Centennial Place received funding for a permanent Behaviour Support Co-ordinator and in November, Erin O’Brien took on the job.  With five years’ experience at the local long term care home, she was also responsible for the pilot program so she came to the job with plenty of ideas.

Her job is to direct residents’ energy to meaningful activities to reduce boredom and anxiety and increase residents’ feeling of well-being.  Her tools are very low-tech and everyone is happy to try non-pharmaceutical options to managing difficult behaviour.  Most ideas are customized for the individual, using past experiences as a source of inspiration to find meaningful activities to boost self-esteem.  Former homemakers find peace in a kitchen area where they can sort and put away groceries.  Many residents are calmed at bed-time with weighted blankets.

Some ideas are effective for groups of residents.  Pushing back against the trend in most public buildings where visitors are asked to be “scent-free”, Erin is using aromatherapy in quiet areas during activity times where the scent of lavender is put in a diffuser.  It is reputed to be a calming fragrance, and one that improves mood and enhances physical well-being.   Erin has noticed that both residents and staff seem to congregate in the areas where the fragrance is being released, providing evidence of its broad appeal.

With only a few weeks on the job, Erin is making plans to extend the program.  She particularly appreciates activities where youngsters visit the home, such as the toddler Music and Movement program, the annual Easter Egg Hunt and the North Cavan School children’s visit in December.  Her dream would be to have a playground on site where residents could watch children play and perhaps even participate themselves.

Erin compares residents exhibiting responsive behaviour to autistic children- they are trying to communicate and it is frustrating for both parties.  This new program will benefit all members of the Centennial Place family- residents, staff and family members- as they try to alleviate the anxiety, confusion and frustration that come when residents can’t make themselves understood.  KG

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