Dementia resident hoarding, shredding, destroying toilet paper

Specialties Geriatric

Published

Specializes in geriatrics.

I need some advice please. I have a new resident who has an almost compulsive habit of destroying rolls upon rolls upon rolls of toilet paper in his room. He is stuffing the paper in his pants. When asked why, he replied "why, are you jealous?" then stated it was for his rash. He doesn't have any skin breakdown. His son brought in looser fitting underwear thinking maybe it was chafing his groin, but no luck. That wouldn't be such a big issue, but he is also ripping and shredding the TP and using it as room decoration. hanging it from his blinds, placing it on flat surfaces, throwing it all over the floor, etc. When he runs out, he asks for more. If we do not give it to him, he goes to other resident rooms to take theirs. He has been very pleasant so far, but quiet and VERY difficult to engage in any sort of conversation or activities. Has anyone out there run into this kind of behavior? What helped?

Specializes in LTC,Hospice/palliative care,acute care.

We would get a psych consult and begin treatment for OCD,that's what is sounds like. Lots of meds available with few side effects.

In the meanwhile maybe provide him with old newspapers, wrapping paper, etc. and ask him 'hey- would you mind helping us make confetti for our birthday parties- you can put it all in this big box here'? If he hasn't really lost some (all?) of his marbles, maybe he's bored. Is activities working with him?

We would get a psych consult and begin treatment for OCD,that's what is sounds like. Lots of meds available with few side effects.

The problem with this is that it actually sounds like typical dementia behavior. If it is not causing harm to the resident or to others, then there is not a good reason to medicate, simply because it is bothersome to the staff. In fact, State Surveyors are starting to look long and hard on unnecessary use of anti-psychotics. There are only four categories that anti-psychotics should be used in LTC: Huntington's Disease, Tourette's, Bipolar D/O, Schizophrenia/Major Psychosis.

I know that with our facility, we do have some resident's that are on anti-psychotics for dementia with behaviors, however, again, these residents can do harm to themselves and to other residents. That is why they are on those medications. We don't medicate just because someone likes to shred paper. That is a harmless behavior.

Keep attempting to engage the resident. Have activities become more involved with his plan of care. Talk to family to find out what his occupation, hobbies, likes and dislikes were. What is the environment like in your unit? Is there too much stimulus that is causing him to be nervous? Is it TOO quiet and not enough stimulus to cause him to be bored? Is he in a secured unit and is it the most appropriate unit for him?

Get your IDT involved as well. Maybe he could use a Restorative Nursing Program. Activities, again. They could do One on One visits, or try other activities such as Aromatherapy and Music Therapy.

The point is that there are a lot of other things you could and should be doing, before resorting to medication.

Specializes in Acute Mental Health.

That doesn't sound like typical dementia behavior to me. I would request the doc evaluate and see if pt needs a psych consult. Does he do this throughout the day or just certain times of the day?

Nothing in his work life that including shredding or ?

Hmmmm, tearing up roll after roll of tp is going to get someone concerned. Reads as though he is pleasant but a bit difficult to redirect. Going into other residents rooms is going to become a problem. Most don't like others in their room. I just wonder if a prn would help if the bx occurs at a certain time daily.

I would care plan the behavior and get a psych consult. Ask the family about the residents history regarding habits, or even the kind of job that they had, it may be related to the behavior.

I work in Assisted living for memory care only. I love it. We also have a resident with roll upon roll of toilet paper issues. Only my resident is causing plumbing problems with it and the cardboard center. The best we can do, as difficult as it is, try try try to redirect. The confetti is a good idea. If your resident is thinking there is a rash it won't hurt to advise him the doc changed the treatment from the use of toilet tissue padding to a special cream. Use barrier cream. No Rx needed. Not harmful. And you are not medicating your resident. We only use medicine when the resident is uncomfortable or a harm to others. Yes, visiting other apartments can become a larger issue, but avoid meds. Ask the family what might he like to do. Checkers, dominos? Get as much info on him as you can to use to come up with a valid redirection that is good for this resident. Lots of luck!

It is typical dementia behavior. I take it some of you never had 24/7 experience with someone other than a resident and a 8 or 12 hour shift where you get to go home. No offense but it amazes me how many people work in LTC and such yet have no clue as to what is typical dementia behavior. I had one CNA that had no clue that not showering or taking a bath was typical dementia behavior or you have the people who think they should be treated as children. They're not and it irritates me to no end when it happens. Or the people that post about how their residents are medicated because it makes their job easier.

You guys need to visit an Alzheimer's forum and read up on what IS typical dementia behavior and what 24/7 caregivers go through.

The problem with this is that it actually sounds like typical dementia behavior. If it is not causing harm to the resident or to others, then there is not a good reason to medicate, simply because it is bothersome to the staff. In fact, State Surveyors are starting to look long and hard on unnecessary use of anti-psychotics. There are only four categories that anti-psychotics should be used in LTC: Huntington's Disease, Tourette's, Bipolar D/O, Schizophrenia/Major Psychosis.

I know that with our facility, we do have some resident's that are on anti-psychotics for dementia with behaviors, however, again, these residents can do harm to themselves and to other residents. That is why they are on those medications. We don't medicate just because someone likes to shred paper. That is a harmless behavior.

Well, it seems to me that the problem is not with the resident but with the people who have not had proper training when it comes to residents with dementia. Medicating them can cause more harm than good and often are the cause of falls.

And you're right, they are taking more of a look at unnecessary medication.

You sound like someone who does know a lot about their behavior:)

It is typical dementia behavior. I take it some of you never had 24/7 experience with someone other than a resident and a 8 or 12 hour shift where you get to go home. No offense but it amazes me how many people work in LTC and such yet have no clue as to what is typical dementia behavior. I had one CNA that had no clue that not showering or taking a bath was typical dementia behavior or you have the people who think they should be treated as children. They're not and it irritates me to no end when it happens. Or the people that post about how their residents are medicated because it makes their job easier.

You guys need to visit an Alzheimer's forum and read up on what IS typical dementia behavior and what 24/7 caregivers go through.

You say no offensive, then continued on to offend all of the posters, and even a fellow coworker, as in nobody knows else what dementia may or may not be? Also, I wonder what happened to allow your self-proclaimed 'diagnosis' of dementia, since OP named no history, nor physical information, nor any background (one poster even suggested finding out the patient's work history)? As far as the toilet paper thing being so common, in my decades I've never heard of that one. For all you know, the guy (if he isn't just angry at being placed there, or bored out of his mind, or maybe suffering from pneumonia, etc. to cause that weird behavior), might be a pervert ('why, are you jealous?'). He might not even require a memory unit, and maybe he hasn't even been evaluated for that, since he's a new patients. Or, maybe he in fact is a risk to other patients. It's common for people to be put in those units before a full-blown evaluation, based on perhaps something the family says.

Furthermore: This post was a quest for OP to ask for advice, and nobody in here made any comments about what 'caregivers' go through, so there's not a reason for you to use her/his post as your own sounding board to tell the world that caregivers are treated badly. As far as 'reading an Alzheimer's forum', I'll take that as a clue that you are not a nurse- and you can take it as a clue that for the nurses in here, probably one or more of us know a thing or two, about a thing or two, about Alzheimer's disease? Not to mention the implausabilty of obtaining a medication order, in THIS day and age, for the 'convenience' of the staff.

Specializes in Acute Mental Health.
It is typical dementia behavior. I take it some of you never had 24/7 experience with someone other than a resident and a 8 or 12 hour shift where you get to go home. No offense but it amazes me how many people work in LTC and such yet have no clue as to what is typical dementia behavior. I had one CNA that had no clue that not showering or taking a bath was typical dementia behavior or you have the people who think they should be treated as children. They're not and it irritates me to no end when it happens. Or the people that post about how their residents are medicated because it makes their job easier.

You guys need to visit an Alzheimer's forum and read up on what IS typical dementia behavior and what 24/7 caregivers go through.

Actually, I have worked with Alzheimers/dementia pts for years and haven't seen the tpaper bx. However, I have seen great success with medications. No, I don't want to just medicate a pt to make my job easier. It's always good to have a consult and have some prn's available. You had lots to say but no suggestions. What do you think would be helpful? Most elderly pts hate to bathe, I agree, but I figure its because your getting naked, freezing your tail off, and it's just not comfortable when your wrapped up and cozy before the whole time to bathe thing comes up. Just my thoughts though.

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