Re-directing tips needed for Alzheimer's/behavior pts

[bluegeegoo2]

What tricks of the trade do you have for re-directing Alzheimer's or behavior pts? There are 2 in particular on my unit that drive me up the wall! One is so very fixated on "going home" that it seems no amount of attempts at redirecting will work. For instance, last night the 2 were hell-on-wheels. I had 2 skin issues, a fall, and a med pass to take care of. After 11.5 hrs of hearing, "who can help me move my stuff?", and "I want to go home" and watching her pace up and down the halls, go in others peoples' rooms, "pack" some of her stuff and drag it to the nurses' station from 1 res, then the other who wails like a banshee at any attempt at redirection had me pulling my hair out by the time I (mercifully) left. We offered snacks, drinks, turned on the t.v., radio, gave them pain meds, anti-anxiety meds, and sat with them in their rooms and NOTHING WORKED. I am sooooo very frustrated I could scream!!! And, naturally, both are up ad-lib. The lady who was trying to move all night sat RIGHT IN FRONT OF ME FOR HOURS going on about wanting to leave, call the police, etc. She, however, was not violent or any other behavior to warrant a chemical restraint. Any tips on keeping my sanity during such occasions would be GREATLY appreciated!:plsebeg:

[achot chavi]

We just got another winner- a neighbor with a dog (with collar, leash and muzzle not to mention shots etc) comes a takes a different pt out while he walks the dog- calmly. The pts love the dog and love going out with them and are calm for the rest of the day!!

[elysia]

I have been working with Dementia/Alzheimer's resident's for over 10 years and they can be a challenge but the most important thing to remind yourself when you are dealing with behaviors is... IT IS NOT THEIR FAULT. Always stay patient, calm and use a QUIET voice. They can sense that you are irritated and their behaviors escalate. If you need to, take a 5 minute break and breath.

The first thing... ONLY USE PSYCHOTROPICS MEDS AS A LAST RESORT!!! They can sometimes escalate the problem and behaviors as well as put the resident at a high risk of falling. Some tips for dealing with dementia residents is to go to where they are... meaning time and place. If they are at home on the farm and need to make dinner... tell them you have already started dinner and that they don't have to worry about it tonight (even if it is 4am). It does get very irritating listening to someone who is constantly asking to go home. If they ask you to help them pack, help them pack! (Things can always be put away later.) If they are repeating that they want to leave or want to talk to the police... fake a phone call and have someone say they are their family member coming to get them or a police officer. You may need to repeat things over and over and over again but as long as you stay calm the resident will eventually calm down. If things excalate to violence then resort to pyschotropic meds.

Hope this helps some.

[skyandsydneysmom]

I agree with the previous posts...if you know anything about them use that to your advantage. I had a lady that loved to crochet so I would give her yarn and tell her I really needed help with a blanket I was making. She could no longer crochet, but she could roll the yarn into a ball (something I do before making a blanket)...she would always graciously accept the offer and when she was done with it she would seem calm and forget about wanting to leave. I think the key is knowing more about our residents!

[topic]

There is a resident that frequently asks to call her sister. The sister has clearly stated in the resident's file all calls are to be made on Sunday before 6pm, unless there's a medical emergency. When asked, by the resident, to call her sister on the other days, I pick up the phone, pretend to dial the number, and leave a "message". I do this in front of the resident and then tell her I left a message and that her sister will call her back shortly. She thanks me and goes on w/ her day. The first time I tried this was because I witnessed a nurse yelling at her, "Your sister doesn't want you to call until Sunday!" The nurse yelled after the resident asked about 20 times. The nurse was a miffed and surprised because I stepped on her toes (I'm a CNA) and that it worked and STILL works. I explained to the nurse that I had to try something when she resorted to yelling at the resident. It's obvious that a person w/ their "wits" about them wouldn't ask the same question in the same manner/fashion 20 times to the same person.

Another resident wants to go home. I pack her a small bag and tell her I'm going to warm up the car and that I'll be back. I step out into the hall and after a few minutes, she falls asleep. No meds!!

Here's where I'm stumped-There are a few residents that forget they are no longer able to walk. They have low-beds, pressure alarms, and ambulatory alarms. I never have less than 24 residents to care for, usually 40-45. So when their dementia/Alzheimer's takes them to a place where they believe they still get around independently, I am rarely close by. The low-bed and alarms are great for warning me that someone is about to get up. But if I'm across the facility, the alarms only alert that a fall is happening. ADM won't increase staff. I don't know how to fix this one. Someone is going to really get hurt one day.

[AlexisWilliamsCNA]

The best thing to do is to keep them from getting into that "loop". For instance, If someone walks by the rsdt and says bye to everybody and that they are going home, this could be a trigger. If the rsdt sees someone walking around in a frenzy, they may become agitated or worried. It is important to keep them in a quiet, calm environment with many positive reinforcements.

[NamasteNurse, BSN, RN]

Do you have any suggestions for more appropriate shows they could watch? I wonder if keeping a liabrary of DVD's would help the ones that don't sleep at night very well. We have one resident in particular who watches tv a lot. We've also had a recent increase in new tv's over the last little while. The residents don't really know how to use them. Or would music be more appropriate at night time? :)

Our day room TV is usually tuned to Turner "old time " movies. The older people love the oldies, Judy Garland, Clint Eastwood, Fred Astaire, etc. Oh and especially musicals...you know how a song will trigger your memory of something and how you remember songs from way back? Well the old folks go back a bit farther, but it works the same for them.

[scribblz, BSN, CNA, LPN]

I take care of lady who is prone to extreme restlessness/ anxiety she is a huge fall risk because tends to stay awake for sometimes 24hrs+ at which point her legs just give out from under her from exhaustion. Found out she really loves babies and got her one those interactive babies that coos, cries everything....amazingly it can keep her busy for hours.

[scribblz, BSN, CNA, LPN]

There is a resident that frequently asks to call her sister. The sister has clearly stated in the resident's file all calls are to be made on Sunday before 6pm, unless there's a medical emergency. When asked, by the resident, to call her sister on the other days, I pick up the phone, pretend to dial the number, and leave a "message". I do this in front of the resident and then tell her I left a message and that her sister will call her back shortly. She thanks me and goes on w/ her day. The first time I tried this was because I witnessed a nurse yelling at her, "Your sister doesn't want you to call until Sunday!" The nurse yelled after the resident asked about 20 times. The nurse was a miffed and surprised because I stepped on her toes (I'm a CNA) and that it worked and STILL works. I explained to the nurse that I had to try something when she resorted to yelling at the resident. It's obvious that a person w/ their "wits" about them wouldn't ask the same question in the same manner/fashion 20 times to the same person.

Another resident wants to go home. I pack her a small bag and tell her I'm going to warm up the car and that I'll be back. I step out into the hall and after a few minutes, she falls asleep. No meds!!

Here's where I'm stumped-There are a few residents that forget they are no longer able to walk. They have low-beds, pressure alarms, and ambulatory alarms. I never have less than 24 residents to care for, usually 40-45. So when their dementia/Alzheimer's takes them to a place where they believe they still get around independently, I am rarely close by. The low-bed and alarms are great for warning me that someone is about to get up. But if I'm across the facility, the alarms only alert that a fall is happening. ADM won't increase staff. I don't know how to fix this one. Someone is going to really get hurt one day.

I've had to actually get an order to put a resident's mattress on the floor with mats on either side. that way even if they "fall" off the mattress they aren't hurt.

[CoffeemateCNA]

It's really interesting (okay, and FUN) to find out your residents' former occupations (almost always located in the chart) and find activities that can be tailored to them. For plumbers, you can take some leftover PVC pipe and have them assemble/disassemble it. Seamstresses love to play with old scrap fabric. Health care workers (doctors, nurses) can be given a clipboard with blank assessment paperwork and be told to go "assess their patients." You can give a former lawyer a simple pen and paper and have them write a "brief" for the case. Accountants and cashiers can play with fake money and a cheap calculator. Custodians can be given some simple peri care wipes and wipe down furniture, tables, etc. Farmers and gardeners may enjoy sorting different "seeds" for planting (seeds are too small but you can just as easily use large nuts such as peanuts and almonds). Librarians can sort books. Artists and sculptors may enjoy working with Play-Doh. Telephone operators and receptionists can play with an old phone (maybe even a rotary phone if one is available).

The list goes on and on...

When they start having problem behaviors or getting into "trouble," you can just have them start the above activities. "Can you help me answer these phones?" "Can you help me do my taxes?" "Here's the chart you asked for. Mrs. Smith is waiting in exam room 3." etc.

[gymnut]

I am so happy I found this thread!

I am currently doing my CNA clinicals in a LTC on a floor that has a combo of rehab patients and LTC residents. We have this mix because they are converting the floor into all rehab and moving the LTC into another area of the facility.

I felt a deep ache in my heart for these residents because not only has their world been turned upside down because of their varying stages of dementia but now they are being up-heaved from their environment. It is starting to create a lot of stress because of all the activity.

One woman constantly cries that she wants to go home because her children and her newborn baby need to be taken care of. I wanted to help her and soothe her concerns but being new to this type of care I didn't know what to do or say exactly. Thanks to this thread I am now more informed and am excited to try these various tips in hopes of bringing peace to these residents.

[Nurse_Candice]

I think it really depends on the resident and the shift. Ive had them "help me do my blood sugar rounds" so I could "get them home faster." usually by the time we are done they had moved on to there next fixation, and usually it was that they were tiered and needed to get to bed after all the walking. I ve also done as others suggested and explained there family member has already taken care of the room for them for tonight and tomorrow theyll be able to see better to pack with fresh eyes and the daylight. substitute weather or anything else you can think of as to why tomorrow would be better. When all else fails Ive let them call a family member,(daughter, son, wife) and usually after hearing the familliar voice they settle down for a bit.

Good luck and just try to look foward to a better shift next time.

[Nurse_Candice]

There is a resident that frequently asks to call her sister. The sister has clearly stated in the resident's file all calls are to be made on Sunday before 6pm, unless there's a medical emergency. When asked, by the resident, to call her sister on the other days, I pick up the phone, pretend to dial the number, and leave a "message". I do this in front of the resident and then tell her I left a message and that her sister will call her back shortly. She thanks me and goes on w/ her day. The first time I tried this was because I witnessed a nurse yelling at her, "Your sister doesn't want you to call until Sunday!" The nurse yelled after the resident asked about 20 times. The nurse was a miffed and surprised because I stepped on her toes (I'm a CNA) and that it worked and STILL works. I explained to the nurse that I had to try something when she resorted to yelling at the resident. It's obvious that a person w/ their "wits" about them wouldn't ask the same question in the same manner/fashion 20 times to the same person.

Another resident wants to go home. I pack her a small bag and tell her I'm going to warm up the car and that I'll be back. I step out into the hall and after a few minutes, she falls asleep. No meds!!

Here's where I'm stumped-There are a few residents that forget they are no longer able to walk. They have low-beds, pressure alarms, and ambulatory alarms. I never have less than 24 residents to care for, usually 40-45. So when their dementia/Alzheimer's takes them to a place where they believe they still get around independently, I am rarely close by. The low-bed and alarms are great for warning me that someone is about to get up. But if I'm across the facility, the alarms only alert that a fall is happening. ADM won't increase staff. I don't know how to fix this one. Someone is going to really get hurt one day.

Well cudos to you I wish I had more like you in my faciluty! I have brought topics like yours up to many floor managers and DON/ADON in regaurd to falls. The responce I get is, ultimatly its there right to fall. we are to do what we can to prevent it, document and make families aware but in the end if they're determined to fall they're going to. This is sad but other than placing a mattress on the floor,( we have had to do this for safety with families permision,) there isnt much else to be done.