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Behavior Management as a Strategy for Promoting Quality of Life
Caregivers Corner December 2001
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According to the 1999 Surgeon General�s Report on Mental Health (Chapter 5 � Older Adults), up to two-thirds of residents in nursing homes suffer an identifiable mental disorder including dementia, depression, late-onset schizophrenia or anxiety. Given this fact, providing optimum quality of life to residents suffering from, or exposed to, the behaviors associated with mental illness is a pervasive challenge to long-term care practitioners. |
Historically, physical and chemical restraints were
used to control a wide range of difficult resident behaviors. This approach provided short-term convenience, but at a
significant cost to resident rights, quality of life and safety.
Behavior management is an approach that, when successfully
integrated into resident care planning, and effectively implemented by
trained staff, can enhance the quality of the living and working
environment of nursing homes.
Incomplete solutions to behavioral management
approaches such as periodic in-services or crisis-management interventions
in response to an injury or poor survey have been of limited value. While one-shot training might provide a short-term �fix�
for an immediate crisis, it generally does nothing to ensure prevention of
future problems. Reliance on
outside consultants has also fallen short of the mark, by reinforcing
staff perceptions that behavior problems require external expertise and
are �not our responsibility.� The
key seems to be empowering nursing home staff to develop a systematic,
consistent and ongoing approach to behavior management within their
facility that reflects the unique culture and specific resources of that
particular nursing center.
In 1998, the Pennsylvania Department of Health
mandated that behavior management would become a focus of surveyors in
Pennsylvania. The
Pennsylvania Association of County Affiliated Homes (PACAH) responded by
working with GeroServices, a Pittsburgh-based psychology and consulting
practice, to develop a behavior management system for resident care.
These are some of the key components that have contributed to the system�s success:
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Informed Leadership: GeroServices consultants first worked closely with the administrator and management to designate a team of key staff members that would lead the project. This leadership group was introduced to behavior management principles and practices, as well as the strategic planning and organizational development issues that would need to be addressed to ensure success of the project. |
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Policy and Procedure: Based on information and decisions elicited from the management team, the consultants laid the foundation to implement the program, generating the procedures for carrying out behavior management within the existing culture and practices of the facility. |
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Staff Training: Two levels of training materials were developed. A basic course provided nursing assistants and other direct care staff with the essential concepts and application of behavior management, including identifying residents with problem behaviors, assessing behaviors, designing and implementing behavioral interventions and evaluating interventions. An advanced course offered care plan team and nursing professionals more in-depth information in behavioral psychology and the biomedical, psychosocial and environmental context of common resident behavioral problems. |
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Skill Building: Developing the competence and confidence of the staff in applying behavior management principles to actual cases followed up the staff training. Using a case conference model, the consultants led a cross section of care planners and hands-on caregivers through the process of behavior management for actual residents with behavioral problems. |
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Program Promotion and Support:
The final phase was expanding the scope of the program to
introduce the behavior management system to all of the units in the
facility. During this phase GeroServices consultants continued to
provide telephone support. |
Most of the PACAH centers that participated in the program continue to use the training materials and follow the behavior management system. Some have made the training mandatory for all new hires. Of the cases piloted almost three-fourths were resolved positively with significant improvement in the target behaviors. Of these, about half were resolved by simple changes in staff approach and response behaviors, while the others required more sophisticated or complex interventions. Perhaps the most important outcome is the increased sense of competence and confidence observed as nurses, aides and other staff report that residents are displaying fewer behavioral issues now that staff members know how to approach them.
To learn more about the Behavior Management System visit GeroServices on the web.