When living at home is no longer an option... You need A Caring Place
Written by Alyssa Gerace for ALFA Update
Senior living providers practice a variety of innovative techniques when managing aggressive behaviors that can be typical of residents with dementia, and they agree one of the biggest components is pro-activity.
Know Your Residents
This typically means knowing each resident and being familiar with their history and their patterns of behavior, says Janet Haynes, RN, director of clinical services at Endicott, N.Y.-based senior living and memory care management company Hearth Management.
“It’s important to know the resident themselves; it’s basically a traffic light of their behavior,” she says. “What gives you the ‘green light’ to be able to provide services and care for them? What is something you see change [that can be] a ‘yellow light’ or cautious sign? Or is there a ‘red light’ (or danger) where residents start exhibiting different patterns of behavior?”
At Silverado Senior Living, which exclusively operates memory care communities, each behavior is seen as a form of communication—including aggressive outbreaks.
“As professionals, it’s our job to try and understand [their] behavior and distinguish changes in it,” says Anne Ellett, NP, MSN, a senior clinical specialist with Silverado Senior Living.
Silverado staff, from executive directors to kitchen workers to housecleaners to caregivers and nurses, meet together to compile a history on each resident’s behavior and fill out ‘behavior intervention worksheets.’
 “What’s the pattern? What initiates it? What are the successful techniques for changing that behavior or altering it?” says Ellett as examples of how staff can understand what motivates certain behaviors.
The challenge, says Haynes, is consistent staffing, to help ensure the more subtle signs that might occur each day are communicated through a reporting system that channels information from day staff to evening and overnight staff. That’s key at Silverado, as well, where an interdisciplinary approach is taken.
Common Causes of Aggression and Treatments
“We all try to contribute information. Our nurses are very active in looking for acute illnesses or sources of pain, because it’s common that the elderly in general might be having pain, whether it’s a chronic condition like arthritis or they’re starting to get an upper respiratory infection or urinary tract infection,” Ellett says. “Be proactive rather than reactive.”
Often, what motivates an aggressive outbreak cannot be communicated by the resident, but sometimes it can be simple to address.
“You’ve got to find the trigger and remove it. Let’s say there is music playing during the meal, and someone gets agitated during mealtime, which can be very overstimulating for residents,” says Haynes. “If you see agitation, start decreasing some of their stimulus.”
That can be accomplished by eliminating the music, or by staff making sure they’re not talking too much.
 But it can be a longer process than merely removing a trigger, says Haynes. Another strategy is for caregivers to redirect a resident’s attention through distraction.
One common source of agitation among residents with dementia is the desire to ‘go home.’ While a typical response could be to say, ‘No, this is your home, you live here now,’ it’s better to counter the behavior by asking other questions, Haynes says, avoiding the use of ‘why’ in favor of ‘how, where, what, and who,’ as dementia patients aren’t able to reason their behavior.
The conversation could be redirected by asking a resident, ‘Where is your home?’ to ‘What color is your house?’ to ‘Who lives with you? Do you have any pets?’ to guide the resident into past memories and distract them from their current agitation.
“You can usually de-escalate their aggression and anger, and redirect the conversation into a different topic that will diffuse their behavior,” says Haynes.
No "One Size Fits All" Solution
A plan formulated by Silverado staff was able to resolve recurring agitation for one resident who didn’t want to be at the community.
“Every time she started [displaying agitated behavior], we’d say, ‘We love you, Betty. You’re safe here, we’re so glad you’re here. We’re going to take good care of you.’ She started hearing that from everyone that walked by, and while she may not have comprehended all of that, she got the body language and the sense that she was safe and secure,” Ellett recalls.
Other distraction techniques include knowing each resident’s “rewards” and being able to offer it to them, whether it’s a piece of chocolate or going for a walk.
Putting together, analyzing, and understanding each resident’s behavioral patterns to come up with an appropriate plan of action can be time consuming, but it’s worth it, says Haynes.
“It sounds like a lot of work, but once you get to know the individual, it gets easier,” she says. “Once you figure out their triggers, then your success story starts: you can start programming around that resident’s mood and lift them out of it.”
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