Understanding Behavior Management & Medications

Behavior Management Plan

Only when all else fails Medicate!

You may be wondering how an Assisted Living manages a residents’ behavior, identifies behavioral triggers, implements interventions, and tracks behaviors and at what point is medication used to treat or manage a behavior.

At Beehive Homes Assisted Living, the answer is:  Only when ALL else fails – Medicate.

Managing behaviors is a large factor in the day-to-day customized care that your loved one receives at an Assisted Living facility.  Understanding how behaviors are monitored, identified and tracked is a large factor in communicating between healthcare agencies, patients and family members.

We often get phone calls from family asking: “How is my mom/dad/etc doing?  What changes have you noticed? Is mom/dad sleeping okay? Is mom/dad eating normal.?

YOUR QUESTIONS ANSWERED

Q:       At what point do you contact family? 

 A:       When severe behaviors such as physical aggression occurs, when the resident or another becomes unsafe because of the behavior.  An Registered Nurse will do another assessment and then contact family and/or physician.

Q:       At what point do you medicate?

A:       When all interventions fail. 

Q:       How often do you monitor behaviors?

A:       Daily with a 5 to 1 resident to caregiver ratio, we are able to monitor behaviors immediately and offer interventions immediately.

 It is important when a resident is admitted into an Assisted Living to have a comprehensive assessment done so that the healthcare providers can track what is considered normal or abnormal behaviors. 

Behaviors are anything different from the norm and might include: exit Seeking, aggressiveness, depression, isolation, decrease appetite, inappropriate conversations, inappropriate physical boundaries, verbal aggression, anxiety, undressing, hallucinations, inconsistent sleep patterns, and refusal of care, with draw. 

 Triggers are any stimulus that change or effect behaviors.  Some examples of triggers might include over stimulation, environment, other residents behaviors, visitors, change in weather, Holidays, change of activity, loud noise, difficulty communicating or word finding, change in condition, time of day (sundowners*), change in medication regimen, death in family, and family dynamics.  UTI: urinary tract infections commonly cause many changes in behavior.

 Intervention is the approach taken to minimize the effects of a change in behavior before it becomes something more serious.  Interventions include one on one conversation, feelings validation, removal from stimulus, removal of stimulus, alternate activity, redirection, phone calls to family, taking a walk, sometimes just offering something to drink or eat,

Sometimes, just taking them “back to something they know” will be an effective intervention, for example: If he used to watch or play football, put on a football game. 

 Tracking behaviors and interventions in charting is a vital element in creating a behavior management plan.  What we are looking for: recent changes in resident’s life that might influence behaviors, environmental causes that might contribute to behaviors, Medical factors that might contribute, Identify situations that trigger behavior, and list planned interventions. 

 What is Beehive Homes Assisted Living Policy and Procedures on Behavior Management?

 Behavior Management Policy and Procedure

 Beehive Homes of North Idaho will assure a timely assessment and planning which uses the least restrictive intervention to address behaviors.  This means that the facility and its employees will use means other than medications to deal with and address resident’s behaviors.

 The safety of all residents and its staff members is a priority.  Residents displaying disruptive, self-injurious, or potentially dangerous behaviors will be approached in the least adverse manner in order to minimize injury to other residents or staff.  Mechanical restraints such as seat belts, lap trays and bedrails are not acceptable and will not be used as a means of behavior control.  Also, chemical restraints and seclusion are unacceptable means of behavior control.

 Behavior Management Procedure

Beehive Homes of North Idaho will identify and evaluate behavioral symptoms that are distressing to the resident or infringing on the other resident’s rights.  The Behavior Management Plan, Behavior Tracking worksheets, Nurses notes the NSA and UAI are all tools that will be used to accomplish this.
 

Behavior Management Plan Evaluation

Beehive’s evaluation will include the following:

A.     Identification of the resident’s behavior is transitory or permanent.

B.     Review of the resident’s previous behaviors and activities.
C.     Review of the baseline date including intensity, duration and frequency of the resident’s behavior.
D.     Identification of recent changes in the resident’s life, such as a death in the family, change in the resident’s daily routine, or changes in the resident’s NSA.
E.      Identification of environmental causes that could contribute to the resident’s behavior such as excessive heat, noise, overcrowding, hunger and staffing.
 F.      Rule out possible medical causes such as pain, constipation, fever, infection, or medical side effects.
 G.     Identification of events that trigger behavioral symptoms, including interactions with other residents’ internal personnel, outside contract providers, family members, and friends.

 Beehive Homes of North Idaho will intervene on such behaviors with the least restrictive method necessary.

A.     All staff will be aware of and consistently implement each behavioral symptom intervention
B.     The intervention will be the least restrictive.
C.     Each intervention will be reviewed within seventy-two (72) hours of implementation, and from then on as appropriate, to evaluate the continued need for the intervention.

 The resident’s mediation regime will be evaluated every six (6) months to assure that medications used to treat behavioral symptoms are necessary and at the lowest possible dose.