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Dementia and Safety-Care

April 10, 2019
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I work with people who are diagnosed with dementia – can Safety-Care help?

Environmental modification and solid de-escalation skills matter when working with individuals with dementia

Sometimes, people who work with older folks diagnosed with dementia are not sure if Safety-Care will make a difference for the individuals in their care. Because Safety-Care’s focus is on creating a supportive, safe environment and preventing behavioral escalation, the methods are extremely helpful for this population!

Years ago, I consulted with a nursing home that provided services for individuals with dementia. We were working with the day program staff to decrease agitation and behavioral escalation. Staff reported that the residents had a harder time after lunch; data showed more wandering, more agitation, more yelling and crying after the noon meal. Of course, one factor suspected was the sun-downers effect; a symptom of dementia in which agitation increases during late afternoon/evening hours. However, we wanted to see what else we could do to help.

We thought about things like lighting, sounds, seating, and temperature. If you are looking at a person’s environment, here are some more specific things to consider.

Environmental Surroundings to Consider

  • Radio/Background music:  Music can be wonderful. It can be relaxing, entertaining, and it can remind us of happy times and memories. However, it can be too loud, annoying, not within our particular taste or triggering in some other way. In the program I mentioned earlier, the radio was on, but it was playing music that the staff members, not necessarily the residents, liked! Also, the volume sometimes seemed a bit loud. While I wasn’t sure how the older folks felt about the music, I suggested we take a closer look at this. What kind of music did the individuals in the program enjoy? Not everyone can answer this question, so sometimes you have to get creative. Ask family members, see if there are any clues in the residents’ rooms as to their musical tastes, watch residents’ faces when we play different songs and styles of music to see if anything appears to be relaxing or enjoyable for them. Then play that type of music at a level that seems appropriate for the person and setting.
  • Ambient sounds: Some background noise can’t be helped; staff communicating, the sounds of daily activities, other residents’ voices, visitors, etc. There are always going to be things going on. However, consider if there are noisy activities that you can be flexible with. For example, if the floor needs to be vacuumed, can we schedule that outside of programming hours? If the lawn mower guy comes every Tuesday morning to mow the lawn directly outside of the windows where we are doing group activity, can we ask him to come after 3 when everyone has gone to a different area of the building that is not next to the windows?
  • Seating: It’s always good to have multiple types of seating available to give residents options. If someone doesn’t like sitting in a chair that has arms, then they may appreciate a chair without arms.
  • Access to activities: Keeping people engaged by providing interesting activities can be a big factor in preventing agitation. However, be careful that the activities don’t overwhelm people. For example, if you have music therapy going on right next to a craft group, and someone else is watching television very loudly so she can hear it, and we’re all doing this in a very small space, individuals could become overstimulated, resulting in agitation. If 2 or 3 activities are occurring at the same time in the same space, consider which activities might complement each other. If you are running a recreation group, perhaps offer 2 choices to each individual instead of laying 5 or 6 things out and asking the person to choose.

Creating a supportive social environment

You also want to make sure that staff members are working to create a supportive social environment. This can be difficult during times in which it feels like there are never enough staff members and/or the staff who are present are stressed out.

A few thoughts on creating a supportive social environment:

  • Take care of yourself and support your co-workers/supervisees in taking care of themselves. It’s hard to help others if you are not at your best!
  • Think about what you say and how you are saying it before you address residents or co-workers. People should feel from their interactions with you that you are happy to assist.
  • Provide lots of reinforcement! Verbal praise, handshakes, high fives, smiles, etc.
  • Create visuals that will help folks communicate if they can’t think of the words for what they need.

Staying safe

Occasionally, someone with dementia may become aggressive when agitated. If this occurs, Safety-Care teaches the elbow check to help staff approach in a non-aggressive and safe manner. Safety-Care also teaches verbal de-escalation strategies designed to calm the person. Staff might use the Safety-Care supportive guide if an individual is wandering toward something unsafe.

Remember to give people time and space – it’s easy to feel rushed when your attention is split in many different directions. If you convey this to residents, you may escalate the situation further. So, take a deep breath, count to three, and ask for help from a co-worker if you need it!

For more information about how your staff can benefit from Safety-Care Behavioral Safety Training, contact QBS.

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