10 replies to this topic

[Colleeni869]

I work at an adult day care and we have recently added four shall we say more difficult clients. I'll describe them individually
One is an older male who refuses to participate in anything and spends the day trying to walk out the door(we have to keep both locked) but we still have to watch him because of damage he will cause trying to get out locked door. And if you try to move him he starts getting loud looking for his wife.
The second is also an older male who refuses to participate, also trys to go out the door, but also will go up to every aide many times in a five minute period asking whens the bus is coming.
The third is a sixty yr old male who is completely wheelchair bound and can not do anything (we have to feed him, empty his cathether, etc) He obviously can't leave but does spend the whole time moaning about everything out loud(boy is he loud)
The fourth is a 96 year old woman who can't be left alone because she will also try to leave and if she doesn't then she just goes on the couch and cries. Don't try to touch her when that happens cause she has swung and scream that she don't give a damn and get away.
We are small staffed 1 AD, 2 assistants, and 1 nurse. We do have a program manager but she is often gone in the day; meetings, evaluations, etc. I know we have had clients ticked off by these four individuals and some who have left because of it. So I thought I would put the problem here and see if there are any suggestions out there?

Thanks in Advance
Colleen

[ILoveMyLVN]

I can just say that my thoughts are with you, and I know it is difficult (often VERY very much so, from my experience) to deal with behavioral problems. I'm trying to deal with geri-psych now at our care center. People yelling across the room and very demanding.

For the patient who tries to walk out all day: I did see an article online that mentioned in some European Country they are using a bus stop sign to deter wandering. The patients will see it and be deterred by it because it triggers their long term memory. Also read it works with regular Stop signs. Would it be possible for you to put a Stop sign on the front door? Or perhaps in the hallway leading up to the door and you could put some items on a table next to it that the client could rummage through? Something interesting to him from past, or hobby related?

Hope this may help at all. I am in the same boat-- still trial and error, but just keep it up and try not to take it home with you! One day at a time is what I keep telling myself.

[jerusha]

Colleeni869, on Jul 18 2008, 07:12 PM, said:

I work at an adult day care and we have recently added four shall we say more difficult clients. I'll describe them individually
One is an older male who refuses to participate in anything and spends the day trying to walk out the door(we have to keep both locked) but we still have to watch him because of damage he will cause trying to get out locked door. And if you try to move him he starts getting loud looking for his wife.
The second is also an older male who refuses to participate, also trys to go out the door, but also will go up to every aide many times in a five minute period asking whens the bus is coming.
The third is a sixty yr old male who is completely wheelchair bound and can not do anything (we have to feed him, empty his cathether, etc) He obviously can't leave but does spend the whole time moaning about everything out loud(boy is he loud)
The fourth is a 96 year old woman who can't be left alone because she will also try to leave and if she doesn't then she just goes on the couch and cries. Don't try to touch her when that happens cause she has swung and scream that she don't give a damn and get away.
We are small staffed 1 AD, 2 assistants, and 1 nurse. We do have a program manager but she is often gone in the day; meetings, evaluations, etc. I know we have had clients ticked off by these four individuals and some who have left because of it. So I thought I would put the problem here and see if there are any suggestions out there?

Thanks in Advance
Colleen

HMMM, they sound like all 27 of my residents!!! Try that one!! lol... I work at an Assisted living facility for Alz/Dementia. I am the A.D./ I spend all day with my residents, most who have the same M.O. The Validation theory works better than the reality orientation theory. Let me explain.
There is no arguing. The man who is looking for his wife? Tell him she will be back later. Tell the other one, that the bus will be here in an hour. Every time he asks, tell him it will be an hour, so just relax and have some coffee, or sit down and wait, or whatever you need to say. Reality orientation does not work. Telling a res with alz/dem that there is no bus, or that his wife wont be back for 8 hours, or that they are who they are , at so and so place, and you are who you are, and they are who they are and bla bla bla,,DOES NOT WORK. Validation theory does. It is this..."I need to catch the bus now, right now" instead of saying that there is no bus,,,say.."what color is the bus? Does it come by here often? Is the bus driver nice? Where does the bus go? Is your wife on the bus? How much does it cost to ride the bus now adays? When they answer these questions just say "oh"..and ask em another...then say "Oh really?" Intervene the questions with questions about themselves, like "where did you grow up?" and get them on a different track as you intertwine questions about the bus, or their wife or whatever they are obsessing about with questions about themselves. Before you know it they have forgotten about the bus, or their wife. Once you get to that point, you take them to an activity, sit them down. Iknow it is hard. It is not easy. If you can do this you are a miracle worker,and that is your job right? Too bad miracle workers get paid crap!!..lol...keep practicing this technique. It will not work at first. It may not work till the 40th time. But there WILL be a point where it will work. The wanderer and the "walker"? WALK THEM! Im like, "you wanna walk? Hell ...we gonna WALK!" I walk the crap outta them. Hopefully your facility has a walking path, if you are taking in wanderers, you better. After 6 laps, they will tire and eventually want to take a break. Time. People need time to adapt to change. It can take a month or so for res to get used to new surroundings. Assimulating a new client or resident is an investment. Over time, like any person adapting to change, they will adjust. Meds??? Some res arent on the right meds. Someone who is anxious all the time could benefit from an antidepressant or antianxiety drug. That is what they are for. Tell the family member the symptoms and have them tell the doctor. I am completely against overmedicating for the comfort of the caregiver, but if the resident is nonresponsive to behavior therapy there may be other problems that you are not aware of like depression or anxiety and the proper dosage of the proper medication does wonders for the residents well being. You just have to do all that you can to make them comfortable and healthy and safe. GOOD LUCK!

[LisaRee]

Jerusha, sounds like you have it made! How I miss the days of working in a small facility. When I first started as an activity aide 8 years ago we were small...just 45 beds. Now we are a 160 bed facility and that doesn't include our skilled unit. I miss being able to sit down with a resident for as long as they wanted me there.
You said something about telling the family about med changes that may need to be made. If our D.O.N. heard that come out of my mouth she would die of a heart attack! It's just always been my understanding that activities is to never discuss any nursing issues with family..thats why we have nurses. If I did have a concern about a residents meds I would go to the nurse, then they discuss med changes with family and the Dr. Maybe things are alittle different where you are though.
Good luck!

Edited by LisaRee, 21 July 2008 - 02:47 PM.

[HelenHere]

Colleeni869, on Jul 18 2008, 07:12 PM, said:

I work at an adult day care and we have recently added four shall we say more difficult clients. I'll describe them individually
One is an older male who refuses to participate in anything and spends the day trying to walk out the door(we have to keep both locked) but we still have to watch him because of damage he will cause trying to get out locked door. And if you try to move him he starts getting loud looking for his wife.
The second is also an older male who refuses to participate, also trys to go out the door, but also will go up to every aide many times in a five minute period asking whens the bus is coming.
The third is a sixty yr old male who is completely wheelchair bound and can not do anything (we have to feed him, empty his cathether, etc) He obviously can't leave but does spend the whole time moaning about everything out loud(boy is he loud)
The fourth is a 96 year old woman who can't be left alone because she will also try to leave and if she doesn't then she just goes on the couch and cries. Don't try to touch her when that happens cause she has swung and scream that she don't give a damn and get away.
We are small staffed 1 AD, 2 assistants, and 1 nurse. We do have a program manager but she is often gone in the day; meetings, evaluations, etc. I know we have had clients ticked off by these four individuals and some who have left because of it. So I thought I would put the problem here and see if there are any suggestions out there?

Thanks in Advance
Colleen

How many clients do you have all together?

[Colleeni869]

Thanks for the advice. Unfortunately going for walks outside our building is not an option. We are in the city a share a building with a barber and a bar. The bar opens at three, gets deliveries all day and we don't close till 4pm. Also on the next block is a mental health day facility that lets their clients run loose outside. We can have a max of 24 people right now it is a very small location. And I got more good news today. Currently we have a heavy percentage of foreign language speaking clients but they didn't like that an assistant and I tried a portuguese activity. Or I should say I did the activity she was supposed to do an alternate activity with the other group but didn't. So it ticked off the english speaking ones and the manager said unless its something like a culture theme day that we can't since we are not designated a portuguese program. Then she proceeds to tell us that we will be getting more alzhemirs and dementia patients and that depending on their stages some will have to be in a seperate group and she even threw around the words "locked facility" as a future possibility.

[ILoveMyLVN]

Hi Colleeni,

Regarding the Portuguese activity, what do you provide them when they are there? We have some new foreign language speaking clients and I have printed off some things for them to read--word search and such, in their language. Other than that we have nothing else for them except the fact that they can all talk to eachother (we have about 5 speaking the same language). Any thoughts on how I need to provide a variety of things for them?

[Colleeni869]

ILoveMyLVN, on Jul 24 2008, 01:00 AM, said:

Hi Colleeni,

Regarding the Portuguese activity, what do you provide them when they are there? We have some new foreign language speaking clients and I have printed off some things for them to read--word search and such, in their language. Other than that we have nothing else for them except the fact that they can all talk to eachother (we have about 5 speaking the same language). Any thoughts on how I need to provide a variety of things for them?

Its a fine line on what can be done. Our place is not a portuguese program according to our manager so we must stick to an english program. So my suggestion is to check with your higher ups. That being said our manager said we could do something like a portuguese theme culture day: food, discussions, etc. If your higher ups have no problem then you could do that. But can tell you from experience at our place we have been told seperate by function levels or personality issues(we have some that must stay separate or they will go after each other.) but not by language.
" Intergrate as much as possible portuguese and english speaking as much as possible what they don't understand in words they understand in gestures"...my bosses words not mine.

[Ella]

I really feel for you in regards to your residents attempting to get out the doors. I agree with the others when they suggest redirecting the residents with conversations about the bus; what time does it usually come? Is the driver nice, etc. Another technique I have heard of besides using the stops signs which generally works, is to put a large piece of black construction paper on the floor in front of the door cut in the shape of a circle. Make sure it is taped down well. Dementia/Alzheimer's residents actually see it as a hole and will not cross over it. We have not had to use this technique yet as the stops signs work but I have heard that the "Black Hole" works. Just something to think about.

You can also try "Life Stations". Set up small tables throughout your facility complete with specific items for them to rummage/reminisce through. Examples are caring for children ( clothes, bottles, diapers, small toys etc), kitchen set-up (dishes, towels, brooms, mops), Office (books, calculator, phone, files, pencils etc.) Keep safety in mind for all stations. Assess your population and set up your stations according to their past histories, what they did, what they enjoyed. You can set up seasonal stations as well. This will give them something to do during non-activity times.

Hope this helps!

[heavenstar]

I have been following your post for a while now, and my ears perked up when you mentioned non English speaking clients. I work in an apartment complex for seniors-- 370 residents-- and most of them (90%) do not speak English! I have been working on a CEU class to be posted on the .org site for activities for Non English Speaking Residents! Hopefully it will be up soon and you can get lots of ideas from it.

It will always be a challenge to incorporate activities that will please the masses and not upset the English speaking ones (they are very verbal!). My suggestion to you to start with is MUSIC!

Music is universal-- you can provide all different types and everyone will be happy.
Start a slide show with flowers and put music in the background.
Have exercises with music-- do the chicken dance, harlem shuffle, line dance or anything else you can think of.
Paint to music
Have a dance with a theme
International music hour-- once a week and each time, play music from a specific part of the world. Vary it each week-- but don't forget American music!


I have often said that I am glad I have non-English speaking residents--- they almost never complain to me because they can't! The English speaking residents will talk my ear off of the things they hate!

Good luck!

[Colleeni869]

heavenstar, on Jul 25 2008, 12:55 PM, said:

I have been following your post for a while now, and my ears perked up when you mentioned non English speaking clients. I work in an apartment complex for seniors-- 370 residents-- and most of them (90%) do not speak English! I have been working on a CEU class to be posted on the .org site for activities for Non English Speaking Residents! Hopefully it will be up soon and you can get lots of ideas from it.

It will always be a challenge to incorporate activities that will please the masses and not upset the English speaking ones (they are very verbal!). My suggestion to you to start with is MUSIC!

Music is universal-- you can provide all different types and everyone will be happy.
Start a slide show with flowers and put music in the background.
Have exercises with music-- do the chicken dance, harlem shuffle, line dance or anything else you can think of.
Paint to music
Have a dance with a theme
International music hour-- once a week and each time, play music from a specific part of the world. Vary it each week-- but don't forget American music!


I have often said that I am glad I have non-English speaking residents--- they almost never complain to me because they can't! The English speaking residents will talk my ear off of the things they hate!
my
Good luck!

heavenstar
my problem isn't not knowing what to do with them. I have music, movies, etc in both portuguese and english. My problem is the boss
won't allow it to be used (says it offends the english clients). She then said the other day that we would be heading more towards alzhemiers and dementia patients and less physically disabled & MR patients. Mysself and another assistant then asked if the english speaking individuals got mad at portuguese activities what did she think they would do when we have to spend less time with them because we have to spend more time with the dementia and alzhemiers. And it will happen because we are doing it already for the clients I mentioned above. She didn't seem to answer right away.