I have talked so far, I want to hear from you!

[bigchris 1]

I ask that all of my folks on AD.net, give me thier scenarios, questions or comments. If possible, I can careplan for one of your "trouble" residents.

 

 

bc

[Ella 0]

Chris:

 

I have a troubled area but am not looking for a care plan at this time, just some suggestions. I have a 74 year old male resident with a primary dx of Dementia with Behavior Disturbances. He is married and is well known in the community. He was placed in Long Term Care by his wife because of his behaviors (aggression). The only aggression we have seen is verbal and some inapproriate touching (slap on the rear), this stops when he his told it is inappropriate. By all observances and assessments, staff feel that he was placed approx. two years too soon as the"norm" goes; (the wife is DPOA).

 

This resident attempts to leave the facility several times a day and night wanting to go home. Staff take him for rides as a way to redirect him, (DON's idea). This worked short term. We have brought him back into the facility to "sign papers" before he can "legally" leave, again this worked for a short time. We have told him the Doc says he has to stay for two weeks, until the end of the week, until next week, etc. waiting on test results, all short term results. He has short term memory impairment so what works this minute may not sick for long.

 

He enjoyed wood working so we tried that, with the end result being "Lets load that up and take it to my garage where all the power tools are". He likes to golf so we purchased the entire Wii set up with golf, bowling, boxing, racing, carnival games etc. along with all the accessories clubs, gloves, steering wheels etc. He enjoyed, the golf and can actually use the controllers but that was short lived.

 

He does read the daily paper and watch TV in his room. He enjoys playing bingo but will not help by calling the game for us. His wife has stopped visiting because when she does he wants to go home. He knows where home is and threatens her when she will not take him home.

 

We have a community program that offers activities as well and we have tried that. He went three times and then refused to go. We even had him go along with the bus driver so that he felt like he had a purpose and was give the task/job of helping those that needed it; on to the bus; helping with seatbelts and fastening down wheelchairs.

 

Last summer I tried gardening in our raised flower beds, both flowers and vegetables and of course I heard the same thing as with the power tools in the garage. Now it is summer again and my VP of nursing wants me to "Do something with him" because he is sleeping too much in the day time and up at night. She wants me to try "Maybe gardening". HA! 1) She knows nothing about this man and 2) I am running out of ideas.

 

I remember once when I took him for a ride, he wanted me to take him to the car dealers so he could buy a car. The only way I got out of that one was to tell him the story of how they ripped me off on a repair job they did a few years back, so I refused to take him there. I said that I would bring him back to the facility and he could get someone else to take him there. By the time I got him back into the building, we were onto another subject and he had forgotten about buying a car. This is the saving grace we have about him wanting to go home. We have the short term memory deficit working in our favor. It just takes a little while to redirect his thoughts.

 

My question to you after this long post, is what can I offer him? What am I overlooking? I don't have the staff, nor does the facility, to take him out for a ride, or a coke every 1/2 hour because that's what he likes and because he forgot that he just back from getting a coke or going for a ride.

 

The only group activity he attends is bingo now and then, occasionally special events (parties) and he will sit in the common areas now and then and watch TV with other residents but generally is in his room most of the day sleeping or lounging and then up late afternoon, early evening and wanting to leave.

 

I do have him scheduled for one-to-one visits once a week. I questioned whether I should have more than that but I talked with our state surveyors and gave them my explanations why and they were ok with the activity levels, independent and staff interactions; so it's not as though he is isolated. I am looking more for a purpose for this man and something to keep him from leaving the building all the time but specifically to give him a purpose.

 

HELP!!!

 

THANK YOU FOR ANY INPUT!!

 

Ella

[heavenstar 0]

It sounds to me like he should either go back home with a caregiver or move to an assisted living. Sounds like he shouldn't be there-- and honestly, if I were stuck somewhere I didn't belong-- and then feel like no one wanted me back (where I want to be) then I would sleep all day too. I know this doesn't help you any, but it is frustrating when family members don't take care of their own.

 

I am in a retirement home and way too often, we have residents that cannot take care of themselves, are bedridden, alzheimers and a wanderer, and the family will refuse to see anything wrong! They just leave them here and forget them (but yet, won't sign over guardianship to a social service that can get them where they need to be.)

[Ella 0]

I agree, he belongs somewhere else rather than here. In the beginning we were trying to keep him here because he has so many people in the community that he knows including family and they would come to visit. Now because his wife RARELY comes to visit, I am not sure why we, as a facility, don't try to find better placement for him other than his wife has the final say being DPOA.

 

She did at one time want to place him in a locked down behavior unit 275 mile from here. 1) he would go crazy and eventually hurt someone because he didn't meet criteria to be there because he is so much more advanced than their population and 2) being locked down and having just a short hall to walk in would drive him crazy to the point of causing harmful behaviors. To date he has not had harmful behaviors. His wife reported upon admission (11 months ago) that he did but we have never seen any, just the occasional pat on the rear of the 50 and under female staff and inappropriate verbal comments; and as I said these stop when he is told that they are inappropriate.

 

His two biggest issues are not being able to go home and not understanding why, and not having a purpose. I really need help with coming up with a purpose for him.

 

I did forget to mention that his wife is legally blind, though please forgive me, not as blind as she would like everyone to think, but none the less, has difficulties. She has her own mental issues but not dementia. I would say selfishness. To look at the big picture, I would say that she got scared of him and does not want to take care of his issues so uses her deficits, no matter how small as a means to slowly shut him out of her life. Her visits are farther and father between as well as the phone calls to Social Services and Nursing.

 

As all staff see it, the only "Cure" for this resident and his current issues is TIME; and is is going to be a long time before he gets to the next stage so I need any and all suggestions that I can get!

 

If anyone has anything they think will help, even if it is short term and then I can try something else, PLEASE post it. I am willing to try anything to help this gentleman, short of taking him home with me! Ha!

 

THANK YOU!

 

Ella

[bigchris 1]

Ella,

 

Sorry for the delay with your resident. I would say this one thing as 1) I am a male and 2) I don't know about your guy.

 

As a male, we are expected to be on the straight and narrow (not me but everybody else) and you said that this guy was predominant in your town....

 

Is it possible he is just acting out because he can????? It sounds (once again sounds) like he is just reverting back and acting up.

 

From your description, he could be in a behavior unit (or equivalent) but it doesn't sound "major" to me. To be honest, most of the guys I have had over the years did the same thing. Most were the men of the house and most were demanding and frisky when we got them in the facility.

 

Tell me if I am off base, or is there more info that you think I could use????

 

 

Chris

[Ella 0]

Chris:

 

Thanks for getting back with me. Let me explain a bit more. First I would say that this guy was not prominent in our community. He was however well known. We are a very old and small community and being prominent and well known are two different things.

 

I believe that his wife admitted him long before she should have and exaggerated his behaviors. We have not seen any of the aggressive behaviors that she spoke of physical or verbal other than the occasional pat on the rear that I mentioned and even this has diminished to almost nil over the last few months.

 

When he was first admitted, what we were dealing with was the constant "I am leaving"; "I am going home". This was hours every day, attempting to leave the building. We tried several different diversions to occupy his time, activities, tasks, etc. Everything was short lived because of his cognitive status (mildly confused).

 

Now; one year later, he still wants to leave but the problem we are having is that he sleeps late and I mean late; 12:00; 1:00; 2:00 in the afternoon. Activity staff including myself try to get him to attend group activities (he likes to sit and visit with the ladies, but we are met by nursing saying "Don't wake him up, he was up all night". Then we have the DON and the VP of nursing telling us that we have to try to get him involved in activities so that he is not up all night.

 

Of course we ignore the nursing floor staff and try to get him up and involved. Then we are faced with him telling us "No, I'm tired". All he wants to do is sleep. He does read the evening paper and will sit and watch TV in his room and in the common area with other residents. All of this is for short periods only. He has a short attention span.

 

As I said we are an old community so even though we are "Long Term Care" our community elders refer to us as "The Medicare Facility" because that is what we were called back in the '50s - ''60s and people came here to die. Many of this guys friends as with a lot of others from the old community find it hard to come here to visit, thinking they are going to see a bunch of dying people, so he has very few visitors.

 

He refuses to do any of his pasts interests because "if he could go home, he could do them there". My questions is how do I reach him and give him purpose? He's not going anywhere, home or otherwise. I need suggestions on what to do with this guy. He won't do the woodworking because he can't use power tools. The Wii golf and bowling is fun but holds his interest for a short period only. It is available for staff to use 24/7 but they don't use it with him.

 

I have him on scheduled weekly one-to-one visits and he agreed to try gardening but I fear that will be short lived as well. It looks like the visiting is all that is working right now. I hope you have some suggestions.

 

Waiting to hear back from you!

 

Ella

[DaddysGirl8 0]

Sounds to me like you have your hands full!

 

Are you still taking this gentleman out of the building for rides daily? I would be afraid that is only making the situation worse. He knows he will get to go out if he acts up enough.

 

What about giving him a daily job to do? IE: passing the mail, hosting the dining room, passing water, small maintenance tasks, takingcare of animals etc.... If he is given a daily task maybe he will feel he is needed and want to stay.

 

What made him so well known in your town, try capitalizing on that. As far as him sleeping throughout the morning, is this his pat lifestyle? If so then your DON shouldn't try and change it, you should accomodate it. Even if that means your midnight shift providing activity. How old is this resident?

 

Hope some of my ideas help.

 

[cindytexan 1]

I ask that all of my folks on AD.net, give me thier scenarios, questions or comments. If possible, I can careplan for one of your "trouble" residents.

 

 

bc

 

Ella, if your Resident is attending bingo, parties, special events, watching TV and reading the paper every day, your doing your job. It's a nursing problem not yours if the Resident is trying to leave the building. We are "Activity Directors" not Baby sitters. Nursing has a way of trying to turn us into the latter so that they don't have to bother with the problem Resident.

Cindy

[Ella 0]

Thank you to everyone for your input on my "Difficult to figure out Resident"! It has been a while since I posted an update about this resident and as my VP of Nursing always tells staff; the only cure for this type of behavior or that type of behavior is "Time". Well time has definately changed him and it hasn't been that long. He has not had med changes to speak of, nothing that would make the changes that I see, just "Time". He doesn't attempt to leave the facility near as much as he used to. By this I mean in a month his attempts equal the same amount that would have equaled 1 day prior to this change.

 

As for your questions; this resident is 74 years old, placed in Long Term Care by his wife ( now his DPOA) who could not care for him or didn't want to deal with what she called aggressive behaviors. We have never seen aggressive behaviors. He worked for the State Highway Department, owned a small motel and belonged to a couple local clubs, (Lions, Moose Lodge). This is how he was so well known in our small community. Since his admission 14 months ago, his visitors have gone from a few in the beginning to none which I believe has to do with his wife telling his friends that if they visit he will want to leave with them so they are afraid to come, rather than letting us deal with him after they leave.

 

He was not a day sleeper prior to admission nor after admission. This is a new behavior. He started sleeping later and later in the day and staying up at night about 4 months ago (not related to meds). Currently he is sleeping late; by this I mean 10:00 - 11:00 sometimes 12:00 and then just lays in bed watching TV. It takes everything we have just to get him to sit up to eat lunch. On good days I can get him up and out to an activity and occasionally on an outing but most days he stays in his room until supper time.

 

I have provided 1:1 activities on all units for staff to use after the Activity Department is closed. This resident will sit and use these with staff and they do have time in the evenings after supper. He does have mild to moderate confusion (degree depends on the day) and will use some of the activities with other residents, so it is not that I have left them high and dry for evening activities. These are available 24/7 so he can use them during the day if he chooses to skip group activities. He used to enjoy playing cards and some of the other residents did also but rummy can be hard to follow so I included UNO in the Activity box. I removed all the skips, reverse cards, draw twos etc. so all they have to do is go back and forth if two people are playing, following the numbers and colors.

 

As far as being a baby sitter; I agree. Before when he was going out the doors all the time, all I heard was "You need to do something with him, he keeps going out the doors, we can't keep chasing him down". Now all I hear is, "You need to do something with him, all he does is sleep all day, you need to get him up and moving". I did not go to school for 4 years to be a baby sitter. I went to provide quality lesuire/activity programming to improve the quality of life for these residents.

 

I have a whole facility of residents to work with not just one. As for him, now floor nursing staff doesn't want me to do anything with him because if I do they are afraid he will try to leave the building. It is Nursing Management that says I am missing the boat on this one because I am not providing quality of life. I say where were THEY when I was pushing for THEM to HELP ME!

 

I have provided everything I can think of including taking him on group outings when he was at his worst and received no extra support so now I say if the man was so active in the community and in his life before, I AM NOT GOING TO LET HIM LAY IN HIS BED AND WASTE AWAY!!!!!! So if I get him to an activity and he enjoys it, then attempts to go out of the building DEAL WITH IT! IT'S YOUR JOB!!!!!

 

Bottom line is "Time, understanding and love" will get us through the difficult times!

 

Please post your input and thank you for letting me vent in my last paragraph!

 

Ella