Behavior management skills for working with clients with cognitive impairment.

        Now that we have a basic understanding of three of the most frequent reasons for cognitive impairment, we will look at some basic behavior management skills.

        As stated throughout this training, you are likely to be faced with challenging behaviors on a regular basis. If you develop strong skills in managing these behaviors and in communicating effectively with clients, this will help you in dealing with difficult situations and provide better care for the clients in all aspects of your job, from helping with ADLs, to encouraging clients to take part in social activities in the home or in the community.

        “Behavior management” involves using certain techniques and ways of interacting in order to increase or decrease certain behaviors. It can be very effective, but it is not a quick fix, and it must be used consistently.

        Think of your behavior management skills as tools in a toolbox. In this toolbox you have many different and effective ways of dealing with people and behaviors. Depending on the behavior, the person and the situation, you will affect the decision about which tool to use. Sometimes it may take a few tries to figure out what will work best, and some days it will be harder than others, but we will begin by placing some tools in our toolbox.

        Remember, we are just touching on these basic principles. There is much to be gained by learning more about positive behavior techniques, and you are encouraged to seek out additional training, observe people who use these techniques effectively and take notice of your own interactions and how you can improve upon them. In addition to the basic ideas we will discuss here, residents in your care will have specific support plans developed by the care team. It is important to become familiar with these plans and use your skills to follow them.

Tool # 1 – Ask questions to figure out the reason for the behavior.

        There are many causes of behavior. If you notice a change in a client’s behavior, talk with other members of the care team to find out what might be going on. If it is an ongoing problem, first look to see what the cause might be. You may need to observe for a while to see what might be happening.

        If a client is in pain, for example, it is important to take note of things such as whether he/she had a recent fall or whether they have recently been ill. If a client is not eating enough at mealtime, this may be a problem with his/her dentures fitting okay, it may be a problem with chewing and swallowing or it may be that he/she does not like the food. Watch to see when and how much the resident eats. Watch the client’s facial expressions. Watch the resident’s reactions to the people sitting at the table. What has changed recently?

Tool # 2 – Use positive reinforcement/rewards.

        If you see a good behavior by a client, praise the good behavior. Behavior that is rewarded will be repeated.

Tool # 3 – Listen with understanding.

        When we show a person that we are interested and want to understand their feelings we are showing that we care about them as a person. We connect with them on a more personal level which can help them feel less lonely. We show this by listening to the resident and talking with the resident. Try to understand the client’s feelings.

Tool #4 – Smile and keep it positive!

        Believe it or not, a smile can go a long way when working with people. The times you feel least like smiling are when it will be the most important that you make your best effort. Take a deep breath, go into the room with a smile and be positive.

General Guidelines

        The following are some simple guidelines that should help you in dealing with care recipients who have cognitive impairments:

  • Speak slowly.
  • Keep conversations short and simple.
  • Do NOT argue or reason with the care recipient.
  • Write down instructions, keeping them simple and step-by-step.
  • Do tasks one-step at a time?
  • Provide objects that make things easier, such as slip-on shoes, finger foods, etc.
  • Maintain a routine. Change of routine adds confusion.
  • Use the memory loss to your advantage to distract the care recipient.
  • Provide a safe living environment.
  • Label drawers, cupboards, and doors.
  • Encourage as much independence as possible.
  • Approach the care recipient slowly from the front.
  • Limit the choices the care recipient has to decide among.
  • Play music since it is therapeutic. Make tapes.
  • Use validation therapy. (Explained below).
Validation therapy.

        Accept and acknowledge when they are feeling paranoid, afraid, etc. and talk about those feelings. Don’t try to convince them their feelings are wrong.

        Look for hidden messages:

  • If the care recipient makes baby crying sounds, it could mean they feel like a baby in a crib when in a bed with the side rails up.
  • Looking for parents could mean they feel lonely or scared.
  • Wanting to go to work could mean a feeling of uselessness.
  • The care recipient cannot express any of these feeling in the usual way. You have to search for them and interpret them.
Nonverbal Communication Techniques

        Care recipient with cognitive impairment will have difficulty communicating with you and understanding your communication to them. Use the following techniques to help you:

  • Use low-pitched voice.
  • Use gentle touch.
  • Give more time for a response.
  • Approach care recipient slowly and calmly. Never display any frustrations you may feel.
  • Get rid of as many other noises as possible.
  • Have care recipient point to an object.
  • Label drawers, etc.
  • Have recognizable pictures in view.
  • Cue care recipient to begin task by pointing, touching, or beginning the task for them.
  • Observe non-verbal behavior for clues.
Wandering Behavior

        Your care recipient may display the behavior of wandering. This can be the result of restlessness, of a search for something, or of unexpressed feelings. Here are some techniques to help you with this behavior:

  • Surround the care recipient with familiar objects.
  • Remove trigger objects, such as coats or suitcases.
  • Check care recipient often for hunger, thirst, or need to void.
  • Keep the care recipient occupied with a task.
  • Put up stop signs or barriers at exits. Cover knobs.
  • Use the care recipient’s memory loss to your advantage by distracting them with something more appropriate.
  • Give the care recipient something active to do.

        Repetitive and/or Inappropriate Behavior As in every other situation, remember that the care recipient does not know that what he/she is doing is repetitive or inappropriate. The part of the brain that would know this is no longer working properly. Do NOT scold or yell at them. Instead, try some of the following suggestions:

  • Be non-judgmental.
  • Calmly suggest a new task that is more appropriate.
  •  Look for antecedents – something that always happens before the behavior.
  • Plan activities to keep the care recipient occupied.
  • Offer reassurance.
  • Praise the care recipient when the behavior is appropriate.

        Use positive statements. Tell the care recipient what you want him/her to do, NOT what you don’t want.