The John A. Hartford Foundation Community Initiative
Seeking Future Solutions

Behavioral/Safety Issues
Ideas from August 2, 2002 Initial Interest Group Meeting

Clarifying priorities/goals:

• Wandering, elopement, injury
• Patient-patient/patient-staff aggression
• Falls-prevent/track/decrease injury
• Desire to be a restraint-free facility
• Look at agitation that leads to aggression
• Role of elder addiction

Overall goal:

• To reduce resident injury due to falls or aggression

Identifying concerns/obstacles to goals:

• Lack of diversion/need for increased structured recreation
• How staff are assigned (CNAs and Recreational Therapists)
• Variability in staff expertise
• Need for Recreational Therapist’s on weekends and evenings
• Lack of cross-training for CNAs in Recreation therapy; need for recreation kits on unit
• Staff beliefs that aggressive behavior is normal- “they’re always like that!”
• Knowledge/philosophy of staff about dementia and these types of problems
• Lack of resources to implement goals such as time and money for staff training

Resources:

• Learning Institute – Alzheimer’s Association
• Local Coalitions
• LIFESPAN
• Pioneer Network
• Trainer Presentations- family focus and support
• Other professional membership organizations
• State of Michigan website
• U of Iowa website

Strategies for achieving goals:

• TRAINING (not only for CNAs but also for administration and nurses)
• Set expectations for Recreational Therapy and other staff to offer activities
• Focus on injury reduction versus prevention regarding falls
• Develop documentation that is useful in fall review and guide
• Provide information/resources to families on diversional activities to use during visits
• Increase CNA involvement in resident assessment and care planning/decisions
• Promote administrative support for reviews of what works or doesn’t
• Employ a patient-centered philosophy (e.g., Eden, Culture Change)
• Individualization of care; get more information from families about the resident’s interests/preferences (list of 100 things you find out about resident
• Interdisciplinary staff reviews (housekeeping, RT, CNAs, nurses, etc.); hold community meetings on unit
• Documentation- checklist to guide investigation of falls/maximize objectivity/foster QI
• Consult family regarding resident’s likes/dislikes/favorites
• Set a community standard regarding falls (how to measure?)
• Work more collaboratively with DOH (a consultant to help collaborate with state?)
• Networking with interested individuals and meeting on a regular basis