Dementia, Mental Illness & Challenging Behaviour

Dementia, Mental Illness & Challenging Behaviour

1.0Introduction:

Service Users with dementia or mental illness may exhibit varying amounts of challenging behaviour. This may include those who would not normally show such signs.

2.0Objective:

To ensure the safety of the Carer and provide training to enable the Carer to deal with a Service User and potentially difficult situations as a result of Dementia.

3.0Procedure:

General

The Carer’s safety comes first.

No one has the right to abuse or attack a Carer.

Where training is necessary, relevant experts/seminars and security measures will be introduced to ensure Carers have the best possible awareness of how to deal with Service Users who present challenging behaviour.

The nature of the Carers role with a specific Service User shall be discussed very fully with all the parties involved.

The Social Worker, shall give the Carer a clear plan about why he or she is there and what sort of assistance he or she is to provide.

Carers shall ensure that they know how to deal with challenging behaviour from the Service User by reading that Service User’s Care Plan.

Carers shall not use physical restraint.

Carers shall record all actions and events on the Service User’s Care Plan.

Records shall be maintained.

Dressing

People with dementia often don’t remember:

Dementia, Mental Illness & Challenging Behaviour

ΟWhich clothes to put on,

ΟIn which order

ΟHow to put them on.

They may end up wearing several skirts and no underwear, or with things back to front or done up incorrectly.

They may have difficulty doing up buckles, laces, bras and so on.

They may not recognise the need to change their clothes e.g. when they are dirty or if they are going to bed.

They may choose to wear inappropriate clothing e.g. going out in the daytime in their nightwear.

Possible Solutions

The Carer may need to try laying out clothes in the order to assist the Service User to choose what to put on.

Avoid clothes with complicated openings and fastenings.

Washing & Dressing

Forgetting to wash and no longer recognising the need to wash may be a problem for people with Dementia.

They may have forgotten:

ΟWhat to do

ΟTo wash certain parts of their body

Some will be unable to climb in or out of the bath safely or manipulate taps.

They may be embarrassed by Carers seeing parts of their body usually kept private, and may refuse to wash at all.

These problems are increased if the Service User is incontinent and needs to wash frequently.

Incontinence can be a real problem, especially if embarrassment leads to concealment and of course, it's a problem for the Carer who may just be as uncomfortable.

The Carer should try to be matter of fact:

“You know and I know that you are wet, and you'll get sore if you don't wash”. Telling themoff or showing that any upset will not help.

Dementia, Mental Illness & Challenging Behaviour

Possible Solutions

The Carer should try to establish or maintain a routine for washing.

Tact is essential.

Do not tell a Service User to wash but perhaps emphasise the more pleasant aspects such as the comfort of:

ΟHot water

ΟPerfumed soaps - and so on.

The Carer may have to:

ΟTell them what to do - step by step

ΟWash with them

ΟClean their own teeth to demonstrate.

The Carer may have to help or supervise them as a result of:

ΟPhysical difficulty

ΟRisk of accident or injury.

Going to the Toilet

People with dementia may forget to go the toilet, which leads to incontinence and constipation.

They may forget where the toilet is - even in their own home.

There may be problems undoing their clothing in time.

At night they may lose their way in the dark or mistake some otherobject such as a waste bin for the toilet.

Possible Solutions

At regular intervals either remind them or take them.

Make sure clothing can be removed easily.

Take them before they go to bed and leave a lamp or light on if they prefer.

When you do ask a Service User if they wish to visit the toilet please ensure that this is done discretely. (Visiting friends & families do not need to know that a certain Service User needs to visit the toilet)

Dementia, Mental Illness & Challenging Behaviour

At all times be respectful

Incontinence

Many people with dementia may be occasionally incontinent and wet the bed. Regular bladder incontinence and bowel incontinence is less usual.

Even the occasional accident can be difficult to deal with.

It is embarrassing and degrading for them and distasteful for the Carer who has to clean up.

There could be several reasons for incontinence:

ΟForgetting to go

ΟUnable find their way to the toilet in time.

ΟUnable undo their clothing easily

ΟUnable find their way at night

ΟAn attack of diarrhoea.

ΟMedical reasons.

ΟGenerally due to the level of dementia and loss of bladder control.

Possible Solutions

The Carer should take the Service user to the toilet regularly

The Carer may maintain a check on the diet.

If they are not getting enough roughage they may develop constipation, which can lead to a blocked bowel and leaking diarrhoea.

All concerns about diet should be brought to the attention of the Co-Ordinator who will note this in the Service UsersCare Plan F/103.

The Co-Ordinator could also notify the Social Worker or person responsible for purchasing for the Service User.

Eating & Drinking

Many people with dementia forget whether or not they have eaten.

Some don't want to eat and claim they have just done so,

Others may want to start on the next meal as soon as the previous one is finished.

They may develop strong dislikes of certain foods and cravings for others.

Some don't know how to eat.

Dementia, Mental Illness & Challenging Behaviour

ΟThey may forget how to use cutlery

ΟBe generally very messy

ΟThey may play with their food not realising it is to go into their mouths.

ΟThey may be confused by different foods on one plate.

Others have physical problems:

ΟThey can't chew

ΟFind it difficult to swallow, which could lead to choking.

Some forget to eat and drink and may become dehydrated.

Possible Solutions

The Carer may wish to:

ΟSet regular times for eating

ΟEat with the Service User

ΟSit with the Service User if possible

If the Service User wants to start another meal soon after the last one, keep some washing up in the sink to show the remains of the last meal.

Don't worry about table manners - spoons are easier sometimes and the use of a plate guard means this can assist the Service user to eat from the plate without food slipping off the plate.

If the Carer assists a Service User to eat:

ΟSit at the same level as the Service User

ΟAssist at a pace that is comfortable to the Service User.

Do not place too much food on a fork whilst the Service User is still chewing they could choke.

The Carer may have to encourage the Service User to eat what is put in front of them:

ΟKeep foods simple.

ΟCut up certain foods so they are 'bite size'

Dementia, Mental Illness & Challenging Behaviour

Ask first.

Do not assume that they wish to have their foods mashed if there is no medical reason for doing this.

Food should look palatable

Large quantities on one plate should not be encouraged.

Make sure that all Service Users have plenty of fluid throughout the day

Make sure that the drinks are not served too hot or allowed to get too cold.

If a Service User needs encouragement to drink make sure this is done

Don't just leave the drinks by their side if you have been allocated time to assist the Service User.

Wandering

Wandering is a common and difficult problem to deal with. People with dementia may wander aimlessly or anxiously around the home.

Possible Solutions

If the Carer can work out a reason for the wandering there may be a solution.

Sometimes wandering results from general restlessness and boredom and is a sign that a person needs more stimulation or physical activity.

They may be searching for things they think are lost.

Keeping personal possessions on view may help.

Often they feel insecure and may need both:

ΟThe emotional reassurance that you care

ΟThe concrete reassurance of:

ΟTheir things being kept in the same places

ΟTheir routines being maintained.

Night Disturbance

People with dementia are restless at night and disturb other people by making a noise when they wander.

Dementia, Mental Illness & Challenging Behaviour

Possible Reasons

ΟLooking for the toilet

ΟSleeping too much in the daytime.

ΟGoing to bed too early

ΟNeeding less sleep.

ΟNot comfortable (too hot/cold)

ΟWaking up confused or frightened.

ΟThinking its daytime.

Possible Solutions

Make sure that Service User has been to the toilet before going to bed.

Try to discourage long sleeps during the day, perhaps by increasing physical activity.

Try to make them as comfortable as possible.

A bedside lamp or night-light may be helpful as sometimes a Service User can wake up frightened.

If they think it is daytime or think they need to get up for some reason, you might have to play along with them if you can’t convince them otherwise, as they may get upset.

Repetitive Questioning and Actions

This can be extremely irritating for Carers.

Usually the Service User is unaware of what they are doing, although their behaviour may reflect underlying anxiety or insecurity.

Possible Solutions

The Carer must not get angry or say “I've just told you the answer”

Try to distract the Service User by talking about something else or giving them a different activity.

Sometimes writing down the answer helps.

Reassuring them of concern may reduce insecurity.

The Carer may have to develop skills at turning a' deaf ' ear if this does not upset the Service User.

Dementia, Mental Illness & Challenging Behaviour

Clinging

Some Service Users with dementia become reluctant to let Carers out of sight and follow them from room to room.

They probably behave like this because they are feeling very insecure and the Carer represents security.

Possible Solutions

The Carer may try giving the Service User a simple task to do or use the clock or watch to point out that they will only be gone a short while.

It may be helpful to write down the name of the next Carer who will be visiting them later on that day

Losing things and accusations of theft

Many Service Users with dementia really do forget where they have put things,

Others deliberately hide things and then often forget.

In either case they can accuse you or someone else of stealing the missing items

The Carer must record all accusations on the Service User’s Care Plan F/103

Possible Solutions

Try not to take their accusations too seriously.

Don't deny the charge and get into an argument – the Carer wont or will be unlikely to be able to reason with the Service User and they will become more upset.

Try and find out if they have a regular hiding place such as in drawers, pockets or handbags.

Delusions and Hallucinations

Delusions are ideas that are imaginary, but seem very real to the person experiencing them.

Dementia, Mental Illness & Challenging Behaviour

Someone suffering from delusions may believe that there are some people who want to harm them or kill them, or that objects, which are simply mislaid or hidden, have been stolen.

Someone suffering from hallucinations sees or hears things that are not actually there.

They may wake to see figures at the foot of the bed or hear dead relatives talking to them.

Possible Solutions

Both delusions and hallucinations are imaginary, but they can give rise to genuine feelings of anxiety or panic, and should be taken seriously.

When a Service User is experiencing a delusion or hallucination, don't argue with them or tell them they are mistaken.

Remember they are outside the person's control so becoming impatient with them will not help.

If the person is distressed try and comfort them, perhaps by:

ΟPutting an arm around them

ΟHolding their hand.

ΟTrying to distract their attention on to something real around them.

Inappropriate Behaviour

In some cases a person with dementia will exhibit inappropriate behaviour such as undressing in public or communal areas.

Appearing undressed in the lounge may simply be the result of forgetting where they are or losing their way to the bathroom.

Possible Solutions

Behaviour such as this can cause severe embarrassment to Carers, visitors or families.

The Carer’s understanding of the problem, and explaining it to others could lessen everybody’s embarrassment.

If a Service User starts undressing themselves, calmly remove them to another room.

Dementia, Mental Illness & Challenging Behaviour

It may be worth checking that they do not wish to go to the toilet or that their clothes are not too tight/loose.

Self Protection

Service users with profound learning difficulties / later stages of Alzheimer’s disease or Service Users with dementia may exhibit varying amounts of challenging behaviour.

There are two types of behaviour that may be encountered:

Unpredictable Behaviour

Definition - Service Users who do not normally show signs of challenging behaviour or violence.

Where there is no written procedure in the Service User’sCare Plan F/103 the Carer should use the following guidelines:

ΟThe safety of the Carer comes first.

ΟNo one has the right to abuse or attack a Carer.

The Carer should:

ΟBe assertive (not aggressive)

ΟAttempt to calm the Service User down.

ΟNot shout or argue with the Service User.

ΟNot use physical restraint

ΟTalk calmly to the client and try to find out what the problem is

IF THE CARER IS SUBJECTED TO SERIOUS VIOLENCE OR THREATS – THEY MUST:

LEAVE IMMEDIATELY

INFORM THE BRANCH MANAGER IMMEDIATELY

RECORD THE INCIDENT ON THE SERVICE USER’S CARE PLAN F/103

Dementia, Mental Illness & Challenging Behaviour

Predicable Behaviour

Definition- Service Users who regularly exhibit challenging behaviour or violence.

The Carer should know to deal with this by reading the Service User’s Care Plan F/103

The Service User’s Care Plan F/103 may detail what level of restrain has been used before as this will have been recorded.

The Carer must not exceed the agreed actions as set out in the Service User’s Care Plan F/103

4.0Persons Responsible:

Group Director

Care Director

Branch Manager

Quality Care Supervisor

Domiciliary Carer

The Group Director has overall responsibility for implementation of this procedure

The Care Director has responsibility for the approval of appropriate training in this procedure.

The Branch Manager has responsibility for the actioning of any reports from Carers or other staff.

The Supervisor has responsibility for the supervision of Carers in the implementation of this procedure

Carers have responsibility for the correct implementation this procedure

5.0Associated Documentation and References:

Documents

QM 4.2.9Dementia

Records

F/103 Service User’s Care Plan

Dementia, Mental Illness & Challenging Behaviour

6.0Document History:

This section shows the approval and revisions of this document since its first issue. A vertical line in the left margin opposite the change will usually indicate changes from the previous version.

Version / Comments / Approved by / Date approved / Date of next review
01 / First issue of document / Q M / 08.07.05 / July 2006

Text, graphics and pictures published in this document are the intellectual property of Briarcare Ltd. They may not be passed to other parties, either wholly or in part, except with the express permission of Briarcare Ltd

Br-SM/OP 4.2.9 Issue 01 Authorised By K Stokeld Printed on 10/10/2018 Page 1 of 12