Hello everyone,

Now that we’ve finished discussing the DICE model for assessing and managing challenging behaviors, we’d like to hear from YOU! Please email us an example of how you and your staff have used DICE to address a challenging behavior of one of your residents. The communities that send us the best examples will cordless sweepers! These are great to use with residents who like to help clean, because they take away the risk of tripping and falling (no cord to worry about), and they are quiet—so no loud noises to bother others.

Speaking of fall risk…

Falling is an ever-present concern and challenge for care communities, and falls at home is often the reason why people move to a care community. Too often, however, staff and residents’ fear of falling can lead to a vicious cycle:

• An ambulatory resident falls and gets hurt.
• The resident recovers physically, but may now be afraid to walk for fear of falling.
• The staff also fear that the resident will fall again, so they continually tell the resident to “sit down so you don’t fall,” reinforcing the resident’s fear.
• The resident then sits more and walks less (if at all), and consequently becomes weak (which is just one of the many negative effects of immobility).
• One day, the resident tries to walk or transfer without assistance (common among people with dementia who forget they need help) and falls because he/she is now so weak.

…And the cycle begins again.

How do we break this cycle?

Tricks of the trade:

1. Review with staff why people with cognitive decline (who may not be able to communicate their needs verbally) want to get up and walk on their own. Are they bored? Do they hurt from sitting for a long period of time? Do they need to use the bathroom? Do they forget they need help to walk?
2. A supervised 5-minute walk could be enough to satisfy their need to move for a while, and may help decrease negative behaviors later on due to boredom or discomfort.
3. Instead of saying, “Sit down, you might fall!”, try to get in the habit of saying something like, “I see you want to walk. Please wait and someone will help you very soon.” Then take the individual for a short walk down the hall, to a common area, or outside to a patio or courtyard. Spending those 5 to 10 minutes walking with a resident will end up saving lots of time in the long run. Have staff take turns doing supervised walks.
4. Perform fun “sit to stand” exercises throughout the day with residents….put on some music, have them grab the rails along the hallway and do 5 minutes of sit to stands with them. They help keep leg muscles strong and use up excess energy too.
5. Spread the love and encourage physical function…..ask the resident, “Could you stand up and give me a hug?” –The reward back is a big hug from you!

Have a great week!