Some of you have told us that one of the most difficult challenges you face is how to care for an aging resident who also has a chronic mental illness. While depression and anxiety—especially in people with dementia—can be common in long term care, other mental illnesses such as personality disorder, bipolar disorder and schizophrenia can present challenges that staff are not fully prepared to deal with. Experts say that nursing homes should plan to see more chronically mentally ill residents in the coming years, as these people are living longer now. Fortunately, some of the knowledge and skills that you and your staff have developed from managing behavioral and psychological symptoms of dementia (BPSD) can be applied when working with people who have mental illness.
Experts agree on some core strategies for working with long term care residents who also live with chronic mental illness:
· Teamwork is crucial. Everyone can play a role here, including family members, nursing staff, recreation staff and therapists. If the resident is not cognitively compromised, include him/her in discussions about interventions whenever possible. Occupational therapists can assess a person’s actual level of functioning and help people address their deficits.
· Identify triggers of specific behaviors. Again–teamwork is important to do this. Listen to what your nursing assistants tell you about what triggers challenging behaviors, what they fear, what motivates residents, what calms them, etc. (Remember the DICE model?)
· Educate staff about mental illnesses and address any fears, concerns and misperceptions they may have.
· Establish trust, consistency and sincerity with the residents. (See Tidbit from July 21st)
· Listen to the person.
· Set clear limits for resident’s behavior.
· Remember the 3 R’s: Recognition, respect and reassurance. This helps them feel a sense of control, maintain dignity, and feel safe.
· Empathize with what the resident is feeling and ask them how you can help them feel safe.
· Be aware of your body language. Are your arms crossed, are you standing over the person?
· Stay flexible throughout the day and expect anything! Staff will need to go with the flow and react calmly to situations, as residents will often mirror your behavior.
· Remind staff to never take what residents do/say personally.
· Learn about the mental health community resources that are available to help you, and seek the assistance of behavioral health professionals when necessary.
Let us know if you have any tips on how to work with residents who have chronic mental illness. We can share them in a future tidbit so everyone can benefit. After all, this is a team effort!
Have a great week!