Help for Families and Residents
Helping you find the safest treatment options that maintain quality of life for your loved one

Understanding Behaviors: Causes and How to Respond
Alzheimer's disease and other dementias can cause a person to act in different and unpredictable ways. Some individuals with Alzheimer's become anxious or aggressive. Others repeat certain questions or gestures. Many misinterpret what they hear.

These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. It is important to understand that the person is not trying to be difficult and that all behavior is communication. (Original source: alz.org)

Please see the attached guides for more information on how to better understand behaviors and how to communicate with someone who is living with dementia.

Behaviors: How to Respond when dementia causes unpredictable behaviors
Communication: Tips for Successful Communication at All Stages of the Disease

You may also click on the links below for more information and suggestions on how to handle behaviors.
 

 

Questions to Ask:
What if my loved one is experiencing unpredictable behaviors?

If your loved one living with dementia is experiencing different and unpredictable behaviors, it is important to understand that all behavior has meaning and a reason behind it. For example, behavior may be related to:
 

  • Physical pain or discomfort (Illnesses, medication, hunger or thirst)

  • Overstimulation (Loud noises or a busy environment)

  • Unfamiliar surroundings (New places or the inability to recognize home)

  • Complicated tasks (Difficulty with activities or chores)

  • Frustrating interactions (Inability to communicate effectively, fear, sadness,or anxiety)

(original source: Alzheimer’s Association)

In general, the following 3-step approach may be used to help identify the causes to common behaviors. If your loved one is living in a nursing home or other long term care setting, you may want to work with your loved one’s care team to use this 3-step approach:

 

1.

Examine
the Behavior

2.

Explore solutions

3.

Try different responses

  • What was the behavior?

  • Was it harmful to the individual or others?

  • What happened just before the behavior occurred?

  • Did something trigger it?

  • What happened immediately after the behavior occurred?

  • How did you react?

  • Could something be causing the person pain?

  • Consult a physician to identify any causes related to medications or illness.

  • What are the needs of the person with dementia?

  • Are they being met?

  • Can adapting the surroundings comfort the person?

  • How can you change your reaction or your approach to the behavior?

  • Are you responding in a calm and supportive way?

  • Did your new response help?

  • Do you need to explore other potential causes and solutions?

  • If so, what can you do differently?

10 quick tips responding to behaviors (alz.org)
 

  1. Remain flexible, patient and calm.

  2. Explore pain as a trigger.

  3. Respond to the emotion, not the behavior.

  4. Don't argue or try to convince.

  5. Use memory aids.

  6. Acknowledge requests and respond to them.

  7. Look for the reasons behind each behavior.

  8. Consult a physician to identify any causes related to medications or illness.

  9. Don't take the behavior personally.

  10. Share your experiences with others.

Questions to Ask:
What if my loved one is prescribed a medication, such as antipsychotics, to treat my loved one’s dementia-related symptoms?

If your loved one is prescribed a medication, such as an antipsychotic, to treat symptoms of dementia or dementia-related symptoms, you may want to ask the following of your loved one’s care team:
 

  • What is the current care plan for my loved one with dementia?

  • What is the reason for this medication?

  • What are the symptoms that the medication should improve?

  • Did the team attempt to identify the causes of the person’s behavior before using medication to address the symptoms?If so, what were the causes identified?

  • Did the team try to use non-medication approaches before trying this medication?

  • What non-medication approaches were tried?

  • How will this medication be monitored and, if possible, reduced?

      (In regulations, this is called Gradual Dose Reduction).

Remember: All nursing homes are required to have a system in place to care for people with dementia. State and Federal inspectors conduct nursing home surveys to ensure that these regulations are followed.

What else can be done? To learn more about what you can do to advocate for your loved one, click here or visit theconsumervoice.

 

Did You Know:
Physicians are responsible for obtaining informed consent for the use of antipsychotic medications in nursing homes

Most California physicians who provide care for residents of skilled nursing facilities are already well aware that under California law, physicians are responsible for obtaining informed consent for the use of antipsychotic (and other psychotropic) medications in nursing homes. Before administering an antipsychotic medication to a resident, nursing home staff must verify that the prescriber has indeed provided to the resident, or the residents’ legal representative, information about the recommended medication and its effects, so that the resident or legal representative can truly provide informed consent.

 

Helpful Websites
 

theconsumervoice.org
The Consumer Voice represents consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves. They are a primary source of information and tools for consumers, families, caregivers, advocates and ombudsmen to help ensure quality care for the individual.

www.alz.org
The Alzheimer’s Association has an online Alzheimer’s and Dementia Caregiver Center with access to information and resources on topics including: daily care, stages and behaviors, safety, support and care options, as well as information on financial planning.

nursinghome411.org
Nursing home consumer resource website from the Long Term Care Community Coalition with resources on antipsychotic medications.

pioneernetwork.net

The goal of the Pioneer Network is to inspire facilities to be resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources. The Pioneer Network promotes grassroots activities and new ways of de-institutionalizing services and individualizing care.

 

 

Oversight Agencies

Health care facilities in California are licensed, regulated, inspected, and/or certified by a number of public agencies at the State and federal levels. These agencies have separate, yet sometimes overlapping, jurisdictions. These agencies are responsible for ensuring long-term care facilities comply with state and federal laws and regulations.

 

California Department of Public Health (CDPH)
CDPH – Licensing & Certification Division is responsible for licensing Skilled Nursing Facilities (SNFs) and providing inspections to ensure compliance with licensing standards. CDPH, Licensing and Certification Division has District Offices throughout the state.

Coontact CDPH, Health Facilities Consumer Information System:

Phone: (916) 558-1784
https://hfcis.cdph.ca.gov/

 

CDPH – Aide and Technician Certification Section (ATCS) has primary responsibility in the certification of Nurse Assistants, Home Health Aides and/or Hemodialysis Technicians.

Contact ATCS:
Please note that the Interactive Voice Response Unit (IVRU) is an automated phone number (916) 327-2445, which accommodates a heavy volume of calls. You may leave a voicemail with the message center at (916) 552-8811. It is preferable to FAX information to the CNA/HHA/Certification Unit, FAX (916) 552-8785, or send an email to the CNA email address cna@cdph.ca.gov

 

Mailing Address:
P.O. Box 997416,
MS 3301
Sacramento, CA 95899-7377

 


 

California Department of Social Services (DSS)
DSS – Community Care Licensing Division (CCLD) is responsible for licensing Residential Care Facilities and providing inspections to ensure compliance with licensing standards. CCLD has district offices throughout the state.

Contact DSS-CCLD:
Department of Social Services, Community Care Licensing Division Statewide Adult & Senior Care Program Office

 

744 P Street, MS 8-3-90
Sacramento, CA 95814
Phone: (916) 657-2592
Fax: (916) 653-9335
http://www.ccld.ca.gov/




Medical Board of California
The Medical Board of California is responsible for the licensing and regulation of physicians and surgeons and certain allied health care professions.

Contact the Medical Board of California:


The Medical Board of California
2005 Evergreen Street, Suite 1200
Sacramento, CA 95815California
Toll-Free line1-800-633-2322
Phone: (916) 263-2382
Fax: (916) 263-2944
http://www.mbc.ca.gov/




California State Board of Pharmacy
The California State Board of Pharmacy is a consumer protection agency that regulates the individuals and businesses that dispense, compound, provide, store and distribute prescription drugs and devices and pharmaceutical services to the public or to other health care practitioners, in compliance with state and federal law.

Contact the California State Board of Pharmacy:


The Board of Pharmacy
1625 North Market Blvd, Suite N219
Sacramento, CA 95834
Phone: (916) 574-7900
Fax: (916) 574-8617
http://www.pharmacy.ca.gov/

California Department of Consumer Affairs (DCA)
The California Department of Consumer Affairs helps consumers learn how to protect themselves from unscrupulous and unqualified individuals and protects professionals from unfair competition by unlicensed practitioners.

Contact the Department of Consumer Affairs:


Department of Consumer Affairs
Consumer Information Division
1625 North Market Blvd., Suite N112
Sacramento, CA 95834
Phone: (800) 952-5210
www.dca.ca.gov


DCA-Board of Registered Nursing (BRN) regulates the practice of registered nursing and certified advanced practice nurses. The Board exists to protect the health and safety of consumers and promote quality registered nursing care in California.

Contact the Board of Registered Nursing:


Physical Address:
Board of Registered Nursing
1747 North Market Boulevard, Suite 150
Sacramento, CA 95834

Mailing Address:
Board of Registered Nursing
P.O. Box 944210
Sacramento, CA 94244-2100
Phone: (916) 322-3350

TDD number for the hearing impaired:
(800) 326-2297
24-Hour Automated Voice Verification:
(800) 838-6828


http://www.rn.ca.gov/
http://www.rn.ca.gov/enforcement/complaint.shtml


DCA-Board of Vocational Nursing and Psychiatric Technicians (BVNPT) protects the consumer from unprofessional and unsafe licensed vocational nurses (LVNs) and psychiatric technicians (PTs). Public protection is the highest priority of the Board in exercising its licensing, regulatory and disciplinary functions.


Mailing Address:
Board of Vocational Nursing & Psychiatric Technicians
2535 Capitol Oaks Drive Suite 205
Sacramento, CA 95833
Phone (916) 263-7827
FAX (916) 263-7857
Phone: (916) 263-7800
http://www.bvnpt.ca.gov/


To file a complaint against an LVN or PT, contact the Enforcement Division at (916) 263-7827; FAX (916) 263-7857, or visit BVNPT-Enforcement http://www.bvnpt.ca.gov/consumers/file_a_complaint.shtml

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