“All behaviour has a purpose,” says Nick Feltz, a behaviour therapist in The Royal’s Geriatric Psychiatry Program. As a member of The Royal’s Behavioural Support Outreach team, Feltz spends his days at various long term care homes across Ottawa. His job is to help patients with dementia who are exhibiting responsive behaviours - things like yelling, grabbing or hitting others, or wandering off.
Feltz and Nancy Lesiuk, manager of patient care services for The Royal’s Champlain Behavioural Support Outreach recently presented a Conversations at The Royal public information session on Dementia and Behaviour Therapy.
“Something is being attained by engaging in a behaviour,” explains Feltz. “There are usually other ways to achieve the same purpose. As behaviour therapists, we’re looking for these other ways to create an individualized support plan.”
Behaviour therapy is a discipline that’s new to dementia care in Canada, but its results are very promising in addressing responsive behaviours among seniors in long-term care homes.
“Behaviour therapy approaches people with an understanding of who they are, looking at the whole person rather than just imposing something on them,” says Lesiuk.
When a senior with dementia living in long-term care is exhibiting a responsive behaviour, members of
The Royal’s Behavioural Support Outreach team will work to figure out what factors are involved in this responsive behaviour and, perhaps more importantly, what’s going well when these behaviours aren’t happening.
Behaviour therapists see behaviour as a response to one’s environment, so they start by analyzing this environment. Another important part of the solution is understanding what the patient was like before dementia set in - what their interests were and how they lived their lives. This information can be useful in determining how to comfort and engage them in their new surroundings.
"Behaviour therapy approaches people with an understanding of who they are, looking at the whole person rather than just imposing something on them."Based on this understanding, a plan can be developed to help long term care staff reduce a person’s responsive behaviours. In many cases, behaviour therapists can offer a non-pharmacological solution that addresses responsive behaviour while improving, or at least maintaining, a long-term care resident’s
quality of life.
Behaviour therapy in dementia care is demonstrated to be effective in reducing hoarding, vocalizations, physically and verbally responsive behaviours, agitation, and wandering. It also has the potential to help preserve a person’s current abilities, such as participation in activities, communication, and continence.
The Royal’s Behavioural Support Outreach Program offers support and services at the 61 long-term care homes in the Champlain LHIN, comprising about 7,500 beds. This includes bringing its expertise to the new Specialized Behavioural Support Unit at the Perley and Rideau Veterans’ Health Centre.
“We foster a culture of collaboration. We all form a circle of care for the resident, for the best outcome for them,” says Lesiuk.
Education is a key part of Behavioural Support Outreach – whether formal or in informal huddles with long-term care staff. It increases capacity within long-term care by helping to equip staff across roles with skills that will help in the future. In 2017-2018, the outreach team delivered 1095 educational sessions with 4500 attendees, who are staff working at long-term care, community, and retirement environments.
Here’s how behaviour therapists approach their work:
- Case review. What’s the behaviour? Why are we needed?
- Questionnaires and interviews with the individual, family members, caregivers and anyone else who can give information to fill in a more complete picture of the resident and their situation. This includes learning about the individual’s values, culture, and preferences.
- Direct observation of the behaviours.
- Analysis and review of findings using charts and graphs
- Recommendations for preventing or redirecting the behaviour by altering the environment around the person. For example:
- A change to routine. Perhaps the first sitting at mealtimes is more chaotic and the second would be better for a particular individual.
- A change in approach. Perhaps caregivers could be more flexible to accommodate an individual’s preferences.
- Specific resources. Perhaps a person needs a modified call bell, a communication aid, or specific environmental cues, such as signage.