Nursing Home Social Services Reference/Flow of Care/Behaviors and Behavior Plans

Overview Residents have healthy, adaptive behaviors and also maladaptive, unhealthy behaviors. There is a broad range of both kinds of behaviors. Some of these impact other residents. Those who have healthy, adaptive behaviors can offer stabilizing and community building impacts. Those with difficult behaviors can endanger the health and safety of self or other residents. Some can also cause destabilizing and challenge the community of residents and staff. The approaches to encouraging adaptive behaviors and discouraging unhealthy behaviors require staff to be clear about the behaviors, certain about the goals of changes and trained and informed by the plan for behavior management for the resident and the specific behaviors. Many of us, unless very well trained, respond to the maladaptive behaviors with punishing, shaming and shunning. These allow us to be justified and allow us to shift the blame to the resident. This is not to say that the resident does not has some responsibility for their behavior. What is available by accepting our responsibility as caregivers for this resident and the nursing home community are ways of changing the rituals of the nursing home and focus and details of care as tools of change. Having this insight is helpful in looking at what levers we have in managing this behavior. Options include expelling the resident, nothing at all, or establishing goals and tasks in a plan for behavioral management. Controlling or stopping the behaviors of this resident is not possible, so no working plans or possible results will include this. First step is to identify the behaviors that would be the target of management. These should be as detailed and clear as possible. Second, is to identify the goals of changes-- that is the behaviors that are to be discouraged and those that are to be encouraged. Use strength-based analysisEdwards D Parkinson K 2023 Applying Strengths-based Approaches in Social Work https://www.google.com/books/edition/Applying_Strengths_Based_Approaches_in_S/tOjAEAAAQBAJ?hl=en&gbpv=1&pg=PA2&printsec=frontcover live 2026-01-13 Google Books en-US to support this projected result. This will also be a part of the next steps. Third, investigate and record possible triggers for this behavior. Fourth, is to develop patterns of care, and interactions that might minimize this resident's behavior. This should include how caregivers should be in the presence of the resident, such as nuturing, supportive, respectful and consistent as an example of working, healthy adaptive behaviors. It may also include changes that acknowledge the triggers. This might be reducing the occasions of triggers, having resources available when triggers occur, describing effective responses to various behaviors and how to encourage adaptive behaviors to triggers. Lastly is evaluation. This is the time to see how the goals and plans. Identifying Behaviors and Triggers Difficult behaviors are reported to staff in a variety of ways. Other residents share reports, staff interactions are identified in notes or in discussions and behavioral health professionals' notes or discussions. These information sources may also propose some triggers. These could be placed on a spreadsheet and used to record the dates and times that each behavior occurs. In care conferences, psychpharm meetings and other care reviews, is a chance to review and analyze these data sheets and develop some hypotheses about these behaviors and triggers. With these hypotheses the behavior recording sheets may be altered to record possible indicators of these hypothetical behavior chains. Behavioral Goals Goals are best when they are clearly stated and achieveable. Expecting to achieve a complete cessation of some behaviors can be impossible. Reduction and a level that might be acceptable generally work best. There are some behaviors that can not be tolerated in public areas and the goal may be to limit certain behaviors to a resident's room. Understanding the strengths of the resident will help evaluate potential goals, the priority of goals and evaluating the achieveability of particular goals. Measurement and Investigating It is important to understand the nature of the behavior, causes and triggers of maladaptive behaviors. These behaviors seem to solve some problem for the resident, so it will be important to see life from the context and perspective of the resident however difficult this may be. Observation of the behavior and its context will be key to this comprehension of behavior patterns. Behavioral Care Plans Plans for these behavior management processes should be developed and known by all care givers. Consistent application of the strategies and tactics in such plans are key to altering behaviors. Evaluation THe only way to tune the care plan and to achieve the results expressed in the care plan is to collect data on the success of the tactics employed in the plan. The fidelity of implementation, the steps taken, what was said and how the tactic was implemented are important areas to collect data about. The review of this data by a group of caregivers with some training in this process will produce the desired results. Cases and Example Care Plans Below are several cases that address difficult behaviors that commonly occur in nursing homes. Sample care plans that might address these behaviors are develop below.