Managing problematic behaviour in care homes

Working with care home residents will no doubt mean you encounter some problematic behaviours. Many of them suffer from illnesses such as dementia, which may result in a wide range of behavioural difficulties that care staff need to find ways of dealing with. With the help of applied behaviour analysis, staff can learn how to use intervention strategies which successfully decrease the frequency of undesirable behaviours (e.g. refusing to eat at mealtimes) and increase prosocial ones (e.g. increasing interaction in residents who avoid contact).  

Applied behaviour analysis identifies both the antecedents of a target behaviour (what comes before it) and the consequences (what happens immediately after), and uses these to modify it. Based on this, care plans can be formed to help individuals with certain behaviours.

Differential reinforcement may be used to modify behaviour- this is where we both reinforce desired behaviour and prevent reinforcement that maintains the target behaviour. Noguchi et al. (2013) observed a care home resident who often left her seat for the toilet (the target behaviour they aimed to reduce). The antecedent was sustained boredom, and the consequence was being relieved of this feeling. Staff provided her with items for leisure activities, such as magazines, and gave positive feedback whenever she engaged in these activities. In other words, they reinforced alternative behaviours.

As a result, there were increases in the frequency of this alternative behaviour and decreases in the target behaviour following the intervention, compared to rates observed during the baseline period. So we can see how this technique could be applied to many different cases, whatever the target behaviour may be.

This is especially useful in circumstances where it’s important that behaviours are modified urgently, for the safety of everyone. For example, applied behaviour analysis has proven more effective than behaviour management intervention for decreasing aggressive behaviours in care home residents. In Lundervold and Jackson’s (1992) case study of a care home resident with Huntington’s disease, behaviour management intervention was able to lower the frequency of his aggressive episodes and allowed him to spend 70% of his time free of restraint, whereas this figure was boosted to 99% following applied behaviour analysis and treatment.

The use of applied behaviour analysis in care homes can therefore be highly beneficial to both residents and staff, and the techniques described are valuable tools for anyone considering work in this area.

References:

Lundervold, D. A., & Jackson, T. (1992). Use of applied behavior analysis in treating nursing home residents. Hospital & Community Psychiatry, 43(2), 171-173.

Noguchi, D., Kawano, Y., & Yamanaka, K. (2013). Care staff training in residential homes for managing behavioural and psychological symptoms of dementia based on differential reinforcement procedures of applied behaviour analysis: A process research. Psychogeriatrics, 13(2), 108-117.

Charlotte Chan