COMMUNITY LIVING AND DISCIPLINE: A CONFLICT OF INTEREST

OPINION:

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My project started with a simple question: How do nursing homes discipline disruptive and inconsiderate residents?

The motivation for this project was my appreciation for, and a reasonable expectation of, continued calm. My stay in the nursing home has been relatively free from noisy interruptions from other residents. For the most part, it has been a quiet existence, and I’ve been able to pursue my interests uninterrupted. However, my concern has always been having a noisy, inconsiderate resident move near me. How does the nursing home administration manage, control, or remove such disturbing individuals?

The simple answer? They don’t!

Nursing homes ignore the problem and those innocent residents subjected to the objectionable noise are left to cope with it. Residents that continually scream and holler throughout the day and night are soothed and quieted by a CNA (Certified Nursing Assistant). If that doesn’t calm the unruly resident, little else can or will be done. The nursing home is more concerned with the individual’s rights rather than the individual rights of those in the immediate surrounding community.

“Many screaming residents are ignored or isolated because their behaviors are so disruptive.” http://alzbrain.org/pdf/handouts/2009.%20behavior%20book.pdf pg 47

I have found that the problem has grown into a science of its own. Psychologists have filled this vacuum and have capitalized on finding solutions to the problem through seemingly endless studies and an equal amount of solutions. None of which are being actively applied in nursing homes.

The issue is referenced by different names: Verbally Disruptive Behavior (VDB), Problematic Vocalization (PV), Repetitive Disruptive Vocalizations (RDV) or, Disruptive Vocalization (DV). All are easily searched on the Internet.

One of the initial interventions, the simplest and least expensive, is the introduction of music to the screamer’s environment.

The Effect of Music on Repetitive Disruptive Vocalizations of Persons With Dementia by Julie A. Casby, Margo B. Holm. file:///C:/Users/User/Downloads/883.pdf

I can say with a high degree of certainty that interventions have never been considered in my nursing home.

One study suggests that the responsibility for intervention falls squarely on the shoulders of the occupational therapist and the activities department.

“Music appears to alter the abnormal or disruptive behaviors of persons with DAT [Dementia of the Alzheimer’s type] residing in LTCFs [Long Term Care Facilitys] (Burgio, Scilley, Davis, & Cadman, 1993). Therefore, music may provide occupational therapists with a means to decrease the incidence of RDV [Repetitive Disruptive Vocalizations ].” file:///C:/Users/User/Downloads/883.pdf page 884.

“The effects of the interventions were clinically and statistically significant, indicating the importance of providing stimulating activities a richer environment to cognitively impaired nursing home residents.”  https://www.researchgate.net/publication/13827140_Management_of_Verbally_Disruptive_Behaviors_in_Nursing_Home_Residents

The seriousness of the collateral damage has been misunderstood and unseen by nursing home administrators. It’s not found in the Minimum Data Set (the resident’s quarterly assessment), nor on the Health Department Survey of nursing homes (the annual inspection).

“Among the disruptive behaviors that are exhibited by nursing home residents with dementia, problematic vocalizations (PVs) are the most frequent, persistent (Nelson, 1995), and annoying (Cubit, Farrell, Robinson, & Myhill, 2007; Whall, Gillis, Yankou, Booth, & Bates, 1992).” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140256/).

“Negative consequences of PVs include increased distress or anxiety of the resident and others in the environment (Burgio, Scilley, Hardin, Hsu, & Yancey, 1996), often causing social isolation (Draper et al., 2000) and over medication (Cariaga, Burgio, Flynn, & Martin, 1991), which in turn results in higher health care cost (Murman et al., 2002).” ((http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140256/).

My concern is justified by the statements above. “Negative consequences of PVs include increased distress or anxiety of the resident and OTHERS in the environment….” [emphasis added].

“Screaming behaviors can provoke assaults by other demented residents.” http://alzbrain.org/pdf/handouts/2009.%20behavior%20book.pdf pg 47

By whatever name, the result is the same. It not only affects the distressed individual resident, but all those in close proximity. It is a concern that the Center for Medicare/Medicaid Services (CMS) and nursing homes have ignored far too long and must be addressed.

“Verbally disruptive behaviors (VDB) are verbal or vocal behaviors that are inappropriate to the circumstances in which they are manifested. These behaviors are a source of concern because they disturb persons around the older person and may be an indicator of distress.” (https://www.researchgate.net/publication/13827140_Management_of  Verbally_Disruptive_Behaviors_in Nursing_Home_Residents)

The psychological/psychosocial well-being of the elderly in the nursing home community is no less important than the individual’s proper nutrition, social services or physical rehabilitation, yet it is ignored by nursing homes.

 

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One thought on “COMMUNITY LIVING AND DISCIPLINE: A CONFLICT OF INTEREST”

  1. Good article, Bob. Too bad they o not remove the problematic residents to another location instead of making all the residents suffer.

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