I’m referring to nurses’ aides, patient care technicians and anyone else below the skill and education level of an LPN. Are they trained what to do? (I assume that RNs and LPNs receive such training in their coursework.)
I don't think anyone is "trained" in how to handle a person who lashes out. I think its learned by experience. And, like anyone, there are people who handle it well and others who don't.
CNAs get maybe 8 to 10 weeks of training and its not medical. An LPN and RN may come across this when doing rotation in their training but I doubt if they get intense training . Not every LPN and RN have worked in NHs and ALs so they wouldn't come across Dementia patients. My daughter worked rehab/NHs for 20 yrs. She loved her patients but she burnt out. She had a Lewy Body patient punch her in the head. She asked her why she did it "I don't know".
Staff may have Seminars but its a lot different when you experience it. You need to be a special person to work with people who suffer a Dementia. If you can't hack it, then you need to find another job.
I don’t know what they’re trained to do except divert, distract & if all else fails, back off & try again later. What I do know is if your parent acts out on them they accept that but if they act out on another resident, they will be removed from the facility. That happened to my mom & once she got out of there, her aggression completed subsided to zero. She’s happy & peaceful now. Some people just struggle & fight institutional living. Too much activity, stimulus of sound, etc adds so much to their confusion that all they can do is fight since they can’t use flight. Try something new & don’t drug them up to subdue them like some nursing homes do. Best wishes :)
I'm getting the moms being aggressive with staff calls from her caregivers. She's on anti-anxiety meds in the am and Seroquel at night. Assuming she doesn't refuse them, which she does often. But she's always been modest, and the issues are always when they need to help her dress or bathe. She will scratch or punch or yell. Otherwise she's fine. Talks with other residents,eats, watches or participates in activities. Its frustrating because she's a big fall risk and I don't want to medicate more or zone her out. But I get it from her perspective, strangers are asking/telling her take off her clothes or wash/touch private areas. Often its a hygiene issue that can't wait until later. The problem with her dementia is that she can't get to know anyone. Add in the staff wearing masks and her being hard of hearing...
Has anyone used CBD patches? Would that temporarily mellow her out in the morning to make this easier ?
I would imagine your facility has all SORTS of caregiving folks around, from kitchen aids on. You might ask the facility itself what requirements and seminars and teaching goes on to help them deal with the issues of their elders. I would imagine that the hiring of some positions depends on the experience they have for the job applied for, the training they have received, whether as a caregiver by CNA certification, and there is general ongoing seminars, and etc. dependent on the skill set required for any of the many jobs fulfilled at a facility.
Sometimes the violent individual is assigned one on one supervision to hopefully head off any meltdowns. The facility doctors are also going to try to find some kind of medication to mitigate any violent outbursts without crossing the thin line that bars them from using long term chemical restraints.
Oh, and if your loved one is dangerous to staff they will understandably be very unpopular, therefore their care needs will be taken care of with the least amount of contact possible - nobody who works in LTC is paid enough to accept assault and injury as part of the job.
This is a difficult question to answer. It would depend on why the resident was angry or perhaps even violent.
For instance, are they reacting out of frustration due to pain? Do they suffer with anxiety?
In those cases, meds are available for them to administer. If pain is not the issue, there must be an underlying psychological reason and an evaluation is necessary.
They also do lab work to see if any medical issues are present. Again, meds would be prescribed.
I suppose initially they give psych meds to sedate a resident who is a risk to others and themselves.
Sometimes, residents and facility staff end up in a physical confrontation. My poor godmother was covered in bruises. She had ALZ and was blind due to macular degeneration. She would start swinging because she was afraid of them. If the touched her, she lashed out.
When I asked why was my godmother was bruised, they were honest and told me that she would become frightened and try to fight them when they tried to change her, bathe her, etc. She was a tiny woman but a spitfire! She was old and bruised easily. So, when they had to fight with her to do basic necessities, she would end up bruised.
Her son only visited once or twice a year. He lives in California. I had no authority to do anything. It was awful to see. I was depressed after going to see her.
You mention restraints. They are no longer legal but I have seen them used. Nursing homes are short staffed. it’s either use restraints or a patient falls out of bed or their wheelchair when they are under staffed. I don’t know what the penalty is for not following the regulations but I know they aren’t always followed. I saw the restraints being used.
I do understand what you are saying, I had an awful accident many years ago and needed surgery. There was a patient in the hospital who had severe mental illness and was in restraints. She broke free and entered my hospital room. I was terrified! This woman was mad as he** and walking towards me and screaming in Spanish! I was hooked up to a pole with an IV in me. I buzzed the nurse and asked her to come to my room immediately!
When the nurse came, I was shaking in fear. The nurse with the help of others managed to get her back to her room and back in restraints. The nurse came back to check on me and I asked the her about drugging this patient. She said that they did sedate her but it didn’t have much of an effect so they had to use restraints. Her adrenaline was so high that she had super strength and escaped. It was a crazy night. I couldn’t sleep because I kept hearing her wailing in Spanish. In extreme cases, restraints are useful!
This bit: "...they had to fight with her to do basic necessities..."
I would have liked to have been a fly on the wall when this was happening. Your client/resident/patient becomes frightened because she can't see you? Then be gentle and careful when you approach her so that she knows you're there and you don't startle her. Take her hand, say who you are and what you're there for, rather than just pulling her up. Wait until she's engaged in the process, don't plough on regardless. If she's resistant, come back after a short time and try again.
There *are* going to be some occasions when a client needs physical care urgently and continues to resist; and then, say for example it's your godmother, one person should be holding her hands and continuously talking to her while the other operates the riser-recliner or the profiling bed, and together you get her up. But I am losing count of the number of new clients who are assessed as being combative, aggressive, challenging, and it turns out they have pain from arthritis or injuries, or sometimes a sensation of falling which terrifies them, and actually all you need to do to gain their co-operation is demonstrate to them, very deliberately at first, how you will take care not to jar or twist or press whatever bit hurts, reassure them that they are safe, and continually explain what you're doing. Once they know they can trust you, there's no problem.
Again, I understand and appreciate that there will be times when you have to use more physical intervention than you like to. But overwhelmingly more often, if you have to fight your care receiver - don't!
I've often wondered this, and I think the uncomfortable part of it is that these caregivers are paid often to deal with problems that we cannot at home, including violent/combative behavior. There are cases where restraints for instance are needed, much as we would not like to see that.
CNAs get maybe 8 to 10 weeks of training and its not medical. An LPN and RN may come across this when doing rotation in their training but I doubt if they get intense training . Not every LPN and RN have worked in NHs and ALs so they wouldn't come across Dementia patients. My daughter worked rehab/NHs for 20 yrs. She loved her patients but she burnt out. She had a Lewy Body patient punch her in the head. She asked her why she did it "I don't know".
Staff may have Seminars but its a lot different when you experience it. You need to be a special person to work with people who suffer a Dementia. If you can't hack it, then you need to find another job.
I'm getting the moms being aggressive with staff calls from her caregivers. She's on anti-anxiety meds in the am and Seroquel at night. Assuming she doesn't refuse them, which she does often.
But she's always been modest, and the issues are always when they need to help her dress or bathe. She will scratch or punch or yell. Otherwise she's fine. Talks with other residents,eats, watches or participates in activities. Its frustrating because she's a big fall risk and I don't want to medicate more or zone her out. But I get it from her perspective, strangers are asking/telling her take off her clothes or wash/touch private areas. Often its a hygiene issue that can't wait until later. The problem with her dementia is that she can't get to know anyone. Add in the staff wearing masks and her being hard of hearing...
Has anyone used CBD patches? Would that temporarily mellow her out in the morning to make this easier ?
Oh, and if your loved one is dangerous to staff they will understandably be very unpopular, therefore their care needs will be taken care of with the least amount of contact possible - nobody who works in LTC is paid enough to accept assault and injury as part of the job.
For instance, are they reacting out of frustration due to pain? Do they suffer with anxiety?
In those cases, meds are available for them to administer. If pain is not the issue, there must be an underlying psychological reason and an evaluation is necessary.
They also do lab work to see if any medical issues are present. Again, meds would be prescribed.
I suppose initially they give psych meds to sedate a resident who is a risk to others and themselves.
Sometimes, residents and facility staff end up in a physical confrontation. My poor godmother was covered in bruises. She had ALZ and was blind due to macular degeneration. She would start swinging because she was afraid of them. If the touched her, she lashed out.
When I asked why was my godmother was bruised, they were honest and told me that she would become frightened and try to fight them when they tried to change her, bathe her, etc. She was a tiny woman but a spitfire! She was old and bruised easily. So, when they had to fight with her to do basic necessities, she would end up bruised.
Her son only visited once or twice a year. He lives in California. I had no authority to do anything. It was awful to see. I was depressed after going to see her.
You mention restraints. They are no longer legal but I have seen them used. Nursing homes are short staffed. it’s either use restraints or a patient falls out of bed or their wheelchair when they are under staffed. I don’t know what the penalty is for not following the regulations but I know they aren’t always followed. I saw the restraints being used.
I do understand what you are saying, I had an awful accident many years ago and needed surgery. There was a patient in the hospital who had severe mental illness and was in restraints. She broke free and entered my hospital room. I was terrified! This woman was mad as he** and walking towards me and screaming in Spanish! I was hooked up to a pole with an IV in me. I buzzed the nurse and asked her to come to my room immediately!
When the nurse came, I was shaking in fear. The nurse with the help of others managed to get her back to her room and back in restraints. The nurse came back to check on me and I asked the her about drugging this patient. She said that they did sedate her but it didn’t have much of an effect so they had to use restraints. Her adrenaline was so high that she had super strength and escaped. It was a crazy night. I couldn’t sleep because I kept hearing her wailing in Spanish. In extreme cases, restraints are useful!
I would have liked to have been a fly on the wall when this was happening. Your client/resident/patient becomes frightened because she can't see you? Then be gentle and careful when you approach her so that she knows you're there and you don't startle her. Take her hand, say who you are and what you're there for, rather than just pulling her up. Wait until she's engaged in the process, don't plough on regardless. If she's resistant, come back after a short time and try again.
There *are* going to be some occasions when a client needs physical care urgently and continues to resist; and then, say for example it's your godmother, one person should be holding her hands and continuously talking to her while the other operates the riser-recliner or the profiling bed, and together you get her up. But I am losing count of the number of new clients who are assessed as being combative, aggressive, challenging, and it turns out they have pain from arthritis or injuries, or sometimes a sensation of falling which terrifies them, and actually all you need to do to gain their co-operation is demonstrate to them, very deliberately at first, how you will take care not to jar or twist or press whatever bit hurts, reassure them that they are safe, and continually explain what you're doing. Once they know they can trust you, there's no problem.
Again, I understand and appreciate that there will be times when you have to use more physical intervention than you like to. But overwhelmingly more often, if you have to fight your care receiver - don't!