Positive Behavior Support and Aging: Kemal

River Bend supports elderly people with physical, cognitive, and/or mental health challenges. Participants can attend different types of activities three to five days per week. These activities provide opportunities for people to make new friends, mentor young people, and cook meals. Other activities include arts and crafts with a volunteer-run store maintained by the River Bend members, visits to museums or other community-based events, and wellness classes. River Bend’s goal is to support each person’s independence, promote an optimal quality of life, and provide peace of mind for a person’s family.

Staff use surveys to find out about each person’s preferences and preferred activities. This information is used to facilitate meetings where staff and elderly people discuss how River Bend can become more person-centered. The group discusses how to ensure everyone feels they are respected by others, have opportunities to choose the activities they believe are important to them, and when they communicate, that other people really listen to them. These meetings foster positive relationships between staff, participants, and families. By creating a plan for increasing positive social interactions, reinforcing the positive actions of others, responding to problems between people in a prevention-focused manner, and celebrating successes together, River Bend has become a more positive and pleasant place, both to work in and to receive support.

Recently, the staff and people who receive support at River Bend are experiencing some challenges during lunch and dinnertime. During meals, staff members are often assisting other people who have specific dietary needs or need some additional support to move into the dining room. Three of the people at River Bend tend to get into loud arguments with each other during this time period. It has become very loud during meals and several people have complained about the noise. Staff members meet with everyone to explore what the issues are that are associated with the increase in noise. The group discusses why these time periods are problematic and find that the three people creating more noise are not arguing, they are hard of hearing and are having some trouble communicating with each other across the table.

During the problem solving meeting, the group of staff and people supported decide that exploring a different seating organization might help solve the problem related to the loud conversations occurring. Each of the individuals who enjoy conversations and are hard of hearing are encouraged to sit by others who are also talkative and have good hearing, or to plan to sit closer to each other so that hearing is not as big of an issue. This has made a big difference and helps everyone experience a more enjoyable meal together.

One participant, Kemal has been diagnosed with Alzheimer’s and has been experiencing distress as his memory deteriorates. He yells loudly, swears and swings his arms at other people when he becomes upset. This happens most often during transitions when he is dropped off, picked up, and before or after lunch. These outbursts happen five to six times per day. Each instance typically lasts six to nine minutes. The first step Kemal and his staff members took was to schedule time for a person-centered plan.

Person-centered planning is a team-based process to identify a person’s strengths and interests. This collaborative, strengths-based approach helps Kemal identify goals for establishing positive relationships, building community participation, and encouraging independence throughout the day. Once the person-centered plan is in place, staff and administrators work with Kemal to complete a Functional Assessment. This is a strategy for confirming the function that maintains a problem behavior. The results of the Functional Assessment suggest Kemal is engaging in these behaviors to communicate his distress when he isn’t sure what he is doing or where he is going during transitions.

Staff members meet with Kemal and his family to discuss supports that may help Kemal keep track of what is happening throughout the day. Kemal and his team create a visual schedule that Kemal can use to remember what is happening throughout the day. Kemal’s staff and family make sure this visual is available during all major transitions. Kemal indicates that he would like to be able to make more choices about when and what he is doing. The schedule provides a way for Kemal to have a memory aid while also increasing opportunities for him to make changes in his schedule in ways that are important to him.