THE CHALLENGE OF MANAGING DEMENTIA

Maria Needs An In-House BSO Team To Better Manage Her Dementia

Maria Tedesco was living in an older, long-term care home in a downtown neighbourhood. She moved there when her dementia became too advanced and she could no longer
be cared for at home. Within a few days, Maria’s daughter Tina began to see changes in her mother – and not for the better. Maria kept telling Tina she wanted to go home and she wouldn’t let the staff provide care, instead pushing them away and raising her voice to anyone trying to help.

She even started shaking her fist at staff and other residents in her room. Tina, who sees her weekly, said her mom, a former opera singer, would never have acted out on any of her threats.

But the community-based Behavioural Supports Ontario (BSO) mobile team that conducted an assessment of Maria prior to her admission felt otherwise. They determined that Maria was territorial and represented a risk to other residents, particularly her roommates.

The mobile team set out a transition plan to help her admission into long-term care, but the home did not have a dedicated in-home BSO team to continue to identify the changing causes of Maria’s outbursts and help staff to map out behaviour care strategies. The care team reached out to the mobile BSO team to assist in identifying interventions to help with these new behaviours but it would be a week or two before they could return to the home.

Each day, Maria’s behaviours grew more agitated until one outburst required two staff to restrain her. Fearing for the safety of other residents, the long-term care home had her transferred over the weekend to the emergency department of the local hospital, a regional trauma centre. Maria waited, restrained on a stretcher in the corridor for several days before returning to the home, heavily medicated.

If Maria’s long-term care home had had an in-house BSO team, they would have promptly coached her care team and implemented changes as to how they communicate with residents like Maria who refuse care. This would have made them more confident that they could gently persuade Maria to cooperate until the in-home BSO team could complete a new behaviour assessment.

And that new care plan? It would have been in place within 24 hours. Also, by including Tina in the planning, they would have learned about her mom’s fondness for Claudio Villa and worked with the recreation department to create a “playlist” for Maria using the singer’s music as part of a therapy plan to reduce agitation.

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