At Cloverdale Healthcare Center, our patient “Claudia” has cognitive impairment and has exhibited multiple episodes of aggression with resident-to-resident altercations. Although high functioning in terms of mobility, Claudia now requires a 1:1 attendant to manage behavior, prevent episodes of aggression, and assist with personal needs. IDT’s focus is on maintaining safety for all residents while providing Claudia with the least restrictive environment.

Background

  • Medical history of anoxic brain injury, r/t status asthmaticus
  • Multiple resident-to-resident altercations, unprovoked outbursts of aggression
  • Psychotropic use: Zyprexa (antipsychotic), Depakote (Mood stabilizer), Trazodone (antidepressant)

In their assessment, OT evaluated ways to address Claudia’s persistent psychosocial and ADL needs related to challenges with cognition, ability to self-regulate and repeated episodes of aggression toward others. The following methods were identified:

  • Nursing: providing medication management and care partner oversight
  • Social Services: behavior management committee review of episodes of agitation, triggers, monitoring of side effects of medications, and sleep patterns
  • Therapy: OT providing cognitive, psychosocial and self-regulation caregiver/care partner training and support through ongoing skilled maintenance services, analysis of daily routines, activities and interests for sensory regulation strategies

Recommendations:

  • Weekly facilitated activity groups with expected social behavior
  • Cognitive support for anticipation of daily routine and all needs (rest, meals, toileting, hygiene)
  • Problem solving with scripted verbal prompts provided by staff
  • Scripted social pragmatics
  • Occupational profile with Life Story Board and adapted communication prompts

View poster: Utilizing Care Partners (PDF format)
 

Nicolette MacLeod, DOR & Natalie Pesce, DON