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.


  • 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


  • 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