Dedicated to helping Activity Professionals with the daily operation of their department.
by Debbie Hommel, BA, CRA, ACC, CRTS, Executive Director of DH Special Services.
Let Debbie answer your
Activity Questions
About Debbie

Debbie Hommel, BA, CRA, ACC,
CRTS, is the Executive Director
of DH Special Services. She is a
Certified Activity Consultant on
State and National level, with
over twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New Jersey,
New York, Maryland, and
Pennsylvania. She is an
experienced trainer and
workshop presenter, conducting
a variety of seminars throughout
the Tri-State area for the Activity
Professional, Administrator, and
allied healthcare professional.
Debbie Hommel is an active
member of Activity Professional
Associations on State and
National levels. She is ACC
certified through the NCCAP.
She is a founding member of
the New Jersey Activity
Professionals' Association,
serving terms as Vice President
and President. She received the
Weidner Lifetime Achievement
Award in 1994 and the
Monmouth & Ocean County
Activity Professionals Life
Achievement Award in 1999.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

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The Activity Director's Office
All Rights Reserved

Behavioral Management Strategies
By Debbie Hommel, ACC, CTRS

It’s just after lunch and the dayroom is full of residents.  The public address system can be
heard continually overhead, while the phone rings and call bells go off at a nearby nursing
station.  Housekeeping staff buffs the hallway floor and other staff can be heard talking loudly
about where to order lunch. The activity staff is on break and “Jerry Springer” is loudly playing
on the dayroom television.   Throughout it all, the residents are calling out, some are weeping
from frustration, while others bicker with each other.  Is this a typical scene in your facility?  Do
staff accept this scene because that is “the way it is” or the residents “always act that way”?

It’s been established that all behavior is driven by a stimulus, either internal or external.  
Unfortunately, in many long term care facilities – the stimulus often lies within the environment
and in how the care is rendered.  Noisy environments, over stimulation, lack of attention or
inappropriate approaches by staff contribute to negative behaviors.  In order to resolve
negative behaviors, the care giver needs to develop strategies to minimize the negative
stimulus which may be provoking such behaviors.

Many long term care settings, as nicely decorated as they may be, are large, unfamiliar and
stressful places.  The “dayrooms”, as they are called, may look like a waiting room in a
physician’s office or worse yet, a bus station.  Generic paintings on the wall, chairs lined up
around the parameter of the room, and plate glass windows allow staff to “keep an eye” on
residents sitting inside the room.  Most people don’t like waiting in doctors’ offices or bus
stations, so the environment provokes a desire to leave.  Considering many residents do not
have the ability leave independently, or worse yet, the staff discourage them from leaving the
room, it contributes further to their individual distress.  Altering the environment in the following
ways may assist in minimizing specific negative behaviors:
  • -Adopting familiar terms to describe facility locations creates a sense of home.  No one
    has a “dayroom” or “nursing station” in their home and to hear those terms contributes
    to a sense of unfamiliarity which creates tension.  Adopting terms like “living room”,
    “parlor”, or “family room” creates a sense of home which might be more soothing to the
  • -Reducing or eliminating overhead paging and institutional noise is helpful in minimizing
    resident stress.  The constant beeping, paging of names and numbers and loud
    television or music playing are significant contributors to negative behaviors.  Many
    facilities are adopting alternate means to communicate with staff through wireless
    systems.  With current technology, there is no need to utilize loud speakers or noisy
    buzzers to communicate information and care needs.
  • -Being mindful of how crowded the common areas becomes or how residents are
    positioned within the space is crucial.  Crowding residents into common areas so they
    can be “monitored for safety” causes much stress amongst those sitting in these areas.  
    Lining residents around the parameter of the room. may cause stress as they may
    wonder what they are waiting for.    The facility needs to develop alternate systems to
    monitor residents and engage residents in the life of the community during non-activity

The caregiver inadvertently can contribute to resident behavioral symptoms. Staff approach
and communication skills can either provoke or soothe a resident.  In some cases, staff does
not realize their impact upon the resident because the negative response is a delayed
response. The caregiver should consider the following communication strategies in order to
minimize negative behavioral symptoms:
  • -The resident should be approached from the front and given time to process that staff
    has approached.  Too often, staff tells the resident what they are going to do – while
    doing it.  This startles the resident and can contribute to a negative response.
  • -All resident requests should be acknowledged and the caregiver should try to address
    the request with a suitable response.  To ignore a resident’s calling out or repetitive
    requests because they “always do that”, is unacceptable.  If all staff attended to
    residents with repetitive verbalizations, the burden would not be so great on one staff
  • -Staff should structure questions and direction in a manner that can be understood and
    processed.   Giving choices, providing information in a sequential fashion, and allowing
    time for processing are important caregiver techniques.

A popular intervention in managing behavioral symptoms is the activity program and activity
approaches.  It is well known how effective a good activity program can be in reducing agitation
and anxiety.  Common mistakes occur when a resident is in the midst of a behavior and staff
the resident into an activity and expect the activity to miraculously resolve the behavior.  
Following are some helpful hints in using the activity program to address negative behaviors:
  • -The overall program should be a balance of active and passive stimulation.  Non-stop
    activity which places continuous cognitive, physical and social demands on the resident
    can be as detrimental as too little activity.
  • -Activities need to be adapted to the level of functioning of the resident. The resident
    needs to feel successful without feeling patronized.
  • -There needs to be a balance of group and 1-1 interventions available throughout the
    day.   When not in formal groups, the resident may need to be engaged in some form of
    leisure or relaxation.
  • -The activity program needs to be interdisciplinary and integrated into daily life of the
    community.  If the team could accept this concept, resident needs would be met as they
    occur and excessive needs of one individual would not be such a burden on one staff

Although some behavioral symptoms are extremely difficult to interpret and resolve, there are
many more that can be addressed through the environment, caregiver strategy and the activity
program.  All staff can participate in understanding and responding appropriately to resident
behaviors, to contribute to a positive quality of life.  - END
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