After his wife's sudden death and with no one to care for him, John, a 72 year
old man with Alzheimer's disease, was admitted to a nursing facility. During
his first week, John was frequently found crawling on the floor. The staff
would get John up each time but he became increasingly agitated and combative.
Due to his combativeness the staff contacted his physician and obtained an
order for sedation. He continued to crawl on the floor. The nursing staff
obtained an additional physician order to restrain John in a wheelchair.
His niece visited about 3 weeks after he was admitted. John's niece was a nurse
and questioned the use of physical and chemical restraints. She was dismayed
with the answers to her questions.
She knew that John had been a carpet layer for 40 years and it was normal for
him to be on the floor. John's niece purchased a pair of kneepads and along
with the staff developed a care plan that would allow John to spend time on the
floor wearing the kneepads to protect him.
His medication and restraint were discontinued and he was no longer combative.
Mr. P was a cognitively impaired, ambulatory and generally very pleasant
nursing home resident. He began not sleeping at night and would wander around
the facility. He started to examine everything and appeared to be trying to fix it.
Not understanding or knowing how to deal with this disruptive behavior, the
staff would restrain him in a chair. He became increasingly agitated and
A staff member took his behavior as a challenge and decided to investigate
Mr.P's background in an attempt to understand his situation. She discovered
that for many years he had worked for the local phone company. She contacted
the phone company who donated some small outdated equipment. The equipment was
placed strategically around the facility. When Mr. P would start to wander or
become involved in unsafe activities, the staff would re-direct him to the
equipment and he would happily occupy himself "fixing" the equipment.
His combativeness disappeared, he no longer was restrained, and his behavior
again became cooperative.
Justin, a 55-year-old developmentally disabled man, lived at home with his
mother until her sudden and unexpected death. With no other family members
available to care for Justin, he was placed in a local nursing home.
Justin's communication skills were limited and his mother left little written
documentation pertaining to his care. The transition was difficult for both
Justin and the nursing home staff. Care was often given on a frustrating trial
and error basis.
After six months, new clothing had to be purchased for Justin. Whenever the
staff dressed Justin in his new clothing, he would remove it, turn it inside
out and then struggle to dress himself. If the staff re-dressed him he would
repeat the process.
One day a very distant cousin came to visit. The behavior was explained to her
and she told the staff that his mother had always cut the labels out of
The staff removed the labels from Justin's new clothes and he never reversed
Sally and Susan
Sally and Susan were residents in a skilled nursing facility. Both sisters
suffered from significant cognitive impairment. Neither had ever been married
or had children.
Nancy, a member of their Mennonite church, would visit them often and became
their only spokesperson. Nancy became worried and questioned the staff when the
sisters seemed to become increasingly lethargic. The staff explained that the
sisters had been medicated because of their combativeness when being dressed.
Nancy noticed that the sisters were wearing sweat pants and realized that these
conservative Mennonite women would never have worn slacks or pants. She
requested that the staff no longer dress the women in this manner.
The sisters responded positively to the change and ceased being combative during
care. Their medication was discontinued.