3.16" 3.16" 1.08" Developed by Kathie Gately, BSW

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1 3.16" 1.08" 3.16" Developed by Kathie Gately, BSW

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3 This Home Thermostat (HT) is designed to assist nursing homes, residential care and assisted living facilities with a tangible tool to evaluate and discover behavioral hot spots throughout their perspective homes. This tool will guide you to objectively listen, look and discuss what root causes within the facility may be promoting behaviors, and what alternatives and rearrangements you may utilize to decrease behaviors and differentiate between abnormal and normal behavior. You will need to form a Home Thermostat team comprised of the following representatives: Environmental CNA Charge Nurse Maintenance Visitor Dietary Family Resident Office Therapy Physician Clergy Social Worker Activities *Facility staff needs to have representatives from all three shifts and weekends To truly obtain a good reading on your facility, it is essential to select individuals that will provide dedication, objectivity and a positive approach. The Home Thermostat Team (HTT) will need to apply the evaluation process without pause for a two week period. A best practice is to begin on Monday. HTT members should perform the HT without formulating findings and separately from HTT individual members during the 14 day testing period. Once HTT has completed the initial 14 day testing period, they should immediately set a conference date to review their data, assessment and conclusions. Lastly, HTT should compose a document reflecting evidence based hot spots and potential resolutions. In addition, due to the ever changing resident/staff facility environment, HTT members should establish a continuous HTT monitoring system and set an annual HTT reading. Let s begin!!! Kathie J. Gately, BSW

4 HTT Journal - Week 1 MONDAY (MONTH/YEAR) Typically, upon arrival to work, we are busy settling into our work day. Begin this day with focusing on how the residents react to your arrival. What did you notice? Tune into resident s verbal expressions regarding weekend situations. Is there a connection between individual behaviors and weekend occurrences? Is Monday loaded with baths? Check on how many residents are receiving baths and are they contributing to negative behaviors? Does your facility hold a Monday morning Department meeting? Observe how many residents you are putting on hold or you see being put on hold for this meeting? Is this affecting them? 4 AIPP Home Thermostat Tool

5 HTT Journal - Week 1 TUESDAY (MONTH/YEAR) Lack of attention and/or boredom is a strong player in prompting negative behaviors. Concentrate on your residents who have the potential of behaviors. Is your facility offering activities and interaction for their inclusion? Spirituality generally plays a very important part in individuals daily life and if not met will make a significant contribution to behaviors. In addition, hosting and more or less making an individual participate in a religious activity that they are not in agreement with definitely has a negative impact. Stand back and view your facility in this area. What did you discover? You will find isolating noise factors in your facility is perhaps your greatest hot spot on your HT. Observe those residents who are located closest to the dining room, the employee break room, the beauty shop and the bathing room. What is the noise level? How is it affecting those residents? How would it affect you? How long is a day when you have nothing to do? How many residents do you see that are not involved? Do you see these residents with behavior episodes? AIPP Home Thermostat Tool 5

6 HTT Journal - Week 1 WEDNESDAY (MONTH/YEAR) What we eat is one of the highlights of our day, no matter where we are in our life journey. It is a natural human behavior to become upset when we do not get what we want to eat, when we want to eat, and where we want to eat. Focus today on these three aspects of your behavior residents dining. Note what you noticed. Does your facility group behavior residents together during meal times? Observe this practice. Is it positive or negative? What if I want refreshments during meals? Coffee, Tea, Juice, snack etc. What happens if staff tells me no, later or I am busy right now. Listen to the interaction between staff and residents. Be sure and spend a good part of your observation around the kitchen area. What did you see or hear? Was it what you expected? 6 AIPP Home Thermostat Tool

7 HTT Journal - Week 1 THURSDAY (MONTH/YEAR) Study your admission process. How well is it designed for you and the staff, the family, or the resident? Based off your review, do you see where it could lead to behaviors? What,if anything, does your facility do to assist new residents? Meet with your admission coordinator to set up an observation of a new resident admission. Do not have them change their process as you want to observe it as it is at this point. Review new admissions for the past 30 days. How many came in without behavioral medications? Who has them now? Why? AIPP Home Thermostat Tool 7

8 HTT Journal - Week 1 FRIDAY (MONTH/YEAR) Individuals interrupting us are challenges that we deal with daily on a job, yet generally not in our home. Below you will find various categories that are prone to cause people to enter and exit a resident s room. Select two residents and simply keep count of how many times we interrupt their home. 1. Assistance with dressing 12. Physician 2. Assistance with transferring 13. Volunteers 3. Monitoring 14. Activities 4. Changing of water 15. Dietary staff 5. Medications 16. Social Services 6. Housekeeping 17. Business office staff 7. Maintenance issues 18. Residents 8. Meals 19. Religious 9. Snacks 20. Misc. 10. Visitors Total 11. Therapist *Important that HHT carries this one throughout a 24 hour period 8 AIPP Home Thermostat Tool

9 HTT Journal - Week 1 SATURDAY (MONTH/YEAR) Throughout our lives, weekends are the times we look forward to relaxing, enjoying time with friends and family, or participating in hobbies, social groups, etc. Take a good look at what the main focus in your facility is on Saturday. Is it the same as M-F? Is there a difference? What do you feel is different and are you seeing an increase or decrease in behaviors? AIPP Home Thermostat Tool 9

10 HTT Journal - Week 1 SUNDAY (MONTH/YEAR) Is there a correlation between behaviors and feeling left out? Take notice as Sunday is generally the prime day for families and visitors to visit residents. How would you feel if you had to sit back and watch others with visitors, knowing that no one was coming to see you? What emotions do you see displayed by those residents? What if the only option you had for social interaction was participation in a religious activity? While this might appeal to you, it may not appeal to others, and could very well lead to discord between residents or between residents and staff. Take a good look at what your facility is offering on Sunday other than religious activities. In addition, are you covering everyone s religious beliefs? 10 AIPP Home Thermostat Tool

11 HTT Journal - Week 2 MONDAY (MONTH/YEAR) Monday is perhaps one of the most chaotic days! Moods seem to be different between staff, family and residents. Listen to the tone of voice staff uses when speaking to residents and to each other. Are you hearing tones that would spark your temper? Break your HTT members into specific departments for observation today without staff department notice. Do not consider this spying on staff as this is an internal tool and can only produce real hot spots if conducted objectively. Observe staff interaction in a regular shift occurrence. Pay attention to tone of voice and body language. Did you observe any incidents that prompted a negative behavior? AIPP Home Thermostat Tool 11

12 HTT Journal - Week 2 TUESDAY (MONTH/YEAR) Are we focused on each other or our residents? Channel your observation to listening carefully to how many times a day staff is directly interacting with each other and how many times they are interacting with residents. Staff to staff interaction Staff to resident interaction 12 AIPP Home Thermostat Tool

13 HTT Journal - Week 2 WEDNESDAY (MONTH/YEAR) Are we escalating a behavior by ignoring residents? Concentrate today on viewing times that you hear a resident requesting assistance either verbally or utilizing their call light. Was their request postponed by staff? How long did it take staff to respond and provide the resident service? How long would you wait before you became angry? *It is important to get a HT reading for all three shifts to obtain an accurate hot spot decision. AIPP Home Thermostat Tool 13

14 HTT Journal - Week 2 THURSDAY (MONTH/YEAR) Does death affect our behaviors? What do you do in your facility when a resident dies? Be sure and pull this one back up and study it when the next death occurs. Medical crises occur almost daily in your facility. From accidents within the facility to ambulances in and out transporting residents to acute hospital stays. Observe how staff handles the medical crisis. Is it smooth and non-dramatic? Is it handled in a manner that could promote anxiety resulting in negative behavior? 14 AIPP Home Thermostat Tool

15 HTT Journal - Week 2 FRIDAY (MONTH/YEAR) I want what I want when I want it. Is the resident s request reasonable? How is the staff responding? No, you can t have that, Not now, etc Record staff response? Ever had a sad day for no apparent reason? Do we allow our residents to have a sad day? What happens when staff, family or visitors try to cheer them up? When do we go outside? Daily, weekly, monthly ever? Observe your courtyard and other areas that your facility has set up to allow residents to go outside. Who utilizes these areas? How often? Could the lack of access to going outside promote behaviors? AIPP Home Thermostat Tool 15

16 HTT Journal - Week 2 SATURDAY (MONTH/YEAR) Cognitively impaired residents are viewed as those which we feel medication therapy is our only option. But is it? Divide your HTT members up over a 24 hour period and have them really get to know your behavior residents who are significantly cognitively impaired. See if there are cognitive memory triggers that are causing the behavior. Record your observations. 16 AIPP Home Thermostat Tool

17 HTT Journal - Week 2 SUNDAY (MONTH/YEAR) Staff can be very negative regarding their shift (e.g., shortage of staff, resident assignment, disgruntle at shift change, etc ). Observe how overall shift changes occur in your facility. Consider breaking your HTT members up to view all departments during shift change. Is it loud? Confusing? Disruptive? Now, watch how your residents react. AIPP Home Thermostat Tool 17

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19 HTT Daily Journal BEHAVIOR CHALLENGES PULL-OUT TOOL What behavior did you observe? Make copies of this tool to be placed a binder located in a central location. Encourage all staff (housekeeping, dietary, maintenance included) to use the tool to inform the HTT of event surrounding a challenging behavior. Your perception of what caused the behavior? How could the behavior have been avoided? _ Resident s room number _ Date & Time AIPP Home Thermostat Tool 19

20 READING YOUR HOME THERMOSTAT Now that your facility has completed your Home Thermostat reading, it is time to reconvene! HTT members need a time and place to review their individual and team readings of the facility without interruption or interference. At this point, HTT members are encouraged to only discuss their findings among the various HTT members. HTT members please remember to pull in the facility Behavior Challenges Daily Journal for your facility reading. HTT members should review and discuss each member s HTT tools during their HT reading meeting and see those hot spot areas within their facility. Once these have been isolated the HTT should utilize the HT reduction tool to begin crafting a facility coolant plan. All should hold a positive vision that each coolant applied to a hot spot may not be the right mixture at first, yet with the right adjustment will work. HTT should rank the HT reading hot spots by those that are at the highest risk of promoting negative behaviors. It is recommended that the facility address one hot spot at a time. Naturally, recording the effects of behavior reductions based upon coolant implementation is essential as this will maintain a constant HT reading and awareness of changes in your HT related to this particular hot spot. While two weeks may seem like a significant amount of time to implement, remember that your goal is to reduce behaviors, not only increasing resident quality of care and quality of life, but affording more efficient staff usage. This first HTT member HT reading meeting should be targeted as a time to share readings and set up your top facility hot spots. Then, HTT members should establish a HT reading meeting weekly for a month while they craft coolants. Suggest that HTT meets for the next six months to adjust coolants and monitor new hot spots that may occur. Once your facility hot spots are under control, quarterly meetings are suggested. A new HTT should be formed annually repeating your HT to keep your readings objective and current. 20 AIPP Home Thermostat Tool

21 Hot Spot Reduction (Coolant) Identified hot spot HTT Coolant mixture Training required Coolant Implementation Timeframe Begin Date Mid Point Date Success Date AIPP Home Thermostat Tool 21

22 Hot Spot Reduction (Coolant) Identified hot spot Two residents identified during HT reading as displaying an increase in negative behavior during facility group activities. HTT members noted that these residents shared rooms closest to the facility dining room where large group activities were held. One resident, who has a room close to the facility library where medium group activities are held, was noted by a HTT member with the same increase in negative behavior during group activities. HTT Coolant mixture HTT members met with facility administrator to discuss their coolant mixture, involving working with those residents and, if needed, their family members to relocate to a different part of the facility where group activities would not be disruptive to their daily routine. In addition, to put into place a facility screening policy for future residents to be of the type that could tolerate the disruption from group activities being held this close to their room. Training required HSR did not require facility staff training to implement coolant. Coolant Implementation Timeframe Monday September 11th Wednesday 26th Monday October 10th Begin Date Mid Point Date Success Date 22 AIPP Home Thermostat Tool

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