Care of Residents with Dementia/Mental Illness/Mental Retardations?

Introduction:Sad woman

This module reviews how to care for residents with dementia, mental illness and mental retardation. The residents in your home come from a variety of backgrounds, have different life experiences and have unique personalities. Some are easy-going and cheerful. Some may like to argue. Some are very active. Others are relaxed and content. In addition to the basic differences, many may also have impaired mental abilities, whether it has been a condition all of their life or a more recent onset. As a direct care staff person, it is important to have a good understanding of each resident with whom you will be working, including those who have mental deficits or impairments.

In this session we will look at the three main causes of cognitive impairment. You will be able to identify the symptoms, describe some of the behaviors common to these conditions and identify methods of interaction that are most effective in dealing with challenging behaviors.

Every person is different, and everyone has good days and bad days. It will be important to get to know each resident and develop your skills in working with each resident as an individual.

Mental retardation:

What is mental retardation? A person with mental retardation has lower intellectual functioning – meaning his/her IQ is significantly below average. He/She may need help with the daily living skills needed to live, work and play in the community. These include communication, self-care, social, leisure and work skills.

Mental retardation can be caused by any condition that impairs development of the brain. Some common causes of mental retardation include genetic conditions, problems during birth, alcohol and drug use by the mother, some childhood illness and exposure to toxic materials.

The abilities of people with mental retardation vary. Most people with mental retardation are mildly affected and are able to learn new skills. With appropriate supports all individuals with mental retardation can live satisfying lives in the community.

Residents with mental retardation have social interests and needs that match their age. Keep this in mind as you consider the music they like, the clothes they want to wear and the activities they enjoy. It is important to get to know the abilities of each person and allow as much independent decision-making as possible. It is also important not to talk to or treat a person with mental retardation like a child. He/She is an adult who likes adult activities and has adult interests.

Mental illness:
Taking Medication

What is mental illness? A mental illness is a disturbance in behavior, mood, thought process, social skills or interpersonal relationships. There are many different types of mental illnesses and different levels of severity.

A resident with a mental illness may be younger and in the home due to his/her care needs, or the resident may be elderly with a mental illness. These will be important issues to know about each individual. A resident with a mental illness may feel deep sadness, may hear voices, may be very suspicious of others, may change moods quickly or may have emotional highs and lows. These are symptoms of mental illness and not a person’s choices or bad behaviors.

Many people with mental illness are treated with medication under the care of a doctor. These medications can greatly reduce the symptoms of the illness, but many often have unpleasant side effects. It will be helpful to you and the resident if you take the time to learn what medication is being taken, and the side effects. You may also notice that there is frequently a cycle that occurs with some mental illnesses. A person can be doing quite well for a period of time, and then start to slip into some of the symptoms of their illness. This can be a challenging time for everyone. There needs to be a re-evaluation by the doctor and possibly an adjustment in medication or in the person’s program or environment. As a direct care staff person, you are part of the team that observes behavior. If you are noticing changes in behaviors, be sure to follow the home’s system for reporting and documenting. This will be very helpful to others in considering treatment options.


What is dementia? Dementia is a gradual decline in mental and social functioning compared to an individual’s previous level of functioning. A resident may have memory loss, personality change, behavior problems, and loss of judgment, learning ability, attention and orientation to time and place and to oneself. Alzheimer’s disease is the most common cause of dementia, and we will spend more time on this as it will likely be one of the more frequent causes of cognitive impairment of residents in your facility.

Alzheimer’s disease is a chronic, progressive debilitating illness. At first the symptoms are mild and might include difficulty remembering names and recent events, showing poor judgment and having a hard time learning new information. At this early stage the person often tries to deny their problems. Most difficulties at this time are with performing IADLs.

As the disease progresses, the person is unable to judge between safe and unsafe conditions and will need help to dress, eat, bathe and make decisions. There may be personality changes such as increased suspiciousness. Unfamiliar people, places and activities can cause confusion and stress. The person shows less interest in others and wants to withdraw to familiar, predictable surroundings and routines. The person in later stages has difficulty performing basic ADLs.

Some common behaviors associated with Alzheimer’s disease are rapid mood changes, crying, anger, pacing, wandering, doing things over and over, asking the same question, following people closely and inappropriate sexual behaviors.

Behavior management skills for working with residents with cognitive impairment:

Now that we have a basic understanding of three of the most frequent reasons for cognitive impairment, we will look at some basic behavior management skills.

As stated throughout this training, you are likely to be faced with challenging behaviors on a regular basis. If you develop strong skills in managing these behaviors and in communicating effectively with residents, this will help you in dealing with difficult situations and provide better care for the residents in all aspects of your job, from helping with ADLs, to encouraging residents to take part in social activities in the home or in the community.

“Behavior management” involves using certain techniques and ways of interacting in order to increase or decrease certain behaviors. It can be very effective, but it is not a quick fix, and it must be used consistently.

Think of your behavior management skills as tools in a toolbox. In this toolbox you have many different and effective ways of dealing with people and behaviors. Depending on the behavior, the person and the situation, you will affect the decision about which tool to use. Sometimes it may take a few tries to figure out what will work best, and some days it will be harder than others, but we will begin by placing some tools in our toolbox.

Remember, we are just touching on these basic principles. There is much to be gained by learning more about positive behavior techniques, and you are encouraged to seek out additional training, observe people who use these techniques effectively and take notice of your own interactions and how you can improve upon them. In addition to the basic ideas we will discuss here, residents in your care will have specific support plans developed by the care team. It is important to become familiar with these plans and use your skills to follow them.

Tool # 1 – Ask questions to figure out the reason for the behavior.

There are many causes of behavior. If you notice a change in a resident’s behavior, talk with other members of the care team to find out what might be going on. If it is an ongoing problem, first look to see what the cause might be. You may need to observe for a while to see what might be happening.

If a resident is in pain, for example, it is important to take note of things such as whether he/she had a recent fall or whether they have recently been ill. If a resident is not eating enough at meal time, this may be a problem with his/her dentures fitting okay, it may be a problem with chewing and swallowing or it may be that he/she does not like the food. Watch to see when and how much the resident eats. Watch the resident’s facial expressions. Watch the resident’s reactions to the people sitting at the table. What has changed recently?

Tool # 2 – Use positive reinforcement/rewards.

If you see a good behavior by a resident, praise the good behavior. Behavior that is rewarded will be repeated.

Tool # 3 – Listen with understanding.

When we show a person that we are interested and want to understand their feelings we are showing that we care about them as a person. We connect with them on a more personal level which can help them feel less lonely. We show this by listening to the resident and talking with the resident. Try to understand the resident’s feelings.

Tool #4 – Smile and keep it positive!

Believe it or not, a smile can go a long way when working with people. The times you feel least like smiling are when it will be the most important that you make your best effort. Take a deep breath, go into the room with a smile and be positive.

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