The Humanistic Approach to Residential Support (They are humans, right?)

calm-down-i-m-only-human-2I’m often amazed how people are treated when they happen to become residents in various residential support programs or facilities. Once a person assumes the title, “resident” the rules change for him or her. Suddenly they are no longer a person with the same wants and needs that you and I have. In fact, their individual needs as a human being are somehow traded in for the “rules” of that particular facility! For example, “Breakfast is at 7:00 a.m.” Every day breakfast is at 7:00 a.m.? Well, what if the person wants to sleep in one day? I mean you and I can choose to sleep in one day, right? But, oh no, not the “resident.” The resident must be up at 6:00 a.m., showered by 6:30 a.m. and the dining room, by God, for breakfast by 7:00 a.m. Whether or not they like it is inconsequential. What matters is the facility rules…end of story.

Being a Program Administrator, I certainly understand the financial considerations of staffing, scheduling etc. But, what I can’t wrap my mind around is the lack of consideration for people not being treated like human beings. No we don’t have the staffing to man the dining room all day long, but isn’t there a better solution? It seems to me (and you may call me crazy), that the people living in our programs should be able to get up whenever they choose. And can we not figure out some alternative meal for the guy that got up at 9:30 a.m. The same sort of logic applies to bedtime. Again, what time do you go to bed? My guess? Exactly whenever you want to! Can you even imagine some 22 year old staff member telling you it is lights out at 10:00 p.m.? And we wonder why our people tend to escalate. They escalate because they are adults who have probably spent considerable time making their own choices. Just because they were forced to move to your facility does not mean they stopped being adults. People with Alzheimers are still adults. People with brain injuries that are older than 18 are still adults. Elderly people in their sunset years are still adults! Something is wrong with our philosophy, I think.

How about that dreaded adult activity called sex? We have the audacity to get flabbergasted when we find resident A in bed with resident B. Moralistic considerations aside, that is sort of what adults do, isn’t it? Yet in the facility it is reportedly a “no-no!” I remember one of my staff telling me once, “Such and such is in his room with his girlfriend and they have the door shut!” (Lord help us quick!) I responded, “Well good, make sure you don’t go in there (as that is generally what the door closed symbol means!). Sure I know we can’t have some kind of hippy-free love thing going on, but we ought to take into consideration that adults have needs and who are we to stifle them? Really, if we are doing our job with a serious commitment to human needs being met, we should encourage people to get their needs met in ways that are, of course, decent and considerate of the other humans. That’s how we do it in real life, yes?

Now, here is the ultimate shocker! What about alcohol? Oh no – don’t you even go there! Again, we are talking about human beings, right? Can you have a glass of wine when you get home from work? If you are an attorney, you can have one at work (smile). What about a beer? It seems you may do so if you so desire. So, where did we ever get the idea that facilities needed to be “lock-down” centers when it comes to alcohol? We got the idea because the thought of alcohol at work just doesn’t seem right; introduces potential liability and thus we pass along that concept to people who have the misfortune to live with us. I recognize that certain “residents” are on many types of drugs. Alcohol and drug interaction is a serious thing. But, why don’t we run that idea by the treating physician? Maybe 2 beers wouldn’t make a difference? Maybe it would? But the all encompassing “no alcohol” rule, well maybe that is a little much for (here it comes) “adults!” We manage liability successfully in a multitude of realms at work like driving vehicles, safety rules, behavior support training, but when it comes to alcohol we default to – no way! It seems the same care we take in making sure Mr. Jones with the brain injury doesn’t costume too much food because his “I’m full valve” isn’t working, could be taken in making sure we regulate the alcohol intake in light of potential drug interactions. Ya think?

We need to take a fresh look at how we interact with the people in our programs. We need to stop seeing them as “labeled adults” and get back to seeing them as simply, “adults.” Human beings require a humanistic approach and the sooner we can make that happen, the better we become at providing true residential support!

Written by an adult for adults…




Common Sense Approaches to Behavior – Meeting Needs…

Cart_Anger-2Working in a residential facility for people with acquired brain injuries means we encounter many behaviors during the course of a day. Sometimes people scream and curse at the staff, sometimes they threaten with violence and at times may even become physically aggressive! And while this is often nerve-wracking for all involved, there is often a simple common-sense solution that we fail to employ.  But, before I get to the simple solution, let’s first think of behavior in terms of something people use to “get to” or “get away” from something.  And adding to that, let’s consider an example of how almost all of us respond in certain situations.

Imagine that you are peacefully living in your own home and suddenly become a little hungry.  How would you handle it?  My guess is that you would walk into the kitchen, open the fridge and grab a snack.  Then you would return to your favorite chair, munch on your snack while you finished watching “Parenthood.” Simple… worries, right?  Now imagine a similar scenario but you are living in a group home for people with certain disabilities. You feel a little hungry and walk into the kitchen to grab a snack. But this time you are met by a staff member with an agitated look on his face who promptly informs you, “Sorry the kitchen is closed bud!”  Imagine!  The kitchen is closed?  All eating possibilities are suspended until tomorrow?  Imagine!  What would you do in that scenario?  My guess is that even absent an acquired brain injury you would start to escalate and yell and even demand, by God, that someone better get you a snack or there is going to be hell to pay!  And chances are, if you made enough of a scene, someone would reward your behavior with the food you requested, complete with requesting assurances from you that next time you would obey the kitchen “rules” etc., etc!

So, doesn’t it make complete sense to you that given such constraints a person would exhibit certain negative behaviors?  Yet for some reason we falsely conclude that a person with certain deficits should  somehow feel differently!  I think if we as Managers and Administrators fall into the trap of putting our residents into any category different than the general group “human” we will end up dreaming up ideas and rules that fail to take into consideration basic human needs. And the most common reason for a person to escalate and demonstrate negative behaviors is not getting their needs or perceived needs met.  So the first question we need to ask ourselves, when challenged with negative behaviors, is what need does this person have (or perceive they have) that we aren’t helping them to meet.

Here is another common scenario.  A resident approaches the staff and says I need to go to the store.  The staff typically respond with some answer that states in one form or another – no!  The responses could be “it isn’t your shopping day” or “we don’t have the staff available to take you to the store right now” or “we are just about to eat dinner” or even “you just went to the store yesterday!” Yet what do all of these responses have in common?  They all represent the answer – no!  And worse, they communicate that we aren’t really concerned with what your need is as much as we are concerned with following our schedule or plans.  Screaming follows, we write reports and the day ends like yesterday ended.

In order to stop or greatly reduce the cycle of negative behaviors; behaviors people are using to get something they want or get away from something they don’t want, our number one job is to find out what the need is and then work creatively if necessary to get that need met!  Oh sure, I get the dollars and cents of business.  I understand the limitations of staffing and staff costs.  I even appreciate the necessity for rules or guidelines to help things run more smoothly and efficiently.  You bet!  But even more than that, I understand people and how they respond when their important needs aren’t being met (even if it just their perceptions).

So the simple solution to escalating behaviors is to work with your staff to become expert at finding out what the need is and then assuring your customers that it will be met. Our motto here at Intellegis is that we never say “no” to a request.  We may say, okay let me go talk to the supervisor and figure out how we can help you, but we never give answers that can be interpreted as “no.”  Why?  Because a no answer to a perceived need will almost always end in escalated behaviors which in most cases we end up meeting anyway as a response to the madness that just ensued after we said no!

So do yourselves and those people you serve a favor.  Instead of getting caught up in the yelling and the cursing and the threats, respond calmly in a way that communicates your sincere desire to help the person get their needs met. And you know what you will discover?  Old such and such really isn’t such a bad person after all!