Trying to advocate for nh residents dx with HD. NH's are stating that the behaviors are too severe for them to handle. Any recommendations on how to manage behaviors (other than actually have staff providing good quality care) <smirk>?

I'm posting this on behalf of Dave ....

Ya know, every time I'm around Jim Pollard, i ALWAYS learn something...at
the convention this past June in Orlando, Jim was talking about finding the
lowest common denominator when dealing with behavior problems...i THINK he
drew from his experience as a teacher or as an educator...his suggestion is
to defuse the situation first by finding common ground between the pHD and
the caregiver..."Can I get you a glass of cold lemonade?" gets the pHD off
of whatever is bothering her/him so that you can calm them down enough to
find out why they are acting out or angry, etc. I know it's worked wonders
with my wife since I began using this technique. For Paula, most of her
anger stems from just plain boredom as she either sits on the couch all day
watching TV or reads...sooner or later, that just plain gets old. She gets
bored and unless one of the family takes the ball and deals with her
bordom, her behavior just gets worse until the source of the bordom is
removed. So find that lowest common divider...once the source of the
problem is removed, most pHD's seem to calm down. As an aside, I think
most of us probably act in the same manner, whether or not we're a pHD OR
caregiver. I know *I* do.
Peace and love from a rainy Chicago,
Dave

I'm posting this response on behalf of Phil Hardt.

Suggestions for Managing Behavior of People with HD from Dr. Chiu.

Most unacceptable behavior is in response to unmet personal needs,
frustration, or a sense of powerlessness. People with Huntington's Disease (HD), because of organic brain damage, are unable to rationalize certain situations and, therefore, may appear to be irrational, demanding, or selfish. They are often unable to learn new tasks. Techniques using reward and punishment and behavior modification are beyond their mental ability.

In difficult situations, caregivers who are tired and overworked may stop
rationalizing the behavior and fall into the trap of reacting to it by becoming either authoritarian, rude, or even angry. Caregivers will forget that the person with HD is brain impaired, and that the impairment is one of the reasons for the behavior.

DON'T ...

Don't argue with the person. Remember he or she may no longer have the ability to be as rational as you.

Don't order the person around. Few of us like to be "bossed" and the HD person is no exception.

State directions positively rather than negatively. Instead of "You can't go," say something like, "Let's look at these pictures."

Don't be condescending. A condescending tone may provoke anger even if the words are not understood.

Don't ask a lot of questions that rely on good memory. Remember, the person may have memory loss and may feel humiliated or angry if you ask
questions he or she can't answer.

Don't speak about the person as if he or she were not there.

DO ...

Do try distracting the person. Diverting the person's attention to a different activity, offering a snack, may be enough to diffuse an angry mood.

Do ignore the verbal outburst if you can't think of any positive response.

Do reward positive behavior with a favorite food, a hug, sincere praise.

Do offer "cooling off" time in a quite room. It can help the person regain control of feelings or behavior.

Do try forms of communication that don't involve words.

If you think we all look different physically, man, look how different we all are behaviorally!!!! In other words it's hard to give recommendations without lots of detail. There are lots of aspects of nursing home life that are difficult for young people, people with impulse control problems, people with depression...there are some aspects that are helpful such as routine, consistency, etc. There are no easy answers. Anyway, if you think I can help call me at work here at Laurel Lake Center in Western Massachusetts at 413-243-2010.