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Healthcare Training Institute - Quality Education since 1979

Section 28
Reassurance, Expression, Coffee, Change Staff

Table of Contents | NCCAP/NCTRC CE Booklet

a. Use Reassurances and Share Techniques with Others!
Here are some reassurance statements you might use to get a resident to leave his or her room. 
“I’ll take you back." 
"It’s only thirty minutes long." 
"It’s just down the hall.”  How about this one? 
“If you have any visitors, they will be notified.” 

When you are using reassurance as a motivator, share with other departments the words of reassurance you use that are effective.  In short, if you find some magic phrases that work, share them! Put these in Progress notes, share these phrases that are effective in motivating the resident with others in a care plan conference, or share them in the employees’ lounge.  State, “I can’t believe it!  I finally got Effie out of her room, and this is what I said…, and this is what worked…!” 

Below write the names of residents and words of reassurance that are effective in getting him or her to leave their room.  Then, duplicate this table in Word, Excel, or a notebook and list additional residents.

Residents who may become motivated by words of "Reassurance"

Culture Change CNA Inservice:  Brainstorm about residents whom the CNA successfully motivates with “Reassurances” & what words work.

b. Offering a Choice!
There’s more of a chance that alert residents will attend an activity, for which if they have had a chance to plan that activity.  I have found January and August are two good months for theme parties, because there aren't any major holidays in those months.  Oriental Trader is a catalogue that provides reasonably-priced party decorations that are delivered in an on-time manner.  Also check Google or Yahoo for theme party resources.  For example, how about going to your Residents' Council, telling them what the budget is that you have for a January or August Hawaiian Luau, and having the Residents' Council pick out the decorations?  Or, go to some room-bound, alert residents, and encourage them to make a simple choice about the Luau decorations.  You might show the resident a picture in the catalogue and ask, "Do you like the red leis or the blue ones, Ellen?  What do you think?  Red or blue?  That’s all you have to choose.” 

As you know, offering a resident choices is an important point related to CMS regulatory compliance.  So give yourself credit in your Progress Notes regarding giving resident's choices about his or her preferences.  In summary, have a theme party and have residents choose decorations.  If they have had a hand in planning there is a greater chance they will not only attend but participate in any activities conducted.  It becomes their party not your party.
 
Below write the names of residents who might be motivated by "Offering them a Choice."  Then, duplicate this table in Word, Excel, or a notebook and list additional residents.

Residents who may become motivated by "Offering a Choice"

Culture Change CNA Inservice:  Brainstorm about residents whom CNAs have motivated by offering the resident a “Choice.”

c. Coffee, Food, and Telling the CNA
Oftentimes an Activity Director or Social Services person has said to me, “Cathy, the only activities this resident will go to are the activities where there’s…"  What?  Food.”  Well at least that’s a motivator and it works.  However, make sure you let the CNAs know that certain residents are motivated by food.  If  you put a list at the nurses station for residents to be gotten out to an activity, tell the CNA, Sara, that “At 2:00 this afternoon, when you’re getting Effie ready to go, tell her there will be cake served.”  This way, you are utilizing your Effie’s resident's greatest motivator… food.

Below write the names of residents who might be motivated by "Food."  Then, duplicate this table in Word, Excel, or a notebook and list additional residents.

Residents who are motivated by "Food"

Culture Change CNA Inservice:  Brainstorm about residents whom CNAs feel “Food” has, and is a good motivator they can use.

d. Culinary Council
It's no secret that food motivates many residents to participant that are not normally involved.  Here are two ideas you might try, or revisit if you have tried them before.

Idea #1  Here's a tip that will help you out at CMS Survey time and with interdepartmental cooperation!  List your most forgetful, most complaining residents. As you know, forgetful Low Functioning residents often complain to Surveyors about not being fed.  The problem is these lower functioning residents are too disoriented to serve on your regular Resident Council.  So why not start a Culinary Council?  This Council meets monthly with the dietician or more often if a need arises.  The sole purpose of the group is to discuss food concerns, as well as food requests.  This is a double win!  You get a viable activity for residents, who normally are not of the level to participant in the Resident Council.  However, be sure that detailed Progress Notes appear on residents' charts regarding their contributions to the Culinary Council meeting.  Thus, when Surveyors question a complaining forgetful Low Function resident about getting proper nutrition, make sure the dietician is aware of your Activity Progress Note regarding their contribution to the Culinary Council.  This note will verify the fact that even lower functioning residents are encouraged to speak and are heard.  Remember this is the same Dietician who needs to remember to order the punch for your monthly birthday party... get the idea?  I have found, like you, that interdepartmental cooperation is often achieved by giving first.  Volumes 9 and 10 in this series of courses deal with this topic.

In summary: 
1. Create a subcommittee of your Resident Council specifically targeting food and the lower functioning who are able to communicate. 
2. Food issues are major areas of focus at Survey time.  So support Dietary by making detailed Progress Notes of resident involvement in the Culinary Council and informing Dietary. 

Residents who may be motivated to attend a "Culinary Council" meeting

Culture Change CNA Inservice:  Brainstorm about residents whom CNAs feel would be interested and appropriate for a “Culinary Council.”

e. Using Food to expand your One-to-One Volunteers
Idea #2:  As mentioned earlier with your low functioning and unmotivated residents, food can serve as an enticement for some to come out of their rooms.  You know the old adage, "They only come to the activities where there is food!"  But go a step beyond the obvious.  With your next church group that brings the monthly event cake, as they are cutting the cake and passing slices to those in your lounge, give each volunteer a 3" x 5" slip of paper with two to three low functioning residents names and room numbers.  Tell them how much the resident would enjoy the cake. 

However, beware...
(a) make sure the resident's room has not been changed and
(b) that the resident is alert enough at that time of day or evening to be aware of their visit.  I was able to get some of my tried-and-true "Group Only" volunteers to broaden their horizons and do some one-to-one activities by getting them to pass cake to those in their rooms first.

In summary, keep a ready stack of note papers in your pocket so when group volunteers are wrapping up, give them a name of a low functioning resident to drop in on and just say "Hello" to.   You may strike it rich by getting your group-only volunteers to do some one-to-ones!  Good luck!  This idea is expanded upon in our course that deals with Volunteer Recruitment.

Residents who do not attend Group Activities, but are alert enough to be aware of a Visit

Culture Change CNA Inservice:  Brainstorm about residents whom CNAs feel will not attend groups, but are alert enough at the time the activity is ending to benefit form a volunteer visit.

f. Change Staff: Being Everything to Everybody! Doesn’t Work!
Sometimes you have to admit you are not the person to get through to that resident.  You have to admit that you cannot be everything to everybody all of the time.

Remember the 400 bed home I consulted to?  Here is a very sad story.  There was an African-American, male admission in his thirties admitted because he had both feet amputated due to frostbite.  He had other physical problems as well.  Thirty years old, and what is his future?  The next fifty or more years in a facility!  How would you feel?  The activities and social services staff was all white and all female.  I stated, “I think the first thing that needs to be decided here, just in the context of who you are, you may not  be the people to get through to this man.”  Here is what prompted me to make that statement.  John would roll himself around the facility all day long, up and down corridors, up and down the elevators. When you would say, “Hi John,” he would turn his head to the wall.  If you dared to pursue the conversation, he would cuss you out. 

However, luckily there were certain African-American, male residents who were buddies to the activities and social services department, so to speak.   So the activities and social services staff talked with these residents about John.  They stated, “There’s a new admission on B Wing; his name is John.  How about going down and talking to him this evening?"  They started visiting with him regularly and started playing cards.   The point is this.  In a 400 bed home unfortunately it can be easy for resident’s needs to get lost.  It would have been very easy for John not to have connected with the other residents if Activity and Social Services had not made the connection for John with the others. 

--The first key point here is you have to go to where the resident is regarding the issues he or she is dealing with. 
--The second key point is to think about a resident you are unable to reach.  Maybe everybody else can get through to this resident and you can not.  Stop beating your head against the wall.  Maybe you look like Esther’s Aunt Mildred and she couldn’t stand her Aunt Mildred.  Now Esther doesn’t even remember this; this is in her subconscious and for whatever reason she just doesn’t  like you!  And as a matter of fact, you just don’t like her.  So just admit, “I am not the person that’s going to get through to motivate my Esther.  I am going to use another staff member, a volunteer, or a family member."  You don’t have to be everything to everybody all of the time. 
Below write the names of residents currently not involved in an activity and the staff member, volunteer, other residents, or family members you might talk to about encouraging the resident's involvement.  Then, duplicate this table in Word, Excel, or a notebook and list additional residents.

Residents who might be motivated by "Changing the Staff" to encourage involvement

Culture Change CNA Inservice:  Brainstorm about residents whom CNAs have been both successful and unsuccessful at motivating.