Can Residents with Behaviors go on Outings?

I have been told that you cannot take residents with behaviors on outings. I have been given multiple reasons why you cannot.  Well, I tend to disagree. I believe that keeping them in may add to their behaviors.  If you kept me inside all the time, I would have huge behaviors.

Let me start with a personal situation.  My Mother-in-law was always on the go.  She NEVER stayed home.  She had a shih tzu dog that she took on daily walks in her neighborhood.  She went out to eat at least once a day. She went shopping a lot. She went to church, church functions and outings with her Sunday School class. She did things with friends.  She even mowed her own yard, planted flowers in her landscaping and I could go on and on. She developed dementia and eventually went to live in a facility. She did get involved at first but would need reminding of times and places to meet for the outings.  She ended up having to move to another facility.  She was considered a flight risk and was not allowed to leave the facility without family or for an outing.  Eventually she was moved into the Alzheimer’s unit and wasn’t allowed to leave the unit without family because of her behaviors and being a flight risk.  She lasted about 2 weeks and had to be moved to another facility when her behaviors escalated and she ran her hand into her TV. She broke the TV and her wrist.  We were able to work with the facility to get her out of the facility at least once a day. Her behaviors started to decrease, and we were able to spend quality time with her. Unfortunately, all the changes caused a downward spiral that could not be reversed.

The first thing you need to know is what kind of behaviors you are dealing with.  The second thing is what does their assessment say. If they were an outdoor person and are stuck inside, you are going to see behaviors. The third thing to consider is, does the behavior require extra help? Just because they have a behavior doesn’t mean they should be disqualified from going on an outing.

I worked in a facility that had a lot of behaviors.  One resident was a drug addict which caused her to have a stroke.  She was paralyzed on one side but could still get herself around in an electric scooter.  She ended up in our facility because family could not handle her anymore. She would do whatever she could to get someone to get her some drugs.  We went to the county fair and she would ask people walking by for cigarettes or a drugs. She didn’t have any money on her but she would offer favors in exchange for those items. We were aware of this behavior so the staff or the volunteer that was assigned to her was able to redirect her or move her away from areas where a lot of people were. We also did not take her electric wheelchair on outings.

Another example is a resident that had a head injury at work.  He was a Vietnam vet that had a lot of issues before the injury. He had a whole list of behaviors. He did not talk appropriately to others, especially women. He was known for taking care of business no matter where he was. We had a men’s group that went out for breakfast once a month. One morning it was his turn to go.  We get to the restaurant and the waitress asks him what he wants to eat.  He says, “I’d like some hairpie on toast”.  The waitress without missing a beat says “We are fresh out of that, what else would you like to eat?” I had no idea what he was talking about, but I had a male volunteer who was amazing and he handled the situation.  This male volunteer was a gem, he went on a lot of my outings with me and he always made sure he kept his eye on my gentleman.  This same gentleman loved to help gather up trash on the bus.  I usually had a garage bag available for when we went out for ice cream or had water bottles. I was unaware that sometimes he did not always use the trashbag.  One such day we were coming home from the county fair parade. Everyone had waterbottles after we got off the float and back in the bus.  He was collecting the empty water bottles.  I kept hearing the window open but did not think much about it.  That is until the next week when I got called into the boss’s office.  Apparently someone saw water bottles being thrown out the window of our bus and reported us to the authorities for littering.  Needless to say he did not sit by the window after that.

I had another resident that would “take” the dishes, cups, silverware and menus home from restaurants.  It took me several outings before I realized what was going on.    Apparently, she was tucking the plates and menus in her shirt and pants.  The silverware went into one pocket and the cups went into the other pocket. No wonder her clothes looked tighter on the way home. I started catching our waitress when we got to restaurants and explained the situation to them and asked that as soon as they saw her plate empty to say they needed to get it cleaned and ready for the next person.  She would also get up to go to the restroom and then they would clean her dishes up so they were gone when she came back. Just as a side note she did this in the facility as well, but I didn’t know it until one of the aides brought the items to me and asked if I wanted to return them.

Another resident was bipolar and even though she was on medication it was hard to know when she would cycle down.  When she cycled down, she would start to cry, and the cry would turn into a siren sounding wail. She loved to go out, but you never knew when the siren was coming.  We had gone to the county fair and we were watching the kids do barrel racing with their horses.  Several of our residents had grandkids they were watching. Out of no where comes the siren. We had her sitting on the edge of the bleachers in a wheelchair and a staff member was able to quickly redirect her chair to another area of the fairgrounds where it would be less disruptive.  The rest of the residents were able to finish watching the kids without any issues.

One of my residents who had dementia, loved men.  She was not like this before developing dementia. She was a very religious lady. She loved to go out to eat, the movies and anywhere she could. She would talk to every man she met and ask him if he was married, if he was interested in dating or if she could take him home with her. She also had a habit of speaking her mind. I guess you could say she had no filter.  We went to a Christmas concert and somehow she ends up sitting next to a very nice looking gentleman.  I tried to move her over and sit a volunteer next to her but to no avail.  She struck up a conversation with this nice gentleman. She began her list of questions.  He was really sweet and kept answering her.  He told her he wasn’t interested in dating anyone.  She was quite upset and said “don’t you like me, do you think I’m ugly?”  To which this nice gentleman said “I am a priest.”  She paused for a minute and then said, “Well I don’t care if you don’t care”. Thankfully the concert started.

One of our aides was in a beauty pageant and had gotten tickets for the residents to attend. My very outgoing lady wanted to go. We made sure she was sitting beside staff and volunteers. As we were sitting in the audience, my lady was making comments about all the girls dresses.  She would say how beautiful the girls were and how pretty the dresses were. She even recognized the aide that was up there. Then comes one young lady out on stage that apparently did not met her standards and she let it be known.  We all tried to redirect her and get her to look at someone else or at the program to no avail.  Then when you think it can’t get any worse, it becomes quite clear that the young ladies family is sitting in the row directly in front of us.

One Resident I will never forget.  She was born and raised in Puerto Rico.  Her family moved her to New York City when she was 19 years old.  She was a Puerto Rican New Yorker and she was fiercely independent.  Her husband was drafted in WWII.  He never came home, not because he died but because he couldn’t deal with a wife and kids. She was left to raise 2 girls on her own. She lived in a building that was owned and run by the Mob.  According to her daughter, money would show up under their door from time to time.  Well, mom knew where that came from and she would take it to the room of the Mob and throw it back and them and tell them she didn’t need their money. She would go out every day and go down to the local vendor and get a newspaper. Her apartment was only blocks from the twin towers.  She was in New York City when the towers came down. As she got older she was having issues living on her own.  Family hired helpers but that didn’t go well.  They finally moved her to Ohio so they could help take care of her.  She ended up in my building.  This was during a time when we were still allowed to restrain residents to their wheelchairs for safety reasons.  We were allowed to release them in activities as long as someone was right there with them.  She was having a lot of falls, yelling at staff, throwing things at staff, and trying to get out of the building.  She was angry about being moved.  She was in her 90s and didn’t like being told what to do. She was used to being outside working on the flowers outside of her building. She was a pill according to her daughter.  I asked permission to take her to the county fair.  Her daughter laughed at me and said I don’t think that would be a very good idea. She did not want her mom going on outings because she was afraid of what would happen. After completing her assessment I realized that going on an outing may just help decrease her behaviors and I explained this to her daughter. She finally agreed to let her go but informed me that I was signing my own death certificate. I assured her that if this didn’t go well we wouldn’t have to take her again.

I went down the hall and asked the resident if she wanted to go to the county fair with me.  She wanted to know how I got that approved with the prison guard.  I smiled and said I have my ways.  We went to the fair.  When we got their everyone heads to the restroom.  I took her “seatbelt” off so she could use the restroom.  When she came out of the stall, she washed her hands and then looked at me and asked me if I was going to tie her down again.  I looked at her and said I will make a deal with you, if you promise to stay in your chair and ask for help when you need something I will leave it off.  I was the one pushing her around the fair so I would be right there with her the whole time. She looked at me and stuck her hand out to shake mine and she said “Deal”. She had a blast at the fair and I never had one behavior out of her the entire day. When we got back to the facility and were unloading, she looked at me with a tear in her eye and thanked me for giving her, her life back. Then she asked if I had any pull on getting her to be allowed outside. We met with the care plan team and were able to come up with a plan for her to be outside.  Eventually she was able to be outside unsupervised.  Therapy even taught her how to get in and out of her wheelchair so she could sit on the ground and deadhead the flowers around the facility. Her behaviors basically disappeared without medication. Just as a side note she did not have dementia.  She was one very sharp lady and was very much aware of what was going on around her.

She taught me how truly important outings and being outside are to those living in facilities. Behaviors are a challenge and yes it can make planning an outing a little more challenging.  I truly believe that as a team we can come up with a plan to help those with behaviors have an opportunity to enjoy events outside the facility.

Tammy Point NAAP Leadership Team