Solve the WHY not the WHAT

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The great Evy Cugelman used to tell me ?- “Behavior is just an unmet need.” If you can find the root cause, the solution will be a lot simpler.

Every single day at 3pm, Ethel would get very upset. She would put on her coat and hat and try to run out of the memory care home where she lived. Since there was a busy street out front and Ethel couldn’t see very well, this was not a great idea.

When staff tried to redirect, go on a walk outside, or find out what she wanted – it always escalated as she got more and more upset.

They tried therapy, medication changes, proximity alarms, distracting her with activities before 3pm, even going on a trip outside the building every day around 2:45. Nothing worked.

At 3pm she would quickly get very upset and yell about needing her babies. Bringing in school children, or a doll (which she loved), or even her “babies” who were 65 and 67 years old, did not change this daily routine of sadness.

Someone had written in her chart “daily early sundowning” and a doctor recommended heavy psychotropic medications.

So many meetings, conferences with families, visits to specialists, and staff one-on-one time was spent trying to help Ethel.

Until one day a very smart nurse, Shawn Laird, asked her, why?

Why do you need your babies? Ethel said “I’m late, they are waiting at the school”.

Ethel could rarely tell you what day it was let alone the time of day which prompted the next question.

‘How do you know it’s time for picking up the kids from school?’

Ethel kept crying and said “it’s late, it’s late, I haven’t got the babies and haven’t even started to make dinner.”

‘How do you know it’s time for dinner Ethel?’ She kept repeating it’s time for dinner and I’ve forgotten to get the babies.

Then a moment of realization – “Ethel are you hungry?”, “yes, its dinner time and I haven’t got the babies”

After hundreds of hours and thousands of dollars spent on trying unsuccessfully to help Ethel the solution was far more simple once the root cause was discovered.

From that day on, Ethel got a sandwich or cookie at 2:30pm. It worked. Not a one-on-one, not a medication, not any of the behavioral interventions – a sandwich changed her life and she never had a 3pm meltdown again.

Whether it is with patients or staff – we try to treat or discipline what we see. But what is the root cause? What is the fundamental need? It might be a need to change work hours, or a difficulty understanding my silly accent, or even just a sandwich.

Take the time – with employees and patients – find what need they have that is unmet and solve for that. The behavior will take care of itself.