A vital part of your role as staff in a community program is to make sure that the individuals with mental retardation whom you support are as healthy and safe as possible. Your responsibilities will depend on the type of program in which you work. For instance, while staff in day support, case management, or in-home services play a vital role in carefully observing individuals and in reporting any changes in behavior, appearance, or eating habits that may relate to good health, congregate residential staff often have the additional responsibility of arranging for and accompanying individuals to doctor or dental appointments. In addition to this chapter of the workbook, you may receive First Aid and CPR training to assist you in your work. You may also receive training and be tested in procedures for safe administration of medication. This chapter is not intended to replace that training. In general, your role is to help the individuals access quality health care, assist them in learning or practicing behaviors or skills which maintain good health, and help them become aware and informed regarding their own health concerns.
Maintaining Good Health Through Good Nutrition
People with mental retardation have the same needs for good nutrition and maintenance of proper weight as non-disabled persons. Since mental retardation and other developmental disabilities can be associated with other medical conditions, such as epilepsy, allergies, diabetes, and heart problems, you may support people who are required to follow a special diet for health reasons. Depending on the needs of individuals, your role may include planning nutritious and well-balanced meals or assisting the individual in doing this, overseeing meal preparation, and noting food consumption.
Important Point: As staff in a community program for persons with mental retardation, resist the temptation to reward or coax good behavior with food. Individuals with mental retardation experience the same problems with excess weight as the rest of us. Many of them have never had the opportunity to experience a regular exercise program. When you wish to reward someone for positive behaviors, offer a meaningful, non-edible reward, such as:
– A fifteen minute walk around the neighborhood,
– A telephone call to a relative or friend,
– A short shopping trip,
– A visit to the library.
What’s Your Role?
1. Read the medical and social history records for all individuals you support.
– Who’s on a special diet?
– Who has food or other allergies? If so, what are they?
2. Monitor an individual’s food intake during meals, but do so in an age-appropriate, respectful manner.
– For example, if an individual has difficulty with overeating, serving food
family style may create too much temptation and lead to conflict. An
alternative would be to prepare everyone’s plate in the kitchen, possibly
serving smaller helpings initially to allow for the satisfaction of “seconds.”
3. See the Food Guide Pyramid on page 44 to help you in meal planning.
An individual’s maintenance of his or her personal hygiene plays a major role in how others perceive that person. It is important for all of us to wear clean clothing, to keep our hair clean and healthy, and to bathe regularly. For people with mental retardation, it is even more important. Already perceived by others as “different,” individuals with mental retardation will be seen as more unappealing if they are wearing dirty clothing or have a sloppy appearance.
It is likely you will work with some people who need prompting or assistance to keep up their personal appearance. Depending on the needs of the individual, your assistance could range from physically bathing to helping someone shop for attractive shirts that are appropriate for his new job. Maintaining good hygiene, including dental care, is also important for health reasons. Lack of attention to bathing or routine care of teeth and gums can lead to serious medical conditions. You may support people who don’t understand this and may not enjoy participating in such activities. It will be your responsibility to develop strategies for encouraging individuals to participate in necessary bathing, shampooing, and the other personal hygiene activities.
Important Point: You should expect the personal hygiene of the individual you support to be kept at a level equal to your own, your child, your spouse. It is no less important!
What’s Your Role?
1. You provide residential supports to a young man who drools due to a severe cleft palate. To assist him with maintaining a positive personal appearance, you take him to purchase several sets of men’s handkerchiefs and teach him how to wipe his chin, if needed, with a simple verbal prompt.
2. You help a person find a dentist who accepts Medicaid or offers reduced rates for low income patients.
3. One of the individuals in your day support program is having toileting accidents. You alert the case manager and residential staff that the team needs to try to identify the cause, such as medical problems, behavioral communication, depression, etc., and come up with a solution in the meantime, such as extra change of clothing maintained at the day program or possible short-term use of Depends.
Regular Medical and Dental Care
Scheduling regular doctor and dental checkups is usually the responsibility of residential staff or family if a person lives at home. However, all staff who work with individuals with disabilities should look for changes in appearance or behavior which may be symptoms of illness. It has been shown that challenging behaviors are frequently the only means of communicating physical or mental pain for some individuals with mental retardation. Since some persons with mental retardation are unable to tell you how they feel or what a change in health may mean, staff must be responsible for monitoring this regularly. The following lists areas where changes may indicate signs of illness or a change in health status:
A. Changes in Daily Patterns
1. Eating/ digestion
4. Medication – changes and reactions
B. Changes in Appearances
1. Weight gain or loss
2. Condition of skin or hair
3. Eyes: appearance or sensitivity
5. Hygiene deterioration (such as body odor, untidy clothing, bad breath)
C. Changes in Bodily Functions
3. Vital signs (such as pulse and blood pressure)
4. Bowel movements
5. Mobility – use of hands, arms, and legs
6. Senses – seeing, hearing, touch, taste, smell
D. Changes in Behavior/Demeanor
1. Obvious change in mood (such as depression, crying, agitated)
4. Anxious, restless
5. Obvious change for that individual (previously energetic person appears listless or a typically quiet individual talks nonstop).
What Can You Do?
If you notice any of the changes listed above, you should:
1. Note it in the staff communication log so others can be aware and observant.
Documenting incidents of these changes may be key to diagnosing a problem if one exists.
2. If you’re new to a program and note changes in an individual, speak to your supervisor or a co-worker to get a perspective on the person’s history.
3. When in doubt, and if symptoms persist, call a doctor!
You will most likely receive or have received training in First Aid and Cardiopulmonary Resuscitation (CPR) prior to supporting individuals alone. This will enable you to react appropriately and possibly to save someone’s life while medical care is on the way. It goes without saying that any condition which would be considered an emergency if it happened to a member of your family is also an emergency if it occurs to a person with mental retardation. Call 911 at the first sign of a medical emergency!
Important Point: Since many individuals with mental retardation have other medical concerns, such as epilepsy, diabetes, food or drug allergies, it is very important that staff become aware of any individual signs or symptoms of medical distress. People who have epileptic seizures often signal an oncoming seizure through an involuntary facial expression or other behavior. Get to know the people you support. It may mean the difference between life and death.