The overlooked role of deficit or non-productive behaviors in traditional assessment of long-term care residents

Most instruments that examine long-term care residents' problem behavior assess only productive behaviors that require immediate behavioral management (e.g., kicking, wandering, screaming). However, it was hypothesized that the deficit or non-productive problem behaviors of older adults in long-term care (e.g., social withdrawal, excessive sleeping, and not eating) may be as problematic as their more salient counterparts. A factor analysis of 561 staff members' ratings of residents on the Nursing Home Problem Behavior Scale, along with three additionally constructed items, suggests that deficit behaviors can be assessed reliably and that they account for a unique, underlying dimension in problem behavior. After controlling for level of burnout, caregivers associated more unfavorable attitudes with residents' deficit, than with certain productive (e.g., irrational and annoying), behaviors. Recommendations are made to include deficit behaviors in traditional measures of problem behavior and to help professionals in long-term care become cognizant of their potentially negative impact upon caregiving.