How To Stop Dementia Patients From Wandering
I have spent my career as a gerontological nurse practitioner working with people who have Alzheimers disease or other forms of dementia. My interest in this field began when my grandmother developed dementia and I was dissatisfied with the care and level of understanding she received from medical professionals.
Families often consult with me about one worrisome symptom of dementia: wandering. For dementia patients, this behavior is very different from the aimless wandering of hikers exploring the woods or tourists moseying around a new city. Most often, there is nothing purposeless about the wandering behaviors I observe.
My grandmothers case is an excellent example. While she was in the middle stages of the disease, she became adamant about going home across the river. She must have been thinking of a childhood home in Europe, because she never lived near a river in the United States. My grandma would escape from the house, walk straight across a nearby golf course and interrupt peoples games. Later, she would remark that the people outside were very nice because they waved at her. In reality, the golfers were mad and trying to shoo her off the course!
Encourage Participation In Activities
Maybe you’re not sure what to do or say when you visit your loved one in a new facility. Consider going with them to an activity. Nursing homes offer several activities, and becoming involved in them can help foster socialization and provide stimulation for their mind. You can go with them to the exercise class or the music program. This is a positive way to spend time with them and help in their adjustment to the facility.
Moving Into A Care Home Is A Life
But even though a care home may be a home from home, it is still an institution, and as with any institution, it can take some time to get used to. So if you are moving into a care home or helping a loved one to do so how can you make the process easier?
Routines matter. Many of us have routines that we take for granted for example, having early morning tea at 7am, or eating lunch while watching TV. Care home staff should aim to fit in with your routines, rather than the other way round, but they wont know how you like your day to go unless you tell them.
Stay connected. Even if relatives or friends cant visit often, there are lots of ways to stay in touch, from having a pay-as-you-go mobile phone for your room, to setting up a tablet or laptop so you can talk to and see family members via Skype, or simply keeping a supply of stamps and notecards so you can communicate by post.
Food for thought. Care home menus should be designed to be varied and nutritious, but that may mean that they offer meals youre not used to or dishes youve never heard of. Let staff know your likes and dislikes, and make a note of your favourite meals so you remember to ask for them.
Attend relatives and residents meetings. Many care homes now offer regular sessions to air any issues that may be affecting residents. These can be helpful as you may realise that youre not alone with a problem such as the food not always being hot, or noise in the corridor at night.
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When Should Someone With Dementia Move To Assisted Living
According to the Alzheimers Association, around 16 million Americans dedicate their time to taking care of a family member with dementia. While it is good for these people to devote themselves to their loved ones, it can be a burden to ensure home health care without falling sick or affecting their careers.
More importantly, time will come when the increasing needs of dementia patients exceed our capabilities. Even relying on caregivers is just a temporary solution. It is the time when we have to carefully consider moving a loved one into an assisted living facility.
But when should people with dementia move to assisted living facilities?
Every patient is different, so there is no specific guideline to follow when deciding if its time to move them to a facility. However, according to experts, the following are the most common signs that call for a shift from home care to assisted living.
Provide Information About Your Loved One
You have the advantage of knowing your family member, their history, their likes, and dislikes. Share that information with the staff.Sometimes, there will be a meeting shortly after admission where staff will ask questions about your loved one, their needs, and their preferences. If this doesn’t happen, ask to speak with the nursing supervisor on your their hall or the social worker. You can then choose a few things that you want to share with them, such as the best time of day for a shower, what they really dislike to eat, or the nickname that they loved to be called. When you share these things, your loved one is more likely to respond positively to the staff and the staff to them since they know them as a person, not just a patient.
You can also create a short life story to share with others about your loved one. This can be done through writing, photos or video and is an effective way to help staff members get to know them.
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Care Homes: When Is The Right Time And Who Decides
Advice and practical tips for carers on when is the right time for a person to be moved to a care home.
Care homes: when’s the right time and who decides?
A person with dementia will need more care and support as their condition progresses, and there may come a time when they will need to move into full-time or residential care. This could be because a care home may be able to meet the needs of the person better. Or, it could be because something changes that then makes it difficult for the person with dementia to stay living at home.
It can be hard to know when the time is right for a person with dementia to move into a care home and who should make this decision, if the person cannot make it themselves. This factsheet is aimed at carers, friends and family of a person with dementia. It provides information and explains what might need to happen in these situations. It also talks about some of the feelings you might have when the person with dementia moves into a care home, such as relief, loss or guilt.
To help you to find the right care home, see our booklet on selecting and moving into a care home. It explains the process of finding and visiting homes, and has checklists and tips of things to consider when deciding which home is the right one.
First Steps: Getting An Assessment
The first step towards choosing a care home is to get a new needs assessment from social services.
If the assessment suggests a care home would be the best option, the next step is a financial assessment .
The financial assessment will show if the council will pay towards the cost of a care home.
In most cases, the person with dementia will be expected to pay towards the cost.
Social services can also provide a list of care homes that should meet the needs identified during the assessment.
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Who Makes The Decision
In some cases the person with dementia will be able to decide for themselves whether or not they need to move into a care home. If this is the case, then they should make their own decision and be offered any help they need to do so. However, often by the time the person with dementia needs the level of care that a care home provides, they have lost the ability to make this decision for themselves.
If the person is not able to make this decision, someone else will need to make this decision for them. This would usually be the persons attorney under a health and welfare Lasting power of attorney, or their personal welfare deputy, if they have one. Any attorney or deputy must make decisions in the best interests of the person. An attorney or deputy for property and financial affairs is often able to make this decision for the person with dementia. This is because they have the legal power to arrange the finances to pay for this care. However, professionals or members of the persons family can challenge this decision.
For more about mental capacity in England and Wales, and how to know if someone is able to make decisions for themselves, see our page on the Mental Capacity Act. For more information on attorneys and deputies see Lasting power of attorney and Becoming a deputy for a person with dementia.
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Your loved one may have difficulty communicating. They can have trouble telling you if they are uncomfortable. Signs of physical discomfort may be that your loved one is:
- having trouble sitting in one place
- constantly on the move
- fidgeting
- irritable
Making sure that your loved one is physically comfortable will drastically reduce aggression and agitation. Below is a thorough checklist to help you identify physical discomfort:
Always look for ways that you can cherish your loved one. Choose not to focus on the more frustrating aspects of caring for him or her. Pay attention to the immediate situation or activity. Notice if the activity seems to be triggering your loved one. If so, try to be proactive in changing the situation or activity. Redirect to a more peaceful and relaxing activity. If a conversation is upsetting either of you, change the direction. Acknowledge what your loved one said and then move to a different topic.
Aim to say yes as much as possible. If your loved one mentions that she saw someone who passed away years ago, agree with how lovely that would be to talk to them again. Even build on it and ask what they talked about. This gives you both a sense of connection and comfort with one another.
“Yes” is a powerful and affirming word. Saying “yes” lets your loved one know that you understand what is important to him or her. That you hear them. That you are listening.
Resources:
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Avoid Arguing About Whether They Are Already Home’
For a person with dementia, the term ‘home’ may describe something more than the place they currently live. Often when a person with dementia asks to go home it refers to the sense of home rather than home itself.
Home may represent memories of a time or place that was comfortable and secure and where they felt relaxed and happier. It could also be an indefinable place that may not physically exist.
Its best not to disagree with the person or try to reason with them about wanting to go home.
Adjusting To Dementia Care: Final Thoughts
Theres no way to predict how long the adjustment to dementia care will take. Meet with your loved ones medical provider to address any underlying medical issues like depression and mood disorder before the move. Then, bring familiar items from home, give loved ones a period to bond with dementia care providers without family visitors, and encourage engagement in community activities to help ease the transition. Finally, dementia care providers will be able to provide helpful and insightful guidance along the way, too.
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Tips On Choosing A Care Home
One of the most important things to check when choosing a care home is the most recent Care Quality Commission report.
The CQC regulates all care homes in England. Its inspection reports can show you how well a care home is doing and any areas of concern.
When visiting a care home, spend time looking around and talk to the manager and other staff and residents.
It’s useful to take a friend or relative with you as you can compare notes after your visit.
It’s a good idea to make your own checklist before visiting care homes. These tips may help.
With Many Families Having Concerns About A Loved One Moving Into A Care Home With The Ongoing Coronavirus Pandemic Beth Britton Offers Some Advice
Care homes have been in the news extensively in recent months as the coronavirus pandemic has gripped the UK.
Despite the many frightening stories, lots of people are still living positive and healthy lives in care homes. With this in mind, Care Choices have asked me for some tips for families whose loved ones may be joining the care home resident population in the coming weeks.
As someone whose father lived with vascular dementia for nineteen years and spent the last nine of those in three different care homes, I hope this Q& A will help you by answering a few of the most common questions Ive been asked recently.
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Schedule The Move For Their Best Time Of The Day
Typically, late mornings and early afternoons are a dementia patients best time of the day. Early mornings and evenings may be more difficult.
The transition from one home to the next will be less stressful when your parent is most likely to be calm, allowing more time to settle in before s/he becomes fatigued or agitated.
Start A Conversation Early
If possible, begin making the long-term care plan as early as possible after the dementia diagnosis.
If your parent or loved one is in the beginning stages of Alzheimers or dementia, looking ahead to find the right community allows them to be a part of the process, which can make for a smoother transition when moving day arrives.
Ideally, the time to move to a community is when s/he is no longer able to live safely and independently at home or when the level of care required becomes more than what you and/or other caregivers are able to provide from a time and safety perspective.
On the flip side, if your loved one is in mid-to later-stages of the disease, it can be upsetting to engage him/her in selecting a community and planning moving day. In some cases, it is better to wait until the change is eminent to announce the move, and enlist the help of family and friends for decision-making, sorting, and packing.
Visit ourGuide for Talking to a Loved One About Memory Care for more insight into this topic.
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Helping Those Living With A Diagnosis Of Dementia Reach Their Full Potential
Helping a relative living with dementia to lead a fulfilling life through the activities of daily living could become challenging within a home environment. Cramond Residence offers a solution that is always in the best interest of the person living with dementia. We provide a warm and welcoming environment in which the person will feel safe and in which all of their needs will be addressed and met. Family members and friends can then visit whenever they like to provide the love and support they want to give, without having to go through the emotional strain of being the primary care giver.
Our dementia care is offered within the general Care Home community or in our specialist area, which has been carefully designed with the right facilities, amenities and calming décor for those where dementia is at a more advanced stage. Where care is given depends on the developmental stage of the illness.
Choose A Community Specializing In Memory Care
Not all assisted living communities are created equal, and many of them arent equipped to adequately care for residents with Alzheimers or dementia. Moving is challenging enough, and the last thing you want to do is have to move your parent a second time unless you absolutely must, so it is important to select the right community specializing in memory care.
Use theseQuestions to Ask When Visiting Memory Care Communities to help you select the best new home for your loved one.
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Transition To Residential Aged Care Facility
In the later stages of dementia most people will require total care.
Whether this care is provided at home or in a residential care facility will depend on the person, the carer, the family and their situation.
For people who live alone, the move to residential care may come sooner than for those who live with family. The timing may also be influenced by the presence of comorbidities. For many people, the move is rushed as it follows a crisis at home or an admission to hospital. This can increase the stress and distress for all involved.
Moving into residential care is a time of upheaval for the person living with dementia, their carers and family. Adjustment to residential care is more than a discrete event . It begins with thinking about and planning the move, and continues with the actual move into care and beyond as people settle in and adjust to change.
People going through this major transition do better when given holistic support. Health professionals working in aged care assessment teams, community services, aged care facilities, hospitals and health care can provide information, explore options, assist with practical tasks and provide emotional support.
How Involved Can I Be In My Loved Ones Care
You can be as involved as the coronavirus restrictions allow. The minimum need most care homes have will be for an emergency contact and some family input into creating an initial care plan, with care reviews periodically thereafter.
Try to be creative to maintain contact with and support for your loved one, aside from video or phone calls, you could:
- write letters
- have tea together during video calls
- send packages of cosmetics, clothing or favourite foods that will help to support your loved ones comfort and wellbeing
- create life story resources, this Foundation of Nursing Studies pack contains a number of examples
- send links to things you think they might enjoy watching, like virtual tours of favourite galleries or reminders for staff to put sports on that they love to watch. Distancing with Dementia has some great ideas you can try
If the care home runs any events on platforms like Zoom for families to connect with their loved ones during activities, try to join in with these as well.
If you find you are struggling to communicate with your loved one, perhaps because they have dementia and it is advancing, its worth speaking to staff to ask for advice to help you communicate more effectively with your loved one. Good care home staff should be well-trained and able to guide you.
Still, deciding which care home to go with? Our article, Choosing a Care Home can help you identify the right option for your loved one.
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