One of the things that most makes a person want to escape is being locked in. It is better to accompany a wanderer and lead them back safely inside than to frustrate their attempts to leave.
But it is also resource-heavy, requiring time and high levels of staff training and very high calibre caregivers - it takes endless patience to go with Muriel when she's off on her travels for the fourth time that shift and not just want to shove her back through the doors - and it's the scarcity of those resources that makes this a bit of a counsel of perfection.
But if you ever do find a memory care unit that is aiming for it or has actually achieved it, book a place for yourself immediately, in case. That is gold standard patient-centred care.
Security is so important- what if you loved one walked off and were lost and confused. I seen stories, person w/Alzheimer's wanders off- here in Tucson AZ- it is deadly. Too many times that is the outcome. Just my opinion. My mom is locked in her Alzheimer's unit, and I am grateful.
A second thought for Susanna - Have you personally cared for and/or had anyone you loved living with you, who is a dementia patient? I, as a former Hospice Care volunteer who worked with the chaplains in that capacity, would 'visit' patients and leave. While their caregivers could leave while we were there or if I was 'sitting' with someone while their caregivers went out for a few hours, always went home and did my normal every day chores, had the evening to myself, etc.
Now that I'm a full time caregiver, knowing everything there is to know about this affliction having cared for a MIL in the past, I'm finding it hard to deal with. There are times when I (and I'm guessing many out there) lose my temper and just ask Why can't you do that? Or, what's wrong with you! And I KNOW the reason, I just lose it at times.
Those who may spend a few hours per week (or even eight hours per day) with patients with brain function problems KNOW how hard it is. They, too, can elicit little poems and sentences from their 'lost' loved ones, but in the end, they are 'lost', i.e., they do not think like we do, etc.
While art and the Living Word can help divert the attention of a person with dementia (and don't get me wrong, I certainly admire your work, at the end of the day, they are still lost in their own 'thoughts', wandering around, walking because they 'have to' not because they 'want to'. Perhaps in a more perfect world, this will happen, but unfortunately, I can't see it happening in this world we live in.
Key phrase in the center of the article: "Additionally, the home had higher than average staffing levels and staff would always know where each resident is. If a person did start walking towards the gates, a member of staff would accompany them, maybe even take a walk around the neighborhood, before returning." --------------------------------------------------------------------- Additional staffing would be wonderful and indicates to me that whomever owned the home in the first place perhaps wasn't as interested in profits as s/he was in providing good, quality care to the patients, which, to them, meant letting them roam around.
Great in theory, but most owners want a profit.
In the end, the patient loses.
Nice fantasy, but I doubt it would work in theory except in very few instances where the owner(s) are seriously doing this work in the Christian/Judea manner. Unfortunately, the Christian/Judea model is fast disappearing. More and more as we become a secular world, few children are being brought up to really care (i.e., CARE) about anything/one but themselves.
I find that to be sad, but true. I realize many have relatives who are loving and caring, but I'd suggest at least one half of the population (at least in this country, i.e., US, have more important things to do and money to make, running around, with iPhones as the extension to their hands.
I love the concept, but more staffing isn't going to happen.
nerie86...the door guards work for a lot of people, but there are some that constantly try for the doors and it's to much risk that they will end up slipping out after the 15 sec lock down...it isn't easy to do but it's done occasionally.
My mom is like this...we had to move her to the lock down section, although if she stops trying the doors and becomes comfortable with where she is at then she will be moved back to the door guard only community (same home, different sections). We all feel better about the situation, she isn't going to be happy no matter what, but that is par for dementia in some people...not all.
Nerie 86: I think you did miss something. Spending unnecessary time reeling these big guys in can be daunting. Ditto with keeping people who prey I seniors out is another issue. Do you lock your doors at home?
I wonder if there are laws that are in place, for which means security pads, and locked doors have to be in place. I had my mother at a very nice place, that as well had nice patios, the whole area was surroounded with windows, which made if feel less closed in. One does know that wandering is part of many issues that go along with his issue. Let' not forget the opportunity for not so nice people getting in for saftey. If I were an emloyee, I would feel more sucure wtih locked doors.
I care for my mom at home, and know at some point I will have to move her, and, yer I hope I will be able to find one that makes her feel, not so closed in. The ones I have called so far a full. They have what are called cottages with property for walks. I will be my mother's advocate even when I transition her, I wonder how many have no one?.
Often times when dementia patients say "I want to go home" they may not be speaking of a geographical place, not a house, not an address but they are speaking of a point in time. They want to go back to the time before they became so sick with this horrible disease. "Going home" means different things to different people..
For their own protection. You are not dealing with reasonable adults, therefore, it is up to the facility to protect them. They become like toddlers and toddlers do not know how to take care of or protect themselves. It's a whole different scenario. When my mom was in the rehab memory care center, I was glad she was under lock and key because when she was at my sister's house, she had to have a special bar put on the door so she wouldn't "go home." If she got out, she may have been hurt very badly.
Dementia residents come in all shapes and sizes. I can't imagine the staff trying to restrain the large, confused and sometimes angry men I have seen. The staff needs to be helping residents not guarding doors. Most of us lock our doors at home to keep the bad folks out, so it works both ways.
My mother's NH is wonderful. Small, family owned and spotlessly clean with kind and caring staff who have been there forever - one 40 years! Visitors can come and go any time of day or night. There are key pads on all exterior doors. As so many of the residents have dementia/alz it's essential to keep them safe. On exiting I've had residents ask me to "push the buttons" or what the code was and even try to bolt through the door with me. On more than one occasion I've had to turn and walk the halls for a few minutes until a resident went away and I could safely leave.
It's sad but essential for safety. This particular NH is in a very rural location and a "runner" would be lost in the corn fields and forest within a very few minutes.
My mantra is about the dignity of the elder, so it goes without saying that I don't like locks or restraints.
I'm realistic enough to know that locked memory units are used even in excellent care situations because there isn't enough staffing to keep people safe, however the right thing to do - God willing, we'll see it someday - is to have staffing that allows people to feel whatever freedom their disease allows them to feel. Letting them roam freely while be monitored in a friendly way would be ideal.
Disguising doors, using sensors and other methods can be very helpful and don't have the feeling of being under lock and key.
I also feel that family members should be allowed to visit at any time. Nursing homes in my community allow that but I've read where many don't. Part of knowing that my loved ones are safe is knowing that I can stop by anytime, not just a predicted time.
I see that comments are all over the board......some are really adamant that no locks, no bars, no gates should be the rule while others see the need for them. From my perspective since my MIL became an escape artist for a while is that in some situations they are needed. It is true that some people will feel like a prisoner in that situation, those are the ones who still have some true cognitive functions. My MIL was "going home" every time they found her outside of the facility. She had no idea where she really was. It was/is for her safety that outside doors are locked at night. It also keeps people out who should not be there. I'm betting that if anyone here who is against the locked doors,gates, etc. ever lost a loved one due to an "escape" then they would be outraged and probably sue the facility. There is no way to watch someone 24/7 no matter how many people are on staff. Did you never leave your baby/toddler alone ever-even when they were sleeping? Come on, get real.
I should mention that the community my mom is in has an open door policy as far as family members coming and going. 24/7 availability and we have all of the codes, even for the staff quarters...it is encouraged for people to come and volunteer and for the community to be involved if they like.
No odd smells !! So far after several visits at different times I have never smelled anything odd or any chemicals for covering up smells and I've never seen any resident in distress or being treated poorly while I've been there.
Feeling very fortunate to be honest...I know we are lucky. Also staff turn over is almost non existent and most of the staff have been there for years.
They really care for the people they are caring for.
I agree with you! It should be open doors policy. My mom even said if she had to go to one she would rather die. Its the last place you go before you go to heaven. I worked at one in california. It smelled terrible. I reported it to the health officials. they were fined.
It really depends on the situation, but the truth is every person is different and every facility is different.
My mom is on Medicaid and Medicare and suffers from both Early Onset Alzheimer's and Frontal Lobe Dementia, both of which appear to be deteriorating at the same rate.
Plus with her personality and the stage at which the disease is at, she is literally portraying manic behavior that is almost impossible to stop...unless I suppose we kept on trying different meds, although non actually worked well.
So while I don't like medications unless necessary we had her on three different meds to try and minimize her behavior because frankly it was getting scary and there was some real risk to her getting into trouble.
As a mother of three, and wife and an independent business owner it was kinda hard to watch her all the time, but we tried and at some point there was a realization that she needed to be in a situation where she was secure.
My mom has never felt settled in one location, she never felt "home" in her life and consequently was always on the move. Her work allowed her to live for weeks at a time in different locations, living out of hotel rooms basically and coming home two maybe three times a year.
If she was home longer then 2 months she felt trapped and was depressed.
This basic part of her personality and experience in life remains strongly with her even though she has forgotten most of her life experiences.
She may never feel settled and may for all of the remainder of her years, how very few are left, will be going for the door and trying to escape her situation.
For my mom, being in a lock down situation is the safest situation that will allow her the best possible life that she can have at this point.
The other component of this is looking at where the homes are located and is it a community that is relatively safe in case someone wanders off unintentionally?
Many of the Nursing Homes and Care facilities are located in very busy areas, by very busy streets and are truly unsafe.
These days, the costs of care and cost of facilities does not lend to having high numbers of staff. Even though the facility and the group that owns it are actually staffed better then most and all are trained in dementia care (including the cleaning staff), they are unable to be with each resident every second of every day.
Even with the added insurance from Optum (cool insurance...medicaid patients don't have to pay extra for extra services and private pay is very reasonable costs) it still isn't going to change her wandering ways.
Now the facility mom is in has door guards in part of the building and is lockdown in others.
We tried her in the main community at first, but she liked going out to the court yard in the lock down section better and spent most of her time there anyhow, and she really was a wander risk so we moved her to lock down about a month ago.
She feels trapped, but I have to say she felt trapped living in my home as well...even though we did not restrict her from going out and wandering the neighborhood, as scary as that was for us.
The truth is she feels trapped in her disease and does not understand what it is, and she feels she is perfectly fine...but in truth she is fast approaching the later stages of dementia.
Personally I think one of the best designs for Dementia care homes I've ever seen is in Germany, where the community itself was locked down, but it was set up with stores, restaurants and community apartments to emulate life outside the community. Everything was all inclusive so the residence didn't pay extra, but they feel like they are still being involved in a regular daily life.
I'm hoping that one day we will see this model as the norm.
Locking human beings up like dogs in a kennel just doesn't get it for me. Yes, watching where those who are unable to care for themselves takes an effort. So does helping them to the bathroom rather than keeping a catheter in them, holding their hands or providing some touch and stimulation, surrounding them with comfortable things that are their own rather than getting rid of everything that reminds them of being human requires more thought and effort. Unless for some reason they deserve punishment (and some do!) these are the folks who changed OUR diapers when we wet them or soiled them, who spoon fed US when we were unable to do that for ourselves, who put a cool wash cloth on OUR faces when we were feverish. My MIL who wasn't even in any stage of dementia ended up in a terrible place. Not right.
Dear, My mother took off from her home at least 6 or 7 times before measures had to be taken. The last time, the house had actually been secured. She climbed over a gate and broke out a window to get out. This open concept you are attached to, would be a death sentence for her, if someone ever took their eye off of her. Also there are so many different stages of this horrid dementia, that one stage might could be fine with an open environment and another would not be at all. She requires 24/7 watching one on one, when she is at home I sit with her all the time or she is gone, and I mean literally gone.
The facility is not the prison, her diminshed mind is the prison. Even if she is at the home she lived in for 48 years now, she wants to "go home", no matter how loving everybody is to her, she wants to "go home", "when are those people going to come and take me home", is her constant refrain.
Unfortunately her uncoorperative mind is the prison she cannot get away from. Not matter how much physical freedom she has, the prison of her mind is ever present and never diminishing.
I love your sentiment, but for the most mentally diminshed alzheimers patients, they need to have some type of "gate" or "fence" or "key pad" to keep them from getting to the other side. Otherwise there would have to be 24 staff members for 24 patients.
My mother feels that her Assisted Living facility, which is totally open except between 8PM and 7AM, is a prison. Other residents express the same thing. The reality is, the prison is her body and her failing abilities. We told her (at least while she was ambulatory) that she was free to leave at any time -- to walk out, to take a taxi, etc., but she was imprisoned by her inertia, and by the effort it would take to make an "escape."
Dementia/Alzeimers disease patients can be unpredictable they can perceive anything in an unpredictable manor prompting them to exit a facility. It would be nice if there could be a one on one staff ration to ENSURE that this couldn't happen but it is cost prohibitive. Key pads and guardian systems are in place to protect Residents that have little to no safety awareness. Facilities cannot have residents eloping as this could and would result in closure of the facility as well as open to lawsuits. This is for many their only choice for care as they have been kicked out of unsecured facilities. One needs to understand that while they may perceive secured facilities as being locked up dementia residents may not even know what the key pad is or why its there, we have residents that push the numbers and then speak into the pad thinking it is a phone . Metal gates are often used as they allow visual sight thru them so as not to feel closed in. I have metal fencing and entry gate at my home as do a lot of up-scale subdivisions they are considered a plus for home owners. I encourage people to be optimistic and not pessimistic everything has an up a down, a good a bad, a positive a negative how you choose to see something is your choice.
A serious danger posed by Alzheimer's disease is when the individual turns around, the place they expect to see is gone and they find themselves standing helplessly confused what they see is different and totally unfamiliar to them. An alternative to locked doors: are sensors "dandyfunk4.blogspot/" warning when a person is within 15' of the detector,(near to warning point)
It is true that sometimes people can get scared in new environments and we do want to keep them safe, but we do not want to treat them like prisoners! We need to be compassionate, caring and most of all, patient.
My mom was one of those who were "kicked out" of a specialized but open-doored assisted living facility for the memory-impaired. I then had to place her in a locked facility. The reason the first facility gave for kicking her out ...watching her so she didn't depart the premises took too many staff members. They simply didn't have the staff to give every resident a one-on-one babysitter. Similarly, keeping her at home would require someone to watch her 24/7, and I am only one person who has to, for some odd reason, get some sleep occasionally. Yes. It bothers me that she is locked up, and can't leave the facility except when accompanied. But the alternative is to have her wandering the streets, getting confused and lost as to her whereabouts, and asking strangers for rides to where exactly she doesn't know. What am I supposed to do, I ask? When she has been hospitalized, the hospitals have ended up assigning her a babysitter to keep her from pulling out her tubes, wandering the halls, entering other patients' rooms, and departing the premises. It all goes into the hospital bill, which is mighty fat. The assisted living facilities don't have that kind of budget.
Dementia causes people to behave irrationally. Our family member who at times seems like the brightest most reasonable person in the room spends his night and early am hours wandering, banging on others' doors, confused about the elevator yet refusing to get off and return to his room for dry pants. Alzeimers the disease, once advanced, requires more supervision than earlier stages.
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The Problem with Placing People with Dementia Under Lock and Key
But it is also resource-heavy, requiring time and high levels of staff training and very high calibre caregivers - it takes endless patience to go with Muriel when she's off on her travels for the fourth time that shift and not just want to shove her back through the doors - and it's the scarcity of those resources that makes this a bit of a counsel of perfection.
But if you ever do find a memory care unit that is aiming for it or has actually achieved it, book a place for yourself immediately, in case. That is gold standard patient-centred care.
Now that I'm a full time caregiver, knowing everything there is to know about this affliction having cared for a MIL in the past, I'm finding it hard to deal with. There are times when I (and I'm guessing many out there) lose my temper and just ask Why can't you do that? Or, what's wrong with you! And I KNOW the reason, I just lose it at times.
Those who may spend a few hours per week (or even eight hours per day) with patients with brain function problems KNOW how hard it is. They, too, can elicit little poems and sentences from their 'lost' loved ones, but in the end, they are 'lost', i.e., they do not think like we do, etc.
While art and the Living Word can help divert the attention of a person with dementia (and don't get me wrong, I certainly admire your work, at the end of the day, they are still lost in their own 'thoughts', wandering around, walking because they 'have to' not because they 'want to'. Perhaps in a more perfect world, this will happen, but unfortunately, I can't see it happening in this world we live in.
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Additional staffing would be wonderful and indicates to me that whomever owned the home in the first place perhaps wasn't as interested in profits as s/he was in providing good, quality care to the patients, which, to them, meant letting them roam around.
Great in theory, but most owners want a profit.
In the end, the patient loses.
Nice fantasy, but I doubt it would work in theory except in very few instances where the owner(s) are seriously doing this work in the Christian/Judea manner. Unfortunately, the Christian/Judea model is fast disappearing. More and more as we become a secular world, few children are being brought up to really care (i.e., CARE) about anything/one but themselves.
I find that to be sad, but true. I realize many have relatives who are loving and caring, but I'd suggest at least one half of the population (at least in this country, i.e., US, have more important things to do and money to make, running around, with iPhones as the extension to their hands.
I love the concept, but more staffing isn't going to happen.
My mom is like this...we had to move her to the lock down section, although if she stops trying the doors and becomes comfortable with where she is at then she will be moved back to the door guard only community (same home, different sections). We all feel better about the situation, she isn't going to be happy no matter what, but that is par for dementia in some people...not all.
I care for my mom at home, and know at some point I will have to move her, and, yer I hope I will be able to find one that makes her feel, not so closed in. The ones I have called so far a full. They have what are called cottages with property for walks.
I will be my mother's advocate even when I transition her, I wonder how many have no one?.
Thanks Jazmine1
It's sad but essential for safety. This particular NH is in a very rural location and a "runner" would be lost in the corn fields and forest within a very few minutes.
My mantra is about the dignity of the elder, so it goes without saying that I don't like locks or restraints.
I'm realistic enough to know that locked memory units are used even in excellent care situations because there isn't enough staffing to keep people safe, however the right thing to do - God willing, we'll see it someday - is to have staffing that allows people to feel whatever freedom their disease allows them to feel. Letting them roam freely while be monitored in a friendly way would be ideal.
Disguising doors, using sensors and other methods can be very helpful and don't have the feeling of being under lock and key.
I also feel that family members should be allowed to visit at any time. Nursing homes in my community allow that but I've read where many don't. Part of knowing that my loved ones are safe is knowing that I can stop by anytime, not just a predicted time.
Thanks for your thoughts!
Carol
No odd smells !! So far after several visits at different times I have never smelled anything odd or any chemicals for covering up smells and I've never seen any resident in distress or being treated poorly while I've been there.
Feeling very fortunate to be honest...I know we are lucky. Also staff turn over is almost non existent and most of the staff have been there for years.
They really care for the people they are caring for.
My mom is on Medicaid and Medicare and suffers from both Early Onset Alzheimer's and Frontal Lobe Dementia, both of which appear to be deteriorating at the same rate.
Plus with her personality and the stage at which the disease is at, she is literally portraying manic behavior that is almost impossible to stop...unless I suppose we kept on trying different meds, although non actually worked well.
So while I don't like medications unless necessary we had her on three different meds to try and minimize her behavior because frankly it was getting scary and there was some real risk to her getting into trouble.
As a mother of three, and wife and an independent business owner it was kinda hard to watch her all the time, but we tried and at some point there was a realization that she needed to be in a situation where she was secure.
My mom has never felt settled in one location, she never felt "home" in her life and consequently was always on the move. Her work allowed her to live for weeks at a time in different locations, living out of hotel rooms basically and coming home two maybe three times a year.
If she was home longer then 2 months she felt trapped and was depressed.
This basic part of her personality and experience in life remains strongly with her even though she has forgotten most of her life experiences.
She may never feel settled and may for all of the remainder of her years, how very few are left, will be going for the door and trying to escape her situation.
For my mom, being in a lock down situation is the safest situation that will allow her the best possible life that she can have at this point.
The other component of this is looking at where the homes are located and is it a community that is relatively safe in case someone wanders off unintentionally?
Many of the Nursing Homes and Care facilities are located in very busy areas, by very busy streets and are truly unsafe.
These days, the costs of care and cost of facilities does not lend to having high numbers of staff. Even though the facility and the group that owns it are actually staffed better then most and all are trained in dementia care (including the cleaning staff), they are unable to be with each resident every second of every day.
Even with the added insurance from Optum (cool insurance...medicaid patients don't have to pay extra for extra services and private pay is very reasonable costs) it still isn't going to change her wandering ways.
Now the facility mom is in has door guards in part of the building and is lockdown in others.
We tried her in the main community at first, but she liked going out to the court yard in the lock down section better and spent most of her time there anyhow, and she really was a wander risk so we moved her to lock down about a month ago.
She feels trapped, but I have to say she felt trapped living in my home as well...even though we did not restrict her from going out and wandering the neighborhood, as scary as that was for us.
The truth is she feels trapped in her disease and does not understand what it is, and she feels she is perfectly fine...but in truth she is fast approaching the later stages of dementia.
Personally I think one of the best designs for Dementia care homes I've ever seen is in Germany, where the community itself was locked down, but it was set up with stores, restaurants and community apartments to emulate life outside the community. Everything was all inclusive so the residence didn't pay extra, but they feel like they are still being involved in a regular daily life.
I'm hoping that one day we will see this model as the norm.
The facility is not the prison, her diminshed mind is the prison. Even if she is at the home she lived in for 48 years now, she wants to "go home", no matter how loving everybody is to her, she wants to "go home", "when are those people going to come and take me home", is her constant refrain.
Unfortunately her uncoorperative mind is the prison she cannot get away from. Not matter how much physical freedom she has, the prison of her mind is ever present and never diminishing.
I love your sentiment, but for the most mentally diminshed alzheimers patients, they need to have some type of "gate" or "fence" or "key pad" to keep them from getting to the other side. Otherwise there would have to be 24 staff members for 24 patients.