The Problem with Placing People with Dementia Under Lock and Key


A care home I visit every few weeks has recently had new management put in place. Previously, the home operated an open door policy: There were no key pads on the front door and the tall metal gates that join the road were always open.

Most of the residents in this home were referred from the local hospital, having been "thrown out" of their previous care homes due to "challenging behavior." But the previous manager believed that if people are respected and feel safe, they won't walk out. 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. In reality, no residents went AWOL; preferring to walk on the grounds leading to the gate. There were no runaways.

However, last week, as I approached the home, I saw the imposing metal gates were closed and a keypad and buzzer system was in place for visitors to be allowed entry.

The gates being locked saddened me more than I might have expected. Positioned between two regular suburban houses, the open gates had signaled to me that this place was part of the community. Now, with gates closed, they stereotype this home as a "madhouse" and present the message that the people in this place are dangerous and "other" from those who live outside the gates.

I hear and understand the new manager's concern for residents' safety but the previous model worked. Sometimes, protection is based in fear, and fear always shuts down communication and visibility.

Each June, in England we celebrate National Care Home Open Day. Set up by the UK's National Care Forum, CEO Des Kelly OBE said to me "Good care homes are always open! This day is about bringing that into people's awareness and highlighting their place in the local community." The care home I was working in this June had a fantastic event, with many locals popping in for a bite and a chat; the local Member of Parliament opened the new garden; and I facilitated the sharing of words and poems of the residents I was working with.

In finding a care home for your loved one, of course you want them to be protected, but you also want them to feel alive and free, not living like a criminal.

Ask yourself what position the home has within the community—is it open all hours to visitors?

In my experience of working with people with a dementia living in care homes, I have often heard individuals express feelings of incarceration and injustice. Of course, we could just put this down to their experience of dementia, but environment is a crucial factor in enhancing our wellbeing. Even people with dementia know when they are in a place that has been separated from the rest of society.

What would you want for yourself?

The extracts below are from poems by two men who feel the suffocation of the locked door and gate:

The Inner

If …

Something could be done to enable

Me to be

More independent

That's –

What I would like

Nothing I don't like except being

Locked up

I'm Normal Man


Feel badly, like a criminal

I know I'm not

Never done a crime in me life

Not this sort of crime

No nothing, no harm

I can tell you now I'm going to die

This talk of jail makes me sick

The truth is right, now it is truth

This murdering your life

I can feel it

At Living Words, we believe the future of dementia care lies in the openness of care homes and their integration into local communities, where love (not fear) rules the decision making process. Whilst the realization of this is many steps away, we can challenge the homes our loved ones live in to be more open and integrated, as the best are. Good luck!

Susanna Howard is creator and artistic director of Living Words, an arts and literature program that uses the spoken and written word to help people with dementia and their caregivers communicate and connect with each other.

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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 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.