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

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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!