By Jane Verity ©dementiacareinternational.com
The Challenge
What do you do when a person with dementia continuously asks to go home? Or when people with dementia beg you to let them out because their children are crying? This behaviour can be intense and may be very frustrating for staff, residents, visitors and volunteers.
The Answer
A popular answer seems to be… install a bus stop! The person wanting to go home can then go and sit at the bus stop and wait for a bus that never comes. A staff member may creatively say, ‘The bus isn’t coming today. It only comes every second day.’ Or even, ‘The bus has broken down and isn’t coming.’
Our first reaction to this solution may be that it is a simple and innovative idea.
Undoubtedly, the bus stop solution was created with the best of intentions in mind; namely to ease distress and keep the person with dementia happy. However, it is only a band-aid and we can make a bus stop unnecessary by addressing the cause of the behaviour.
I Want to Go Home
The bus stop band-aid solution does not address the underlying cause of a person with dementia wanting to go home.
To experience what the person means by the words, ‘I want to go home,’ we need to ask ourselves, ‘What does home represent?’
Think about this for a moment and then write down the first three answers that come to mind. Do it now before you read any further.
Our answers are most likely to be emotional representations of home and this is also true for people with dementia. It is unlikely that they are actually thinking of the physical home that they are either living in right now or have left in order to move to a residential care facility. Some people with strong religious connections may think of home as going home to God. Others may be searching for emotional fulfilment of unmet needs.
The five universal emotional needs often unmet for people with dementia are:
- To be needed and useful
- To have opportunity to care
- To love and be loved
- To have self-esteem boosted
- To have the power to choose
These needs are universal and do not change. What does change is the opportunity to have these needs met – especially for people with dementia or anyone else living in an institution where the focus is on tasks and routines rather than on the social and emotional wellbeing of the individual.
When these needs are not fulfilled in this reality, the person with dementia may go back in their memory to a time when their needs were met. When a person wants to go home they are usually looking for love – unconditional love. When we experience love, we also experience safety and security. In our home it is OK to be ourselves and our self-esteem and identity are maintained.
When a person with dementia says, ‘I want to go home,’ it becomes not so much a symptom of dementia as a symptom of something lacking in their care or environment, and a need for purpose and love. It can take only one staff member to trigger the need to go home. This staff member may be unloving in their approach, and may reprimand people for their creative ways of being active.
The Solutions
Think about a person you care for who keeps saying, ‘I want to go home! ‘ Then read the five universal needs again. Now ask, ‘Which of these needs is this person not having fulfilled?’ Use your intuition and stick with the first needs that come to mind. Write them down. Then use your creativity to find solutions to fulfil these needs within your constraints.
Ask, ‘What is this person able to do to feel needed and useful?’
People with dementia show us by their actions what they’d like to do, such as busily dusting with an imaginary duster, kneading imaginary dough on their lap or cleaning up, which may mean moving everything around or taking other peoples’ cups away. Instead of becoming frustrated,interpret these actions as a direct communication of needs that are not being fulfilled. You can take cues from these actions and act on them.
Ask, ‘What can I do to enable this person to experience the ability to care?’
Care can be expressed in many different ways, care of plants, pets, people, of a child or a baby. (Read our Doll Therapy article.) Animals and children provide wonderful and creative spontaneity, something that may be missing in the lives of people with dementia. Wonderful opportunities for caring can be created through small but powerful gestures, such as turning your collar inside out for the person to adjust. Pull your blouse or jumper up so it needs to be pulled back down. If you have cold hands, ask the person to warm them for you. And…remember to say thank you.
Ask, ‘How can I boost the self-esteem of this person?’
Avoid telling the person everything they do wrong or that you disapprove of. Instead, ask the person for help, remembering to say a genuine thank you so they know their help has been meaningful. You can ask for assistance with activities such as drying dishes or making the bed but only suggest things the person can successfully complete. Remember to set the person up for success and acknowledge their success – no matter how small. Genuinely and sincerely tell them something positive such as, ‘You have the most beautiful eyes. I love looking into your eyes. It makes my day.’
Ask, ‘What can I do to help this person feel loved?’
This point is about ensuring the person with dementia has the opportunity to receive and give love. Instead of giving the person a hug, you could ask them for a hug, which will fulfil many of the emotional needs. The person will feel needed and useful; they can care for you, their self-esteem will be boosted as you asked them for the hug; and they get to share their love with you. When you ask for a hug you also give yourself permission to receive and that is one of the most profound gifts we can give another person.
Instead of using ‘band aid’ solutions in dementia care, take the opportunity to make a conscious decision to move care to a new level. Seek out the underlying social, emotional and psychological causes of challenging behaviour. There is so much we can do to prevent the behaviours we normally think of as challenging. It takes willpower, creativity, understanding, patience, love and a desire to do things better.
If your facility has achieved best practice you may automatically think that it cannot be improved. Shift your mindset with a proactive outlook by telling yourself, ‘Yes, we are doing great, however, greatness is our aim. It has no end. It is an ever-evolving process.’
Working towards creating a positive environment where people with dementia experience the emotional feeling of home eliminates the need for band aid solutions such as a bus stop.
Further reading – Click topic
- How to Communicate with Someone who Can’t Speak – Jane Verity (Learn 4 body language techniques to show people with dementia that you are really listening; learn the importance & the difference between intuition & logical, rational thinking; learn strategies & effective questions to uncover unmet needs & to draw out the person’s feelings & needs; learn question techniques to check on your guesses & 6 steps to being a good communicator.)
- My Neighbour is Trying to Kill Me! – Reveals the deep symbolism behind this once seemingly delusional accusation.
- Hugs not Drugs – Jane Verity (Discover 3 factors behind attention-seeking behaviour, the 5 secrets to great hugs & 5 hints to check if a hug is creating discomfort in another person plus a wonderful non-threatening excuse for exchanging a big hug.)
- A Doorway to the Present – by E. Joy Bowles BSc. (Learn how brain cells respond to incoming messages about odours & how we can use them to redirect or distract agitation; plus learn how odours can be used to encourage people with dementia back to the present.)