“Dolores” is a charming, sociable, and independent woman who recently moved to long-term care. She also has dementia. Although she seemed briefly confused when she arrived at her new home, finding herself in unfamiliar surroundings, she appeared to be pleased and happy to be there. Dolores thought she was at a “hotel” and the residents in the dining room were “guests” staying at the hotel or “customers” at the “restaurant,” which was actually the Care Home’s dining room.
The staff showed her to her room and helped her unpack. As Dolores was still physically independent, she wandered up and down the halls exploring the beautiful paintings and admiring how nice the “hotel” was. At lunchtime, she joined the other “guests” without incident.
However, the staff quickly noticed her memory was quite poor. Shortly after being shown her room, she would forget where she was. When reminded she was a guest, she would cheerfully acknowledge and continue sharing stories.
Later in the day, Dolores began to show signs of exit-seeking, repeatedly asking the same question with increasing frequency. As a relatively young, strong, and physically able woman, it was challenging to prevent her from leaving the building.
Why was Dolores Exit-Seeking?
After supper, Dolores got up and politely thanked the staff for their hospitality. She picked up her purse made her way to the door, and greeted them goodbye.
One of the staff members, “Trinity,” who had attended several training sessions on managing dementia-related behaviours, approached Dolores to “escort” her to the door, playing along as if she was just going to walk her to the main entrance. Trinity knew that telling Dolores she “cannot” leave or that she “has to” stay could escalate the situation and cause her more anxiety, making her feel trapped and without a choice.
As they walked slowly towards the main entrance, Trinity led Dolores on a longer route, knowing she might not remember the way. She used this time to build trust and friendship, seeking to understand the reasons behind her exit-seeking behaviour.
During this short walk, Trinity discovered that Dolores was concerned her “Dad” was waiting for her at home and that it was getting dark and he might be worried. Dolores’ language and tone reminded Trinity of a teenager or a young woman in her early 20s. She frequently mentioned school and often recalled how her dad always reminded her to return home before it got too late or too dark.
During that brief walk, Trinity realized that Dolores’ dad was central to her sense of security and well-being. It was clear that Dolores deeply respected her father, believing he was still alive and waiting at home with her mom. Dolores took pride in being a good girl with strong familial and moral values, and she was concerned about appearing “inappropriate” by staying out late in an unfamiliar place.
Trinity’s Creative Solution to Manage Dolores’ Exit-Seeking Behaviour
Hearing that this was Dolores’ concern and the reason behind her exit-seeking behaviour, Trinity knew she had to quickly find a way to reassure Dolores that she was not going to get in trouble with her Mom and Dad and that staying at the “fancy hotel” overnight would not be misconstrued as her behaving “inappropriately.”
Trinity thought she could use Dolores’ Dad to convince her to stay at the care home. In a cheerful and excited voice, she said:
“Dolores, I might get in trouble telling you this, but I guess it’s hard to keep this a secret now. You’re here because your Mom and Dad wanted to surprise you. I am definitely spoiling the surprise by telling you this, but actually your Dad paid for your stay here as a guest at our hotel for the weekend. Your Mom and Dad thought this would make you happy. They’re so proud of you. You’ve made their lives so much easier by being such a good girl, so they thought to treat you with a stay at our hotel. Their way of telling you that they trust you. Our Manager was actually going to tell you this during supper tonight. So, do you think you can stay and act surprised when your Dad calls you later tonight?”
Upon hearing this, Dolores laughed as if she expected this “type of thing’’ from her Dad.
“My, my, my…(laughing). You know, it doesn’t surprise me. It’s just like my Dad to do something like this!… so is he here? (still laughing and giggling).”
To which, Trinity replied, “No, he’s not here. He called and paid for everything.” Dolores was so touched and excited and said in a cheerful tone, “Well, can you show me my room then, don’t worry, I promise I’ll act surprised.”
Why Trinity’s Creative Solution Worked
Remembering her training, Trinity remained positive, supportive, and reassuring using Therapeutic Reasoning™. Not once did she use negative language, remove Dolores’ options or freedom, nor did she restrain nor force Dolores to stay. She stayed in Dolores’ reality and leveraged Dolores’ relationship with her Dad.
She became Dolores’ friend. Dolores led, and Trinity followed. Dolores welcomed Trinity into her world. She felt safe and didn’t feel she needed to get her guard up. After all, Trinity was just a hotel staff member following her Dad’s orders (wink! wink!)
Person-centred care, kindness, asking “why,” investigating the meaning behind the behaviour, and trying creative, non-pharmacological, non-restraint-based approaches, do not take a long time. The walk to the main entrance and conversation took only approximately seven minutes. Dolores was chatty and loved telling stories. Trinity asked only one question, “why are you in a hurry to go home?”
Now imagine how long and upsetting this interaction would have been if Trinity had said “no” and called in other workers to physically stop Dolores from leaving? Can you think of the negative impact on Dolores’ well-being if she had been restrained or forced to stay? How would you feel if this happened to you or someone you love?
Trinity reports that eight months into the care home, she and Dolores remained friends. Dolores may not recall Trinity’s name nor have any memory of her first day at the care home, nor her exit-seeking behaviour, but she remembers how Trinity made her feel.
Seven minutes was all it took to start a trusting, caring relationship between someone living with dementia and her caregiver. Seven minutes of kindness, empathy, and compassion that led to a friendship. Seven minutes.
If you have concerns about a loved one or a friend and don’t know what to do, you are not alone. Reach out and ask for help. We can help by brainstorming ideas with you that will best suit your situation. Begin by contacting us through our website www.DementiaSolutions.ca to arrange your free 20-minute consultation with one of our Dementia Care Advisors.
DISCLAIMER:
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.
