When you talk to “Merle,” you might not immediately recognize her as someone living with dementia. She presents as fairly independent, dresses well, and articulates her thoughts clearly. Merle knows exactly what she wants and is quite particular about her routines—she insists on having her clothes folded in a specific way and her bedding arranged just so.
However, Merle frequently rings the call bell, often for non-urgent matters, such as asking for the date or time or inquiring about the day’s menu. In a busy care home that often faces staffing shortages, her requests tend to be deprioritized, especially during hectic morning and evening routines when staff are occupied attending to more urgent needs, like changing pads or assisting residents with toileting.
Merle has gained the reputation of being a “difficult” and “demanding” resident.
How Care Homes and Care Professionals Can Unknowingly Trigger Escalation
The staff do the best they can so they try to prioritize responding to more urgent tasks and residents who are at a higher risk for falling, wandering, or getting injured if not attended to in a timely manner.
To ensure Merle’s safety, however, the staff would check in on Merle discreetly, without her knowledge, while attending to other residents who require physical assistance. Unfortunately, this approach can inadvertently contribute to Merle’s frustration and feelings of neglect. When her needs go unmet, she becomes increasingly agitated, often ringing the call bell incessantly and calling out for help.
Worse, her yelling would agitate other residents who would then start ringing their call bells to complain about Merle. The staff would sometimes close her door to muffle the noise. As expected, this only made matters worse as Merle would yell even louder and not let go of the call bell until someone finally came in to attend to her.
Ultimately, the staff’s response to Merle not only triggered her escalation but also created a ripple effect throughout the care home.
Putting Knowledge into Practice and Finding the Courage to Do the Right Thing
“Fatima” is a new Personal Support Worker (PSW) who recently began her role in the care home. During her orientation, she was cautioned about Merle and advised to “ignore” her as a strategy to discourage her from ringing the call bell for non-urgent matters. “She will eventually tire of it if you ignore her,” Fatima was told.
Not even 30 minutes into her shift, Merle rang the call bell. Fatima felt a dilemma. As a new staff, she wanted to get along with her co-workers, but she also felt their advice contradicted her “moral” and professional judgment. Taking a deep breath, she decided to stick to her values and went to Merle’s room.
As soon as she walked in the door, she noticed how surprised Merle was who commented, “Oh, you’re here. I wasn’t expecting someone to come right away.” Fatima felt an ache in her heart. Merle has gotten so used to the long waits that getting a timely response felt like a “strange gift.” This threw her off-balance that she forgot why she rang the call bell in the first place.
Having read Merle’s Care Plan and notes, Fatima asked, “Is it time for your Voltaren cream? Would you like me to apply it on your legs now?” to which Merle responded, “Oh yes! Yes, please.”
Fatima took this time to introduce herself to Merle while applying the cream. She also gave Merle’s legs a bit of a massage, which Merle loved. To Fatima’s surprise, Merle wasn’t as grumpy as everyone described her to be. She laughed and giggled the whole time Fatima applied the cream. She felt so relaxed that she slept earlier than usual that evening.
There were no call bells that came from her room until late in the morning. None of the other residents complained about noise coming from Merle’s room. It was a peaceful night shift for Fatima.
Fatima realized that Merle’s loneliness was exacerbated by staff ignoring her. By taking the time to engage and offer undivided attention, Fatima brought a sense of calm to Merle’s world.
Remember the Person Behind the Dementia
It’s crucial to remember that the individuals we care for are just like us. They too require attention, compassion, and connection. Imagine how we would feel if we were routinely ignored.
When we feel lonely, we are at our most vulnerable—yet expressing vulnerability is difficult for many of us, so we often communicate through our actions instead. Think of times when we struggle to tell a partner that we simply need a hug or want their undivided attention. Instead, we “speak” through non-verbal cues, perhaps by appearing unusually quiet or looking visibly sad. And when they don’t pick up on these signals, how do we feel? Disappointed? Frustrated? Neglected? Ignored?
People with dementia communicate through their behaviour, often expressing unmet emotional needs.
By choosing kindness and understanding, caregivers not only fulfill their responsibilities but also affirm the “personhood” of the person with dementia, creating a nurturing environment for everyone. These moments of connection can provide opportunities to bring comfort and reassurance, foster trust, and provide the person with a vital human need– a sense of security and belonging.
Let’s not underestimate the healing power of authentic caregiving. A simple, caring response to these unspoken needs restores a sense of wholeness for both the caregiver and the individual with dementia.
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.
If you have concerns about a client/resident, a loved one, or a friend and don’t know what to do, please reach out and ask for help. You are not alone. We can help by brainstorming creative 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:
This article is based on a true story; however, names, locations, and certain events have been altered to protect the privacy and confidentiality of the individuals involved. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
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.
