WE NEED TO LISTEN AND OBSERVE TO UNDERSTAND WHAT'S REALLY GOING ON
I received a call concerning an elderly couple who had been moved to a group home after decades of caring for each other. Mary was apparently upsetting the other residents by going into their rooms and helping herself to their personal belongings. She was pleasantly confused but in good physical condition for her eighty plus years. Bill was watchful of Mary and would become quite concerned, even irate, when she wandered out of his view. He too was forgetful but not as agile and walked cautiously with a walker. His hearing was also lacking making communication a challenge at times.
The call was initiated by a complaint that the couple needed private duty care to help Mary establish a new routine with boundaries and to help Bill with his angry flare ups. He had apparently raised his voice and stomped his walker on many occasions frightening the other residents.
On the day I arrived, there was a lot of activity in the common area of the group home. Someone had brought a puppy for a visit and many people were gathered on the sofa enjoying the energetic ball of fur. A chili cook-off was scheduled that evening, so the interruptive parade of crockpots were frequent, bringing new faces and voices into the home. There was also a high school student painting hands and faces, to get her service hours, in another area of the room.
Lots of changes for an impaired brain to follow and the added excitement had Mary on the move. Bill was not pleased with the situation since it made keeping track of his sweet Mary very difficult. I was there observing the environment and the interactions to see if I could put together a helpful care plan for the private duty caregiver to implement.
Shortly after I arrived Mary wander out of sight and Bill stood up and stomped his walker on the ground stating, “I demand to know what’s going on here!” This was met with a sudden moment of silence and a staff member chiding, “It’s just a puppy, Bill!” Sadly, the noise quickly returned.
Unhappy with the response to his request Bill stomped his walker again and with more volume he shouted his orders. I approached him from the front and introduced myself and extended my hand with a smile. I then invited him out to the patio with Mary and myself where it would be a little quieter.
Fortunately for me, he responded to my suggestion and the three of us went out to the secured patio where Mary could investigate the area and Bill and I could talk. He was wonderful one on one and explained to me all his responsibilities in World War II. Bill clearly portrayed himself as the guy who loaded the bombs to the undersides of the aircraft. Recognizing him as a Veteran, I immediately started addressing him as “Sir” which he seemed to appreciate.
After about fifteen minutes, Mary wandered back into the building and I suggested we check on her, which pleased him immensely. I held the door for him to pass through with his walker. He stopped suddenly and asked permission to ask me a question. I responded, “Yes Sir”. He asked, “Is my position in jeopardy here?” “No Sir”, I replied. “Your position is quite secure here.” I was not completely sure what prompted his question but later found out the staff had warned him sternly about the stomping of the walker and instructed him repeatedly to cool his attitude if he planned on living there much longer.
I was intrigued by the conversation we had outside and was starting to put some pieces together concerning why Bill was reacting the way he was. Confirmation of my assumption was made, once we came in and found Mary sitting with the face painter. Bill had no interest in being painted but Mary willingly allowed the teenager to paint a rainbow on her hand.
Mary raised up her hand causing the design to be upside down and quickly asked, “What is it?”. Bill was not happy and stated with fear, “Does that hurt!” “What” said Mary? “Does it hurt!” hollered Bill? “No, but what is it” said Mary? Bill’s head slumped forward in great despair as if his spirit had been crushed and said, “They have numbered us now.”
That is when I was sure that Bill was living in the past, possibly PTSD, Dementia or both. I was pretty certain, in his mind, they were living in a Nazi prison camp or something similar. No wonder he was irate when Mary wandered out of his sight. He knew the women were taken and killed and he was determined to protect her.
Once the management was made aware of my assessment, they educated their staff and changed their care plan to accept and agree more in addition to taking a minute to see it from the Resident’s perspective. Private duty was still utilized to help establish routines and boundaries with Mary, and Bill became an honored guest as a WWII Veteran. Care was taken to promote safety and alleviate fear which can lead to agitation and even violence with people living with dementia.
There are millions of other stories like this one where we fail to look at the situation from the perspective of the person struggling with dementia or another mental health disorder. I hope this encourages you to listen more, assume less, and practice being a detective instead of a judge when you see inappropriate behavior. You can be part of the problem or part of the solution. I choose the latter and I hope you will consider it too.
For more information on memory care, go to www.teresayoungstrom.com. Teresa is a seasoned RN and Dementia Specialist. She is the founder of A Better Approach to Memory Care and provides family consultation, workshops and staff training for all caregivers and family members working with Dementia. Please note that the names have been changed to protect privacy.
Source: Teresa Youngstrom, RN, Dementia Specialist
copyright@2019 A Better Approach to Memory Care, All rights reserved
