A Kinder, Gentler Approach

Hospice helps bridge the gap between nursing home staff, Alzheimer’s disease patients and their families. Operating around the concept of comfort care, the goal is to allow patients to continue to be as autonomous as possible. In other words, patients should not be forced to do what works best for the facility. Certainly, with advanced Alzheimer’s disease, patients may not be able to verbalize what they want, or need, or even if they are experiencing pain. However, by developing a plan of comfort care and educating staff about a patient’s propensity to wander, a happy medium can be reached which allows for some exploration in a safe, restraint-free environment.

Working with patients who have advanced dementias such as Alzheimer’s disease is very challenging. But we can learn much from these patients simply through observation and understanding their history. An Alzheimer’s disease patient who constantly sorts or rearranges books or other objects, for example, is sharing clues from a former life. Perhaps this person used to work in inventory or in the post office. Patient care for this individual would include suitable activities that safely fulfill the desire to sort things. Does the Alzheimer’s wandering behavior satisfy a need to explore, socialize, seek out someone or something, or is it simply a manifestation of boredom and lack of stimulation? The answers may lie in learning what the patient did at home before coming to live in the facility. Again, there must be open channels of communication between staff and family.

Easing the Transition from Home to Facility

When families are no longer able to care for their loved one at home, placing them in a facility can be very traumatic. Even the term “institutionalized” is scary. They wonder whether anyone else can provide the loving care and understanding they did—and how this change will affect their family member. It is helpful for everyone if the family can participate in setting the care goals; after all, no one knows a patient better than the family. Here are a few ideas of how you can help ease your loved one’s transition from home to nursing home:

• Share information about your loved one’s history—for example, past professions, particular likes or dislikes, and whether wandering away from home was a motivating issue for placement.
• Disclose problems with depression or anxiety that you have observed. This can alert staff to problematic behaviors; seeking socialization and need for companionship are major reasons for wandering behavior.
• Note any history with falls, especially recent falls, and problems with gait or balance. This helps staff plan safe, uncluttered wandering areas.
• Relate past incidences of urinary tract infections, which can cause pain and agitation and constipation. With constipation, for example, moving regularly helps, whereas restraining the patient could make the situation worse.
• Request to be kept informed regarding any elopement attempts and suggest that you discuss problem-solving initiatives together with staff.

If you have a relative with advanced Alzheimer’s disease and are considering moving your loved one to a facility, the first step is to do your homework on the care facilities in your area. Visit the facilities in person and compare the environment, staff, and patients who reside there. Ultimately, you need to feel confident that the facility you choose will try to encourage, support and maintain your loved one’s desire to explore, investigate and move about independently as long as possible.

Patients with Alzheimer’s and wandering behaviors should always be assessed to determine the cause so that any unmet needs can be addressed. Wandering behaviors will be better monitored if staff can keep your loved one engaged in a social activity, provide stimulation and companionship, and maintain quiet times with decreased stimuli. It’s also essential for the staff to update the plan of care regularly as Alzheimer’s disease progresses. If falls are or become an issue for your loved one, closer staff supervision is necessary—but restraints are not. And remember: it is never too early to call a hospice. Hospice care is synonymous with support, for families as well as patients.

Celebrating Life!