“But the bus is coming, I need to go home.”
“I need to pack up all my things and get home.”
"Please take me home will you."
These are all common things I hear from people living with dementia, especially those in aged care facilities and those in the later stages of the disease. This often occurs in the afternoon, often called the "sundowning period" - but not always.
We need to consider that people with dementia can experience varying degrees of consciousness. For example, one minute they may be looking to go home to feed their small children, and the next minute they may become aware that their children are grown adults now. Our job is not to orientate them to reality, but sometimes this happens naturally.
We need to think about validating their distress and empathising with them. Meeting them in their reality is not lying to them.. It is ok to meet them in their reality, which may be many years ago. Us telling them "you are not going home, you live here now.." is likely going to LEAD TO MORE DISTRESS.
Why are they searching for home? What underlying need hasn’t been met? Are they looking for safety? Familiarity? Routine? What are they going home to do?
So how do we respond when this happens? What do we say to them?
1. First, VALIDATE..
Validate their distress and match their emotion.
“You seem worried, can I help you?”
Mirror their facial expression, if they have a frown and look concerned, try and match it. Mirroring a persons emotions helps to show empathy.
Reassure them that you understand that they want to go home.
“I understand you want to go home.”
"YES, I want to go home!” They say...
“You want to go home” you could then say. Match what they are saying. This often leads to more conversation and more hints about what they are seeking!
"THE MOST IMPORTANT THING THAT WE WANT TO DO IS TO HELP THE PERSON WITH DEMENTIA EXPRESS THEIR EMOTIONS, AND FEEL AS THOUGH THEY ARE HEARD AND LISTENED TO BY AN EMPATHETIC CAREGIVER. "
Try using factual questions that include "when, what, who and how." Try to avoid using "Why?"
“Tell me about your home, what is it like?”
“What will you do when you get home?”
Find the underlying need why they want to go home.
What are they needing to do? Talk about it. “I need to get home to the kids.” “You need to get home to the kids, tell me about your kids” you could respond with. May be they need to get home to cook, or meet their husband.
This is one way we can validate, but also reminisce with them. Asking such questions helps the person to reminisce. LISTEN EMPATHETICALLY. This means listening to what they are saying, use eye contact, match their emotion, use non-judgemental words, use gentle touch if appropriate.
Although we are not always trying to bring the person with dementia back to reality, sometimes this happens, and sometimes they realise that they are not going home.
2. REDIRECT only after you have validated their distress. Re-direct to a meaningful task. A task that makes them feel needed and as though they still have purpose can be helpful.
“Can I ask a favour of you? Can you help me set the table? I could really do with a hand!”
May be you could ask them to help you set the table, or wipe down the furniture, or even wipe the dishes while you wash! Try and do the activity "with" them. Make sure the activity matches their abilities and interests. We may not be asking a person who hates cooking, to help prepare dinner. An occupational therapist can help you to identify a list of suitable activities.
Re-directing is not "distracting" or "dismissing" their emotional needs, particularly if we have validated them first.
Brooke George, Occupational Therapist