We have a new admit to our locked dementia facility today, Rosie. Up until now she has gently gone along with family plans to place her in a locked dementia facility.  All psychosocial needs, including validation, appeared to be appropriately met.

“Suddenly,” to everyone’s surprise, Rosie vehemently refuses to pass through the lobby double doors into the facility.  This is an unexpected response as viewed through the eyes of staff and resident’s daughter, Pam.

Even before reaching the lobby I can hear Rosie shouting adamantly at her daughter.  “I WILL NOT stay here and YOU can’t make me!”  Disappointment and shock overflowed in Pam.  Just this morning she woke up for the first time in a long time sensing the stress and worries regarding her mom’s well-being were about to be resolved.  Wrong.  Right back to square one and for another roller coaster ride through angered emotions, fears, and fighting.

Facility Placement

Pam wanted to care for her mom.  Unfortunately she not only had a family who needed her attention, she also worked a full time job.  Rosie’s safety awareness continued to decline.  Now she was considered to be at risk for harming herself and/or others.  Placement in a locked facility could take care of a whole lot of problems.  Rosie’s recollection of the options however clearly showed there were no new plans on the horizon to move.  Why move?  She loved her home.

Observations told me Rosie understood they were coming to this facility today.  For lunch.  Once she “discovered” she was supposed to be moving in her world flipped upside down. 

Yes, she rode in the same car as Pam and “the girls.”  True they were hauling a mini trailer with Rosie’s belongings in it.  Pam was free to do as she wanted as far as Rosie was concerned.  But now everyone was talking about “her apartment and her new home.”  Rosie drew the line.  Rosie “knew” everybody tricked her.  Rejected by her family.  Thrown out like yesterday’s garbage.

Rosie finally sat down on one of the lobby couches, just as far away from “them” as was physically possible.  Newfound psychosocial needs were going unmet.  “It’s time to make my move,” I thought.

Psychosocial healing during facility placement

“Do you mind if I sit next to you?” I query.  Rosie gives me a quick once over.  “HUMPH!” she grunts.  “Help yourself,”  

Huge sighs and some squirming in my seat catch Rosie’s interest.  “I’m having a horrible day!  How are you?”  “Well, not much better I’m afraid,” Rosie grumbles.  “It’s just that I’m sick and tired and I’M NOT GOING TO PUT UP WITH IT ANYMORE,” I exclaim.  Identifying similar mood states, her interest is piqued as she physically shifts her body in my direction.

“I’m sorry, I didn’t mean to burden you with my problems,” I continue.  “My daughter seems to think she’s the mother and I’m the daughter!  Me!  Where is this coming from?!  I’m not stupid!  But she thinks I am!  Feeble?  She may think so, but I’m not!  Have you ever heard anything crazier than that?!”  

Words of complaint, but their purpose was to bond Rosie and I.  Sounding as though I was complaining, she heard validation of her feelings.  We were becoming emotionally bonded friends.

The game plan

In conversation form, I listed off all of Rosie’s concerns.  She intuitively felt I understood her situation.  “Same for me!” she shouts.  Our own form of bonding begins to grow.

Bringing her back to calm with every validation, Rosie begins to relax.  “I sure could use a cup of tea.  How about you?” I ask already knowing she is an avid tea drinker. 

It just so happens we keep the tea on the other side of the lobby double doors.  We can now go through those doors without kicking up a storm of emotions.  Tea is delightful.  It doesn’t usurp anyone’s autonomy.

“Pick where you would like to sit.  I’ll fetch the tea,” I say as I leave the dining room to get our tea.  Letting her choose the seating was filling her much depleted autonomy needs.  After a bit I ask where she lives.  Rosie gave me a quizzical look and shrugged her shoulders.  “Okay, it’ll be easy to find.  Maybe you and I are neighbors!”  “Oh I sure hope so!” she said while squeezing my arm. 

She found her room … and her quality of life

I knew which room was hers.  We began to walk down the hallway.  Rosie’s reality said we were meandering.  Suddenly she recognizes her furniture in one of the rooms.  “Hey that’s just like my chair and that’s just like my bed too!  Oh my!  And that’s just like my dresser!  Hey!  These are my things,” she blissfully announced.  “Great job, Rosie!  Yes, I think you just found your apartment!”

Rosie thoroughly enjoyed facility living.  Activities of every sort drew her to new adventures.  Gracious manners and a spot of tea won Rosie many friends.  Once all her medical, physical, and psychosocial needs were regularly met, a socialite was born.

Psychosocial encouragement

• Validate the loved ones feelings by echoing back their own words.
• Breathe slowly and calmly when the loved one is upset as this will help return their calm.
• Listen not to the content of their statements, listen to their feelings.