We all need something important to do each day.
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It is thought that people in nursing homes don’t die of chronic disease as often as they die of loneliness and boredom. A memory care unit can offer many activities during the day, but for the person who has had a lot of responsibility and something important to get up for every morning during their working years, this may not be enough. As memories fade, the person with dementia sometimes reverts to the routines that were followed every day for years. However, as attempts are made to maintain routines such as catching the bus, clocking in, finding the office, or fulfilling perceived responsibilities, confused residents become frustrated and even angry because they cannot do their jobs. Sometimes delusions or hallucinations can be the result.
A good example of this behavior was seen in John, who walked around the memory care unit trying to screw his cane into every opening he could find including spaces between chairs, partly opened doors, and trash cans. This became an extremely obsessive behavior and all efforts to distract him or assist him with personal care were met with agitation. Eventually John was becoming combative even when the staff tried to toilet him, preferring to work with his cane. John’s quality of life was declining and his health began to suffer. Soon he started to refuse meals, preferring to find places in which to screw his cane and doing so until he was so tired he would stagger and fall if the staff could not stop him.
A call to his family and a discussion of John’s behavior revealed the fact that he had been a factory worker whose job included screwing large bolts deep into airplane engines. Because his behavior was so obsessive, a psychiatric consult was done and he was put on an anti-anxiety medication.
The staff also worked out a care plan that would fulfill John’s need to work. Each morning they would approach him for morning care by asking if he would like to get ready for work. When meals were served, they reminded him to have a good breakfast because he had a busy day ahead, or told him it was time for a lunch break. They also found another “job” for John—sorting bolts of different sizes, something he seemed to enjoy. In the early afternoon they convinced him that his work day was over and it was time to go home.
While this plan did not work perfectly every day, most of the time it kept John busy at an activity he liked that did not wear him out. It’s important to point out that this behavior did not last long. In a few weeks John no longer seemed interested in doing his “job” and the staff was able to engage him in a few other activities. Although it was expected that John would soon forget about his job, it was important to address his need in the moment. All dementia patients are constantly changing, which means the care plan has to be altered frequently to accommodate those changes.
↪ Put yourself in John’s place. You have late mid-stage dementia. How would you spend your day if you had nothing important to do?
- Filling bird feeders. The reward is watching the birds.
- Helping to hand out snacks. The reward is eating them with the other residents.
- Folding napkins for meals. The reward is seeing the table set and ready for dinner. Feeling you have contributed.
- “Visiting” with other people who have dementia. The reward is sharing stories and memories.
- Anything that a person is still capable of doing that leads to a positive feeling of accomplishment can go a long way to enhancing their quality of life, especially if they get compliments on a job well done.