Post by norbert1 on Aug 3, 2006 10:23:55 GMT -5
PB writes, ""In the evening she gets so nasty. I know that this is "sundowning" but she only has one problem "this is not my house, when are you going to take me to my house". It never ends until she becomes exhausted and finally falls asleep. She is in the same house for 53 years so its not like we took her out of her house and put her somewhere strange.""
----------------------------.
Usually this is a problem seen in a nursing home, not in a person's house of fifty years. Any way, here is the best advice I have seen on this subject.
What one dementia expert, Geri Hall says:
There are two factors that produce these statements: fear and insecurity. The need to go home is the need to go back in time to a place where you are intact, loved, and are safe. Patients often imply a deep feeling of emptiness and a longing for those who made them comfortable before. This is especially common when the patient begins to experience difficulty with consistent recognition of familiar people. Imagine if you had to stop and worry about strangers in your environment on a regular basis.
It is critically important in repetitive behavior to forget the words and go for the feeling behind the words. If you simply attend to the words, you will get nowhere. The questions will continue.
I would first sit down with her and ask her why she is asking. "Why do you want to go home now? What are you going to find there?" Her response should be listened to -- even if it is gibberish because you are going for non-verbals here, not words. And trust me, by sitting, listening, watching, and perhaps holding her hand, you will develop a deeper understanding of her distress and how to address it. Moreover, is there a pattern? For example, if it occurs later in the day, it may be her _expression_ of fatigue and the need for a rest, or that the TV is bothering her. If it is earlier in the day, there may not be enough structure and she doesn't know what to do next (thus day care might be of real benefit), or she may be suffering from depression. Or, she may be actually telling you she doesn't like living with you.
Approach the question with warmth. Instead of trying to convince her that this is your home now.... acknowledge her distress and that you love her and want to help. Give hugs instead of explanations. They are easier, mean more, and are a lot faster than trying to approach with reason.
So, the next time the question comes up:
1. Acknowledge her distress
2. Give a hug
3. Sit down and ask why she wants this; and then
4. Listen, observe, and FEEL her response. The feeling part is the most important.
5. Acknowledge to her what your gut is telling you and let her respond to this.
6. If this makes you fearful or sad, let her know how you feel. It puts you on the same side of the table.
Another approach is to use validation - "Tell me about your home. Are you feeling homesick? What about your home do you miss? Who is there for you?"
Always reassure the person that you are there with them and that they are safe. The one thing that doesn't work is trying to convince the person it is their home.
What one caregiver reported - I asked her why she wanted to go there. Her answer was "because I know more places there".
-----------
Other suggestions (based on my experience an advice from the dementia doctor on this.)
Never say NO. They can not process that word. You cannot take away all hope on something they want so badly.
However,
They can accept delay and some uncertainty.
Ask her to stay a few days longer--
You need her to stay a few days because you need help, or stength training, etc Or the house is being worked on, I will be out of town for a few days, etc. Use the memory loss to your advantage. These things work if short term memory does not work and she does not remember this later.
I found it best to get my mom off the subject as soon as possible. If I did not change the subject, she would go on about going home for almost an hour. This just gave her to opportunity to practice and reinforce her speach. But she would not be easily redirected immediately. She would still demand to go home for a few minutes until I could finally redirect her.
Aides were surprised at the intensity of the wanting-to-go home speach she directed to me. They said she was quite content until I showed up. My appearance triggered the thought and the speach. (It was an automatic response to my presence, it was the first thing she would say when she saw me.) And afterall, I was the one with the ability to affect the situation. Others have reported similar experiences.
------------------------
Rules for dealing with difficult behavior
join in - Empathize, ask what home was like
distract -
redirect - get her onto another subject, or an activity.
---------------------------------.
From the Beacon Newsletter, September 2009
Banner Alzheimers institute
“Ask the Expert” by Geri Hall, PhD, RN
Dear Geri,
The one thing that really drives me crazy is trying to respond to Mom’s request to “go home.” She begs to be allowed to go home, usually late in the afternoon. I spent hours trying to explain that she IS at her home, not in the hospital, and that I will take care of her. When I stop to get her a glass of water and after one drink, she starts anew, asking to be allowed to go home. I have taken her to housed we lived in before and the location of her childhood home, but she doesn’t know them. Now, I just drive her around the neighborhood, but that doesn’t stop it either, Last week I lost my temper. How can I get her to understand?
Signed, “Out of Gas.”
Dear Out of Gas,
This is a very complicated problem that commonly occurs about the same time when the person has difficulty with selecting their own clothing and dressing. There are several reasons that help explain the behavior. First, people with AD have changes in their visual perception that limit their ability to recognize objects and places, making familiar places seem unfamiliar. Second, the fact that the behavior occurs later in the day means fatigue is compounding the problem. If her home does not look familiar, it can be frightening. Third, you need to expand your definition of the word “home” to include more than a house. Our friend Carole M. who has AD describes “wanting to go Home”:
Home is a state of mind. . . . Home may have been any of a number of different places physically, but emotionally and intellectually, it was always the one place in which I felt most comfortable.”
“No matter where your relative with dementia refers to when he or she asks to go home, the chances are hat it is somewhere neither of you will ever visit again. In some respects, I am still “Home,” but in others, I will never get home again. Living in this twilight zone is frightening and I wish I were not there. However, I understand that none of my living relatives could help me to get somewhere that no longer exists.” (printed with permission.)
How to handle requests to go home:
1. Acknowledge your wife is feeling lost and frightened. Tell her you know she doesn’t recognize the house and don’t try to convince her she is wrong. Ask her to tell you about the home she longs for: who lives there; what she would be doing: and why it feels safe.
2. Reassure her that you will keep her safe
3. Try to involve her with a familiar activity such as helping you prepare supper.
4. Increase her rest periods during the day so she is not so fatigued in late afternoon.
5. If the behavior includes agitation, crying or trying to elope, speak with her health care provider to check for urinary tract infection and/or determine the need for medications for anxiety.
6. Enrolling the person in adult day programming provides additional structure and the reinforcement that she is now “home” in the afternoon.
----------------------------.
Usually this is a problem seen in a nursing home, not in a person's house of fifty years. Any way, here is the best advice I have seen on this subject.
What one dementia expert, Geri Hall says:
There are two factors that produce these statements: fear and insecurity. The need to go home is the need to go back in time to a place where you are intact, loved, and are safe. Patients often imply a deep feeling of emptiness and a longing for those who made them comfortable before. This is especially common when the patient begins to experience difficulty with consistent recognition of familiar people. Imagine if you had to stop and worry about strangers in your environment on a regular basis.
It is critically important in repetitive behavior to forget the words and go for the feeling behind the words. If you simply attend to the words, you will get nowhere. The questions will continue.
I would first sit down with her and ask her why she is asking. "Why do you want to go home now? What are you going to find there?" Her response should be listened to -- even if it is gibberish because you are going for non-verbals here, not words. And trust me, by sitting, listening, watching, and perhaps holding her hand, you will develop a deeper understanding of her distress and how to address it. Moreover, is there a pattern? For example, if it occurs later in the day, it may be her _expression_ of fatigue and the need for a rest, or that the TV is bothering her. If it is earlier in the day, there may not be enough structure and she doesn't know what to do next (thus day care might be of real benefit), or she may be suffering from depression. Or, she may be actually telling you she doesn't like living with you.
Approach the question with warmth. Instead of trying to convince her that this is your home now.... acknowledge her distress and that you love her and want to help. Give hugs instead of explanations. They are easier, mean more, and are a lot faster than trying to approach with reason.
So, the next time the question comes up:
1. Acknowledge her distress
2. Give a hug
3. Sit down and ask why she wants this; and then
4. Listen, observe, and FEEL her response. The feeling part is the most important.
5. Acknowledge to her what your gut is telling you and let her respond to this.
6. If this makes you fearful or sad, let her know how you feel. It puts you on the same side of the table.
Another approach is to use validation - "Tell me about your home. Are you feeling homesick? What about your home do you miss? Who is there for you?"
Always reassure the person that you are there with them and that they are safe. The one thing that doesn't work is trying to convince the person it is their home.
What one caregiver reported - I asked her why she wanted to go there. Her answer was "because I know more places there".
-----------
Other suggestions (based on my experience an advice from the dementia doctor on this.)
Never say NO. They can not process that word. You cannot take away all hope on something they want so badly.
However,
They can accept delay and some uncertainty.
Ask her to stay a few days longer--
You need her to stay a few days because you need help, or stength training, etc Or the house is being worked on, I will be out of town for a few days, etc. Use the memory loss to your advantage. These things work if short term memory does not work and she does not remember this later.
I found it best to get my mom off the subject as soon as possible. If I did not change the subject, she would go on about going home for almost an hour. This just gave her to opportunity to practice and reinforce her speach. But she would not be easily redirected immediately. She would still demand to go home for a few minutes until I could finally redirect her.
Aides were surprised at the intensity of the wanting-to-go home speach she directed to me. They said she was quite content until I showed up. My appearance triggered the thought and the speach. (It was an automatic response to my presence, it was the first thing she would say when she saw me.) And afterall, I was the one with the ability to affect the situation. Others have reported similar experiences.
------------------------
Rules for dealing with difficult behavior
join in - Empathize, ask what home was like
distract -
redirect - get her onto another subject, or an activity.
---------------------------------.
From the Beacon Newsletter, September 2009
Banner Alzheimers institute
“Ask the Expert” by Geri Hall, PhD, RN
Dear Geri,
The one thing that really drives me crazy is trying to respond to Mom’s request to “go home.” She begs to be allowed to go home, usually late in the afternoon. I spent hours trying to explain that she IS at her home, not in the hospital, and that I will take care of her. When I stop to get her a glass of water and after one drink, she starts anew, asking to be allowed to go home. I have taken her to housed we lived in before and the location of her childhood home, but she doesn’t know them. Now, I just drive her around the neighborhood, but that doesn’t stop it either, Last week I lost my temper. How can I get her to understand?
Signed, “Out of Gas.”
Dear Out of Gas,
This is a very complicated problem that commonly occurs about the same time when the person has difficulty with selecting their own clothing and dressing. There are several reasons that help explain the behavior. First, people with AD have changes in their visual perception that limit their ability to recognize objects and places, making familiar places seem unfamiliar. Second, the fact that the behavior occurs later in the day means fatigue is compounding the problem. If her home does not look familiar, it can be frightening. Third, you need to expand your definition of the word “home” to include more than a house. Our friend Carole M. who has AD describes “wanting to go Home”:
Home is a state of mind. . . . Home may have been any of a number of different places physically, but emotionally and intellectually, it was always the one place in which I felt most comfortable.”
“No matter where your relative with dementia refers to when he or she asks to go home, the chances are hat it is somewhere neither of you will ever visit again. In some respects, I am still “Home,” but in others, I will never get home again. Living in this twilight zone is frightening and I wish I were not there. However, I understand that none of my living relatives could help me to get somewhere that no longer exists.” (printed with permission.)
How to handle requests to go home:
1. Acknowledge your wife is feeling lost and frightened. Tell her you know she doesn’t recognize the house and don’t try to convince her she is wrong. Ask her to tell you about the home she longs for: who lives there; what she would be doing: and why it feels safe.
2. Reassure her that you will keep her safe
3. Try to involve her with a familiar activity such as helping you prepare supper.
4. Increase her rest periods during the day so she is not so fatigued in late afternoon.
5. If the behavior includes agitation, crying or trying to elope, speak with her health care provider to check for urinary tract infection and/or determine the need for medications for anxiety.
6. Enrolling the person in adult day programming provides additional structure and the reinforcement that she is now “home” in the afternoon.
I am no longer able to hold your hand my beloved but I cherish the remembrance of your hand in mine...and the wonderful person that touched so many lives with joy. : )