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Article by Matt Gannon, Communications Coordinator & Trainer with Oregon Care Home Consulting & Training.  At 4:30 a.m. in the dead of winter, the alarm goes off to announce the beginning of another long day. This is a day when nearly 70 people will receive breakfast, lunch, dinner, and snacks cooked from scratch at the hands of the management and talent of my wife, the dietary manager / head chef of our local memory care community. The first step, the shower, helps to wake up the brain and the body which is still somewhat sore from last week's grind, and the soul - with warm water the soul awakens to a calling, a passion to serve gracefully, and all the work that comes with it. She now dons the uniform, and steps into the shoes still damp from doing dishes with the crew three nights before. This happens regularly due to being short-staffed. She attacks the dishes with the others to make sure everyone can leave together to go home and no one is left behind. One of her shoes has a crack in the bottom from hours upon hours of being on her feet and so much water spilling into them over time...she plans to get a new pair of shoes, but you know, life is busy, and there is work to do and people depending on her - who the hell has the time? ...the soul awakens to a calling, a passion to serve gracefully, and all the work that comes with it. A work week of three back-to-back 12.5-hour shifts, and a 6-hour final day to cap it off - of grinding and a labor of love is about to kick off. This has been happening for nearly four years on a full-time schedule, and she's never late and never leaves early. The first year was while Covid was in full effect, a year with perfect attendance, another year with maybe one sick day (essentially unheard-of in long-term care), and finally, she was able to reach a point of permitting herself to begin taking vacations after two years of blood, sweat, and tears. She rises on a Monday morning to begin it all once again. She feeds our elders.  She walks quietly downstairs with the dogs to start the coffee and let them outside so they can get their fill of the morning air and do what dogs do. She prepares breakfast for our three dogs, two cats, a guinea pig, and a bearded dragon. She dishes their bowls and whispers lovely things to each one, but not before administering insulin to our geriatric and diabetic cat. She runs out to the car to start the heater so she doesn't freeze on her way to work. Now, it is time to prepare our kids' lunches for school, put fresh water in the pets' bowls, and put dog cartoons on TV so the dogs can finish their sleeping on the couch with full bellies in the living room next to the Christmas tree - while listening to Bluey, or some such show, before the rest of us wake. She bundles up in her winter coat, grabs her coffee, and tells herself, "You got this, and you know why you are going to go and grind once again - you know why you are doing this. Deep breath....let's go." She goes out to the bitterly cold morning air and falling rain, and into the car. The house is still asleep, the sun has not yet risen, Christmas lights twinkle in the foggy rain from each home, and she's on her way. You got this, and you know why you are going to go and grind once again - you know why you are doing this.... It's a short drive to the memory care community in our town, where there are elders who live out the remaining chapter of their lives. This is your mom, dad, grandma, grandpa, great-grandma, great-grandpa, neighbor, the people you always saw at church, who may have worked in your schools, built or maintained your streets and bridges, and who played a part in the community and society of your town. People who lived full lives - who've raised children, grandchildren, and great-grandchildren, served their country and did it all the best way they knew how. And, now, in their later years, fate has delivered - dementia. This has landed them a residence and room at the memory care building and a seat at my wife's tables. These are our elders, and my wife, our children's mom, feeds them. The time from the alarm waking her to pulling up to the parking lot is barely enough to prepare herself to answer the usual questions: who will show up today to work and who won't? Has that resident I love so much and who tells me she loves my food passed away since I was last there? What condition is my kitchen in and how far back will it set me to have to pick up the pieces of what someone else was supposed to do? Many unknowns, but one thing is known well - the chances of walking into what "should be" is a rare and mostly non-existent occurrence. No matter, people are depending on her, and the residents need to eat. She tells herself, "You can do this, and no matter what happens, they need me so they can eat, so here I am." Fighting back the emotions of facing the hard grind all over again, likely having to do it short-staffed (double the work), she stops for a moment and thinks of some of the brave, bleeding hearts who do work there, have worked there, and the good work and care they provide - her staff who she inspires with her unwavering standards and integrity to do the right thing always (and to wash their damn hands!), even when no one is watching because the residents deserve it. They look up to her and care about her and make it a point to let her know so, and she finds the strength to keep on going and do what needs to be done - she feeds our elders. ...she inspires with her unwavering standards and integrity to do the right thing always...because the residents deserve it. I worked as a dietary assistant, activities assistant, and certified nursing assistant in memory care for nearly a decade. I then worked as an administrator for memory care for some years. My private caregiving practice also led me to visit and serve my clients in many memory care communities across the Metropolitan area for over two decades. I know memory care and I know dementia care - it is my life's mission and passion to serve our elders who live with dementia. The doors are locked, they can't get out, and people are losing who they are and what they have as they try to make any type of sense of their day-to-day life in memory care. To say the work can be hard is an understatement. It is not because of the residents who make it hard, they make it all worthwhile in fact. Rather, it is the lack of consistency and longevity of a quality team unit that gets in the way. It is certainly not for everyone. For anyone to last even one year as a full-time worker is admirable, two years means you probably have a gift and are doing the work you are built to do, three years and you are as tough as they come, four years and the toll your emotions and body take have you questioning if you've been stretched too far at this point. This is one of the tragic truths of the work. And if a person decides this is enough then it is not because they are anything but someone who has learned they must listen to their heart and care for themselves, before it's too late. You eventually come to a place of recognizing, "I have made a difference." You are left with flash vivid memories of the many people you've served, you've touched in a meaningful way to ease their pain or suffering, who you made smile at the taste of your food, who you've won over from the taste of your food, and who felt a sense of peace and comfort by your presence and the overall satisfaction of a yummy meal. Most importantly, they feel recognized because you showed up and you showed care. You know you've made an impact, a difference, and the memories will carry with you throughout the rest of your life. Most importantly, they feel recognized because you showed up and you showed care. Taking care of yourself to better take care of others is talked about in this game, but put into action - training, mentoring, and support to see to it everyone can do this - this is not reality. So, instead, you have to save yourself to take care of yourself and you can only depend on yourself to do it, and lean on those who love you, to make sure your self-care is strong and true. And, wherever that leads you is the path you must be walking - even if it means your time in that particular place comes to an end at some point in the future. When you care deeply about the work it can hurt deeply. It is not hard to care for the people, it is all of the rest of the crap that usually gets in the way. My wife has shown so much more than mere strength. She is a model of a giving heart of service, standing up for what is right, and holding people accountable - all of this to make sure the elders are fed. What she teaches our children through the work she does is a lesson that is second to none in this world. We love her for it, we are proud of her, she is strong and brave and caring, and willing - all necessary traits the residents need in their support. She has these traits no doubt, and has exemplified this time and time again, day after day, seasons after season, year after year - she feeds our elders. ...we are proud of her, she is strong and brave and caring, and willing - all necessary traits the residents need in their support. The day is done, and she arrives home to our menagerie, her family, who couldn't be happier to see her, knowing the work she's done, the differences she's made, the fatigue and sometimes heartache she feels, and the quality and taste of all she's put out in the work day to so many. How fortunate are we all, that she feeds our elders?
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Article originally published March 2019. Updated December 2021.  When I was an elder abuse investigator several years ago, I investigated a challenging case. Miriam*, who was 87, had eloped from her adult care home the previous day. She had managed to leave out the one door that was not alarmed. She had fairly advanced Alzheimer’s disease, and though her memory and judgement were both strongly affected, she was physically able to maneuver with little issue. This is often the case with individuals who have Alzheimer’s disease. My stomach sank, though, as I continued reading the report. Miriam was still missing. I investigated and hoped for a good outcome, but unfortunately there was no positive outcome for Miriam in this case. I found out a few days later that local law enforcement found Miriam deceased, not far from her care home. This story highlights an extreme outcome of wandering and elopement. Fortunately, most cases end with the resident safely back at home. Still, this story reinforces the importance of not becoming complacent. This situation could have happened to any care home provider. It’s an unfortunate story that illustrates the importance of managing wandering and preventing elopement in adult care homes. Wandering vs. Elopement The terms wandering and elopement are often used interchangeably; however, they are not exactly the same. Wandering is pacing or aimless walking. This generally takes place inside the home or facility, though it can also take place outside. These are the individuals you see who pace up and down the hallway, seemingly without direction. Elopement, on the other hand, is the unplanned exiting of the home or facility. It commonly includes “exit-seeking behavior.” This exit-seeking behavior and elopement from the home puts residents at great risk of harm, as Miriam's story tragically illustrated. According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once. Who is at Risk? According to the Alzheimer’s Association, 60% of people living with dementia will wander at least once. Additionally, according to adult foster home surveys conducted by the Portland State University Institute on Aging, 45% of residents in adult foster homes in Oregon have some type of dementia. Who is most at risk?
Assessing for Elopement Risk What can you do to recognize and reduce the risk of elopement? Your screening process is the first step. It is important to conduct a thorough screening to find out if your potential resident is at risk for elopement and if you have elopement prevention options in place. During your screening interviews, ask if the individual has ever displayed exit-seeking behavior or wandered outside the home or facility. Additionally, if the individual is currently in a facility, review their narratives, care plan, and any incident reports to find out if there is a concern about wandering and/or elopement. Also, be sure to assess for elopement risk both during screening or after the resident has moved to the care home when their condition has changed. It is important to understand, even if you’ve conducted a thorough screening, or the resident has no prior history of wandering or elopement, they could still elope from your home after admission. In these instances, it's vital to put interventions in place and care plan to reduce further risk of elopement. 9 Tips for Keeping Residents Safe How do you keep residents with wandering or exit-seeking behaviors safe? Below are several tips and evidence-informed interventions for keeping residents safe. This is not an exhaustive list, as each resident’s needs and situation are unique, but it is a place to start. Tip 1: Care plan around wandering Recognize and document when a resident is most likely to be at risk, and what possibly triggers their wandering or elopement. Increase the level of observation. Tip 2: Meet the holistic needs of the resident If a resident is confused about where he or she is and insists he or she needs to “go home,” or “go to work,” use non-pharmacological interventions to address his or her underlying feelings and needs. Could she be bored? Might he be lonely? Tip 3: Keep residents active during the day Provide person-centered, meaningful activities and tailor the activities to the cognitive abilities of the resident. Tip 4: Install door alarms on exterior doors of the home Make sure to install alarms on all exterior doors and keep them turned on at all times. Tip 5: Consider using an ID bracelet An example of an ID bracelet is the Alzheimer’s Association Medic Alert + Safe Return® bracelet. Tip 6: Enroll the individual in a local safe return program Ask the resident's legal representative to contact your local sheriff's office or police precinct to find out if they have a registry for individuals at risk, like the Washington County Sheriff’s Office Help Me Home Program. Tip 7: Make changes in the home environment Paint exterior doors a similar color as the wall or consider a mural. Make the home environment comfortable, as well. Tip 8: Provide a space for residents to wander safely inside or outside Residents can wander safely with advanced planning. If a resident wants to walk outside, plan for a caregiver to go with him or her. Tip 9: Include the resident's care team Involve the resident's family and/or legal representative and others to help problem-solve around concerning, exit-seeking behavior. You don't have to do this alone. Awareness, Prevention & Intervention Sometimes you can do everything within your power to keep residents safe, and things will still happen. It is important, then, to recognize the point at which an adult care home may no longer be the safest placement for a resident with exit-seeking behavior who is an elopement risk. Fortunately, what happened to Miriam is a rare outcome in situations when a resident elopes from the home. With awareness, prevention, and intervention, you can keep residents who wander safe. *name and details have been changed
Article by Matt Gannon  Life is fundamentally about relationships and our connections to others. Humans operate to gain and maintain control (in varying degrees) within relationships: to ourselves, with others, to our environment, spiritually, and to our place in the larger world around us. This is like a balancing act we operate throughout our lives. We ascribe meaning and purpose to the different relationships. Many relationships will shift and change over time, while others remain relatively the same. Within our relationships we have choices and we maintain control of our time, effort, participation level and, the interests being served - all of which shape who we are, our characters, and our identities.  The Dementia Experience Dementia is progressive. Over time dementia demands a different type of communication to find and keep positive connections in relationships. Dementia creates a loss. For the people living with dementia, there is a progressive loss in abilities and independence. When we attempt to understand the dementia experience, what can become more understood is how a person living with dementia is losing a sense of control in their lives. One thing I have come to know well in my time of caring for people living with dementia is how life for them tends to become less about content and detail - and more about feelings. I also know people living with dementia do not lose their ability to feel, understand and recognize the emotion they are having when feeling it. They may not be able to understand and express fully why they are feeling what they are, but the feeling itself is familiar. Emotional memories are very deep-rooted memories and are still often more accessible and familiar (especially when utilizing the senses). The emotional experiences of a person living with dementia can be broken down into two categories: positive & negative. They may be feeling one way or another, or a combination of both at times, but how they are feeling and what they are feeling matters when it comes to providing care. Over time dementia demands a different type of communication to find and keep positive connections in relationships. What is Person-Centered Language? When providing person-centered care and communicating with a person living with dementia, it is important to do all we can as providers so the person ultimately feels more of a sense of control - this becomes our goal in each moment. It starts with an acknowledgment and validation to the moment you share, and to what emotion you sense is being felt. This can be done by communicating with feelings, both verbally and non-verbally. What is person-centered language and why is it important when caring for people who are living with dementia? It is about respecting the individual in our care approach at all times. Once we know the person we are caring for, we can plan and deliver care to them based on our knowledge of who they are as a unique person who also happens to be living with dementia. As you read the phrases below, ask yourself how does it feel to switch from one phase to another? I have a dementia resident.......
 When we move to using person-centered terms, our approach, attitude, tone, body language, and empathy can change. It will benefit both us and the person living with dementia because what we do and say can have a significant effect on how they are feeling. If we carry the right mindset, the right attitude, and the right outlook then we are ready in our right care approach. Less is often more when choosing the words we say as we communicate to a person living with dementia. Show more, talk less is generally a good formula. We pursue short, brief, and repeated words and sentences as many times as necessary. We strive to create words together that become familiar between us and familiar to whatever activity we may be doing within our routines, we can identify the words and use them repeatedly as they become mutually understood. We can look to use words the person living with dementia tends to use or respond best to, or phrases that mean something to them. It is up to us to learn what those important words and phrases are, and when we do, to share those words with anyone else who provides care to that person. When we move to using person-centered terms, our approach, attitude, tone, body language, and empathy can change. Insert positively-charged words into statements, such as “ah, that’s a good thing, that’s a good one isn’t it, I like that, I love that, that feels good, doesn’t that feel good? that looks good, and thank you”. A positive way of communication can be to offer suggestions over telling or directing what one needs to do. When assisting a person in any way, from pushing their chair in for them to buckling their seat belt, or helping to get a jacket sleeve on, it is important to seek their sense of satisfaction or approval before moving on to the next thing/task. This can be done by simply asking, “Ok then? Are you happy with that? Does that feel good? Is that a good one?” Or even doing the thumbs-up gesture and awaiting their response before moving on, as this communicates respect and how you see them and care enough to ensure they are satisfied with what you’ve done to assist, before another task or agenda takes over. This is person-centered language.  Why is this important? How much or how little we know about a person we are caring for makes a big difference. A person living with dementia is still the “person” they have always been and in many ways will continue to be. But they are also changing and different in some ways now. What they need from us the most is to SEE them for who they are and to know what makes them unique. By doing this we are reaching the center of a person and can care for them in a way that charts their personal care course - providing a feeling of control, not taking more away. Person-centered language is part of how we communicate to people living with dementia who depend on us to understand, and to be able to connect in the most respectful ways possible. Respect matters in all of our relationships, but for the person who is living with progressive dementia that is affecting their brain, we must ensure our approach and the language of our care is received in the way our residents living with dementia require - to have the strongest relationships we possibly can. What they need from us the most is to SEE them for who they are and to know what makes them unique. By doing this we are reaching the center of a person...
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About Oregon Care Home ConsultingOregon Care Home Consulting & Training is the compass that helps current and future APD adult foster care home licensees successfully navigate the licensing process and have a successful adult foster care home business. ORCHC provides coaching, consultation, training, and ongoing support. This ultimately saves time, reduces stress, and improves compliance, which allows AFH/ACH licensees to focus more time on providing excellent care to seniors and individuals with disabilities.
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Disclaimer: Oregon Care Home Consulting LLC is not affiliated with the State of Oregon or Multnomah County Adult Care Home Program (ACHP). We are not State licensors, therefore we are unable to require compliance or guarantee your adult care home is in full compliance with current state and/or federal requirements. State and/or County licensors make the final determination of compliance. Additionally, we are unable to offer legal or medical advice, and no guidance provided by Oregon Care Home Consulting LLC should be construed as legal or medical advice. Always consult an attorney or doctor, when necessary.
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Disclaimer: Oregon Care Home Consulting LLC is not affiliated with the State of Oregon or Multnomah County Adult Care Home Program (ACHP). We are not State licensors, therefore we are unable to require compliance or guarantee your adult care home is in full compliance with current state and/or federal requirements. State and/or County licensors make the final determination of compliance. Additionally, we are unable to offer legal or medical advice, and no guidance provided by Oregon Care Home Consulting LLC should be construed as legal or medical advice. Always consult an attorney or doctor, when necessary.
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