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By guest author Alexis Baker, MT-BC with Bridgetown Music Therapy  “I think music in itself is healing. It’s an explosive expression of humanity. It’s something we are all touched by. No matter what culture we’re from, everyone loves music.” You may know music is powerful and beneficial to humans, but maybe you are unsure how to utilize it as a meaningful activity in your care home. If so, I’ve got some ideas for you. Music is a wonderful tool for connection and engagement! It’s kind of like a vitamin—a little bit everyday does wonders to nourish the body, mind and soul. Music can be a daily activity for residents, and I’m going to share 7 ways to engage residents through music. #1: SingEven if you don’t describe yourself as a “singer,” we each have a voice and can use it to sing. Did you know the activity of singing has a ton of benefits? In many ways, singing is similar to exercise. It’s an aerobic activity, so it gets more oxygen into the blood leading to better circulation which can cause improved mood. Singing causes the release of endorphins, which give us that wonderful “lifted” feeling often resulting in stress relief. Also, because singing requires deep breathing, a natural result is often reduced anxiety. It's as simple as turning on a song and singing along. Take advantage of free or low-cost resources like YouTube or Spotify. Create a playlist of you and your residents’ favorite tunes to sing together. Learn the lyrics of a few songs together so you can sing a cappella when you aren’t able to conveniently turn on the music. Another more formal way to regularly sing would be for your residents to receive music therapy services. #2: PlayDo you or your residents own any musical instruments? Pull them out and invite them to play. Tell them not to worry about sounding good or playing correctly. They don’t necessarily need to know how to play. Prompt them to start out by exploring the instrument and see what sounds they can make. Instrument play is fun and can provide opportunities for playfulness and self-expression as well as physical movement. Musical instruments can be played on their own or with accompaniment music. Small percussion instruments like maracas are generally easy to pick up and play without any previous knowledge or experience. Just turn on some music, have fun and jam out with the instruments. Some of our favorite older-adult friendly instruments to use include maracas, tambourines, jingle bells, eggs shakers and paddle drums (check out WestMusic.com for quality instruments at reasonable prices). For a couple of more unique instrument options, check out an Easycussion pentatonic xylophone, Suzuki QChord, or an ocean drum. #3: DanceMusic and dance go hand in hand. Because music is a natural motivator for the physical body, most people can easily pick up the rhythm of a song by tapping their toes or bobbing their head to the beat. Sometimes we do this without even thinking! Movement and dance are the body’s natural response to rhythm. So, turn on some music and get dancing with your residents! Choosing songs that are familiar or well-known to residents can be helpful but don’t shy away from exploring new-to-you and different types of music. You never know what new songs or styles you’ll discover. To help get you thinking here are some genres of music you could dance to: big band, jazz, rock’n’roll, folk, bluegrass, country western, classical, rhythm and blues, gospel, pop, Broadway showtunes, soul, funk, disco… Remind residents that while formal dances like the waltz, tango or cha-cha-cha are wonderful, they are not the only way to move the body to music. Suggest to residents they try making up their own moves, or try something simple like swaying, shuffling, or doing seated movement to music. They can try stretching, exercising, or simply doing rhythmic body percussion like clapping, snapping, patting, stomping, kicking, tapping, marching, shaking, waving, etc. It’s a time to get creative and have fun! #4: Listen and ReminisceListening to music can be an enjoyable activity all on its own. Find a playlist the residents living in your care home enjoy, or create a playlist with their favorite songs. Listening to music is an excellent activity for relaxation or brain stimulation. It can be a passive, receptive experience by simply listening. Or, it can be an active, engaging experience by discussing the lyrics and various elements of the music, such as the sound, feel, different instruments involved, etc. There is no right or wrong way to listen to music. Do what feels best and what your residents enjoy most. Listening to music also function as a great accompaniment to other activities such as meal time, physical movement, or doing an art project. One word of caution: beware of over-stimulation using music in this way. Many activities require a great amount of focus, and some types of music can actually lead to the brain having too much to process at once. Try to match the musical energy to the energy level of the activity. Instrumental (or music without lyrics) can work well for times when your residents will need to talk during the activity. Music can also be an amazing catalyst for reminiscence. To start off, choose songs associated with positive, meaningful memories. Observe your residents as you listen together and consider asking a couple questions about that song afterwards. For more info and practical tools, I recommend the book Music, Memory, and Meaning written by a few of my music therapist colleagues! #5: RelaxMusic can be a wonderful tool for relaxation. We all find different types of music calming for us, and the music we find relaxing can change throughout our lives. It’s important for you to consider and choose music that’s calming for your home environment and residents. I use music as a structured space for deep breathing, gentle stretching, guided relaxation, and meditation. There are different techniques for each of these; however, don’t get bogged down in the how-to. Begin by experimenting to see what it’s like using music to assist in relaxation, and then go from there. If you’re at a loss as to what kind of music to play for times of intentional relaxation, try looking up a playlist of the type of music spas use during treatments such as massage therapy. Nature sounds or ambient music can work beautifully to calm mind and body. #6: RecordThis is a simple activity for you and the residents living in the home. It’s a reminder to capture those moments of music making together! With resident authorization, you could use the voice memo app on your phone, your phone’s camera to video record, or write down a special moment in a notebook. This is a great way to share this experience with residents and they can choose to share this with their family members and friends. They will appreciate it, and you’ll be grateful for capturing those special, memorable moments of resident bonding through music. #7: Connect with ProfessionalsTo help support you in providing beneficial music activities for care home residents, Bridgetown Music Therapy has created an engaging online music program for senior care homes. As a licensed and board-certified music therapist, my focus is on improving older adults’ quality of life through the intentional use of music. Our high-quality videos are designed to promote active and engaging experiences that include singing, movement and relaxation. We provide life enrichment through meaningful music activities that are enjoyable, easy to engage with, and effortlessly accessible. Our mission is to spark JOY with engaging music classes for older adults, and we would love to be a part of serving your residents! If you’d like to give Bridgetown Music Therapy a try, click here to get started with your free trial. New content is released weekly! Sometimes we just need to be given permission to try something new. So, I hereby grant you full permission to make music with residents! A Few Tips - sometimes we just need to be given permission to try something new. So, I hereby grant you full permission to make music with residents! Additionally, here are a few tips that might further help you push through any initial discomfort or unfamiliarity:
The benefits of music are abundant and far-reaching. Music can create connections and spark joy. Music is fun and engaging. It’s a natural motivator for the mind and body. Music really makes a difference! Connect with Bridgetown Music Therapy on Facebook and Instagram. Interested in services? Visit Bridgetown Music Therapy to become a member [affiliate link].
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We want to continue to highlight the work of our amazing adult foster care home providers in Oregon. Matt Gannon spent some time talking with Margaret Gikaru, RN-BSN, operator of Troutdale Adult Home Care, which is a classification 3 care home in Multnomah County. Please read below to learn more about Margaret. Tell us a bit about your background and what lead you to work in care and service.  My husband and I arrived together in the United States from Kenya in 1995. We flew into Los Angeles with only $70 between us, and I was 9 months pregnant. We started our lives in the United States in California but moved to Seattle, Washington two years later. Being African immigrants, we are used to taking care of our elderly and I helped to take care of my grandma when I was a little girl. We didn’t have nursing homes in Kenya then. When our parents grew old, we’d take care of them. It was a new experience for us when we came to America and realized we could work in care settings to take care of elders. We decided to move from California to Washington because most of our family was in Seattle. I started working as a certified nursing assistant (CNA) and started working in a nursing home in 1997. We recognized that it is easy to get a job as a CNA and raise a family. Within a few weeks, you can be working with a certificate from the state. While raising a family, we found this to be easier than having an office job, especially arriving from Kenya. I then began working in in-home care and was also working at an adult family home. I worked as a CNA for a total of six years. My husband was in a different field before we started this business, mostly in computer software engineering and health information management systems focused on global health. Switching his career to be part of this business was a challenge, but he fit in quite fast, and I value his support. At what point did you decide to become a nurse? I was encouraged by my manager at the time who was a registered nurse (RN) and was the owner of the adult family home I was working in. She encouraged me to go to school to become a licensed practical nurse (LPN). She saw something in me. In fact, she once told me if she ever got ill or needed care, she would want me to be her nurse. After graduating as an LPN, I worked at a home care agency for six years while pursuing my RN degree. After graduation, I continued working for the home care agency. Soon thereafter, I went back to the same school to get my bachelor's degree in nursing, BSN. Soon after graduation, I started working at Valley Medical Hospital, a University of Washington affiliate. I worked there for six years - three of those years were in the intensive care unit (ICU). I worked there up until January of 2021, which was right before starting our Troutdale Adult Home Care business in Oregon. Why are adult foster care homes so special?  As compared to institutional care, you can care for people in a more person-centered way. For example, regarding a resident's diet, the idea is to create an environment that is as like a family home as possible. Serving only five people we can really tailor the menu to the residents' desires, so this is never a problem. Because it is a home-like setting, we can be more flexible in involving the special and important family and friend connections. We feel it provides better outcomes for the residents in this type of care setting. We have live-in caregivers, and they get to know the residents in a uniquely special way, as compared to many other places where turnover is high and the few caregivers working must care for so many. There is more consistency here, and this is good for everyone. "We feel it provides better outcomes for the residents in this type of care setting." What does nursing add to the overall success of care homes? Because of my experience and training I can move into any high-acuity care situation with a resident and provide the right care to them with confidence, ease, and experience. When giving reports or communicating with the healthcare teams, I understand the language and can interpret important information. This is information such as what to ask and how to use my voice as an advocate, and this can make things so much clearer for everyone. This matters for quality of care. This experience and skill set makes a difference. What do you love most about the work you do? We live where we work. Having the flexibility makes a real difference and I enjoy being my own boss. Countless times in my career my patients or residents have told me they cannot do what I do for people, and they don’t know how I do it. It is in those times I know I am making a difference, and we get to make this difference in our own care home and do this together. "It is in those times I know I am making a difference, and we get to make this difference in our own care home and do this together." Anything else you'd like us to know about you? We have four kids: three boys, and one girl. In this country, there is the old motto from the Army “be all that you can be,” and as immigrants, we feel we are here to achieve our dreams. Now, we are doing just that, and we know we cannot do this where we come from. Also, as immigrants, we are so very grateful to have the opportunities we've had and to create the life for our family that we want. Together, we notice some challenges in this business. Finding caregivers is one of the biggest and we know this is a problem in many different healthcare settings. As a community of care home providers, we do not have a voice yet. We, and some other interested providers, are looking to gather and create a Council of Providers and have a seat at the table at both the state and county level to create necessary changes in the industry. You can reach out to Margaret at [email protected].
By guest author Tory Thompson with Providence ElderPlace.  What is Providence ElderPlace PACE, and what is the PACE program? Providence ElderPlace is part of the national PACE: Program of All-inclusive Care for Elders. PACE is both a health insurance and the health care provider. We serve seniors 55 and over who are Medicaid Long-Term Care services eligible (or who want to pay privately). Services go beyond traditional health insurance. For example, ElderPlace PACE includes specialty care, behavioral health care, dental, vision, hearing, and foot care. All of a person’s medications, medical supplies and medical equipment, labs, physical, occupational, speech and recreational therapy are included. PACE insurance has no premium, co-pay or deductible for the senior. How does ElderPlace support residents living in adult care homes? This is done in a variety of ways. First, ElderPlace PACE provides transportation with PACE vans and consistent drivers to all of the resident’s medical appointments. Having a consistent driver allows the driver to learn each resident's preferences and needs. The drivers are considered an important part of the participant's care team. Alternately, virtual visits are available, as well as home visits by a community care licensed nurse. Next, our medical teams specialize in geriatric care, and the residents can also receive palliative care for chronic conditions all the way through the end of their life. In addition, we have master's-level social workers, behavioral health experts and chaplains to support all aspects of a resident's health. It is also important to note: residents on ElderPlace PACE do not have to pay into the state and can keep more personal money each month. What are some of the key ways ElderPlace supports the adult care home providers to help them maintain a better work-life balance?
"ElderPlace helps me manage my residents’ care needs, so I have more time for my family." What are other adult care home providers saying about working with ElderPlace? Providence Elderplace has a long-standing, 30+ year relationship with adult foster care home providers. Some of the feedback we’ve received speaks to how the program can truly be life-changing. Here is some of the feedback we received from providers: “Staff are fast in responding to issues and supplies come on schedule.” “When my residents need more care, ElderPlace works with me to keep them at home and out of the emergency room.” “With ElderPlace I feel like I have a team of professionals backing me up.” “ElderPlace helps me manage my residents’ care needs, so I have more time for my family.” How do care home providers connect with ElderPlace? The Providence ElderPlace PACE service area is Multnomah County, parts of Clackamas county, Washington County, Clatsop and Tillamook counties. To learn about contracting with ElderPlace please call: 503-215-6556. To refer a resident for ElderPlace PACE services call: 503-215-6556. To report a vacancy and get free referrals, send a weekly email to: [email protected]
We want to continue to highlight the work of our amazing adult foster care home providers in Oregon. Matt Gannon spent some time talking with Provider Cherie Bray, owner of Country Comfort Adult Foster Home in Lane County. Please read below to learn more about Cherie.  How long have you worked in the adult care home business?  I've worked in the business since July of 2015. I was a career hairstylist and was looking for something new, so I enrolled in Lane Community College's Women in Transitions (LCC WIT) Program. My co-worker from the salon later referred me to a caregiver job at Country Comfort Adult Foster Home in Veneta, Oregon. Country Comfort was established in 1999 and is a class 2 home. I ended up taking the caregiving job and after thirty days I knew this was exactly what I wanted to be doing, so I quit my other career. For the next three years, I was groomed and mentored by the provider of the adult foster home. I then became a co-licensee of Country Comfort in February of 2018. Then, in May of 2018, I took over the business completely when the previous provider retired. For about the first ninety days, I was the only caregiver and worked full-time doing everything to completely wrap my arms around the responsibility I took on, and to get my bearings. Opportunities for staffing support presented itself, and once I had that support and partnership, I was really underway. What do you believe makes adult foster care homes special? The adult foster home model is designed to enable people to live independently in a family home environment, but it is much more than that. Too many people become isolated in later life. The adult foster home gives them more of an opportunity for new connections, sustaining old connections, and supporting traditions and life experiences. We don’t want people to feel isolated at the end of their lives, and so we give them a place to feel like this transition and the experience of us all being together in the home is another positive chapter in their life. My journey from career hairstylist to caregiver opened a path to service for me that is so much more profound... What do you love most about the work you do? This career came to me as my youngest child was going to college, so I was going through the empty nesting stage which is a big change. The adult foster home allows me to continue to care for others. Being the provider of the home has afforded me so much healing in my own life through caring for others, and it distracts me from any of my own issues. This healing began to happen immediately when I took my first job and began serving others in this special way, and it continues to do so. My journey from career hairstylist to caregiver opened a path to service for me that is so much more profound than just helping someone look pretty. There was a woman living in the home early on in my caregiving career, Mrs. H., who was nonverbal and a full assist with ADLs (activities of daily living). We meet people in this stage at times, and you of course never knew them before they required the level of support you must give, even though they’ve lived a very full life up until you become a part of their life. Something special happened. I realized she would respond to my touch, and if I gently put my arms around her, she would then begin to lean into me and want me to hold her. I realized I made a difference to her with this act alone, in this world - in her world, I made a difference through my presence and through my touch. She was also the first resident I cared for who passed away. I realize still to this day, what I do as a provider, I do for her and the gift she gave me. It is successful work when you are being told that your presence and what you do makes a difference in their lives - this is what it is all about for me. What do you believe makes someone’s work successful? Positively impacting the lives of others; providing a safe home for the residents and protecting them in some of the darkest days they've ever had. It is successful work when you are being told that your presence and what you do makes a difference in their lives - this is what it is all about for me. Since taking over as sole provider, I’ve also incorporated hospice care through a community partnership. This partnership has allowed me to also be there for my residents until the very end. It makes me feel triumphant in my work of service knowing I was able to serve them the whole way home. Anything else you’d like us to know about you? I do not do this work alone. My best friend is my live-in substitute caregiver. My daughter and her husband are my backup caregivers. With the pandemic, getting staff has been the greatest challenge I have ever faced in this line of work. My husband does all of our finances and shopping so we don’t have to worry about more exposure issues. Without them, the team, I could never do this at the level I do. The residents' families also become family to us. There are residents who’ve passed away, and their families still remain in touch with us as time goes on because they value the ongoing connection. It helps them feel closer to their loved ones, I believe. Being an adult foster home provider has given me the extended family I’ve always wanted. I make sure everyone hears from me just how important they are to me. This is key. We invest in everyone's self care in different ways because it matters to us that everyone has the balance in life to be happy and not rundown. And, I know you cannot give what you haven't got, so it starts with me. Visit Country Comfort Adult Foster Home on Facebook.
By guest author Julie Ouellette, Owner NW Senior Resources   Julie Ouellette NW Senior Resources has been around since late 2007. It was started by Nancy Raske. I went to work for Nancy about 3 years before she retired and then I purchased the company in late 2015. Kay Loeffl joined me in 2016. It has been our goal to maintain and expand upon the high ethics that Nancy started the business with. I have been in the Senior Housing Industry since 1999. I began my career as a marketing director, I then took a regional marketing position, I helped open a home care agency and I went into regional operations for a mid-sized senior housing company.  Kay Loeffl I believe my years of experience have served me well on the placement side of the industry. Since I was a long-term care community sales and marketing director and a former administrator, I know how important it is to find the appropriate options for clients. We also understand why one care home might work for a specific client and another care home won’t. We believe it is our job to advocate for our clients as well as to advocate for you, the provider. We believe it is our job to advocate for our clients as well as to advocate for you, the provider. Working with a Placement Professional Referral Agencies or Senior Housing Advisors can be helpful in many ways to adult care home providers. Our first step is to pre-qualify the client so we make sure it is an appropriate referral. We do our best to determine which homes can meet specific care needs. Some of our intake questions might include the following:
If someone is an insulin-dependent diabetic, we look for homes that are willing to assist with the insulin shots. We ask the client or family what is important to them in a new home. For example, if someone hopes for a home with children or pets in it, that is what we look for. We also ask about the financial ability of our clients. If they only have a year's worth of private pay funds, we look for locations that are willing to work with those terms. Senior Housing Advisors are a great resource for families to start their search. We have several referral sources that send folks our way. Hospitals, communities, skilled nursing facilities, past clients, and more, regularly send us folks in need of assistance. We help educate families on the many positive aspects of care homes. We help them understand what a safe and positive environment it can be for their loved ones. I often say that care home residents become members of the household's family. Many people don’t understand how care homes operate. We explain this and sometimes have to dispel incorrect notions. We share how we have had our own family members in care homes and we’re always grateful for the tender loving care our family members received. We often point out that care homes have the best staffing ratios in the industry. We share how we have had our own family members in care homes and we’re always grateful for the tender loving care our family members received. Because we all get multiple calls each month from folks seeking help, we are able to bring valuable referrals to you. We know how busy you are so by doing the prequalification work, we only bring tours that should be viable potential residents. We review provider records with DHS. If a provider has a clean record, we will readily refer to them. If there are questions about violations on a record, we may call the provider to see if there is a reasonable explanation for it. We hope you understand when we call about violations, we aren’t pointing fingers, we simply want to hear your perspective on things. We coach our clients on how to interpret violations as well. Posting Your Vacancies We enjoy being a member of the Oregon Senior Referral Agency Association (OSRAA). It has its benefits. OSRAA provides training programs for our members. We receive education on disease processes such as dementia or Parkinson’s. We have had speakers discussing funding programs, ethics, changes in laws or rules and regulations, and more. It is an expectation for OSRAA members to meet certain standards to be a member. We also all work really well together. In fact, When one of our members has a tough client, we might email the whole group asking for suggestions based on a brief description of the individual’s needs. These emails or phone calls between members happen weekly if not daily. This collaboration again allows us to bring these individuals to the homes that are best suited to meet those needs. If you wish to let us know about your openings, please go to OSRAA.com and post your vacancies. This reaches all OSRAA members. We can easily access the information anytime we wish. We also get an automatic email every Tuesday showing any vacancies that have been posted that week. It isn’t necessary to post vacancies more than once per week but you are certainly welcome to. Many of us look at the weekly email when looking for clients. We often call the homes that have reported vacancies first - before calling others. We know you all work incredibly hard to take care of the residents in your homes. We appreciate what you do more than we can say. We enjoy meeting adult care homeowners and staff, and I think we learn from one another every day. We enjoy having good relationships with providers. We know you all work incredibly hard to take care of the residents in your homes. We appreciate what you do more than we can say.
Authored by Matt Gannon  Imagine if you will, a man. He is age 83 and has been living in a care home for the last several months. Let’s call this man Stanley*. Stanley is living with Alzheimer’s disease. It has reached the later stage, to the point where Stanley can no longer perform actions in sequence, whether it is getting dressed, brushing his teeth, or putting together the necessary steps of having a successful trip to the bathroom, as he is 100% incontinent. Stanley will even use a razor to try and brush his teeth and the shaving cream may take place of the toothpaste if someone isn’t there to prevent it. Stanley is mobile without the use of any type of walking device. He is a very classy guy and very polite, but he has lost the ability to clearly express himself, verbally. That is to say, he can no longer stream full sentences together, so instead, he relies on short replies to what others say: “yes," "no," or "you becha,” or a nod or shake of the head one way or the other. There are also times when he will smile at certain things but say nothing. Stanley’s family is very supportive and visits him daily. I am one of his caregivers. In His Element  One day while I was about to clean the kitchen area after serving Sunday lunch, I found Stanley standing at the sink. Before him was a large number of dishes needing attention and were waiting for me. I always have one side of the sink filled with fresh hot soapy water, and of course, a trusted scrub brush and clean towels for drying. Stanley at the sink unbuttoned and rolled up his black and red striped dress shirt sleeves, and after a few seconds of assessing the situation, he started to dig into the washing, rinsing, and stacking process with the mugs. He was determined and in his element, cranking out clean, steaming dishes left and right. Stunned, I joined him at his side and wiped them all clean to put them away. This process continued for at least fifteen minutes and Stanley didn’t miss a beat. In fact, when washing the many coffee mugs he used a technique I was sure he had done countless times before for many years while performing the ever-so joyful act of dishwashing. For each mug, Stanley repeatedly took the mug in his hand, dipped it in the hot steaming soap water, and then filled the mug nearly all the way from the running water in the opposite sink. Stanley then covered the top of the cup with one hand, while placing his other hand underneath, and he shook the water inside back and forth for a thorough cleaning, poured out the water, then refilled once more, repeating the shaking technique, poured the water out once again, then rinsing away any left-over soap residue (not shaking this time) and handing the clean cup over to me. And he repeated the same process until all the mugs were thoroughly rinsed and cleaned. A Driving Force Within What did this experience teach me about Stanley? As I stood witness to this man who just that morning needed all of my help to get himself out of his urine-soaked bed, in and out of the shower, groomed and dressed, I understood that “something” was a driving force within him and it came from both his mind and his body working together as one - with his environment in the moment. I know what muscle memory is and I understand about people living with dementia having lucid moments, but Stanley’s participation in the dishwashing lasted nearly half an hour and I realized he was doing something he knew how to do from a lifetime of experience, the same way he had so many times before, his way, with his technique to get the job done. As I look back, I believe this was a manifestation of consciousness; the consciousness that does not separate between mind and the body, or the person and Alzheimer’s disease, but instead allowed this man for a bit of time to do what would seem impossible given his supposed level of impairment. And, yes, the time to complete the chore in this fluid way is brief in the fullness of a complete day, and then he is in need of assistance and direction once again because he just cannot connect the dots to any new activity, but this moment and experience in time were real, and Stanley did it. I think Stanley experienced what perhaps some artists refer to as “the mind in the hand,” some mysterious force that creates a type of auto-pilot within one’s self. Sort of like driving for 20 minutes and stopping at a red light to think…gosh, I don’t really recall driving to this point, but I somehow did it. It wasn’t Stanley’s mind alone that was trying to get the task done by repetitiously cleaning mugs, soup cups, and plates, but rather his mind and his body connected to the moment in time and to the environment he was in…to himself – and to the meditation of dishwashing. Stanley was Stanley, a man living with late-stage Alzheimer’s disease, and for the sake of getting dirty dishes well done, within himself he realized the chore at hand. Stanley chose to engage and do those dishes, knowing this is something that has to be done, and understanding this is how. Stanley and many others since have taught and reminded me how consciousness matters in dementia care, and in order to truly see the person I am serving, this cannot be left out of the discussion or the person-centered care approach to dementia care. Dementia will take away all kinds of abilities and can alter and distort reality in drastic ways, but consciousness does not go away due to dementia. Dementia will take away all kinds of abilities and can alter and distort reality in drastic ways, but consciousness does not go away due to dementia. While life can become increasingly cloudy and dark at times for people who are living with dementia, and where time and space may not be fully realized, a conscious alignment to the environment, to others, and to one’s self is still a possible part of their individual dementia experience. I have learned to always factor this truth into my dementia care practice, and as a result, I believe the care relationships I’ve had with the people I’ve served have been only strengthened and fully realized. *name and details have been changed
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
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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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