While touring Laguna Honda, I visited two old-style wards for people living with dementia. There’s a beautiful new Laguna Honda to be opened this fall, but for now, many of the old wards still have 28 people in beds, lined 14 to a side. They have done a lot with dividing lockers, colors and personalization, but it is what it is.
I spoke with Charge Nurse Oliva on the men’s ward and she mentioned that there is a fair amount of aggression, and it is hard for her to convince staff that medication may not be the answer. Later she mentioned that they have frequent outings with the men. This piqued my interest.
I asked how many men they could take on an outing at one time. She replied, “We take them all, unless someone is sick.” So up to 28 at one time? How many staff? “The usual complement, plus a social worker and/or activities therapist.”
I asked Oliva how much aggression occurred on the outings. She replied, “Very rare.”
I told her she had ammunition right there. Why is it that the men are aggressive on the ward, yet the aggression melts away on an outing? Engagement, empowerment, enjoyment, fresh air? A chance to interact with the larger world? All of the above?
And what is it about the ward that stifles that, and leads the staff to choose sedation?
Later, I heard about a gentleman from that ward who enjoys a nice stroll with any staff member, but then stops outside the door and won’t go back in afterward. He was presented to me by the psych group.
My reply? We need to find out what it is about the ward that makes it a place that he doesn’t want to return to (reminiscent of Carol Ende’s story of “Ray” from her Alaska days). How can we create more feelings of safety, relationship and meaning, in order to make it such a place?
It was mentioned that he was a schoolteacher for many years. I asked who he is able to teach now? How can we continue this longstanding role for him, so that he can continue to share his experiences and feel valued. After his orchestration of many years of hectic classrooms, it is clear why he resists the attempts of others to control him.
Finally, a CNA was identified who has a connection with him, and can consistently get him to return. (He only gets to go on walks when she is on duty.) How can we learn from her? I mentioned Jane Verity’s “solution circle” concept for them to try.
No doubt about it–Elders are our greatest teachers.