The Architect Who Still Went to Work
Preserving dignity within a dementia unit
After years of bedside nursing, my first position within management was at a long-term care facility on a unit that was unofficially a dementia or memory care unit. The residents were complicated, the staff challenging, and the unit considered broken by leadership. After a short time on the unit, I agreed with the assessment, but it inspired me to improve the environment for residents and staff.
My initial review of data outcomes on the unit identified that the unit was most challenged with assaults, verbal and physical, between residents and resident-on-staff. There were a significant number of injuries reported by staff members, and one could feel the despair on the unit.
It was clear that interventions were needed to reduce the number of assaults on the unit. Frankly, it was a horrible place to live in, too. Nobody envisions their final days being in a nursing home, losing their freedoms and personhood. In collaboration with the clinical psychologist, we built and implemented a disruptive behavior response team, and a Montessori-style program for the residents. It turned out that both were wildly successful, and the unit turned around from the highest number of disruptive behaviors, incidents, and assaults to the lowest.
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What I learned from this experience was the vital nature of honoring and respecting the lived stories of each person on the unit. I came to understand that the core values of each person remained within the fog of dementia, and discovering what these core values were for each person became instrumental in addressing the behavior issues and environment for each person.
So that I don’t cross any privacy lines, I’ve modified the story to protect the person. I share with you the story of Ralph, a person who had a significant number of behavior issues and was quite angry all of the time. What I discovered was that Ralph had a long career in architecture and was accustomed to getting up early every morning and going to work. That was his pattern on the unit, too. Ralph would get up early, gather his papers and head off in his wheelchair to get to work. If he wasn’t able to get to work, it was very common that Ralph would become agitated and physically aggressive.
After initiating the two programs, we identified Ralph’s story and his motivation in his actions. In other words, we spoke with his family and learned his story, and we moved to honor that story. Within the Montessori-style program, it is a focus on sensory stimulation and allowing each person to identify what resonates with them. For Ralph, it was going to work and meeting his family obligations. Eventually, Ralph would come to my office each morning with his work tools, and he would ask me if we were going to work. Every time, I would say, “Yes, Ralph let me finish this up, and we will head down to work.” For anyone looking at us, without knowing the story, it would’ve seemed a bit odd. I’m heading to work with Ralph who has his papers and his crayons, which in his mind were actually his designs and tools.
I took a picture of Ralph’s hands with the crayons, to capture the moment and to highlight the need to understand each person’s story and honor that story. In striving to identify his story, and with family input, we were able to establish a routine that supported the person. We eliminated his aggressive outbursts, and we solidified a program that honored his story.
No restraints, no interventions with medicines to sedate him, just knowing him and his story.
As I transitioned into other positions and into retirement, I’ve carried the photograph of Ralph with me to every office, and it inevitably would raise questions from staff or visitors. I would share the story of Ralph. How he made me a better person and leader by working to understand his personhood, honoring him, the human being. I continued to strive to understand each person I came into contact with, regardless of patient or staff, and learn each person’s story.
I’ll never forget Ralph.
