Going Home

[Paprikat]

I am wondering, and hope I could get some input from some nurses/aides experienced with this:

What do you do when a resident in a facility wants to "go home?" How do you answer this? Do you say this is your home or what? Do you try and change the subject? Some nurses say, "Oh, you'll go home once you get better." I find this a difficult question to answer and often just don't know what to say, I don't want to lie to them.

Also how do you answer this: One of my residents who is 98 often comes looking to see of her dad knows where she is, she feels that he must be terribly worried about her. Some tell her that her dad is not alive anymore, some play along and say that "yes, your dad knows where you are." How would you answer this?

Thanks.

[nursedawn67, LPN]

As far as the going home question, I just tell them "I know and I understand that you want to go home, but the doctor feels you need our help to get stronger and your family loves you so much that they are willing to let us help you."

As far as the resident wanting to let her parents and/or family know where they are, I tell them "they know you are here and they said it is ok for you to stay the night with us" sometimes I get "well can I go in the morning?" I tell them "we'll check into it in the morning" By morning generally she/he has forgotten the whole thing. There is no "reorientating" some of these residents.

Originally posted by Paprikat

I am wondering, and hope I could get some input from some nurses/aides experienced with this:

What do you do when a resident in a facility wants to "go home?" How do you answer this? Do you say this is your home or what? Do you try and change the subject? Some nurses say, "Oh, you'll go home once you get better." I find this a difficult question to answer and often just don't know what to say, I don't want to lie to them.

Also how do you answer this: One of my residents who is 98 often comes looking to see of her dad knows where she is, she feels that he must be terribly worried about her. Some tell her that her dad is not alive anymore, some play along and say that "yes, your dad knows where you are." How would you answer this?

Thanks.

[donmurray]

Good answers, greer128. Especially hard is responding to the second situation. I still have problems with this one, but believe that reorienting such a person is cruel. Every time you inform them that their parent/spouse is dead, no matter how gently, they are effectively hearing this awful news for the first time. Over and over.

I go for the politicians option, and answer a different question, generalising to the fact that their family knows they are safe in hospital.

[duckie]

I wholeheartedly agree with the two previous posters. Sometimes repeated reality is cruel if the resident is confused. I used to have a man on my unit I loved dearly. Every night he would cry out for his wife Nellie to come to bed. He had Alzheimers and didn't remember going to her funeral. The way I handled it was to tell him she was busy and wanted him to go to sleep and she'd come to bed when she was finished. I would usually sit with him for a couple of minutes discussing Nellie's many hobbies and he was happy knowing she was involved in one of them and would go to sleep. Yes, it was a lie, but one I truly believe that the good Lord understands. Wouldn't it be much more hurtful to say every night that she was dead and have him loose her all over again. I just say use good judgement based on each resident. As for the "going home" comments. I just tell them that if they become strong enough to be able to take care of themselves again, I'll talk to the doctor. That always makes them happy. It's not a yes, but it's also not a no and that's what they need to have is ....HOPE. If you take away hope, then chances are, they'll just give up and die. Look into your own heart and don't let others tell you how to deal with it, you'll know if it feels right.

[tex]

I agree that taking away hope or telling them over and over that their loved one is dead is cruel and starts a chain of tears, and heart ache all over again. I know for a fact, that by sitting with them, holding their hand, offering reassurence and also telling them once they get stronger and can take care of themselves usually works, as far as going home. Not only am I a RN working with long term residents, I have also done Hospice for years and probably my best experience was the fact my Father passed away having Alzheimers. I wasn't even a nurse yet, and it was the most frightening, horrible experience my mother and I could of endured. And this was exactly why I went into nursing. To help others as much as I could so that they would not have to be in the dark of how these terrible changes occur. I hope I have made a dent. I love what I do.................Tex

[RN-PA, RN]

All of your responses are so loving and compassionate. I would be thankful to have any of you caring for my loved ones-- God bless you!

I worked in LTC right after graduation and although I had precious little real experience as a nurse, I'm glad that it came fairly naturally to do as you all have done. I became quite imaginative and proficient at the stories I would tell to calm the residents and to sometimes distract them. I would occassionally be challenged by their needs and have to get really "creative", but seeing them relax and accept when I would say, "Well, the buses have stopped running for the night, so you'll have to spend the night here with us; we'll figure out transportation in the morning", made the tales worthwhile.

[km rn]

For Dementia or Alzheimer's Residents:

We just try to validate the resident's feelings. Home usually mean family so I will ask about their family and may re-direct them to their room and look at family pictures with them.

Other times, I tell a therapeutic fib and say I will drive them home after my shift. Usually they forget within minutes.

It is helpful to find other ways of distrating residents - we have baby clothes for residents to fold, yarn to roll, dishes to wash, "papers to correct", vegetables to peel for supper, etc.

We are lucky that this generation is usually so willing to help us out and feel wonderful to be able to do this.

We dramatically changed the care on our Alzheimer's units based on an inservice done by Mary Lucero. She also has video tapes on managing resident's behaviors. They are excellent resources.

Our Social worker always says - "you'll never win an arguement with a confused resident so don't argue - validate the resident's feelings and try re-directing their attention.

[Paprikat]

Thanks for the replies. You have all brought valid points and I appreciate them. I agree that reorientation is a really hard thing to do with some of these people and I generally just go along with what they are saying. We have one nurse who believes in reorientation no matter what and I find myself having a hard time agreeing with what she does, as I'm sure, she doesn't agree with what I do. It is a hard thing to tell people that their parents, kids or spouses are dead, and that their home has been sold, etc. I also agree that seniors need to feel needed and it must be hard working all your life and then reaching a point where there is nothing to do...

One of my little ladies used to be an RN and it is so touching to see the way she treats her room mate... She thinks it's her "grandma" and she tucks her in at night and massages her feet "to keep the circulation going." I hope that that is how I'll be when I get older...!

Thanks again for your replies...you all sound like wonderful people!

[Fran-RN]

I read once that when the confused resident asks for their parent, or family they are afraid but unable to express it, sort of like when a child cries out for mother, I always reassure them that their parents know that they are here safe with us and that we will be here to help them and take care of them. A hug never hurts either.