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Wandering and Wondering

January 20, 2013

Recently there was a crisis in my usually quiet little world. A phone call on a Monday morning that one of our clients (let’s call her Karen) was in the hospital. I’ll tell you why she was in the hospital in a moment, but first let me set the scene.  Karen has Alzheimer’s but is in the constant care of either a family member or a paid caregiver through our agency.  She is never left alone-not even for a few minutes-unless she is sleeping.

That’s the key-unless she is sleeping.

Karen spends the day in her own home with a paid caregiver.  Her daytime care is paid for through Medicaid as part of the Aged and Disabled Waiver program.  She receives assistance with bathing, dressing, meal preparation, household chores, transportation, bill paying, prompting for when it is time for her medications, and overall supervision. This dear sweet woman likes to get outside and get going.  Karen has been known to grab her vacuum cleaner and head off down the road to clean a home or an office. This is a memory lapse back into an earlier time in her life when she supported herself by cleaning other people’s homes and offices.

Her wandering is the reason for the constant supervision. Now when she goes to grab the vacuum and head out the door the caregiver gently takes the vacuum from her hands, makes sure she has a nice warm jacket, or appropriate clothing for the weather, and they head out the door for a walk around the block. The caregiver is trained to redirect Karen from thinking she’s going to work by gently leading her with cues that will focus on something different such as checking out the bird nest in the tree two houses down or looking for animal prints in the snow.

Just before dinner time the caregiver leaves and a family members takes over. Some nights the family member stays at Karen’s home and other nights she goes with the family member to their home.  Karen has a large family and they all take turns caring for her in the evenings.  Wherever she is the routine is the same; supper is served, a little time is passed in front of the TV, listening to the radio, or playing old records, but there is always someone in the room with her.  Bedtime comes early, especially on these long winter nights in the northwest.  Dentures are cleaned, the face and hands are washed, a warm flannel nightgown is donned and the daughter, or other family member,  sits with her reading the Bible or a good story until she falls asleep.

Remember she is under constant supervision unless she is sleeping, or perceived to be asleep.

Somewhere around 2 or 3 in the morning she stirs and her vigilant family member helps her to the bathroom then back to bed. It’s a perfect routine until something goes wrong as it did early this past Monday morning.

The bedtime routine went as normal, but sometime in the wee hours of the morning she woke up. She didn’t call out to use the bathroom as she usually does.  Instead Karen made her way through the house and out the door. She was barefoot, dressed only in her nightgown and wandering on frozen snow and ice in the dark. When she was found at 4 AM she was in a frozen, slushy mud puddle with a dangerously low body temperature. Her daughter had awakened thinking it odd that there had been no bathroom trip in the wee hours. When she went to Karen’s room to check on her and felt the cold draft from the open front door she was filled with dread and quickly went looking.

Karen hadn’t gone far, only a couple of blocks from home, but she was cold, wet, and would probably have died before daylight if she hadn’t been found.  Luckily for Karen she has a strong, healthy body and she recovered quickly from her time in the mud puddle. Unfortunately, her mind is betraying her and makes her unaware of what is happening at any given moment.  Her family wants to keep her in her home for as long as possible and they do their best to make sure she is safe. Karen was only in the hospital for 2 days and then she returned home.

The big question is how to keep this from happening again? How can she be monitored even when she is supposedly asleep?

There are no easy answers to this question, but the purpose of this post is to give you a few pointers on how to avoid a similar situation.

Years ago patients with a tendency to wander were often physically restrained. It was not uncommon to see patients in hospitals or nursing homes tied to their chairs or beds with wrist restraints.  Somewhere along the road it was finally determined that restraining a patient by tying them down was inhumane. Such methods are no longer utilized. If you’ve ever visited an Alzheimer’s unit in a nursing home you’ll hear buzzers and alarms, but you will no longer see wrist or ankle restraints.

In Karen’s situation it would benefit her caregivers to install alarms on the doors. Some dementia or Alzheimer’s patients are adept and disabling these alarms if they are visible so there are mats that can be placed under an area rug or even under the carpet and turned on or off as needed. Some patients where a bracelet, ring, or necklace that can activate an alarm if they step into an area where they shouldn’t be. There are many items available to meet a variety of different needs. Speak with a durable medical equipment expert or alarm company salesman to get an idea of what is available and the cost.

A very low-cost method of monitoring sleeping individuals is to have a baby monitor set up in their room with another one at your side. These are portable and can be carried from room to room. For some this may interrupt their sleep, but it is better than finding your loved one out in the cold on a dark, wet night.

Explore the options, ask questions, and find what works best for  your situation.

Do you have a solution or a similar story to tell.  Feel free to leave a comment or ask a question. I’d love to hear from you.




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