Incarceration and Escape

 

            The reality of moving into a facility is that this is an “incarceration.”  People are isolated from their normal environment and not able to simply leave on their own.  Any move is a major life change, irrespective of the added incarceration.  Of course, in a facility like this, they can go out with friends or family members—to go to an event or meal.  Even that creates potential difficulties, especially early in their time in the facility.  Our nervousness about taking Beverly out was met with cooperation from the then-Director of Nursing who went along on our first family outing for dinner with Beverly.  An independent support system can help those of us who face the issue of how they will react to being out.

 

            Incarceration is too strong a term, as the treatment of those so placed (certainly in this facility) is much kinder and less regimented than in a prison.  Still there is evidence for us to see that at least many of those so placed do feel imprisoned.

 

            One man often said, “I don’t know why I am locked up like this.  I didn’t kill anyone.” Another said to me several times,  “Why are we locked up like this?  I didn’t do anything.”  And, to me, he would then ask, “What did you do?” And there are so many times that a resident (several different ones) talked about desperately needing to leave because the children were “waiting out in the car” or were “home from school.”    For others it was “Which way do I  get to State Street for my job?” Or “How do I get to Mason Street where I live?”

 

            We were fortunate that events unfolded to make staying in this facility more “natural” for Beverly at the start.  She fell, was hospitalized for several weeks, then went to rehabilitation in one area of this facility, then moved into a room in the Memory part of the facility.  So there was no immediate objection to “moving in.”  For most other people, it is not so natural.  The dementia patient typically objects to moving into such a place. Perhaps others can share their advice about the basis of success at convincing someone to enter into such a facility.  How did you succeed?  Or how did others succeed that you know about?

 

            The most striking case I know of was a man who had been fooled into moving in with a complex cover story.  He was convinced that he was moving in for an extended retreat with training courses.  He was so excited that he put great effort into moving himself in, carrying furniture into the building.  I observed that.  After a number of days, though, he was sharp enough to realize that the basis for moving him in was false.  Then he was very angry and there were several near-violent confrontations with staff in the facility. 

 

            I do not know much about how others with dementia were so convinced.  I do know that most were very unhappy for a period of weeks or months.  There were major changes in their lives including this “incarceration.”  In some of these cases (as in Beverly’s), the person leaves their living circumstances of many years, including their residence, neighborhood, and family.  After a period of time, nearly all seemed settled into the current circumstances and seemed to be comfortable or even happy with the new circumstances.

 

            But escape is an issue, especially early in the process.  Beverly’s first attempt was successful.  She went out to one of the outdoor areas during the day, put a chair up to the fence, and climbed quickly over.  A bit later someone staff members were looking for her and could not find her.  Then there was a careful search and finally a review of surveillance video, where they saw the fence climbing.  About then, someone in the neighborhood brought her back to the building.  That was much easier and quicker than the “escapes” she managed at the house, e. g., the one described in the first blog.  She tried climbing the fence a second time, but the staff were alert to the attempt and interrupted it.  This second attempt was followed by a decision to put Vaseline on the top rail of the fence as a preventative.  I concluded that the grease would likely foil an attempt but also create an accident hazard in case of an attempt.

 

            There were many other attempts by others while I was around the facility and/or were reported to me.  The most common was a resident rushing the front door when someone else was being let in or out.  The failure rate for that must have been 98% and the true escapes seemed to happen when there had been a large group leaving and a resident slipped in with them.  The receptionists were certainly on guard about this.  

 

            And the use of redirection (“happy lies”) was constant at the front desk in the lobby.  “The door is locked and can’t be opened.”   “You can get out this way.  Just go down the hall to the end where there is a door.”  “You don’t want to leave now.  Your sister said she was coming right away.”  “There is a party in that room right down the hall.”  “Your brother Tom came to see you.  He went to your room, looking for you.”

 

            One resident who was burly and still very strong managed to get a hand through the glass door and a couple of family members pressed the door shut against fingers (without damage to the fingers) and held the door against the strong one until he finally gave up.  I watched that and it was quite memorable to all.

 

            A resident whom I had known in a professional and social way for many years had developed dementia and came to this facility, reportedly transferred by his family because he had simply walked off from the other facility on two different occasions and that facility did not even know he had left.  On one occasion (reportedly) in that facility he was more than a mile away when someone in that neighborhood determined that he was clearly very confused and called the police to help.

 

            There are various methods of controlling exit for residents; controlling the entrance and exits of staff members can be easy by using electronic “keys.”  But having visitors creates the problem of needing someone who monitors the process.  And lapses of attention can result in escape.

 

            One resident managed successfully to hide behind a cart near the back door and race out as a staff member came in.  That was only momentarily successful as the escape was known at the time it happened.

 

            Of course, there was also the time when the guy who moved his furniture in was insistent that he was leaving.  He was the in the lobby and was so persistent that more and more staff members had come, resulting in quite an extended interchange with him.  That long spell (certainly more than half an hour) also kept some of us (including me) from being able to leave, hung up by the reality that the door would not be opened while this was going on.  It was then and on many other occasions that the happy lie was simply that this door is locked and cannot be opened.

 

            It is sad that there has to be incarceration, but it is in the best interest of the residents and of their families.  Prior to the incarceration, almost all of them, like Beverly, had wandered and been totally lost, which was sometimes dangerous due to weather or traffic.  Indeed Beverly’s only disappearance during Winter had really scared me.  Still those trips by her and others were generally not dangerous to others.  But there was one description by a family member of how their husband (who became a resident) went to the bus stop and had conversations with girls or young women to the extent that there was a fear the police could be called and/or legal complaints filed.  What kind of conversation was never stated, as it was not known.   Incarceration seems necessary in a system where we family members want those with dementia as functional as possible (meaning not very sedated).  So there we are!

 

Still we should have some understanding, even sympathy, for those incarcerated.  The problem was not exactly a crime on their part.  Most of them still want to be functional members of society and not prisoners.  The effort to explain what is happening to them and why must take place.  This may mean explaining the situation to them repeatedly while confined because they forget.  Frankly I was surprised how well our children could talk to Beverly about that, especially since I did not seem to be very effective.  So it is key that all of those who deal with such an incarceration make the effort to explain and even persuade.