For many of us, the word "home" signifies refuge, safety, caring and warmth –a sanctuary where we belong. It's a place that we know is waiting for us at the end of our daily journey into the sometimes cold and uncaring world.
The actual location of our home may be dynamic rather than static—ever-changing as our personal world changes. Yet the meaning of home remains the same: a place of comfort.
Most of us who've cared for people with dementia have heard the sad, repetitive lament, "I want to go home." If the person lives in a nursing home or assisted living facility, relatives naturally think that the home the elder wants to return to is the last place he or she lived before going to the care home.
More likely, at least in the case of Alzheimer's disease, the home this elder misses is a childhood home. It's the home where he or she felt the comfort of a mother's arms; the safety of a father's protection.
Again, this home is a state of mind rather than a building. Even if we could take our loved one to the actual house of his or her childhood, it's not likely that this structure would bring comfort. A sense of comfort comes from being with other human beings who love us and will do what they can to care for us.
A comforting experiment
Loving, hands-on care, positive feedback and flexibility often help people with dementia feel less anxious and more cared for, and thus, makes them feel more at home.
I recently read of an experiment at the Parker Jewish Institute in New Hyde Park, N.Y. It began when a certified nursing assistant found that she was able to calm a person with Alzheimer's who wandered nightly simply by inviting him to sit down with her for a cup of coffee and a snack. After his snack, the gentleman was content to get up from his chair and go back to bed.
The care home has since made it a point to provide this simple, comforting service regularly for their night owls. A measure that has been met with much success in helping to control wandering in Alzheimer's patients.
It's thought that people with dementia are often anxiously trying to go some place they think they need to be; whether to a former workplace or their current version of home. Providing comfort through companionship and a light snack seemed, in the experiment above, to help the anxious person calm down and feel satisfied that he or she had accomplished whatever was needed.
Helping loved one feel at home anywhere
To make assisted living feel like home, it's helpful to bring as many familiar items as possible into a loved one's new living space. We may find that the most cherished items are the old toy soldiers from the attic, rather than the retirement watch, or the picture of youthful parents at the family lake cabin, rather than one of current friends at the seaside.
People with Alzheimer's move back in time as their short-term memory depletes, so what they enjoy also goes back in time.
Even if we've done everything possible to ensure a comfortable, memory-filled living space, often it's the hands-on care that makes the most difference.
If the staff at the home is truly caring, the person with dementia will likely sense that and feel safe. If the people caring for him or her are doing their jobs, but doing so in a brisk and hurried manner – going through the motions, if you will – then the elder may feel the coldness in the care and have a harder time feeling safe. This could, in turn, trigger a longing for home, wherever home may be to your loved one at that moment in time.
Tell me about it
One tip for caregivers who are faced with elders who want to go home is to take them by the hand and sit down with them. Look them in the eye and say "tell me about home."
Allow your loved one time to think. He or she may then begin to talk about a long ago home or something not remotely connected. It doesn't matter; being patient is one of the key tips for talking to someone with Alzheimer's. Just the offer to listen can provide the sense of love, safety and connection needed to make them feel calm.
After a time, your loved one may be distracted by something interesting and, for a short time anyway, the caregiver can get on with the day – or night. Yes, this routine will have to be repeated. However, listening is easier than arguing, especially since arguing with someone who has dementia is rarely productive.
Remember that no approach is guaranteed to work. Don't blame the staff of a care home or yourself if your loved one continues to ask to go home. No matter what we caregivers do, we can't defeat the realities of this disease. Sometimes whatever we do is simply not enough to calm our anxious loved one. All we can do is accept the uncomfortable moment, knowing that it will eventually pass.
Home at last
Often, elders or others who've been terminally ill for a long time say that they just want to "go home," meaning they want to die. They feel close to their creator and know in their hearts that the only place now that can offer pure safety and comfort is the afterlife.
Even people who don't have a spiritual belief in an afterlife may want to "return to the earth." They become, understandably, tired of the struggle. A peaceful death – returning to the earth – is what they long for.
To feel as though we belong, are cared for and are relatively safe are human needs. If the idea of home now signifies this utopian place to our loved ones, then doing what we can to provide a sense of safety and comfort for our elders is only right.
As caregivers, we need to understand that we won't always succeed in our struggle to comfort our loved one. Sometimes the disease gets the upper hand. Even then, we should find some peace in knowing that we have tried our best and that's all we can do.
