Memory Care: Locked vs. Secured Units

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As if choosing a dementia care community for a loved one isn’t confusing enough as it is, there are actually two different types of care units to decide between. 

While the community where I currently work is the third care community I’ve worked in, it is the first not-locked unit. Instead of being a “locked” community, it’s a “secure” community. This essentially means that my residents with dementia, while they live on a separate section from the rest of assisted living, have the ability to walk or wheel through the unlocked doors into the other part of the community. The doors are alarmed, so we often find ourselves going to get our residents back into the community when the alarms go off. (This is why I use bookshelf door decals on the doors, see below.)

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The bookshelf decal prevents most residents from exiting through the door, just because they don’t know it’s a door. However, it doesn’t work for everyone.

One of my residents, Jake, knows how to get upstairs and seeks to do it often. Lately, that kind of exit-seeking has increased, so much so that his family is considering moving him to a locked community.

He keeps going upstairs to “find his mother” because “she’s here to pick him up.” Jake is highly focused, very smart, and is almost impossible to redirect when his mind is set on something. 

It took me 2.5 hours to get him back downstairs, not without the help of other staff members.

Here are the tactics I tried, many of them more than once:

– I waited until he was seated and tried to wait him out

– I suggested to him that his mom was calling and we had to go downstairs to hear the message

– I provided him with a lot of water to drink so he’d eventually have to use the bathroom and go downstairs to do so

– We walked outside so that he could see she wasn’t here yet

– I called another staff member’s phone and pretended to be his mom, saying that I would be there the next day (this is a risky one to try, but sometimes you have to be creative!)

– We used “change of face” which is when other staff members approach, trying similar tactics, to see if he will respond positively to them instead of me

– I told him we could use the phone to call her back, but had to go downstairs to do it

– We walked outside and back in another door, in the hopes that we could avoid the sitting area and head back downstairs

Eventually, being patient and trying these tactics over and over again worked. The one that got Jake to come back downstairs, it seemed, was the one where I suggested that we had to use the downstairs phone to call his mother because she had left a message. As soon as we got downstairs, he calmed down and wanted to eat lunch.

In truth, his mom is no longer alive. Despite the fact that we tried many tactics to get him downstairs, we never broke his reality. I never told him that his mother wasn’t alive anymore. 

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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