Understanding the Resident's Perspective
For a person with dementia, the statement 'I want to go home' is rarely a literal request to leave the facility. Instead, it often represents a deeper emotional need, such as the desire for security, familiarity, or comfort. The memory loss associated with dementia means they may no longer recognize their current living situation as 'home,' causing distress and agitation. The key for a nursing assistant is to understand this emotional root rather than focusing on the factual inaccuracy of the statement.
The Wrong Way to Respond
Many common reactions, while well-intentioned, can escalate the resident's anxiety. Directly confronting the resident with reality—for example, saying, 'This is your home now' or 'Your family moved you here'—can be distressing and confusing. This approach can cause the resident to feel invalidated, leading to increased agitation, fear, and a breakdown of trust between the resident and the caregiver.
The Best Way to Respond: Validation and Redirection
The most effective approach is rooted in validation and therapeutic communication. The process involves several steps:
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Acknowledge and Validate Feelings: The nursing assistant should first acknowledge the resident's feelings and their desire to go home. A simple, empathetic statement like, 'It sounds like you really want to go home,' or 'You miss your home, don't you?' validates their emotion without challenging their reality. This builds trust and shows the resident that they are being heard.
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Redirect Attention: After validating their feelings, the nursing assistant should gently redirect the resident's attention. The goal is to move the conversation toward a pleasant topic or activity that aligns with their feelings. For instance, the nursing assistant could ask, 'What do you miss most about your home?' or 'Tell me about your home.' This approach taps into long-term memory, which is often better preserved in dementia, and allows the resident to reminisce positively.
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Engage in a Comforting Activity: Once redirected, the nursing assistant can transition to a soothing activity. This might include:
- Going for a short walk down the hallway
- Looking at old photo albums together
- Listening to calming music
- Offering a favorite snack or drink
- Folding laundry or performing another familiar, repetitive task
This provides a distraction and addresses the underlying need for comfort and security that the resident's statement represented.
Techniques for Effective Communication
For a nursing assistant working with dementia residents, mastering communication is paramount. Here are some techniques that support the best response:
- Use a Calm and Gentle Tone: The resident can pick up on the caregiver's tone of voice and body language. A calm, reassuring, and gentle tone will help de-escalate their anxiety.
- Maintain Eye Contact: Getting down to the resident's eye level and maintaining soft, non-intrusive eye contact shows respect and attention.
- Simplify Language: Use simple, short sentences. Avoid complex instructions or multiple questions at once, which can be overwhelming.
- Offer Choices: When redirecting, offer choices rather than commands. For example, 'Would you like to look at pictures or have a cup of tea?' gives the resident a sense of control.
- Know Their History: Understanding the resident's past, hobbies, and family members can provide excellent redirection topics. Personal stories or memories can be powerful tools.
Comparison of Communication Techniques
| Communication Technique | Approach | Rationale for Use | Potential Drawbacks | Effectiveness |
|---|---|---|---|---|
| Validation Therapy | Acknowledge feelings without correcting reality. | Preserves resident's dignity and reduces agitation. | Requires empathy and understanding, not just a learned script. | Highly Effective |
| Reality Orientation | Reiterate factual information (e.g., 'This is your new home'). | Attempts to re-orient the resident to the present. | Can cause extreme frustration, confusion, and fear. | Ineffective & Harmful |
| Therapeutic Redirection | Shift attention from a distressing topic to a pleasant one. | De-escalates anxiety and provides a calming distraction. | Can be challenging if the resident is highly agitated; may require multiple attempts. | Highly Effective |
| Confrontational Approach | Argue with the resident about their memory or desire. | Based on the mistaken belief that logic will work. | Deeply damaging to the resident-caregiver relationship and increases distress. | Extremely Harmful |
The Role of the Environment and Care Team
Creating a supportive environment is also key to preventing and managing this behavior. A facility can utilize memory boxes outside resident rooms, which contain personal photos or mementos, and offer consistent routines. The entire care team, including nursing assistants, should be trained in these communication techniques. A consistent approach across all staff members ensures the resident receives the same compassionate and therapeutic response every time.
For more in-depth training on dementia communication, the Alzheimer's Association offers valuable resources and guides for professional caregivers. Their programs can provide further strategies for handling challenging behaviors with empathy and expertise.
Conclusion
The best response by a nursing assistant to a dementia resident who says, 'I want to go home' is not to correct them but to validate their feelings and gently redirect their attention. This person-centered approach acknowledges the resident's distress, builds trust, and de-escalates anxiety. By using empathetic communication and offering comforting alternatives, nursing assistants can effectively manage this common dementia behavior, ensuring the resident's safety, dignity, and peace of mind.
