The entrance to Paradise Cove, the section of the Sherbrooke Community Center where Don Wilmut lives, has a prohibitive feature.
The door does not open to let someone out unless a numeric code is entered in an electronic keyboard on the wall. Wilmut and the rest of the 20 people with dementia living in the "second neighborhood", as this safe area is called, must ask to be released if they want to visit another part of the long-term care home.
He didn't get along well with Wilmut when he came to live there more than a year ago – not so much for himself, since his son and his daughter help him go around the rest of Sherbrooke, but for the other residents who have less opportunity to move. He would see them try to push the door out of the drive, his son Patrick Wilmut explained.
"It goes against our social norms. We don't block people," Patrick said.
Some managers have thought the same way.
As a result, in late spring, after the technology introduced is tested and proven to work reliably, Sherbrooke will gradually eliminate its safe housing units, starting in Paradise Cove. The measure will directly change the lives of about 70 residents with dementia, who live in three "neighborhoods" and a "home".
Sherbrooke calls the initiative "included dementia".
The freedom of every resident to move will be planned individually, according to his needs. Some residents will wear an electronic bracelet that will monitor their movements and let them pass through some doors – for example in one of the outdoor gardens – or magnetically block a door. The bracelet can indicate where the person went, through notices to the phones carried by the staff.
Don Wilmut calls the "ideal" bracelets.
At age 75, he shows the effects of brain atrophy from a series of concussions associated with hockey and work. Speak in a low voice, sometimes barely audible, as you collapse in a wheelchair. But he still loves to meet people and chat with them.
Don wants to be able to leave his "neighborhood" in the company of other residents, perhaps to visit the coffee shop or the gift shop or the art studio. This could become more feasible as movement restrictions are facilitated for many people.
The inspiration for the change came over three years ago, when some staff members attended a conference in Little Rock, Arkansas.
"We came home and we knew we had to do something different," said Kim Schmidt, Sherbrooke's home care services leader.
The conference focused on Eden Alternative, a philosophy of care that Sherbrooke adopted many years ago. Emphasizes the environments designed to overcome the "three plagues" of loneliness, impotence and boredom, as described by the founders of philosophy.
A conference speaker, a dementia care authority, told delegates that segregation is wrong, Schmidt recalled. He left "feeling sick," he said.
"People with dementia already have a stigma attached to them".
Keeping them behind closed doors only increases. More opportunities for social interaction also means more possibilities to feel the connection, purpose, joy and autonomy.
"The advantage is to improve people's sense of well-being," Schmidt said.
Change has come slowly, Schmidt acknowledged. "C & # 39; it is a lot of anxiety in doing something of the kind".
Last year at another conference in Atlanta, another nursing home explained how he unlocked his doors. Spurred on Sherbrooke.
Patrick Wilmut admits he was a little surprised by the planned change in the beginning, but then "rejoiced at the idea". His father seemed excited about the prospect of going to his physiotherapy appointments alone, he said.
"Return a little normal."
Caring for a significant number of people with dementia is a complex undertaking. The condition affects different people in different ways and can change over time as it progresses.
Some can safely go to certain places on their own, while others cannot. With an altered perception of reality, a person with dementia can go into danger.
However, Schmidt said: "We have learned from history … that segregation is not good for people … We really feel like that model is one of those we don't want to continue with."
Schmidt notes that people with dementia are able to cope more successfully when they are in the vicinity of people who do not have the condition, who shape "positive social signals" in conversation and eating, for example.
On the contrary, when everyone in one area has dementia "they can enter the space of the other and do things that make no sense", leading to confusion and conflict.
Furthermore, dementia does not affect the entire brain. People still have interests and areas of ability, and "humans never really lose their need to belong," Schmidt added.
The point is "this is a real community here" and the mission is to help people lead a real life. "There are coffee clubs, it's a wine club, there are so many wonderful things that people generally don't experience when they're behind those safe doors."
What about the added risk?
On the one hand, Schmidt notes that in another structure "when people stopped using the doors, people stopped trying to leave".
This could be due to the fact that, as the rest of the staff points out, when residents become more free to find the things that interest them, they will be less likely to go beyond the limits of security.
Schmidt maintains that the fact of letting people know and circulate increases their safety. The staff and the nearly 200 residents throughout the facility will be in a better position to help them, more likely to notice changes in people that could lead to wandering.
In meetings with residents to discuss the next change, Schmidt listened to comments such as "it is now".
On the other hand, while the potential benefits outweigh the risk – and this risk has yet to be managed – Schmidt also notes that the choice of risk that an individual is willing to accept is a normal part of life.
Safety and security remain a top priority, but "there's a lot more security in healthcare," Schmidt said.
In preparation for the change, she and her team educated staff, residents and their families.
Most families "are excited to see what experiences their loved one will have," he said.
In supporting the change "I feel I am making the decision that (my father) would like me to make," said Patrick Wilmut.
Sherbrooke's staff, meanwhile, not only must understand the reasons for the change, but also what is expected of them. In particular, they may have to stop everything they are doing to involve a resident that happens.
For Robin Kitchen, the head of learning and growth at Sherbrooke, it's not such a dramatic change. Sherbrooke already has some people with dementia – and who are not considered at risk of wandering – they live in areas that are not kept closed.
"Our staff is used to supporting people," he said.
Melinda Sweeney, who manages safe neighborhoods, has spent the last two years working to change culture, in part by guaranteeing a mix of residents with varying degrees of dementia.
He wants to see the residents help each other, he said.
"You know, I can push you, but the person in the chair can lead the way … work together. And this is already starting to happen in our neighborhoods."
Moreover, he does not see the time to put an end to the labels that accompany people in the closed areas.
"Once you crossed the threshold of the safe neighborhood, you were considered someone with dementia who needed a safe neighborhood, if things had changed for you or you had accustomed yourself to your environment, or if you were comfortable with your living arrangements, or people knew you, "Sweeney said.
Sweeney and Kitchen also note that the new technology will be used throughout Sherbrooke, increasing overall security – and residents will not have to move from one living unit to another while their condition worsens.
"We know it is not normal to be locked up, and people with significant dementia know this," Sweeney said. "They will say & # 39; that the door does not work … that door is broken." They know they're stuck. "
Meanwhile, Sherbrooke will follow the difference that the change will entail. For example, there may be a decrease in the use of antipsychotic drugs, Schmidt said. Sherbrooke will also share his stories, possibly through a video that outlines what staff and residents feel before and after.
It could be a valuable contribution to the ongoing conversation around the world. Schmidt said that while other nursing homes have never had "safe units", "the current trend is to segregate" by building new specialized dementia care facilities.