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View this email in your browser Resident Rummaging, Hoarding, Hiding It is not unusual to step into a secured Alzheimer’s’ unit where you observe someone actively rummaging or searching through cabinets, drawers, and any number and any manner of subjectively intriguing storage areas, even closets and the refrigerators. It is also a common practice for residents to hide coveted items in the most peculiar places that they will likely be unable to remember later. Although the behavior can be concerning and disruptive, it provides engagement at best but can easily turn into a safety risk. Proactive measures must be implemented to ensure safety that provisions concerning this behavior prevents potential hard to self or others. It is not recommended that you eradicate opportunities for this behavior as it often helps the resident to dissipate anxiety, offers engagement and in fact often helps your resident to feel useful. Note: The behavior might have some level of logic behind the action. Residents often set about this behavior because they are actually looking for something specific, although unable to neither identify nor describe that illusive item. Understanding the Basics According to the Alzheimer's Association, hoarding and hiding behaviors usually begin in the early to middle stages of the disease, and often stem from trying to have some control in their lives. Rummaging, meanwhile, may occur when an individual with Alzheimer’s disease believes something has gone missing. More specifically, the Alzheimer's Association identifies a few possible causes -- psychological, medical and environmental -- for rummaging, hiding, and hoarding, including: Physical changes within the brain leading to confusion, memory loss and impaired judgment The individual senses loss of control The desire for a sense of security or feeling that they may "need" something Seeing and touching things gives them comfort Fear of losing items or being robbed Inability to distinguish between valued and disposable items Boredom, lack of stimulation, and difficulty initiating new activities Reasons for Rummaging Behaviors Boredom: Rummaging behavior may spring from boredom; particularly when opportunities are not abundantly available for engagement. These busy “seekers” are doing just that – keeping busy with something that is found to be self occupying- even when the behavior behind their quest becomes unwanted and has the potential to increase safety risk to self and/or others. Note: In fact, the old adage applies here: “negative attention is better than no attention at all”. Try to quickly understand and recognize what is causing the behavior and measure your response appropriately to prevent that unwanted behavior. Coping Mechanism: Rummaging can be a coping mechanism in response to the disorientation typically caused by dementia. The behavior can occur when the resident is trying to reassure him/herself or self-soothe with familiar items or when they are trying to fill a void or need, like eating when hungry. Loss of Useful Contribution: Consider that what looks like rummaging could also be a way for the resident to feel that they are doing something productive or helps them to feel useful in some way. In the days past, your resident may have fallen into that “problem solver” or “fixer” personality. These characteristics almost are always the reason for “busy seekers” to search for anything that is perceived to be lost items. Triggers: In some cases, the resident with dementia might start rummaging in response to a “triggering” event. The ability to understand the circumstances that “trigger” the unwanted behavior before it occurs puts you way ahead of the game to support a peaceful environment for your resident. Source: https://dailycaring.com/9-ways-to-manage-dementia-rummaging-behavior/ Note: Consider creating a “behavior log” to record the time of day, the surrounding environment, the individuals involved and the type of event to see if there is a repeated situation from which the resident becomes agitated. You will be looking for repeated patterns to determine what circumstances instigate the behavior. “An ounce of prevention is worth a pound of cure” Rummaging Freedom [Safe Zone] Treat rummaging as an opportunity for engagement. Include items like clothing, socks, copies of memorable photos, a fake checkbook, reading books, greeting care, or a wallet filled with old receipts, credit card “look alike” and fake money – anything that could spark interest. Hobbies or career related items from the resident history are sure to peak interest. Themed boxes like a sewing or knitting drawer, a sports basket, a costume jewelry box, a tool box, or any music related items, etc. Always show the resident where to find his/her themed box so as not to elevate anxiety levels. Review the following for more ways to create a “safe zone” for resident rummaging: Keep the person with Alzheimer’s from going into unused rooms. This limits his or her rummaging through and hiding things. Do a search to learn where the resident often hides things. Once you find these places, check them often, without the residents’ knowledge. Keep all trash cans securely covered or out of sight. Alzheimer’s residents may not remember the purpose of the container or may rummage through it. Check trash containers before you empty them, in case something of value has been hidden there or thrown away by accident. Note: A resident that often disposes of dentures, hearing aids and/or glasses can make for a very unhappy family member. In addition, loss of such adaptive devices has the potential to further increase resident agitation and increase unwanted behaviors. More ideas to ensure safety and less disruption as follows: Lock up dangerous or toxic products, or place them out of sight and out of reach. Keep backups of frequently lost items to prevent the start of yet another frantic search. Example: Several similar look-a-like handbags stored out of sight will do the trick when the original one becomes lost. You will always be viewed as the hero when you help your resident find that missing handbag. Remove spoiled food from the refrigerator (if accessible) and cabinets. Food gone bad simply becomes a doctor’s visit when consumed due to the resident's lack of judgment and/or sense of taste. Make commonly used items easy to find. The resident behavior may be valid if they are looking for something specific, but can’t find it. This is particularly frustrating when the resident is unable to explain nor describe what they are looking for. Consider putting things in clear containers or specific drawers and label contents. Or keep similar items together, like similar clothing in the same drawer – underwear, tops, bottoms, socks, etc. Failed attempts to stop a resident from hiding, rummaging, hoarding, and or re-organizing things can cause increased agitation and paranoia for the resident that is bound and determined to engage in such behavior. You can mitigate agitation and manage the behavior through creative and inventive ideas that allow the behavior while maintaining a safe and less disruptive environment. In doing so, the resident will regard you as a supportive partner rather than viewing you as someone that is interfering - - and that’s exactly where you want to be. Reference: https://www.nia.nih.gov/health/when-person-alzheimers-rummages-and-hides-things?utm_source=NIA+Main&utm_campaign=8c48100ffd-20190409_rummaging&utm_medium=email&utm_term=0_ffe42fdac3-8c48100ffd-7499965 Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. 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