I have been dealing with a new and difficult situation at work. I have a male resident with early dementia who continues to suffer with grief and the loss of his wife 5 or 6 years ago. In my non-clinical estimation, he is looking to fill the hole of his grief with another relationship with a woman. His history from before he moved in with us seems to confirm my theory. He has focused on one of my female residents who also has early to moderate dementia. So even if she were interested in returning the emotion, the competency to make such a decision is questionable at best.
The male resident continues to pursue the female resident and just will not leave her alone even after multiple discussions with he and his family. I had no choice but to give him notice that he must move out. This situation has been such a challenge in many ways. No child wants to think about their parents and their sexual needs or even admit they exist. But when you look at Maslow's hierarchy of needs, those needs for love are very basic. Not to mention as adults with long time life experience, expressing these needs are something that resides in the long term memory part of the brain. The reasoning and decision making part of the brain is compromised early in the diagnosis. It doesn't help that there are so many stereotypes to counter in this kind of situation.
I truly believe and have talked with the man's family that this behavior does not make him a dirty old man. I really believe his decision making abilities are so compromised and his emotional need for love so great that he really can't help himself. Again the difficulty comes with a dementia diagnosis because you look at the individual and they don't appear to have any physical symptoms. It is the behavioral symptoms that let you know there is a problem and it's hard to separate the behavior from the person. His family is embarrassed and upset by his behavior. In part, I'm sure my giving notice seems like a punishment for his behavior, but there really is no other way to ensure my female resident's safety. I also think if it weren't this female, it would be another because his need is so strong.
The family of the female resident doesn't get off easy either. They also see the behavior and wonder if their mother had been in some way leading the gentleman on or if in her younger days she was a "loose woman". No matter what the specific situations, it is so difficult for families as the person they once knew becomes farther and farther away and they are left with someone they don't recognize any more.
Education of staff who are minimally trained is another hurdle. I am fortunate that most of my staff have been with me for several years and are pretty well experienced with the symptoms of dementia and what happens to people as they decline when it comes to memory and bodily functions. The aspect of sexuality seems to set everyone back a step or two as cultural expectations and stereotypes come to the forefront in situations we don't experience very often and a situation where as humans we feel the need to protect the person we see as more vulnerable.
As with every situation I experience at work, I now look at it from how I would see things as a family member. I know my mother enjoys attention. I still remember one particularly traumatic situation when I was a child and my parents had a fight about my mother flirting with other men at a party. Knowing how basic the need for love is and knowing my mother, I have no doubt if she were in a similar situation, she would enjoy the attention. Does putting myself in the place of my family's make me better at my job or does it make me less objective and compromise my ability to do my job? I know God has placed me in this position to care for his children. I just pray He will give me the insight to do what is right by my residents and their families.
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