Wanting to Go Home

Practical suggestions for understanding problem behaviors

Possible Causes

PHYSIOLOGICAL OR MEDICAL CAUSES:
- Direct result of physical changes in the brain.
- Unable to recognize home as home, due to memory loss or changes in perception.
- Depression.
ENVIRONMENTAL CAUSES:
- Stress level too high. Too much activity or noise can make the person want to go home.
- Feels bored - not enough activity.
- Recent move to new, unfamiliar place.
OTHER CAUSES:
- Feels insecure or frightened about the changes taking place in self or life.
- "Home" means home of childhood. People with dementing illnesses may be searching for a home that no longer exists.
- "Home"; means a time when life felt more comfortable.

Coping Strategies

GENERAL:
- Go for a walk or drive. Getting out, even for a short time, is helpful. Upon returning home, the person often recognizes it as home.
- Respond to the emotion being expressed, e.g., "Are you feeling scared?" or "I know you are feeling lonely."
- Offer reassurance, e.g., "I will take care of you," or "Don't worry. You will have everything you need here."
- Look at a photo album with pictures of person's childhood. The chance to reminisce about the past may ease the anxiety and trigger pleasant memories. Avoid asking a lot of direct puestions that rely on memory and may cause anxiety.
- Try to redirect the person's attention with an activity, food, music, dancing, a walk, or other exercise. Often, after a while the person will forget about wanting to go home.
- Remove objects that remind person of going home, e.g., hats, coats, purse, coat rack, etc.
- Try keeping a diary or log. Write down every time this behavior occurs. What time of day was it? What happened just before it began? Who was present? What was going on in the environment? Sometimes a pattern may emerge. If the person is particularly insecure or frightened at the same time every day, establish a very specific routine to help build security, and look for distractions to help get through that time of day.
- Examine routine for events or stresses that may be causing or encouraging wanting to go home. For example, in nursing homes or foster care, shift changes are often stressful times; Some people's anxiety about going home is triggered by noisy, confusing shift changes.
- As A LAST RESORT, ask doctor about medications to calm the person, if the behavior is very frequent and agitated, and nothing else works.
In a nursing home, adult day center, adult foster care home:
- Ask the person to assist staff in some way, (e.g., help set table, sort laundry, greet people) to help him/her feel more useful, important.
- Keep outdoor clothing out of sight.
- Work out a telephone routine with family members, if a phone call is reassuring. This might involve a daily or occasional call at a time when staff know the family member will be home. Sometimes, merely giving the person the relative's phone number to keep in their picket can be reassuring.
- Try a reassuring tape recorded message from a family member. It might tell a day care client when he/she will be picked up, and reassure that family knows where he/she is. It might help to tell a nursing home resident that he/she is loved and missed and that family will visit soon. However, for some people, a tape is more confusing than helpful.
- Try having the person carry a letter that provides a brief biography describing memorable events from his/her life. For example, one such letter told when and where the woman was born, whom she married, names of her children, etc. For someone who can still read, this can be very reassuring.
In a long term care setting:
- Have family stay with the person the first day of a move into a long term care setting. This is often a disorienting, frightening experience and family presence may be helpful.
- Try a large poster on a resident's wall or door from family that lovingly describes their last visit together and mentions that they will be coming again soon.
- Try a "visitors' book" that family and other visitors write in. Staff will need to reinforce this by reading it with or to the person. It can help convince a resident that he/she is still loved and visited, and is not forgotten.
- Try looking at the resident's room together and identifying personal possessions. (But don't argue or try to be too logical with the person if this approach doesn't work.)
- Have someone go for a walk outdoors with the person who is determined to "go home to mother's house." Eventually the person may tire or be distracted.
- If this behavior occurs in the evening, try suggesting that the person spend the night since it's late and go home in the morning.
In a day care setting:
- Try making lunch later in the afternoon. Some day care centers have found that the time after the meal is when people begin to get restless and want to go home.
- Have family members write short notes describing their own activities during the day, e.g., "I am going to lunch with Ann and will be here to pick you up at 2:30 p.m. Have a nice time. I love you. Your daughter, Joan."

OTHER CONSIDERATIONS

Wanting to go home is sometimes a phase that eventually passes as the illness progresses. It often seems to be one of the most frustrating and difficult behaviors for both family members and staff, and often requires a great deal of tact and creativity.
Wanting to go home is often connected with the desire to see loved ones who are long dead. Don't contradict the person or try to reason about it, which may provoke pointless arguments or may cause unnecessary grieving if the person had fogotten the death. Instead, try to get the person to reminisce about the person or home which is being missed. Again, it can be helpful to help the person express the feelings of loss, fear, or insecurity, which he/she may be feeling.

REFERENCES

Alzheimer's Association (ADRDA) Chapter Newsletters
Mace, Nancy and Peter Rabins. The 36-Hour Day. Baltimore: The Johns Hopkins University Press, 1981
Powell, Lenore and Katie Courtice. Alzheimer's Disease: A Guide for Families. Massachusetts: Addison-Wesley Publishing Company, 1983