“I’m a prisoner here.”

I just heard one of our patients say that.  He had been sitting in a chair outside my office for about an hour.  Quietly fuming inside.

About an hour earlier, he had pushed the elevator button when a therapist intervened.  It went something like this …

Where are you going?


No, you can’t do that.

Why not?

You have to stay on your floor.

Oh, and why’s that?

Well, because we have to know where you are.  We’re responsible for your safety.

Ok.  I’ll tell you where I’m going.  Outside by the entrance.  I want to go outside.

No, you can’t leave this floor.  If something happens to you, we’ll get in a lot of trouble.

An hour later, his nurse and CNA both tried to get him to go to the dining room.  This time he was resolute.  He wouldn’t budge.  He called himself a prisoner b/c the staff wouldn’t let him leave.  I would’ve been the same way.  After a few back-and-forths about whether he would or would not go to dinner or even ever leave that chair, I stepped out of my office and said,

You want to go outside?

They won’t let me.

Who won’t let you?

The people here.

There must be some misunderstanding.  They probably meant that you needed to go with someone.

No.  They said, “You can’t leave this floor.”

Well … let me see what I can do.  [I went to the gym and asked the therapists about him.  They were thrilled with the idea of me escorting him outside.  They just didn’t want him to go alone as he still has a ways to go to get his strength back and is at risk for falling.  I came back with the good news.  He couldn’t believe it.]

We went down together and I pulled the bench into the sun.  Gorgeous day.  We talked for about 45 minutes.  WWII veteran.  married to a ‘saint’ for 60+ years.  A few kids.  He’s the last surviving child of 8 kids in his family.  He told me about his ‘crooked’ father in law who died with $500,000 in the bank.  We laughed.  I teased him.  He teased me back.  We talked about religion and faith and cashing in his chips after 92 years on the earth.  After a while, he said, “Well, is it time for dinner?”

Yeah, are you ready to go back in?

You bet.

He literally had a large smile on his face when he sat down to eat dinner (after everyone else had already eaten by this time).  It struck me as I sat back down in my office how differently that could’ve gone (and sadly too often does) … the nursing/therapy staff get frustrated by the patient’s “behavior” and start to treat him as an object more than as a person.  He becomes a problem.  Stubborn.  “Non-compliant.”  A pharmaceutical intervention is ordered and the man, the WWII veteran, loses a little bit of his identity and dignity and control.

As a facility leader, it’s my role to establish a culture within the facility where that latter scenario is avoided — when it’s avoidable.  We have to create a mission, a purpose for our staff that is larger than a paycheck or a task to constantly motivate them to SEE their brother, sister, mother, or father in the eyes of the patient sitting in that chair.  I saw the difference tonight in being task-driven/objectifying and human-driven/personalizing.

Our great challenge is to systematically enable our great staff to personalize their residents’ and patients’ experience …

3 thoughts on ““I’m a prisoner here.”

  1. Thanks for bringing up this important issue, Dave. I see this all too often, especially on the matter of getting outside. I’ve seen sundowning residents who want to “go home” but are prevented from leaving the floor by staff. A one-to-one might be needed for a persistent situation. As I see the problem, a one-to-one is a sanctioned action but taking a possibly-ready-to-elope resident outside for a 45-minute chat is not. It’s great that you were able to spend some time outdoors with this resident, but what are we doing to make sure all our residents get to go outside? Group BBQs? Volunteers who bring residents to the patio? Easily accessible outdoor spaces open year-round? Possibly. Permission for staff members to take time from their official activities to bring a resident outside when they need it? Unlikely. If the resident in your story hadn’t been loud and insistent right outside your door, he would have remained inside like everybody else. I really hope we work on this one before it’s my turn to live in the nursing home.

  2. I have a late brother-in-law who had the goal of telling his children “yes”, unless he had a good reason to say, “no”.

    I think there is a parallel here (and, no, it is not drawing a comparison between residents and children). Too often we seem to want to say “no” by default, when if we stop to think about how we can meet a resident wish, we can do it. I think the example illustrated in Dave’s story is less about giving residents time outside, and more about good customer service.

    It is unfortunate that both the therapist and the aid didn’t offer to give the help needed. They may not have felt like they had the ability to do so- and I think therein lies the opportunity for improvement- in empowering our staff to really serve our residents’ needs.

    Thanks for sharing, Dave.


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