Refocusing de-escalation

I've been personally challenged over the last few weeks by the intense focus within aged care and aged care services and programs on de-escalation. De-escalation strategies and techniques for people living with dementia in aged care. How did we get here and what are we doing so wrong that we get to the point that we focus on de-escalation rather than asking the question "How may I have contributed to what is happening for the person living with dementia" or "What else might be happening here"?

How scared is a person with dementia that they are forced to communicate their expression of ill-being with agitation, aggression, or violence?

How absolutely sad as a society that we may not know the people that live in age care settings where we work? Take a moment to think about that last one. The people that live, where we work. That is their home. Every day. Every night.

So much of what we talk about, of what I talk about, goes back to knowing the person. Knowing the people we provide support and services to. Knowing their preferences. Their likes. Their dislikes. From dining and food to air temperature, to style of clothes, their name - their football team, their favorite morning drink, and their bedtime routines. Their history. Their culture. Their story. How sad that in the moments we focus on de-escalation we forget to ask ourselves what got us to this point. What did we miss?

I am not saying we need to not think about what happens when things do go wrong. Because at that moment, there are so many variables and hindsight is wonderful (if we use it to understand as above what did we miss?). We need to consider what else might be going on as we look at this de-escalation. Not everything responds to a change in communication or approach. Medical episodes or changes can occur that create a sense of urgency (or not - if we know what to look for).

But I am asking us to focus on the before just as much. The proactive engagements. The appropriate use of care plans and behaviour support plans. The signposts that tell us someone is becoming distressed - by the choice of radio station or the noise from others, by the approach of care staff, by the room temperature in the bathroom where we've asked them to disrobe, or because they're in pain or because they are bored. Because like you and I make decisions to act and respond in each moment so do people living with dementia. It's just that you and I are able (most of the time) to appropriately frame and qualify why.

So in planning to de-escalate why don't we plan to avoid the escalations? Or at least, plan to know the people we serve as a start. Every day I see so many good things happening in the aged care sector, people who go to work every day to make a difference. Let's plan. Let's plan in partnership with the people living with dementia whom we serve. Let's hear their story. Honour their experience. And understand just a little more.