I wrote two weeks ago about Maslow’s hierarchy, its relation to caregiving, and the benefit of aiming to achieve an esteem level belonging with the care you provide allowing individuals to feel fully respected.

As a refresher, our needs are built across tiers of sorts, each tier must be met before an individual can progress to the next level: physiological and safety before love, esteem, and finally self-actualization.

I received messages from many of you relating to the piece.

Then my family came home Friday to a home burglarized, rooms destroyed, items missing and terrified children, and we immediately move down the hierarchy of needs from esteem to safety.

Maslow says of safety that “safety needs take precedence and dominate behavior.”

Our immediate behavior was to take the kids to a safe place. All but one went to friends’ or family members’ homes, while one (9-year-old Joseph) stayed home with Mom.

And then the burglars returned.

Thankfully, I made it out of the house safely with Joseph, across the street to the neighbors.

The last few days have been a blur, little sleep, with officers and detectives in and out of the house, watching frame-by-frame videos we have of the suspects, and trying to get back into a normal routine.

We have learned the individuals are known from the homeless community and many shelters. Therefore, in attempting to understand their reasoning, I must understand they their needs are not being met at Maslow’s first tier — those of basic physiological needs for shelter, food and water.

Even so, it’s not easy. Every non-normal sound makes you jump. You are always looking out the windows and over your shoulder, and I have spent a lot of time thinking about patients I have seen in the past with paranoia or hoarding behavior.

“Mr. Jones, we promise no one was in your room moving your things.”

“Mrs. Smith, you don’t need to hoard all of your clothes at the foot of your bed.”

Most often, these are individuals in the later stages of dementia or have otherwise suffered damage or degeneration to their frontal lobes.

It has created an entirely new sense of what they experience.

When you have individuals who “refuse” to attend activities, or come to therapy, or leave their room for any reason at all, it can create certain levels of caregiving challenges.

The Alzheimer’s Association recommends the following techniques be used when these behaviors are demonstrated:

  • Don’t take offense. Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care.
  • Don’t argue or try to convince. Allow the individual to express ideas. Acknowledge his or her opinions.
  • Offer a simple answer. Share your thoughts with the individual, but keep it simple. Don’t overwhelm the person with lengthy explanations or reasons.
  • Switch the focus to another activity. Engage the individual in an activity, or ask for help with a chore.
  • Duplicate any lost items. If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.
  • Share your experience with others. Join ALZConnected, our online support community and message boards, and share what response strategies have worked for you and get more ideas from other caregivers.

Another behavior that individuals may demonstrate when feeling a lack of safety and security is hoarding. In the immediate, I am hoarding children. They stayed away for four nights after the events, courtesy of teachers and grandparents. However all are now back.

I find myself trying to keep them all in one central location in the house, and if someone strays, I become extremely anxious.

Alz.org additionally provides tips and tricks for managing hoarding as noted below:

  • Only remove what is needed to eliminate safety and health hazards. Leave behind as much safe clutter as you can. Organize it in large bins or baskets away from walking pathways, stairs, stoves and heaters.
  • Give the individual a good reason to part with their items. They may be more willing to let go of something if they are told that the item will be given to a charity, church, family member, etc.
  • Negotiate. Trade a year’s worth of newspapers for a month’s worth. Trade rotten or expired food for fresh food.
  • Be Creative. Take pictures of items that are given away, and allow the person to keep the pictures. Allow the person to take time to say goodbye to items that you may perceive as worthless.
  • Remove discarded items immediately because the person might rummage through the garbage and bring items back into their home.
  • If the individual agrees to help declutter, give them one box of items to sort through at a time.
  • Start slowly and take breaks frequently.
  • Be prepared for the person’s reaction and have support for the person and yourself. You may want to involve family, friends, clergy or a social worker. Have activities planned and ready to divert the person’s attention from the removal of their items.

What I can say in closing is that patience is key when working with these individuals. Slowly initiate routines and keep structure.

Fresh air, bike rides, movie nights, and more frequent use of a security system are helping my nerves these days.

Safety first … and security needs … hoping this will raise some awareness of how important they really are when providing care to others.

Renee Kinder, MS, CCC-SLP, RAC-CT, is vice president of clinical services for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).