Reference no: EM133328982

The Situation:

John is an 85 years-old male who has moderate dementia. His mini-mental score is 18. He lives at the local Nursing Home, on the Dementia Ward. It is a locked unit. He has few visitors except for his daughter and son who live far away and can only visit in person once per year. Otherwise, they do talk on the phone every 6 weeks. John is otherwise healthy physically. He has been diagnosed with depression in addition to his moderate dementia. He has been a resident at the Nursing Home for 2 years. He doesn't talk much about his life before moving into the home.

Bill is an 87 years-old male. He has been admitted to the local Nursing Home, also on the Dementia Ward, within the past month. He was brought to the home after leaving his stove on and nearly burning down his home. He had been increasingly agitated at home, arguing with his wife of 60 years, Mary. He has two sons and one daughter who are prominent members with their community, who live busy lives and who are concerned about how others within their community perceive the family.

Over the past 2 weeks it has been noticed that John and Bill keep 'finding each other' on the unit. They have gone from following one another to holding hands. This past week they were caught cuddling in the dining room. Staff have expressed concern that Bill may confused, and that John is instigating the interactions with Bill. They also note that Bill seems less agitated, less confused and, appears to be happy.

As the Manager-in-Charge of this Dementia Ward you have tried to make your own assessment of the situation by talking with staff and residents; in addition, you reach out and contact both families to discuss the issue. Both families are the substitute decision makers for the residents and must be-in-agreement with any future care planning. John's family is supportive of their father being 'happier' and finding some meaning in his life, however Bill's children are not prepared to accept his emerging friendship with John. They want this to stop. Now. You have however, noticed some understanding from Bill's wife, Mary, although she understands that her children are confused and upset.

Unfortunately, both John and Bill require a secure unit, and the Nursing Home only has one available. Staff have also expressed their opinion, and you have identified a split amongst how they feel about this issue (some for leaving things as they are, and some demanding John and Bill be separated). They have no problem telling both families what they think. In addition, there are some rumblings about the Unit that some of the other family members of residents are making comments to Bill's family.

Question: How will you assess the situation, evaluate the issues and what decision(s) will you make?