Why is there a bus stop on the ward?  This is a question that is often heard by people currently visiting the wards at Sevenoaks Community Hospital.
There are times when most people want to walk, people living with dementia are no different. Walking is not a problem in itself as it can help to relieve stress and boredom and is good exercise. But as with all behaviour, if a person with dementia is walking about and possibly leaving their home, it could be a sign that they have an unmet need and by understanding what they need and look for solutions, you can help to improve their wellbeing.

Rather than dismissing the person’s behaviour, it’s important to think about why they might be walking and how you can help them maintain their independence, safety and dignity.

There are so many reasons for this behaviour from memory loss and confusion, relieving pain or restlessness, boredom and lack of activity, hunger, thirst, continuing a lifelong habit and staying independent. In addition, it may be that they are feeling lost or looking for someone, or the person feels lost, abandoned or disorientated.

The word ‘Wandering’ is a very overused word in healthcare and can be seen as a label or stereotype and can be used as a negative description of someone

A Definition of ‘Wandering’

There is no fixed definition of wandering and Algase et al (2001) states that wandering is movement that is simply travelling without any clear destination and can take the form of pacing. For the purpose of this, the word wandering is described as:

  • Repetitive walking: observed in patients with dementia or cognitive impairment and includes pacing, walking in a set pattern that covers the same ground repeatedly, following staff, other patients or visitors and walking without any specific purpose from area to area touching and exploring.
  • Purposeful walking: walking with a specific purpose for example going home, looking for someone or something, going to the toilet. There is a risk that this walking could lead to harm if the patient does not have the capacity to understand the risks that come with these actions.

Having a Dementia Friendly Environment

The COVID-19 crisis has affected the healthcare industry immensely and will permanently reshape how patients in Hospitals and residents in Care Homes are cared for. By creating a Dementia Friendly Environment, it can help the patients return to some sort of normality.

What can changing the environment achieve?

Research has shown that 79% of a person’s time in care is spent on a sedentary or an inactive lifestyle.  By creating an environment with just the right amount of engagement, somewhere that has both quiet areas and areas that are socially engaging such as a café or areas of normality, agitation and aggression can be reduced by 60%.

Turning Challenges into Solutions

By having a Dementia Friendly Environment is recognised by the CQC and also score better in PLACE audits.

Why a Bus Stop?

dementia bus stop mural

The idea was first tried in Düsseldorf in 2008 which designed an exact replica of a standard bus stop outside, with one small difference: buses do not use it.

The Care Centre had been forced to rely on calling the Police to locate and retrieve residents who wanted to return to their often non-existent homes and families. The idea had proved so successful that it was adopted by several other homes across Germany, Europe and also the UK.

The model allows the person living with Dementia or a Cognitive impairment to recognise something familiar to them, having something that they once used regularly in their adulthood on a regular basis as a mode of public transport believing they had to go home, to work, or to pick up their children from school by catching a bus.

For a person living with dementia, by seeing something that has some form of familiarity can bring comfort to them. It’s a fabulous addition to the Ward and can trigger many fond memories of past bus journeys with their friends and family.

In addition, this is an opportunity for the people living with dementia to sit down at the Bus Stop, maybe for the first time in a long while after walking for ‘miles’. During this time, the healthcare staff can also introduce interaction, distraction and also promote food and drink to ensure that their nutrition and hydration needs are being met. Families and relatives also use this as a ‘rest point’ and a talking point on the Ward

However a Research Study in 2019 highlighted whether they are ethically justifiable as concerns that the use of fake Bus Stops could cause more harm than good for people living with Dementia, due to their deceptive nature and the potential stigmatisation of individuals seated at a fake bus stop.

The replica authentic looking Bus Stop shelters at Sevenoaks Hospital were installed by the Estates Department and provided by Karen Clayton – NHS Business Account Manager from the FIND Memory Care who have been greatly involved in ensuring the Community Hospitals are a Dementia Friendly Environment.

There is a Sevenoaks Arriva Bus Timetable within the ‘shelter’ and also the Bench was kindly donated by Homebase. There is also a feature wall opposite one of the Bus Stops of a Castle for the patients to sit and look at which is also a talking point.

There are 2 Bus Stops on the Ward, carefully chosen and located to be near the patients which can offer a “quiet and safe place” to help prevent them becoming unsettled or anxious, By encouraging patients to recall and share memories can help the Staff better connect with those with dementia, which enables more personalised care. It can also ease anxiety and boost self-esteem, resulting in the patient feeling more fulfilled.

From a clinical perspective, the installation of fake bus stops is deemed acceptable if driven by the assumption that it will contribute to patients living with Dementia’s physical and psychological comfort and enhance their well-being, regardless of their deceptive nature.

If you would like to talk to our dementia environmental specialist regarding the use of murals please get in touch by clicking here