Paper short abstract:

“Exit-seeking” among residents on secure long-term care units is constructed as a problematic behaviour. This paper critically examines the meaning of movement in long-term care and the emergent discourse of environmental interventions that conceal, distract, and divert residents from exit points.

Paper long abstract:

Quality of life for residents with dementia in long-term care is a growing concern for researchers. Attention is turning increasingly to the impact of the institutional environment on residents' experience of themselves and others in space. Directed by the discourse of medicalized health and safety, "exit-seeking" among residents is considered a problematic behaviour on secure units. In the past, the recommended interventions included adding objects that dissuaded people away from the door, such as stop signs, mirrors, dark spiral-patterned carpet, and grid lines taped in front of doors (Chafetz, 1990; Jones & van der Eerden, 2008). New interventions focus on the concealment of exit-points. An increasingly preferred strategy is the illusion mural, or a trompe l'oeil, painted across a wall and doorway to disguise the exit door and reduce residents' exit attempts. Research on these environmental interventions has focused on an empirical discourse about efficacy, reporting primarily the outcome measures of reduced exit-seeking behaviour, or the arrest of movement in a particular direction. Missing from these research accounts is any critical discussion about "environmental interventions" in terms the language of "distraction," "diversion," "illusion," or "concealment" in the context of spaces of dementia care. Also missing are ethnographic accounts about the experience of the installation of a mural from the residents' perspective. This paper will draw upon ethnographic data to critically investigate institutional understanding and intervention of movement among people living with dementia on a secure long-term care unit.