Decoding Behaviors: Hiding Soiled Underwear & Repeated 911 Calls

Step 1: Rule out a physical cause first. Before anything else, check for pain, a urinary tract infection (UTI), constipation, or a new medication side effect. A sudden increase in these behaviors often signals a physical problem. Schedule a doctor's appointment to rule out a UTI or other infection, as these can cause sudden confusion and paranoia. If the person cannot tell you they are in pain, look for non-verbal cues like wincing, guarding a body part, or a change in appetite.

Step 2: Become a 'dementia detective' and track the pattern. For the next 3-5 days, write down exactly when the behavior happens. Note the time of day, what happened right before, who was present, and what the person was doing. For hiding underwear, note if it happens after a bathroom trip, after a shower, or when they are feeling anxious. For 911 calls, note if they happen at a specific time (e.g., sundowning), after a particular visitor leaves, or when they are left alone. This pattern will reveal the trigger.

Step 3: Respond with validation, not correction. When you find hidden soiled underwear, do not scold or shame. Instead, say in a calm, neutral tone: 'Oh, I see you put these away. Let me take care of them for you.' Then, discreetly remove the item and offer a clean one. Do not ask why they hid it—they likely cannot explain. For 911 calls, when the police or dispatcher arrives, calmly explain: 'My loved one has dementia and was feeling scared. Thank you for coming. We are fine now.' Then, redirect the person to a calming activity like looking at a photo album or having a cup of tea.

Step 4: Address the underlying need for safety and control. For hiding behaviors, provide a 'safe place' for their belongings. Give them a small drawer or box that is 'theirs' where they can put things they want to keep safe. Check it regularly and discreetly remove any soiled items. For 911 calls, address the feeling of being unsafe. If they call because they see a stranger, validate their fear: 'I see you are worried. Let me check the doors together.' Then, walk with them to check locks, showing them everything is secure. This meets their need for reassurance without arguing.

Step 5: Simplify the environment and remove triggers. For hiding soiled underwear, make the bathroom and laundry area easy to navigate. Place a clearly labeled hamper in the bathroom and a second one in their bedroom. Use a picture of a laundry basket on the hamper. For 911 calls, consider removing the phone from easy reach or using a phone that only dials pre-programmed numbers. If they use a cell phone, remove the emergency dial shortcut. However, always have a way for them to call for help if needed—consider a medical alert button that connects to a family member instead of 911.

Step 6: Use redirection and distraction. When you see the behavior starting—like the person reaching for the phone or starting to hide something—immediately redirect to a different activity. For a 911 call urge, say: 'Oh, I need your help with something in the kitchen. Can you come taste this soup?' For hiding, if you see them picking up soiled underwear, offer a clean towel to fold or a stuffed animal to hold. The goal is to interrupt the behavior loop before it escalates.

Step 7: Create a predictable routine. Both behaviors often spike when the person is bored, anxious, or overstimulated. Build a daily schedule that includes calming activities at the times the behavior usually occurs. For example, if 911 calls happen at 4 PM (sundowning), schedule a quiet, familiar activity like listening to music or looking at a family photo album at that time. For hiding, ensure they have a consistent bathroom schedule every 2-3 hours to reduce accidents and the need to hide soiled items.

Step 8: Use visual cues and labels. Place a picture of a toilet on the bathroom door and a picture of a laundry basket on the hamper. For 911 calls, put a sign near the phone that says 'Call [daughter's name] first' with a photo of the daughter. This can help the person remember the correct action. For hiding, label drawers with simple words or pictures (e.g., 'socks' or 'pajamas') to reduce confusion about where things belong.

Step 9: Involve the care team. If the behavior persists, share your tracking notes with the doctor, a dementia care specialist, or the facility staff. They may suggest a medication adjustment, a referral to occupational therapy, or a change in the care approach. In a memory care facility, ask the staff to use the same strategies so the person gets consistent responses. Consistency is key to reducing anxiety and the behavior.

Step 10: Take care of yourself. These behaviors are stressful and can feel personal. Remind yourself daily: 'This is the disease, not the person.' Join a caregiver support group (online or in-person) to share strategies and vent. If you feel overwhelmed, ask for respite care or have a family member step in for a few hours. You cannot pour from an empty cup.