Posts Tagged ‘nursing home’

Anna

November 26, 2013

OLYMPUS DIGITAL CAMERA

I was drawn to Anna’s room this morning because I missed her in the dining room at breakfast. She was always there before me. As I clocked in at the nursing home each morning, and walked through the big open room, no one would be there but Anna. She’d wave me over, and make me twirl in front of her old eyes so she could marvel at my outfit for the day. If she absolutely loved the entire ensamble, she’d clap her hands, and reach out to kiss me. Otherwise, she’d give me a compliment on the bit of pink in my scarf, or the buckle on my belt, or tell me the blue of my blouse matched my eyes.

She wasn’t there this morning. At ninety-six, she’s been like one of those proverbial cats with nine lives. She’s fought off every cold and pneumonia that came her way, and continued to smoke through it all. “When you’re my age, honey, and you’ve lost all your real loves, your twin sister, your husband, your friends, who cares if you die from lung cancer? There’s no one left to grieve for you, and I love me a cigarette.”

I went to her room where I found her small frail body nestled among blankets and pillows. The oxygen tubing ran from her nose to a whirring machine at her bedside. Her eyes were closed and she struggled with every shallow breath.

I pulled up a chair, and took her hand. I sat for a long time rubbing my thumb across the fragile vein-lined skin of her hand. I remembered our trip to the football game where her husband’s University of Virginia Cavaliers played her Virginia Tech Hokies. She stood and cheered and laughed about how her husband was frowning down on her antics from heaven. “He never was a good loser,” she’d said.

At times Anna searched for Virginia, her twin. When reminded that Virginia had passed away some years ago, Anna would say, “Oh hell, that’s right. Once you’re connected with someone from the start, it’s hard to let go.”

As I got up to leave Anna’s bedside, I leaned over and hugged her one last time. I whispered in her ear that it was alright to let go, that Virginia and that Cavalier husband of hers were waiting for her with their arms outstretched, all she had to do was let go. I kissed her forehead and told her I loved her.

Anna completed her journey on this earth today. Godspeed my friend

Advertisements

Her Still, Perfect Form (part 3-fin)

March 10, 2013

??????????????????????

Part 1 here: https://trainswhistle.wordpress.com/2013/02/24/her-still-perfect-form-part-1/

Part 2 here: https://trainswhistle.wordpress.com/2013/03/03/her-still-perfect-form-part-2/

Part 3

Emma was in the bed by the door, oxygen tubing in her nose, an IV attached to her bruised arm. Her eyes were closed.

“Oh my God, what happened?” Jack asked. “Was she in some sort of an accident? Emma, Sweetheart, can you hear me?”

Emma opened her eyes and gave a faint smile. “Hello Jack,” she said in a whisper.

“Do you know who this is?” Jack asked.

“Of course I know who you are Jack,” she said, before closing her eyes again.

He took her hand in his. “It’s cold as ice,” he said, rubbing it between his two. Then, he bowed his head and said to no one in particular, “Oh God, what happened to my baby?”

The driver put a hand on Jack’s shoulder, and said, “Emma fell last week, and broke her hip.”

“Oh my poor baby,” he said. “I know how that feels. I fell on a rail in the coal mines one time and dislocated my hip. It was so painful. Do you think she’s in pain? Emma, are you in pain, Sweetheart?” he asked.

Emma opened her eyes again and said, “Everything hurts.”

“I’m going to the desk to find the nurse, Jack,” the driver said. “You sit here with Emma. I’ll be right back.”

“I’m not going anywhere,” Jack said.

In a few minutes the nurse came into the room with a syringe.

Jack looked up. “I’m Jack Arthur, Emma’s husband. What happened to her?” he asked.

“She had surgery on her hip,” the nurse said.

“What?” Jack asked.

In a louder voice, the nurse re-stated, “She fell and broke her hip. She had surgery on Saturday.”

“Oh my poor Emma,” Jack said. “Why didn’t someone tell me she fell? When did this happen? I could have been here with her.”

Jack turned back to Emma and took her hand. He rubbed and patted it, watching her face. She opened her eyes and tried to smile at him.

The nurse looked at Jack and then at the driver. “I’m so sorry,” she said, shaking her head.

The nurse injected the syringe of medicine into the IV and left the room.

“The nurse gave her some pain medication, Jack,” the driver said. “She’ll probably sleep now. I think we should let her rest.”

Jack pushed up from the wheelchair with effort. His legs shook, barely holding his weight as he leaned over Emma’s frail body. He stroked her cheek with bent fingers. Putting his face very close to hers, he asked again, “Do you know who this is?”

Emma looked so small and fragile there in the bed with tubes running from her arm and to her nose with oxygen. Her usually neat, coiffed hair was in a tangle on her head and her face was so pale it blended with the white of the pillow case. She looked up at Jack and said again, “Of course I know who you are Jack.”

He had turned his good ear to her mouth after he asked the question. “Of course you know who I am,” he said. “I’m the man who beats you within an inch of your life every day.”

Emma smiled. They both chuckled at the long running joke between them. Jack moved his hand to Emma’s shoulder. It was bare where the faded blue and white hospital gown had slipped off. Her shoulder was thin and fit in Jack’s palm. He rubbed her skin before pulling the gown back up. He moved in close again, right over Emma’s face and said, “I need you to get better and come back to me. I miss you.”

Emma closed her eyes tightly, then opened them again. She lifted her hand with effort to Jack’s head and smoothed his white hair. She put on a weak smile again and whispered, “I miss you too.”

As he had done every night since they were married, Jack kissed her forehead, then, each of her eyelids, and finally, moved to her mouth. Emma lifted her lips to his and they kissed each other three times in succession, gently, with only a breath of sound. “I’m going now so you can rest,” Jack said. “You behave, no running after good looking doctors.”

Emma closed her eyes and shook her head, smiling again at her Jack. “You can always make me laugh Jack, even when I don’t think it’s in me,” she said.

Emma came back to the nursing home a few days later, back to room 242, back to Jack, but with a new diagnosis of bone cancer. Surgery to repair the hip was unsuccessful. Morphine kept her comfortable. She slept most of the time with Jack by her side, holding her hand. His worry was etched in the lines on his forehead. Emma awakened sometimes when he kissed her forehead. She reassured him with her smile.

Emma had no appetite and her disinterest in food carried over to Jack. Staff members encouraged him, telling him he needed to keep his strength up for Emma. That afternoon, Jack finally accepted a bowl of his favorite soup. He bowed his head over the bowl and sent up a prayer for his Emma.

As he brought the spoon to his mouth, soup spilled onto the front of his starched white shirt. He looked down at the stain, and frowned. As he unbuttoned his shirt, his hands began to shake and tears welled in his eyes. He finished stripping the shirt off and wiped his eyes with it, then threw it to the floor. He wheeled to the closet, pulled out a fresh one, struggled into it, and fastened the buttons. He pushed the wheeled table with the bowl of soup on it out to the hallway and closed the door.

Jack hadn’t taken his colored pencils out since Emma fell. His worry had filled him, and his inspiration had slipped away.

That evening, Emma opened her eyes when Jack leaned in to kiss her.

She lifted her hand to his cheek with effort. “You need a shave handsome,” she whispered, smiling.

Jack reached up and put his hand over hers, pulled her palm to his mouth and kissed it. They held each other’s gaze until Emma’s eyes closed.

A little while later, he wheeled over to the night stand and gathered his sketchpad. Going back over to Emma’s bedside, he took out his pencil and began drawing her still, perfect form.

Her Still, Perfect Form (Part 2)

March 3, 2013

??????????????????????

link to Part 1:
https://trainswhistle.wordpress.com/2013/02/24/her-still-perfect-form-part-1/

On Saturday afternoon Jack came out of the room looking for Emma. He wandered the long hallways, knocking on doors, peering inside to see if she was there. That night, his usual sound sleep was interrupted. He got himself up in the wheelchair to check her bed. She was gone. He wondered where she was, what had happened to her. It wasn’t like her to be out after dark, gone in the middle of the night. He wheeled to the door of the room and asked a nursing assistant passing by if she had seen his wife.

“She’s still in the hospital Jack.”

“In the hospital? What happened? Why didn’t someone tell me?” he asked.

“We did Jack. You must have forgotten,” the nursing assistant said.

“How could I forget something like that?” he asked.

“You just woke up Jack. It’s easy to forget things when you’ve been asleep. I’ll call the hospital and check on her for you. Let me tuck you in and I’ll come back with the news,” she said.

“Thank you,” Jack said, letting the nursing assistant help him.

On Sunday, Jack fell. He had gotten the wheelchair stuck between the double doors leading to the parking lot. He was trying to pull the chair free. A nurse found him on his knees, struggling. When she asked what happened, he said, “I lost my balance. I need to find Emma.”

At lunch Monday, he wasn’t eating. “Just try a little bit Jack,” the nurse said.

“I’m worried sick,” Jack said. “I can’t take a bite of anything until she gets here. Emma is always here for lunch.”

“She’s in the hospital Jack. Remember? She fell and broke her hip Friday.”

Jack looked up, alarm on his face. “Oh, no. She fell and broke her hip?”

“Yes, on Friday. She was standing at the sink, lost her balance and fell. She broke her hip. They operated on Saturday. She’ll be home soon.”

After his shower on Tuesday, Jack stopped at the nurse’s station. “Can you tell me where Jack Arthur lives?” he asked.

“Just down the hall, Jack. Room 242. It’s the third door on the left,” the nurse said.

“Can you tell me where Emma is? I haven’t seen her this morning,” Jack said.

“She’s in the hospital, Jack.”

“In the hospital?” he asked, his voice rising, his eyes wide. “What do you mean she’s in the hospital? What happened? Why didn’t someone let me know?”

And so it went. Jack searched and asked. Staff members reassured and explained. Mid-morning, a housekeeper found Jack sitting with his head in his hands, sobbing. “I’ve lost the only woman I’ve ever loved,” he said. “Why would Emma leave me?”

A nurse called the hospital to ask someone to take a phone to Emma so she could reassure Jack. The staff there tried, but Emma’s voice was weak, and Jack’s hearing was poor.

That afternoon, the nursing home arranged for the facility bus to carry Jack to the hospital. He might not remember he had been to see Emma, but in the moment he was there, seeing her, being with her, he might find some comfort.

It had been awhile since Jack was outside. “It sure is beautiful out here. Look at all these colors. I don’t remember the trees being this big. Look at all these cars. Emma would love riding on this bus. I wish she was here. I want to tell her about this,” he said on the twenty minute trip to the hospital.

“Room 502,” the volunteer at the front desk said. “Take this hallway to the elevators. She’s on the fifth floor.”

“Fancy place,” Jack said. “Look at all these paintings. They’re beautiful. Emma would love them. She likes my drawings, but they aren’t nearly as fancy or pretty as these. She should come here and visit. Remind me to tell her about it and maybe you could bring us back here sometime.”

“Sure Jack, I’ll be glad to,” the driver said as she pushed his wheelchair toward Emma’s room.

Emma was in the bed by the door, oxygen tubing in her nose, an IV attached to her bruised arm. Her eyes were closed.

“Oh my God, what happened?” Jack asked. “Was she in some sort of an accident? Emma, Sweetheart, can you hear me?”

TBC

Her Still, Perfect Form (part 1)

February 24, 2013

??????????????????????

They liked to sleep in. Emma’s breathing was not the best, and it took her a while to gather energy. Jack just liked to laze in bed. Emma was usually the first one up, walking barefoot in her long flannel nightgown to the sink to wash her face and brush her teeth. She looked in the mirror, patted her hair into place and pinched her cheeks for color. Then, padding over to Jack’s bed, she leaned down and kissed him awake.

Opening his eyes, he reached up, touched her face and said, “there’s my morning sun.”

“Oh stop that foolishness Jack and get yourself up. Breakfast is coming,” she said.

They ate all three meals together in their room at the nursing home. The dining room was just too crowded and they would have to share a table with other people. Somehow, in their sixty-two years of marriage, they stayed selfish enough to be an exclusive pair. They didn’t plan to be childless, but when no babies came, it was alright.

Emma knew how to arrange a dining experience; she had lots of practice. Forty-three years before, she and Jack met at the cafeteria in town. She set tables.

“I knew she was the one for me the minute I looked at that sweet face,” Jack told everyone who met them. “Just look at her. Could you have resisted?”

“Don’t you believe his stories,” Emma said, smiling. “He didn’t really know until the second date.” Then, they both laughed.

Emma pushed their over-the-bed hospital tables together in the center of the room, covered them with a white linen cloth, and placed the vase with a silk rose in the middle. Jack had given her the flower for her birthday. When the stainless steel cart brought their meal trays down the hall, Emma assumed the role of waitress, placing the plates, glasses and utensils in perfect order on the couple’s make-shift dining table. She unfolded the napkin and tucked it under Jack’s chin. His button-up shirts never had a stain.

Jack didn’t have nice shirts until retirement. He was a hard worker, did manual labor, got his hands and clothes dirty. He and Emma lived in West Virginia. He dug coal from the age of ten. Emma had the education. She could read, Jack couldn’t.

The couple enjoyed a small mountain cabin with a garden spot out back. Electricity and running water came later on. Family was close by, and their church was just down the road. They lived in the same small town, in the same house, until Jack retired. That year, their minister died. His widow gave Jack all of the pastor’s clothes because the two men were the same size. Emma liked seeing Jack dressed up, so did Jack. Wearing those clothes made him feel a little closer to God. When he and Emma moved into the nursing home, Emma only packed Jack’s “preacher clothes.”

In the afternoon, when Emma napped, Jack drew. He used colored pencils, and though his artwork was not learned by formal training, he showed natural talent. “My Mama used to ‘oo’ and ‘ah’ over my pictures when I was a boy,” Jack said. “She would take me outside with my paper and pencils and point to trees, flowers, mountain ranges, creeks and animals for me to draw, then she’d tack the pictures up on the wall at home. She’d show them off to anyone who visited. Weren’t for her, it never would have amounted to much. Heck, didn’t really amount to much anyway, but people from as far away as town came up to the house for me to draw them. I even made a little money sometimes.”

Several of Jack’s pictures were framed and hung on the wall in his and Emma’s room. The one of Popeye was his favorite. “I always loved ‘ol Popeye. He’d pick up that can of spinach and get so strong, nothing could beat him or take his girl away,” Jack said.

Some of Jack’s projects took days, some only hours. He drew cars, trains, mountains, birds and houses. Sometimes he sketched staff members’ faces to give away as a thank you for being kind. A nursing assistant asked him once, “Where are your drawings of Emma, Jack?”

“I never drew Emma,” Jack said. “Oh I tried. Just couldn’t do her justice. Look at her. Only God could draw something so beautiful, so I drew love birds instead. That one’s her and this one’s me,” he said pointing to the pair of framed birds on the wall.

When people came to visit, Jack looked over to Emma for all the answers. His hearing was not so good anymore, and of the two, he considered her the smartest. He always had. She smiled graciously, and carried the conversation, while he smiled and nodded. Emma’s steadfastness reassured Jack.

One Saturday afternoon Jack came out of the room looking for Emma. He wandered the long hallways, knocking on doors, peering inside to see if she was there. That night, his usual sound sleep was interrupted. He got himself up in the wheelchair to check her bed. She was gone. He wondered where she was, what had happened to her. It wasn’t like her to be out after dark, gone in the middle of the night. He wheeled to the door of the room and asked a nursing assistant passing by if she had seen his wife.

Part 2 here:

https://trainswhistle.wordpress.com/2013/03/03/her-still-perfect-form-part-2/

Dragon Lady

December 31, 2012

“Get out, go on now. You heard me. Leave.”

I’ve come into Betty’s room at the nursing home for my morning visit. She lays curled inward, knees to chin, arms, hands and fingers curled tight into a protective shield at her chest. She faces the wall.

“I came to check on you, to see if you need anything.”

Her voice comes out in a too sweet, sing-song imitation of my greeting, “I’ve come to check on you,” she mocks. “to see if you neeed anything. No, I don’t need anything. Just leave.”

It’s dark in the room with the curtains drawn. “At least let me open your drapes,” I say. “The sun’s shining outside. Maybe it’ll improve your mood.”

“Oh hell, do what you want to do, then get out,” she says, sighing loudly, frustrated with my need to help.

I sweep the fabric aside, and the sun streams into the room. “There, isn’t that more cheerful?”

“If you say so,” she harrumphs.

I smile, turn toward the door, and when I reach the threshold I call over my shoulder, “We’re ordering Chinese for lunch today.”

Her voice is almost inaudible. “From the Dragon Lady?”

“You’re the only Dragon Lady I know,” I say, laughing.

“Yeah, yeah, just shut up,” she throws back at me. “Order me some shrimp fried rice and an egg roll.”

“Extra soy sauce?”

“No, A1 Steak sauce,” she shoots back, turning her head to stick her tongue out at me.

I blow her a kiss from the doorway. “I’ll see you at noon,” I say. “Save me a seat.”

“Yeah, sure. You can take your place at the end of the line,” I hear her grump as I walk away.

O

Working Thanksgiving

November 26, 2011

Nursing homes never close.   Weekends and holidays are included in the work schedule.  The most popular holidays to have off are Christmas and Thanksgiving.  New Year’s Day is special to those who party the night before.

I worked Thanksgiving last year. It was my turn. We planned our meal at home around my absence. I was annoyed. Holidays are family time and I hate missing my routine, watching the Macy’s Thanksgiving Day Parade in my flannel pajamas and fuzzy slippers, spending most of the day in the kitchen, basting the turkey, mixing batter for pumpkin bars, smacking the boys’ hands as they dip a finger for a taste, peeling ten pounds of potatoes, listening to Johnny Mathis croon Christmas tunes, and later, after the feast and dishes, football games.  Next year, I thought with a sigh.

Oh well, I reasoned, go in early, leave early, dinner with in-laws by four o’clock, help with dishes at their house, and finally football at home. The day won’t be a total wash, but not what I love.  I hit the time clock by the nursing home kitchen door at seven twenty-six, making Thanksgiving a work day.

The halls were quiet, not like a usual nine to five day.  I got the daily newsletter printed and delivered. As I visited room to room, my elder friends greeted me with “Happy Thanksgiving, It’s so nice to see you here today.”  

Most every room’s television displayed marching bands, floats with popular singers, and giant helium balloons coming around the corner onto Sixth Avenue from Broadway in New York City.  Mary and I watched  Kermit the Frog wave to the crowd. Down the hall and around the corner Olive and I laughed at Ronald McDonald as he looked to be running to catch up to his fellow helium-filled buddies.  I sat on Earl’s bed while we watched a marching band move into formations while keeping tune. Earl kept time with his right foot tapping on the linoleum floor tile.

I dropped by the kitchen to see how the holiday dinner was coming along.  Three, golden brown twenty pound turkeys lay side by side in baking pans, Raymond, the chef, kept an eye on the candied yams, green bean casserole, oyster dressing, and glazed carrots.  He was chopping cranberries for the relish and had a pot boiling on the stove for ‘real’ mashed potatoes. Yeast rolls rose in the warming tray and gravy bubbled in a pot.  Twenty-five homemade pies cooled on the rack. In my thirty years, I’d never seen such a feast. I smiled with anticipation for the elders and went back upstairs to transcribe the list of “things we’re thankful for” residents had turned in the week before.

Robert, the maintenance assistant walked into the Activity Room for his break, and put on a pot of coffee.  He was working Thanksgiving day too. As the smell of brewed coffee filled the room, Robert pulled up Tractor.com on the computer and drooled over several John Deere four-wheel drive machines with enclosed cabs.  Robert’s a farmer at heart, keeping up with a small cattle farm single-handedly in addition to his forty hour work week at the nursing home. 

The elders love Robert.  They’ve adopted him as their son.  His daily rounds include a tool box filled with wrenches, hammers,  hugs, cups of coffee,  and often, just five minutes of time to listen to stories. 

“What are you doing at noon?” I asked him.

“I don’t know, probably checking the tags on fire extinguishers, why?”

“Can you carve the turkeys in the dining room?”

“Sure,” he said. “Where’s the knife?”

We searched the cabinets and finally came up with a fairly large, straight edged knife.

“Can’t cut hot butter with this thing,” Robert said, running his thumb across the dull edge. “Let me go find a file.”  Suddenly, he was in his element, finding an implement he could sharpen, like a blade on his hay mowing machine.

Robert and I met upstairs at 12:00 sharp. There are sixteen tables in the dining room. Sixty-four people, dressed in their finest, bowed their heads as Nannie gave thanks.  “We gather today to count our many blessings,” she said. “Thank you Lord for everyone here, for the hands that prepared this meal, and for another year of life. Please help us remember to appreciate each day we are given and to love those around us. Amen.”

Robert carved, and the rest of the staff members served the feast.

The large, flat screen television over the fireplace is perfect for football. Dallas and New Orleans faced off and old men stared intently at the action. One shook his fist at an Umpire’s call. Several cheered when their team scored, and a few on the losing side cursed. It was just like home, only with wheelchairs.

I brought the craft materials into the dining room where several ladies helped me glue the Thanksgiving quotes onto a tri-fold poster board. Earlier in the week, each elder had been given a strip of paper. “Think about what you’re thankful for,“  I said.  We’ll post them on Thanksgiving day for everyone to read.”

“I’m thankful for my health.” –Albert

“My children.” –Jim

“The staff here.” –Mary

“Science Club” –Sonny

“To have won the battle against Cancer.”—Hazel

“Friends” –Anne

“I wasn’t born a woman.” –Robert

“Having enough food to eat, and a roof over my head.” –Patty

We unfolded strip after strip of paper, transcribed with so many blessings in shaky handwriting, by nursing home residents who still felt thankful.

“You write one,” Constance said to me.

I took one of the strips and wrote in bold letters:

Spending Thanksgiving Day with my Friends here.

The Importance of Apples

November 20, 2011

Margaret-Dawn Thacker

Usually, when corporate executives visit the nursing home, the experience raises everyone’s blood pressure. Their expectations seem so unrealistic. After all, they sit in some office somewhere and make policy. We are busy taking care of basic needs and attempting to add a little light into old, frail lives.

This week, the biggest of the corporate folks arrived in force. The company has re-organized due to cuts in the Medicare program. The new directors are moving across country, visiting all the homes, offering assistance, best practices they’ve seen on their travels. They’re asking us questions. They’re encouraging us to share our best practices with them. They’re listening.  Our blood pressure has leveled off, maybe even decreased.

Prior to their visit, sometime over the weekend, someone dropped off a bushel of apples from a local orchard. They were on my doorstep at work Monday morning. I was excited. Here was an unlimited variety of meaningful activity for my elders, a week’s worth of fun, pies, apple butter, applesauce, dried apples, sliced raw apples, juice running off whiskered chins, wrinkled hands peeling, shared recipes, stories of orchards, harvests, and senses enhanced by cinnamon, nutmeg, allspice and real butter.

“You cannot use those apples,” someone said. “They haven’t been FDA approved.”

Something stopped me from getting rid of them. I left the basket of apples on the counter. When staff asked about them, I said I had a plan for them. I wasn’t sure what it was yet, but I knew there was one.

The corporate wheels rolled into the parking lot at varying times on Tuesday afternoon.  They converged in the conference room as our staff whispered, and wondered, and wrung their hands in anticipation. The surface of the place shined, the halls smelled of aerosol orange essence.

There were a whole lot of us, so we met in the activity room. It’s the place where residents feel most at home. There’s a green Formica-top kitchen table with chrome legs, a distressed white-washed kitchen cabinet housing mixing bowls, spices, a flour sifter, a Rumford baking powder cookbook and a china tea set.  Against one wall, a wooden workbench sits under a pegboard with tools attached, a hammer, wrench, oil can, spark plug, fan belt, garden hose sprayer, carpenter’s level and a screwdriver. The piano sits against the other wall with music books. Spider plants and terrariums enjoy the sun from stands in front of the windows. A couch, love seat, and glider rocker sit in a group encouraging rest or reading of the books and magazines on the shelves. It’s a place I’d want to go to find refuge if I lived in the nursing home.

 The VP had us sit in a circle. He introduced himself and asked each of us to do the same and tell everyone how long we’ve worked here. There are five of us who have been working here over thirty years. We are considered the elders of the staff. The VP was in awe of our longevity. He shouldn’t have been. It’s what we do, it’s who we are. These elders are our hearts.

When the meeting disbanded, when we understood the goal, the company director of dining services walked over to my basket of apples.

“You planning some apple activities this week?” she asked.

“I was,” I said.

“And you changed your mind?” she asked.

“They’re not FDA approved,” I said.

“Let’s see,” she said taking one from the basket, washing it thoroughly with soap and water and biting into it. “Seem like perfectly good Granny Smith apples to me, great for cooking and eating. They’d make wonderful pies. Just wash them well,” she said, turning toward the door.

Celia and I peeled a colander full of the crisp green apples this afternoon. She had her own knife, the one she keeps locked in my desk drawer. We tried to outdo each other in making the longest spiral of peel. She beat me hands down. I cored and sliced the juicy quarters into one-eighth inch slivers.

Betty gave up her mother’s apple pie recipe. It took very little coaxing and brought a warm smile to her face.

Robert, a former chef, explained the difference between nutmeg and cinnamon and how much to sprinkle over the pie because Betty’s mother didn’t measure, she just sprinkled.

Elise, whose fingers don’t work like they used to, sugared the apples, and Tessa fussed over the crust.

Ethel tasted the fruit, extolling its tartness and declared it “a good cookin’ apple.”

Laura, who has difficulty finding the words for her sentences, read each step of the recipe with her glasses perched on the end of her nose.

And Sonny, who’d never baked anything in his life, measured out the butter because he didn’t think it was fair to eat a piece of the pie if he didn’t do something to help.

With the oven preheated to 350, two apple pies slid inside and onto its metal rack. We waited the hour of baking, telling more stories of pies from the past, of other mother’s recipes, of days in kitchens from years ago. The scent of cinnamon and nutmeg, butter and sugar filled the room and drifted out into the hallway. Staff members drifted back to us to see what smelled so good. They wanted us to start a bakery. They complimented the group on a job well done.

The only thing better than warm apple pie topped with vanilla ice cream is the feeling of accomplishment in making the pastries from scratch. If you don’t believe it, just ask Celia, Betty, Robert, Elise, Tessa, Ethel, Laura and Sonny.

Jane

October 5, 2010

Most days, Jane sits slumped.  When alert, she shuffles her feet to propel the wheelchair forward. She wanders without purpose.  People pass her in the hallway on their way to meetings or in their haste to give a pill.  Sometimes she watches them.

“Good morning Jane,” the nurse says.

Jane looks up, and in about thirty seconds time, she responds,  “good morning.”

The nurse doesn’t hear her.  She’s turned the corner. Jane’s response is delayed. She has Alzheimer’s Disease.

Every day, we have a small group activity for residents with severe dementia.  We gather in a small circle in a quiet place at eleven o’clock in the morning.  We take turns introducing ourselves.  Sometimes members surprise us and say their name. 

We offer rhythm instruments.  Billy always takes the drum. He was a bass guitarist in an R&B band fifty years ago.  Pete likes the vibrating sizzle of the cymbals, Beth shakes a tambourine, Mary rings a bell, and Jane pushes the box away.  We turn on the CD player and an old familiar tune starts to play.

“You are my sunshine, my only sunshine.  You make me happy when skies are gray.  You’ll never know dear how much I love you.  Please don’t take my sunshine away…”

These five people cannot put a coherent sentence together. If words come, they don’t fit.  Sometimes one word in a mouthful of sound is intelligible.  Music makes a difference though. It comes from another part of the brain.  Maybe music comes from the heart, because every one of these people with advanced dementia, sings this song, every word of it. It’s the same with Amazing Grace, Don’t Sit Under the Apple Tree, Over the Rainbow and Will the Circle Be Unbroken.  When the music is playing, they keep time.  Heads lift, eyes open, and voices sing.   

Jane dislikes this part of the program.  Noise bothers her, and although she mouths the words to songs, it’s easy to tell that she was not interested in attending the Municipal Band concerts in her home town. Acapella is more her style.  She jumps when Billy comes down hard on the drum, and sends a disgusted frown in Mary’s direction when the bell rings. 

We turn off the CD and put the instruments away.  This segment of the activity is always different.  Sometimes we pass around a prop for everyone to see and feel.  Yesterday, it was an old tin measuring cup.  We handed it to each person and asked what it was, if they remembered using one, what they did with it. 

Pete put the cup to his mouth.  We reminded him  about his years of drawing water from the well and taking a cool drink.  Beth said, “baking cakes.” She turned the cup over as if pouring measured milk or sugar. Mary held the handle, smiled, and closed her eyes. She likes coffee.  Billy banged the metal cup on the table with a beat, like a drum.  Jane said, “Stop that.”

This morning,  we chose a close up picture of a three month old baby to share.  He was smiling and his bright blue eyes sparkled from the page.  His fat cheeks invited a pinch and drool was shiny on his chin.  A wisp of hair stuck up on his round head. Jane was offered the prop first.  She took the laminated photo, brought it close to her face, smiled, and with no hesitation at all, said, “baby.”  Then, she  kissed  him. 

Today, we found what Jane likes best.

Build a Green House, They Will Come

January 11, 2010

Our community needs a Green House. Not one for gardening, but one for growing the lives and minds of frail, dependent, elders. One that promotes cultivation of people in a warm environment. Currently, too many of our seniors with physical and cognitive challenges are planted in cold warehouses.

Two of my grandparents died in nursing homes. They had no choice. My grandfather had a massive stroke, lost the use of one whole side of his body, his speech, and his ability to control bladder and bowel.  Days spent in a wheelchair, dribbling food and drink from the corner of his mouth, trying to speak with his eyes alone, made my grandfather the saddest person in my life.  I visited and tried to bring a little light back into his existence, but failed in my attempts. I always left him, crying. A lifetime of fly fishing for trout, growing Beefsteak tomatoes in his garden and building homes from the ground up, only played as old movies in his head.  No one in the nursing home talked to him about his life; no one knew; no one cared to know.

My Grandmother lost her mind to dementia.  She didn’t recognize me.  Looking through me, she mumbled words that made no sense to either of us.  She dressed in backward layers and searched for home.  In her day, she raised five children, cooked meals that fed not only her own family, but others in the neighborhood who were hungry.  She pieced quilts to keep those she loved warm, and braided my long hair while telling me stories of her childhood.  To the staff in the nursing home, she was a wrinkled body that had to be fed, bathed, and chased down the hallway because she wandered, looking for purpose.

When my great-grandparents were elderly and unable to live alone, they spent six week intervals with each of their nine children. When the elders visited, they helped as much as they could with cooking, cleaning, watching the children, doing yard work and small repair jobs around the house.  When they were no longer able to be of assistance in a physical way, they used their knowledge to share recipes and gardening hints. They rested in rocking chairs, and at the end, took to the bed until it was time to ‘go home.’  Family gathered at the bedside, caring for basic needs and listening to last stories. When God and others before them called, this generation was sent to the next life surrounded by love.  Nursing homes didn’t exist.

In the 1960’s family units began to change. Women worked outside the home and children no longer lived in close proximity to their parents.  Something had to be done with Mom and Dad when age took their bodies or minds.  As elders became unsafe in their own homes—leaving pots on the stove, wandering winter streets at night with no shoes, forgetting to eat—families, children, and communities, needed a ’safe’ place.  There was no model.

The early architects of nursing homes looked to the hospital as their model.  Semi-private rooms, long halls, starched staff, polished tile, stainless steel, and shiny linoleum suddenly became ‘home.’  Kitchens were placed far away from living quarters. No one’s mouth watered from the smell of baking biscuits. Laundry swished and swirled in industrial machines and came delivered in folded stacks, with a scent of Clorox. Baths, meals, therapy, activities and laxatives came on a set schedule. For the sake of safety, doors locked, walking discontinued, bodies with weak legs were tied down and when voices rebelled, chemicals in the form of antipsychotic pills hushed them. In caring for elders, quality of life was sacrificed. Staff ‘cared’ the life right out of the wisest ones.

During a visit to the ‘home,’ visitors met with scenes of drooped heads, drooling mouths, calls for “help” and “bring me a pair of scissors to cut this strap.”  Bingo was the only activity that promised a surprise ending in a long and tedious day. Elders didn’t have a say in their care. Their feelings and knowledge were ignored.  They suffered alone in a building filled with people rushing about, or vegetating.

Laws in 1987 tried to regulate care, bringing rights to nursing home residents. It’s a sad commentary on a society that has to pass laws to protect its eldest citizens.  Each of us has these civil liberties—we are born with them, but because of rampant abuse and neglect, Congress passed a ‘Nursing Home Bill of Rights.’  Included in this mandate were the following rights:

  • to be treated with respect and dignity;
  • to receive care, treatment, medicines, and services in compliance with laws;
  • to be free from mental and physical abuse, restraints;
  • to open and read one’s own mail, have access to a telephone, and writing materials;
  • to manage financial affairs;
  • to enjoy privacy in one’s own room,  with a spouse and for the couple to share a room;
  • not to be expected to work for room and board;
  • to have personal belongings.

We, as youthful humans, take for granted and expect these rights. We become outraged if these freedoms are yanked from us.  In 1987, fundamental human rights had to be spelled out and enforced in nursing homes. Legislators developed a three inch thick ream of rules to regulate care facility practice. Nursing homes became the second most regulated industry in the United States behind nuclear power plants. Twenty two years later, there is change, but not nearly enough.

The medical model still exists.  Nursing home residents continue to suffer from loneliness, helplessness and boredom.  Institutions are large and every room, every hallway, looks the same.  Breakfast sits on the plate in a yellow mound. Lunch and dinner are ground into unrecognizable meats and vegetables. Sliced bread is the only piece of normalcy on the plate. There are few spontaneous activities, while choices are limited.

Elders are no longer tied down or given  pills to shut them up, but body alarms have taken the place of restraints.  If someone chooses to rise from a wheelchair and their legs refuse to hold them up, a screeching alarm alerts staff.  In most cases, the noise startles the elder into moving too quickly, and they sprawl on the floor anyway.  As soon as most residents arrive, they are presented with wheelchairs.  The halls in the building are long and the walk to the dining room for meals is quite a hike for arthritic bones. Loss of mobility comes quickly. Loss of self comes even faster. A person’s diagnosis becomes his name, his disability, a nickname, his frustration, and a staff member’s annoyance.

~~~

“There’s a new admission in 208, he’s a fractured hip, a feeder, and a screamer at night.”

~~~

Not all facilities are warehouses for broken, old people.  A reform movement called ‘Culture Change’ is making some progress.   It’s slow in coming, but all needed change seems to crawl when it should sprint. The main principle of culture change is person centered care.  Individuals in these homes are encouraged to thrive in a community environment, not decline. ‘Home’ becomes the operative word, not the residence that each person remembers, but closer than the institutions that exist today.

A social model replaces the medical one. Each resident’s room reflects her personality. Family photographs and artwork recognizable to the individual decorate the walls. Familiar furniture, a favorite chair, a vanity with a dresser set, and a four poster bed with a soft mattress make life more livable.  Memory books, with cards and notes from children and grandchildren, stories from the past, and love letters from a spouse provide comfort. Residents choose when they wake, when they want to rest, what foods they wish to eat, and when they bathe.  Staff members have consistent assignments—they learn the history, interests, likes and dislikes of the elders in their care.  More importantly, the elders recognize their caregivers and relationships develop. Nursing assistants begin to understand that care is not the physical act of bathing and dressing, cleaning and making beds. Care is about the individual, and helping to make her life worth living.

“Clara helps me get dressed for the day, then we can sit and talk a few minutes about the red bird couple visiting my bird feeder this morning,” says Joan, a recipient of culture change care.

Unfortunately, the rules that came in the 1980’s, designed to protect and care for elders, have discouraged a rapid jump into culture change.  Administrators and Healthcare companies are fearful of the new direction. Regulations are strictly enforced and severe monetary penalties are imposed for noncompliance. ‘Infection control’, limits family style dining, homemade foods brought in by the community, and the adoption of pets.  Medical care and treatment still supersedes a resident’s right to eat and drink what he enjoys, or have a peaceful night’s sleep without being awakened for turning, positioning, and care needs.

~~~

“I’m 96 years old. Sure I have diabetes, but I’d rather die from the sugar in a Hershey Bar than die from wanting one,” says Earl, a three year resident in a care facility.

~~~

Staff are so concerned with documenting care , that they don’t have the time to deliver it in a way that makes the resident feel like an individual.

“If services are not documented, they did not occur.” This statement comes directly from a State inspector.

“Get it done, write it down,  that’s what I have to do in eight hours with a caseload of ten residents,” says an overworked C N A. This rushed approach leaves the elder feeling like a piece of furniture to be dusted or a wilted plant needing water.

A forerunner of the Culture Change movement is The Eden Alternative.  It’s a small not-for-profit organization which is turning eldercare on its gray head.  This organization embraces the belief that aging is a stage of development and a person can continue to grow well into the age of elder-hood.  The Eden Alternative has developed new models for housing those in our society who are frail and dependent on others for care.  These communities are called ‘Green Houses’. They promote growth in their inhabitants.  When an alternative Green House is built, instead of an institutional design with long foreboding hallways, smaller, residential housing units are organized.  Each unit houses no more than ten private bedrooms with private baths.  The rooms have doors that open to a short hall or a great room. Each house has its own kitchen, dining room, laundry, front porch, mailbox, backyard with grass, bird feeders, a cat or a dog, and a garden.  There are upwards of fifteen units in a Green House community. Each house has ten elders, and a family of care staff.  Residents can assist as they are able with meal preparation, cleaning, laundry, gardening, pet care—all activities they would normally participate in at home. Recreational pastimes, calendared events, interests and hobbies are pursued with passion or not, depending upon the likes of each individual. Elders feel needed, valued and activities are meaningful. Each house is run separately from the others.  Each small community within the larger, is autonomous.

Where are the nurses?  Where are the administrators, social workers, business office personnel, maintenance workers, housekeepers, and dietitians?  This innovative living concept does away with some positions. Those that are necessary, are housed in a separate unit within the confines of the community. Care staff in the Green Houses are cross trained to provide personal care. Staff cook, clean, assist with activities, budget household expenses and shop for needs.  There is one ‘Administrative Building’, which houses offices and the nursing staff.  Nurses travel from house to house like home health workers. They come at a specific time, provide medications and treatments, then leave. The housekeeper comes once or twice a week for deep cleaning, and the bed and bath linens are taken to a separate building for washing. They are delivered back to the house when clean, reminding elders of the old time laundry services.  Personal laundry is washed, dried, folded, and ironed in each house with the assistance of the residents.  The elders rule their homes. They plan meals, celebrations, spur of the moment ice cream making, trips to the store, or poker nights.

Green Houses in existence have waiting lists. The concept is innovative and studies show that elders thrive in these communities.  Costs are lower, staffing needs are less, and quality time between elders and caregivers increases. With the Baby Boomer population reaching retirement age, society needs a new and better way to care for those who will be unable to care for themselves in the near future.

In a prime example, the City of Charlottesville prides itself on being a mecca for retirees.  Cultural, educational, medical and community based services for seniors abound in this city.  Yet, when a certificate of need is granted for an eldercare facility, an old medical model nursing home is built.  Isn’t it time that we, as an innovative community, take the reigns in the Culture Change movement.  Shouldn’t we set the example of improved quality of life for our frail elders?  Shouldn’t we make the difference before we are placed in a medical model facility and wish we had done something about care when we had the ability?

26″ Snowfall

December 26, 2009

 

     I usually spend too much money at Christmas.  By December 24th I realize that I’ve overdone it and start focusing on my bank balance to see how I can eek out the bills. All of my impulse buying happens the weekend before Christmas.  My self control freezes and I spend my savings trying to buy love.  This year we had a 26” snowfall the weekend before Christmas. The storm started at rush hour on Friday evening and the last flake fell pre-dawn Sunday. Snowflakes are tiny crystal miracles.  I wondered how many were in our 26” on the ground.  Traffic stopped, people walked in hip waders to the mailbox, only to find that the postman couldn’t keep his promise.  This year, instead of throwing myself into the shopping frenzy,  I sat at home, writing Christmas cards the old fashioned way because the electricity went out.  I read a book by the woodstove. I watched my children play in the snow. I drank hot chocolate with little marshmallows. I fed the birds.

     I wrapped the three presents I had for my husband and the boys, a hand-tooled belt with a hammered silver buckle, an 1865 volume of Virginia History, and a telescope for universe gazing. Presents were few, but special because they reached out to me from artisan booths, an antique book store and the pages of the Buck Saver earlier in the year. These gifts spoke to my heart in May, August and September and it listened, compelling me to shop for Christmas when the sun was warm.

     I spent eight months creating a photo book for my mother.  My camera and I chased sunsets west on Rt. 250, rested on our elbows, eye level with dandelion blooms, waited for raindrops to hang like tiny crystal balls from pine needles, and made old, abandoned houses feel like Home and Garden cover girls.  These treasures, along with my best words were bound in leather. The book was under the tree.  If I was stuck in the snow, my family would understand that at least I loved them a little bit.

     I had to work all week, early mornings and late evenings.  The holiday season in the nursing home is busy.  People in our community want to do nice things for old people at Christmas.  Citizens come in flocks to sing carols.  They buy boxes of fruit and sugar free candy to distribute.  Each elder receives a new pair of socks and a bottle of generic lotion in a plastic fishnet Santa stocking from the Salvation Army. If the resident has no feet, the toe ends of the socks are cut off and they are slipped over the arms as “geri sleeves” to protect fragile paper-thin skin.  Staff members gather, sort, box and label gifts so each resident receives at least one item on December 25th. A special menu of ground ham with glaze, instant mashed potatoes and mixed vegetables is planned for mid-day Christmas. It will be served to a lady at the dining table with the sparkly silk centerpiece.  She will sit with a woman who takes her teeth out and licks them between courses.  Christmas is not what anyone remembers.

     Work was especially difficult this week. Extra hours because of the snowstorm, and the holidays are sad for many of our elders.  Their pain extends to enfold us in its intensity.  We find ourselves offering more hugs and tissues than at any other time of year.  For some, we are the only family they have and most often, we don’t measure up. Some residents are related of our staff. It’s hard when your job and caring for your dying mother are the same.   A nurse, cook and CNA lost their mothers this week.  Three of our residents died and left three of our staff members orphaned at Christmas. So, we prepared for the usual Christmas sadness wrapped in glittery paper and curling ribbon, and we planned to attend three funerals.   

     It rained today. I got in the car at 7:00 this morning and drove on isolated roads to the nursing home.  I delivered gifts and stockings room to room, offering a “Merry Christmas” and a hug.  Some voices welcomed me.  My Santa hat received smiles.  Several residents said, “put it over there,” while others dug into the stocking, like it was their last breakfast. Some didn’t understand it was Christmas. That was a blessing.

     My boys met me at the door when I got home.  They were ready for Christmas to begin. They waited for me.  We gathered at the tree and the youngest played Santa. Packages were meager, and I worried about disappointment.  I shouldn’t have. It seems that my heart picks out good presents, and my impulse buying is unwarranted.

     The skies cleared tonight and the universe spread out, over, and around us.  We set up the telescope and pointed it at the Pleiades star cluster. Ryan calls it his “night diamonds.”  We took turns gazing at a gift eight light years away, not a video game, i-touch screen, or text message on a cell phone, but a miracle of nature, just like the snow the weekend before Christmas.