Nursing Homes scare the daylights out of people because they lack the emotional skills necessary to deal with growing old, which is hardly what most consider a user-friendly activity.
Oh, we all know we are going to get old one day. We recognize that, but we also trust that it will happen somewhere in the distant future.
So if we do brave a visit to someone in a nursing home it is usually a pretty unsettling experience, even when it involves an elderly parent. The fact is, many folks simply opt not to do it. Alzheimer’s itself is scary, but so too is the blank and expressionless face of the patient who resides in such darkness.
A case in point is Mickie who is in her late 80’s, and a resident of a small northern Minnesota town and a long-time family friend of mine. She has lived in one of the oldest and least well-accessorized nursing homes in the region – translate that to mean the least costly – for some time. I made a special effort to visit her even though several local people advised against it, saying that I wouldn’t like what I saw and, besides, she wouldn’t remember me.
I found a lonely and bewildered person who hadn’t had a single visitor in over a year. The Director of Volunteer Services was ecstatic that I was there.
She survived her beloved spouse by dozens of years and has three grown sons, two of which live in the same town; the oldest moved years ago to the Alaskan frontier and has never been back. Suffice it to say, he would be hard put to find a more remote enclave. Only the youngest son drops by the lobby occasionally to bring needed items if the nursing home happens to call him.
Contrast Mickie’s aging experience with that of Doris, another friend of mine in that same little town who, at the age of 99, still lives in her own home and even does her own grocery shopping with some assistance from her son who lives nearby.
He drives her there and picks her up 2 hours later so she can be in charge of the grocery experience and also have an outing. There is a belligerent sign taped to her back door that says: “I WILL NOT GO TO A NURSING HOME!”
This is a person who doesn’t hear so well any more but she is competent in all other respects. She cooks her own meals and she navigates the steps to her second story bedroom just fine. I hadn’t been back to the area in a good many years and still she recognized me. She told me that TV and crossword puzzles were her best friends, besides her front porch where she loves to sit and watch the cars go by on busy Highway 38. She also has fed a geriatric Chipmonk on a daily basis for years; he comes right up on her lap to reach for her outstretched hand that holds seeds for him.
From the patient’s point of view
There is some controversy associated with Alzheimer’s Disease; most of it having to do with best treatments by the amyloid-suppressing drugs. Like everything else today, dementia is viewed strictly through a medical lens by experts who vigilantly search for the ‘genetic causes of Alzheimer’s Disease‘…as if that is all there is.
The bulk of the vast literature on this disease fails to attend to the patient him or herself; only to their symptoms and occasionally to psychosocial needs that are thought to be met through the group living experience.
Scary, huh? You can understand why someone like Doris would want to avoid that twilight zone.
The fact is, we are medicalizing a normal and predictable stage of the generational life-cycle. Growing older is not a medical phenomenon. It is a stage of life when higher mental functions begin deteriorating and also when the body in general harolds its inevitable decline. The symptoms are unmistakable: the skin wrinkles, the senses become impaired, bones weaken, the belly protrudes, muscles atrophy from disuse, and squimish things like digestion and elimination come into sharp focus.
This is not rocket science. It happens. And while some elderly people more than others suffer cognitive impairment at this stage, they are still very much the same person inside. They feel the range of human emotion, they suffer from isolation and the lack of touch, and they become bewildered by the losses they experience but can’t necessarily remember.
An emptiness fills in those losses like water rushes to fill a void. And, in turn, the mind retreats.
The role of family
The family plays a vital role in the transition of an individual to old age. A well-connected, loving family with highly interactive and involved members is the best medicine for everyone, but especially for our elderly. This familial network serves as a safety net that keeps their minds active and their hearts nurtured. Those lucky enough to have this net also tend to be spared the worst of life’s physical impairments. They tend to live longer, healthier lives and their cognitive functioning remains intact for a much longer period of time.
Those without such a safety net slowly deteriorate over time, sometimes beginning as early as fifty years of age. During this time they begin to show signs of wide-ranging physical and mental impairments as well as escalating anxiety. Hospital admissions, falls, surgeries, and a host of other medical issues characterize their latter years to the point where institutionalization is finally deemed the most expedient solution for all concerned.
And often it is. Broken families can’t repair themselves. They lack healing capacities. Broken families can look OK on the outside but there is little of substance inside. Family members cut off and run away from each other, they neglect each other, some become abusive, others suffer from the range of impairments that inflict the body and mind – and eventually they die out, sometimes whole families at a time.
Health is a state of mind, it is [not] just a jumble of neurological synapses.
A caveat: some elderly belligerently refuse in-home care. They resent the intrusion of external caregivers and they resist all attempts to provide them with assisted living services, especially when it all happens quite suddenly.
But growing old is hardly a sudden process. Families need to solicit the help of elderly family members well in advance, while they are still competent mentally and physically, in planning for their future care needs. Most such planning is unfortunately done at the very last minute after the elderly person has fallen, or needs surgery, etc., leaving no preparatory time whatsoever for them to get used to the idea of assisted care. This is ill-advised and it leads to a rocky road ahead for all concerned.
It doesn’t help when family relationships are strained to begin with.
Finally, let me say this: it is a mistake to remove an elderly person from an intact social network. It is far better to keep them in their own home with assisted care than it is to transport them to another state, even to another county, to an institutional setting that is close to where one of their grown children happens to live. Read this note from a family that has done the right thing by keeping their mother in her hometown:
“The Wills take Mom to and from church every Sunday. My brother and his wife are 5 minutes away, and Charlaine is Mother’s primary driver for short trips and dental appointments and such. They take care of her laundry and visit every Sunday night. Their children and grandchildren also visit Mother – especially Ed’s son and daughter-in-law who have never missed a Sunday afternoon visit. I visit Mom every week and take care of things like manicures, pedicures, banking and bills, and thank-you notes to those who walk her twice daily and bring her special treats. All Mom hopes for is that her money will outlast her. She doesn’t want to come to Richmond to live with us because she would be away from all of her friends, her doctors, and her church.”
Nursing home horrors?
Many too many nursing home patients are placed in facilities that their families haven’t fully evaluated. After they are admitted, too few are visited by relatives or friends looking out for their interests. Unresponsive staff and administrators should prompt a family to make inquiries elsewhere but they won’t, if or when that multigenerational family is dysfunctional. Or broken.
The problem is that nursing home facilities can’t do it alone. They require participatory families. Some facility problems occur more from unintentional human error or unavoidable medical complications than from irresponsible conduct by understaffed nursing home personnel. For every instance of bed sores, dehydration, weight loss or other common problems there are usually a host of familial and institutional factors at play.
It is a mistake to blame only the nursing homes for the horror stories that abound. Familial neglect is part of the problem, if not a major part of the problem. Neglectful families will grasp at any straw to avoid seeing their own role in the problem; and predictably they will project an intense focus on the institution as their own anxieties escalate. This projection process is an effort to gain some relief by shifting the blame away from themselves.
Society shares the blame
The fact is, the aged in our society are not valued. We do not collectively revere our aged; we consider them a nuisance and a costly burden which they are when they are not loved.
Listen to this YouTube video, and take note of the projection. How is it that a family of 9 children, 39 grandchildren and 14 or so great-grandchildren cannot find a place in their own lives for this elderly woman?
Trust me, the bottom line is not just money but also matters of the heart.
Some things to keep in mind
For those who require institutional care, for one reason or another, there are certain important things to keep in mind:
a. The quality of life for an elderly person is largely dependent on their interactions and relationships with others. A world barren of relationship produces depression and anxiety that, in turn, seriously degrade the person’s overall functioning. Relationship heals; it gives a person something to live for and it is soothes and comforts. The lack of relationship harms.
b. People often think that their relatives with Alzheimer’s have difficulty hearing when, in fact, they are taking time to process what they have heard. Often they are unable to express what they want or, if not that, they cannot interpret information the way they used to earlier. Be patient and make eye contact. Allow them to finish what they are trying to say without correction or criticism. You can help them by guessing which word they are trying to find or you can ask them to make a gesture or point to something that relates to what they are trying to say.
c. For a person experiencing dementia, reminiscing is very calming and it helps them to feel more secure. Talk with them about past events and places and go with the flow…by enjoying some of those past moments with them.
d. Dementia patients are able to read body language and respond to the positive attitudes of caregivers and family members. The reverse is also true. They pick up on our insecurity and it makes them anxious in turn. If treated poorly they feel rejection, loneliness, grief and pain.
e. Tender touch is one of the most important communication devices. A hug does wonders for any anxious person, but especially for an aging parent that finds him or herself in a strange nursing home environment. Touch more, talk less. Give them a massage. Hold their hand. Put a comforting shawl around their shoulders. Take them for a walk, as walking is often therapeutic. Pay attention to the beauty and novelty of your surroundings as you walk.
f. Even if the person with dementia does not recognize those who visit, the contact is nevertheless valuable for them. Even patients with severe language deficiency fluctuate in their abilities; some days they are far more observant and attentive than others. Some of this fluctuation has to do with their level of anxiety and depression and with thoughts of abandonment.
g. Most elderly patients have no awareness of their memory loss. You may feel aggravated at their repetitive behaviors or with having to repeat what you just said but they do not. Let the person know that you have heard them and that you see what he or she is feeling. Try to validate their feelings and try to play a little with them!
h. Medications used in nursing homes can overwhelm; they are sometimes used for crowd control, and sometimes they interact with other medications and induce a kind of depression of their own. Beware of this and ask about their medications and their purpose.
Things you can do with your confined friend or parent
a-bring them large family photos, family momentos, books with pictures of animals, flowers or birds – even pictures of their old house – and talk with them about them
b-take them for a ride to see their old house or farm, or their church
c-if they had a pet, bring a cuddly pet in for them to touch and love
d-bring them favorite foods or beverages if allowed; share vegetables or fruits from your garden for a special treat; or some freshly baked bread or rolls
e-bring a tape player and listen to music together; or play a tape of children or grandchildren talking and singing to them
f-read aloud to them, watch an old movie with them
g-give your father a shave or your mother a new hairdo or a manicure, even a massage
h-arrange to stay and have a meal with them
i-bring a favorite perfume, powder, lotion, or even tobacco if that is something they used to enjoy, as smell is a powerful evoker of memories and emotions
j-bring him or her outside to smell springtime, autumn, rain, or even snow
Above all, remember that they are human first. They were functional members of society earlier in their lives and they probably were instrumental in your life or you wouldn’t be concerned about them.
Remember also that one day the tables will turn and [YOU] may be the one confined to a nursing home – a sobering thought, indeed.