Had a few interruptions this week - dental surgery, sick cat (three late-night hospital runs, doing better now)... So didn't get back on the nursing home circuit until this afternoon.
The target for today - Nursing Home 3, a 150-bed private, for-profit facility in Rockville, MD, located a few hundred feet from Nursing Home 1 (am still wondering why the huge concentration in nursing homes in this particular neighborhood).
I don't want to get ahead of myself and I need to submit everything to hard skeptical testing, but this one felt much better than the others. It wasn't the physical plant - as far as that's concerned, the more I see these places, the more alike they seem - though Nursing Home 5, the big 500 bed factory, is an exception. No, the difference was the staff - in particular the admissions person who gave me the tour. Completely different conversation than the others I've had. Went on for 90 minutes, about two or three times longer than average. And in contrast to the generic, "here's the locked floor" tone of the other visits, had a lot to do with the specifics of Alzheimer's care. I liked what I heard about their approach, which seems to be flexible and intuitive in a way the others aren't.
Examples: she told me about a patient who used to be an accountant, and was perpetually anxious because to her, every day was tax season and there was work to be done. Admissions Person says she went out, found a printing calculator in an antique shop, and gave it to the the patient, along with legal pads and a ledger book. They set her up outside her room so she could work over her numbers. The numbers didn't mean anything but it kept the woman happy.
Similarly: there was a man who decided he'd only shower at 10 a.m. Friday. The staff got together to change his clock whenever they needed him to bathe. Then there were the groups of patients they take outdoors on the grounds (this happens several times a week, unlike the once-a-week routine at Nursing Home 5). Several of the patients decided they wanted to lie down in the grass - it felt good to them. "At first the staff wanted to get them back up into their chairs," said Admissions Person, "but then we decided, what's the harm? The only problem was that there were a couple of the patients who wanted to eat the plantings. So we tore up the plantings we had and put down parsley."
She described another patient who waited anxiously every day for her husband to come home. The husband had been dead for 20 years. The daughter would visit and say, "Dad's not coming - he's dead!" "I told her, 'Let's try something else,'" said Admissions Person. "The next time it happened, we told her, 'He just called and he said he's going to be late - why don't we wait inside?' That calmed her down and then she got distracted by other things. The daughter was upset because we weren't telling her the truth. I said, 'What's the truth? What does it matter what's the truth to you? What matters is what's the truth to her?'"
I liked this because it feels like what I try to do when I'm working with my father. J, my original social worker, used to describe it as "meeting them where they are." This works because the situation with an Alzheimer's'rs patient is always changing and you have to move to meet it. If you get too caught up in consistency or in managing your system, you lose that. You may be very good at healthcare but your approach gets rigid. The priority becomes what's good and efficient for the institution, not what's good and appropriate for the particular patient.
There were other signs that the approach here is progressive. Activities are mostly short-duration (15-minute) exercises that rely heavily on aromas and music to stimulate memory and emotion. That shows a better-than-usual understanding of brain physiology and how to work with it.
Then there were the llamas - baby llamas that were trooped in as part of a regular animal visiting program and were apparently a big hit. "We'd just put in a bunch of hand sanitizers and all of a sudden, in come these llamas and they've got the fluttering split lips and they're kissing everybody and I'm wondering, what germs are we bringing in? Then I decided, what does it matter? There's no infection we can't deal with, and look at how the patients are enjoying themselves..." When she told me the story I was thinking about Nursing Home 5, where they insisted I use the hand sanitizer every time I went from one building for another. That's a very sensible precaution but maybe you lose something else on the way...
There are several resident animals, and there's even an outside chance that I'll be able to relocate one of my father's cats with him. That's a huge thing, both in itself and because, as some of you know, I've been completely hung up on the question of what to do with the cat, which I don't want to leave behind. Without my realizing it, the cat has become a kind of litmus test for the nursing homes I visit - you talk to them about the cat and you find out whether they really get the emotional impact of Alzheimer's's, and whether they can bend or not. This one can. So for that reason in addition to the obvious one that maybe I can avoid breaking up the family, I liked the answer.
Admissions Person tells me she was an Alzheimer's caregiver, for her grandmother. Makes sense. She gets things that you'd only get if you'd spent time dealing with Alzheimer's on a personal level, where you have a stake in the outcome. Which suddenly suggests to me that part of what I don't' like about the staff at the other facilities is that they're dealing with Alzheimer's on a professional level, as set of interesting challenges or maybe just a piece of work to get done. There's a difference.
Now, it's conceivable that all of this - the calculators and the parsley and the llamas - are all a bunch of gimmicks (in the way that the relentless march of the hand sanitizers at Nursing Home 5 seemed like a gimmick - an easy placeholder for conscientiousness, rather than the real thing)... and the quality of care isn't that good. It's also conceivable that I met an exceptional person, and the rest of the staff won't measure up. So no decisions yet. I still have another nursing home to see, and three assisted living facilities. After that there'll be repeat visits to some of the homes, and the Maryland Health Commission statistics to go over, and lots of hesitation and second thoughts before I commit.
But I will say this - today, for the first time, I felt as though, if I have to set fire to all my father's assets, at least in a place like Nursing Home 3 there'll be some value in return.
About the decision-making process, credit here to Shu, who nailed it in a comment the other day:
You'll know what's best for the situation after you've visited a few places and feel where you are instinctually drawn. You'll possibly be surprised at how quickly you have your own inner shorthand about you rank them.
Seems that way.
Now, with all that said, I need to put all the good feelings aside and stay critical and continue the search.
More next week.
Baby Llama-land sounds wonderful. I remember reading about an Alzheimer's facility where the patients kept trying to 'elope' and go home.
So after thinking about it for a while, the facility installed a bus bench and appropriate-looking sign a little ways away from the front door. Mostly they found the patient sitting and 'waiting for the bus' and were able to get them to come back quite peacefully.
Working around the problemm, and with the problem, sounds like a much better way of doing things.
Posted by: P. Jennings | June 26, 2009 at 06:53 PM
I love the sound, the story of NH-3. Very much. Like you say, who knows what the actuality is until the commitment and move is made, but at least one person there GETS IT. Actually sounds like some place I'd like to live, too. How wonderful to have a group of people who are interested in finding a way to make your life feel 'right'. I haven't had that in a long time, maybe nursery school?! I hope it works out to be a true place. And also that the other places you are to visit give you same or similar feelings of CARE.
I've come to feel such great affection and need-to-hug for your dad. I also feel for his kitties. I so appreciate that you are keeping them in mind, too. You truly are a remarkable son.
Best,
Shu
Posted by: Shu | June 29, 2009 at 01:23 AM
Thanks, guys (and sorry again for the late reply - overwhelmedness continues). Nursing Home 3 is still in the lead at the end of the first round of the search. I'm going to be thorough, but I think I know how it's going to come out.
As to the kitties - well, they're sentient beings too, so they're entitled to support. And since they've done hard work in difficult circumstances, I want to make sure they land OK. A lot of moving parts to deal with, but they're very important parts.
Remarkable son? Thanks, but... if there was a more responsible sibling around, I'd be just as happy to blow off the responsibilities and go off and drive across country spending other people's money. But there isn't. So I can't. Like my barber (a true Zen man) says, you gotta do what you gotta do...
Posted by: Alan G. Ampolsk | July 09, 2009 at 07:09 PM