Bringing Elder Care Full Circle

I remember my first time in a nursing home. It was a beautiful and historic building, with a covered porch going halfway around, stone steps up to a gorgeous set of etched glass double doors. The sweeping maple staircase dominated the front hall and the windows stretched from ceiling to floor. Each of the rooms boasted a shining hardwood floor, a brick fireplace and the doors and windows displayed with beautiful wooden casements and topping it all off, intricate crown moulding at the ceiling. The dining room had been enlarged and there were many tables and chairs, centerpieces, fresh flowers and wonderful art on the walls. The effect was pleasant and welcoming.

I attended the Catholic School down the street, St. Mary’s, and we were visiting the elderly inhabitants of this most magnificent abode. The majestic covered porch had marvelous hanging baskets and potted plants: fuchsias and geraniums and trailing ivy and lobelia. The grounds were planted to perfection with regal perennials and bright annuals. The east facing side porch had been converted to a morning room; the sun streamed in bright and warm upon the plethora of spider plants and african violets. I can remember feeling absolute awe in these superlative surroundings. How amazing, I thought, to be able to live here in such a palace. The residents were smiling and happy to see us for the most part, they were engaging and cheerful and I felt happy to be spending time with them in their beautiful space. One white haired sweet looking woman just sat in the sunroom, looking up and out the window and she didn’t seem to be aware that there was a group of uniformed, big eyed youngsters traipsing through. This made me vaguely sad, but it was not disturbing. The experience was overall positive.

The next time I found myself in a nursing home, I was attending nursing school and the home was affiliated with the local hospital. I was assigned to work with a nurse and shadow her as she cared for her assignment of patients that day. One resident was slowly making his way down the dim hallway using a walker and there was an ill smell lying heavily in the air. I went to the nurse’s station to find my assignment. The rooms were clinical and uniform, the windows small and the layout unimaginative. They took their meals in their rooms alone, unless they had a visitor. There was no common dining area that I recall. Residents were permitted to go to the hospital cafeteria if they had visitors willing to take them.

The nurse sent me to bathe, dress and serve breakfast to one of the residents. I felt so ill prepared to do this, never having performed these functions for anyone much older than three or four. I entered the room experiencing much trepidation. The resident, a cheery woman with hair dyed bright orange commenced chatting and put me at ease promptly. I felt so happy to have been of service to her in her time of need. Another patient was not so kindly. He must have had some form of dementia and did not recognize my efforts as assistive. I tried as hard as I could with him; my efforts were met with insults and epithets. I went to the break room and had a good cry; then it was back to work. My day ranged from the most glorious of successes to the most dismal of failures, but I digress. The nursing home itself was dictated architecturally by the fact that is was a hospital ward. The residents were more acutely ill than those in my initial experience, but it was quite clear to me that this was a place to avoid. The thought of spending one’s precious final days, weeks or months in an environment as cold and clinical as that was appalling to me. Not that I did not think the staff did what they could, I am quite sure that they did. But the place was devoid of anything of interest. All of the television sets were turned on, yet the residents were usually not engaged with the programming. There were some visitors, but they were few and far between. The set up was not appealing and there was a lack of community space. There was no dining room. My impression was of one of starkness, hopelessness and gloom. It was not one bit like the private nursing home I had visited as a child.

I recently read Being Mortal, by Atul Gawande. In the midst of this dissertation on the end of life, I came to a section describing a nursing home like I had never previously imagined. The home, Chase Memorial Nursing Home, is in an unlikely setting, coincidentally just over the mountain from my parents’ home in Upstate New York, in the tiny rural town of New Berlin. Dr. Thomas, a local doctor tired of the night shift and the unpredictability of emergency room work, took a job directing the facility. His vision of a good life is a life of maximum independence. He made a decision to introduce more “life” into the nursing home in order to fight the boredom, loneliness and helplessness that pervade such settings. He began by applying for a grant that was awarded for innovative ideas. Into the grant went all of the ideas he had about putting a little life into the place. Only live plants would be allowed, each resident would have a bird in their room. Each floor would have a resident dog or cat. The lawn would be plowed up and flower and vegetable gardening would take place. At the time of the writing by Gawande, the home had not only rolled out the animals listed above, but also had a flock of chickens and a colony of rabbits. They provided on-site daycare for the children of employees and were sponsoring an after-school care program.

The new program was studied for two years with a resulting 15% decrease in the rate of death of residents and a nearly 50% drop in prescription drug administration, particularly psychotropic drugs that are given for agitation. The researchers were unable to state a reason for their findings. Dr. Thomas ventured a theory: the decrease in rates of medication and death can be attributed to the “fundamental human need for a reason to live.” What he was able to show is that it is possible to provide even disabled elderly with a reason to live. What a beautiful model for elder care, what a compassionate and sensible solution! Give them something to take care of: a plant, a pet, a garden plot, a friendship with a child, and watch for something miraculous. Re-engaging with life and letting go of boredom; replacing helplessness with helpfulness and loneliness with new relationships born of caretaking. It is such a beautiful thing. It is a throwback to the idea of extended family living together under one roof, with the elderly and infirm pitching in for the good of the whole, staying firmly engaged in the core of the family, thriving on being needed, on being responsible for the care of another living thing.

The next idea I would like to explore is something I saw online, a story about a nursing home offering free room and board to college students in exchange for time spent with the elderly in the home. The young people are required to log hours taking meals with the residents, spending time in the living areas, talking, reading, and sometimes performing for the residents. The original story that popped up was about Humanitas Retirement Home in the Netherlands, in Deventer. Six college students occupy small apartments in the home with 160 total residents. They are particularly encouraged to spend time with those residents who are sick or unable to move around much. The intergenerational mixing has the same effect as the introduction of living things into Chase Memorial. At Humanitas, the elderly establish relationships with the younger generation, the youth bring in fresh ideas and conversations, leading to greater levels of engagement in life on the part of the elderly residents.

I looked to see if there were any of these Nursing Home/Dormitory combinations here in the United States. I found one in Ohio. The Cleveland Institute of Music is pairing with Dobson House, a home for the retired, providing free room and board to the college student in exchange for performances and time spent; a minimum of 30 hours per month per student. Increased interaction in the elderly, the article stated, has been shown to decrease the effects of Alzheimer’s Disease, heart disease and cancer. The students gain the benefit of free room and board, but also gain immeasurably from their interaction with their elders. The old and the young, living together to their mutual benefit. What an idea!

Our elderly were never meant to be shut up in homes together with each other and apart from the rest of the world. This is a product of an American society that has spread and changed and lost its roots. Few families stay together in the same geographic location. The elderly members may choose to sign themselves into retirement situations, many feel that they would be too much of a “burden” on their adult children and on their grandchildren. I would argue that this move away from extended family toward nuclear families living in geographic isolation from one another is a negative thing for all involved. The aging should be kept close, we should respect their wisdom and their experience. Whenever possible, we ought not to have them institutionalized. In Gawande’s book, even the best retirement homes can feel oppressive to Americans who have been free their entire lives and are suddenly subject to rules and regulations and routines that are not their own. But this is where we are, and economically it may not even be feasible for families to have their elderly move in with them, even with the most loving of intentions. If you are going to have to spend your last days in an institution, let it be one like Humanitas, Dobson, or Chase Memorial, where the human dignity of the residents is preserved by people going out of their way to provide actual palpable engagement and interesting conversations and experiences to those who cannot get out to find these on their own.

These care centers for the elderly, with the focus on living life, continuing to develop relationships and caring for living things and one another are the closest thing we have to the old extended family model from previous days. “It’s tough to get old,” as my father is known to say, but less tough, perhaps for residents blessed with the company of youth and a focus on the living of life.

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Bette HamannDisplay