Music Appreciation

The first week of May is Music Appreciation week. What a great week to celebrate. We all know the value of music for our clients. There are so many music activities to do from reminiscing to entertainment. So schedule in a week of music appreciation for your facility!

Long lasting love

In the nursing home, we have several husbands and wives.  None that live here, but one spouse will visit the other.  There are a few that we as staff marvel at the dedication and love they still have for each other.  I always hope that if I am in a care facility one day in the distant future, my husband will be as kind, patient, and dedicated to me.  These couples truly are inspirational.  I doubt they know they are the topic of conversation among staff for their love.  To them it is a natural thing, an extension of spending most of their lives together. But we all know that it is not the every day occur acne.  With divorce being commonplace, and couples splitting up , or never even getting married, the kind of  love that last a lifetime is rare.  A love that stays even when one person has dementia and asks the same questions over and over. Its this patience and understanding that we all desire and admire.

Making People Happy

I have learned from my job that you can't make everyone happy.  Sometimes, you have to allow someone to be upset with you in order to benefit the most people.  With so many different residents to provide activities for, there is always times when someone is not going to like what you have planned.  When it is someone who is very opinionated and vocal, it can be very disheartening and frustrating to hear complaints.  There are times I have to remind residents I work with that there are other people in the building and we have to provide a variety of groups and services.
As with residents, there are times when I have to do something that makes my boys unhappy to make things better for the good of all.  Once I became comfortable with the fact that there are times what I decide won't make some people happy, it became easier to make those decisions at home too.  Sometimes, especially as a Mom, you have to be the bad guy.
This seems like an easy lesson, but for someone who likes to make people happy, and that essentially is my job, acquiring that thick skin took me a while.  

Savor it

With my boys, there are times when I just wish I could capture that moment and keep it to review later in the same crispness of the present time.  Or to be able to visit that moment again.  Looking back on when the boys were infants, I often think that I would love to go back to that time when they were itty-bitty, just for a day.  It was crazy, sleep deprived and wonderful.  But we can't revisit them.  All we have are our memories of it.  I know that many of the older people I work with at the nursing home, spend a lot of time remembering the past.  I often think that I have to really focus to make those memories so that when I am old I can sit and think fondly of the things that happened in my life.  There are times you have to think about the moment and focus on it, to make it into a memory.  If we don't remind ourselves of the good times we may not remember them. 
Memories are not made watching TV or playing on the computer.  We make family memories from our experiences.  Camping trips, playing in the rain, hiking etc, are all moments to remember.  Both memories for us as parents, but also for the kids to look back on and think about the fun they had.  Maybe when I am old and forgetful, they can visit me and remind me of those wonderful family experiences.

Horrible news....

There have been a lot of horrific events on the news over the past year.  I am thinking of Newton, and Boston and even the Oklahoma tornadoes.  Television stations play the coverage of these events continuously.   I find myself wanting to shield both my young children and the senior population from the endless barrage of bed news and terror.   My children, we just don't watch the news at home, and we try to completely shield them from seeing any of it.  The boys are young and can't understand, and question and worry and have bad dreams.  The know there are bad guys in the world, but I don't want them to worry that someone will shoot them at school.  They aren't looking at the world through rose colored glasses, but they don't need to be exposed to everything yet. There is plenty of time for that.
At work, some of the older people need to get away from all the negative drama.  I often ask the staff to turn off the TVs whenever possible and not talk about it with or in front of our resident with dementia.  These residents can not always distinguish between their own reality and what had happened elsewhere in the world.  They may worry about their children and their safety.  Other residents just need a break as well.  Watching negative TV all day can be very depressing for anyone.  We always encourage people to turn off the TV and to say a prayer for the people and for the helpers and first responders.  We try to channel their worry into something positive.  Its OK to encourage residents to turn off the TV and get out of their rooms.  Plan a fund raiser to help.  Anything to help them turn the negative into a positive for them and let them feel that they are somehow helping make things better.  Because really, isn't that what we all want to do?

Celebrate Life

Today a family member gave her mother (one of our residents) a "Celebration of Life" party.  Her mother, is declining.  When the daughter and the mother were discussing death and all that it entails, funerals etc, the mother stated she wants to be a part of the party.  Hence today's event.  It was a lot of fun and the mom and daughter, both had a great time and enjoyed themselves.  Celebrating someone's life when they are still alive doesn't happen that often.  But why not.  We need to let our elders know how much they are loved and appreciated when they are still with us.  Actually, we need to do that for everyone who is special to us; no matter what the age.  We all know that life is short and can be taken away from us at any time.  Celebrate life when your elderly loved one is still alive to celebrate, and feel loved and special.  She may be gone tomorrow.     

Bad Behavior

What do you do when the behavior of one person upsets another?  At my facility we had an incident where a resident with increased confusion was yelling at staff and calling them racial slurs and other derogatory names.  This resident has had a pretty quick cognitive decline and until recently has not been this belligerent and vocal.  Until recently, she was a relatively social woman who participated in many activities.  Her daughters visit her several times a week.  When she had this recent very public outburst, another resident who is a very social, cognitively active black woman, witness part of it.  She was deeply offended and took the words being said pretty personal, though they were not directed at her.

When she came to me obviously upset, I really could not offer her any comfort.  I tried to explain to her that the resident yelling is sick and it is her illness that is causing her to say such things.  And there are times when, though we would like to, we can not change a person’s behavior.    Just because you are in a nursing home, you are not sheltered from or immune to, the ugly in the world. 

Good bye to our young friends

At my facility we are lucky to have a wonderful day care center less than a block away. For several years, we have teamed up with the pre-K class for intergenerational visits.  Because the daycare works on a school type schedule, the same children remain in the classes from September to August each year.  This year the Pre-K class was able to visit us every two weeks.  With the same children coming to visit each time, we have been able to watch them grow, and to watch the relationships between our seniors and the children grow and bloom as well.   We have watched their hesitation and fear of the elderly and visiting a nursing home, melt away.  After only a couple of visits, the kids realize the residents here are just older people who happen to need a wheelchair, and visiting a nursing home can be fun.  Each time they come to visit us, the children run to their special older friends.  They all have certain residents that they have bonded with and look forward to seeing each time they come. 

The teacher and I take turns deciding on what projects the group will be doing each week.  We have done everything from rock painting for the garden, to show and tell, with both children and seniors showing and sharing their treasured items.  (This event was especially popular).  Next week is our last visit as the children in this class will be moving off to kindergarten.  We are planning a good bye picnic with the senior and children sharing a meal in the garden (decorated with beautiful rocks).   It will be bittersweet to say good bye to this group of kids.  They have won a special place in the hearts of many seniors.  Several of the children have asked me if they could come visit after their class is done.  What a wonderful testament to the bond they have formed with their older friends! 

Update on Chloe...

My wonderful dog Chloe, is getting old, and it is starting to show.  She is nearly 14 now.  If we go by the thought that 1 dog year is equal to 7 human years, she would be close to 98 years old.   For the past year or so, we have noticed that she is slowing down and not enjoying the things she use to.  But just lately, her age is really become evident.  She is having hip problems and stumbles at times.  Occasionally her back leg entirely gives out and she falls.  She seems surprised when this happens.  She has also fallen part way down the stairs because of it.  All of these is very sad to watch.  It really breaks my heart.  This is the dog who hiked miles up mountians with us.  Who always went camping and loved it. 
The other day we put her outside to do her business in the morning and she disappeared.  She was discovered hours later in one of our neighbors' garage.  I honestly think that she might have wandered away and not been able to find her way home. I think she has doggy dementia.  She will often stand still in one spot and stare at the floor of the wall for long periods of time.  Or, the other extreme, wander around the house in circles, like she doesn't know what to do.  This restlessness, added with her staggering when her hip gives out, really puts me on edge.   To complicate matters  she seems to no longer be able to hear much at all.  And she has cataracts in both eyes.  Old age is the pits, even for dogs. 
The medicine the vet gave us for her hips, seems to be making her sick.  She has had diarrhea several times this week, only at night, and only when sleeping in the boys room.  Thank goodness we have a carpet cleaning vacuum!  Chloe has really made sure we got our money's worth this week.  So now she is off the new medicine, and we'll see what happens.  I am cooking rice and plain chicken for her.  The vet said a bland diet.  Chloe seems to be a bit picky about it though.  She is leaving a lot of the rice behind.  I may have to switch to pasta instead.  A girl after my own heart! 

Worlds are Colliding!!

Every two weeks, the Pre-K class from the daycare across the street from the Nursing home I work in, come to visit and do special projects with the residents.  This program has been set up for years.  Many of the staff here and the residents know that my boys go to that daycare.  For the last few years, they have been asking if my boys were in the group.   This is the first year, my oldest, K, is in the class that comes to visit. 

K has been coming to the nursing home every few months since he was born.  I mistakenly assumed he would have no problem visiting with his class. Unfortunately, it seems that his biggest problem is being here with both me in the room, and his class and teacher.  It is like his worlds are colliding!  He wants to sit near me and hug Mommy, but he is also trying to follow the directions and do what his teacher asks him.  Some visits are better than others, but it is an issue I never considered.  I guess for a 4 and ½ year old, it’s a little confusing to see your mom in a different setting.  Hopefully it has, and will be, a good learning and growing experience for him!  Personally I have always believed that any exposure to the elderly, and the nursing home setting, for children of any age, can only benefit them! 

Full Moon

If you have ever worked in a nursing home you know about the "full moon effect."  There are theories and talk about the full moon effecting behaviors of patients with dementia.  Those patients are said to have more confusion, agitation, wandering, and an increased number of falls due to the full moon.   I don't know if I really believe it, but I have never done a real study of it either.  Behaviors do seem to cycle.  Many residents seem to cycle with falls as well.  Whether it is the full moon may just be circumstance, but you never know.  Personally, I think that it is a way to explain things when we want to find an explanation, though it might not be the cause.   As caretakers, we are constantly trying to find the root cause of behaviors and falls.  If we can't figure out why a person's behaviors are escalating, maybe it is because of the full moon.  Why was there an increased number of falls over a weekend?  Must have been the full moon.
 We are always looking for answers, and sometimes, we can't find one, and therefore feel lacking.  Sometimes we also don't want to believe that we could be the cause.  Maybe the increase falls over the weekend have to do with staffing, or lack of programming etc.  Or maybe just the full moon!

Affection

There are times when my kids and the old people I work with both just want to be near me and to hold my hand or give me a kiss.  We aren't talking about the dirty old man type of wanting to give me a kiss, though that does happen occasionally.  There are ladies that just want to give someone a hug or a kiss.  One lady in particular, when she is awake and alert, will pull you in close and give you a kiss. She is very strong too, so you have to be careful because she can get you in a head -lock.  But everyone needs affection, and an affectionate touch.  I think when some people don't get affection that way enough, they reach out for it.  This happens with the elderly and those of us who work with them are use to it, but it can make others uncomfortable.  As adults we are often uncomfortable with touching others. 
 With my children, they want to sit on my lap or be close to me when we are together after a day at work.  At time it is smothering, but it is love.  But love from a child is a pure thing.  Some time I ask them to get off me and leave me alone for a while, but it doesn't last.  There are times when I needs a hugs from them as well! 

Veteran's Day

I am lucky to have a job in which I am required to get to know people and talk to them about thier lives.  Most people have an interesting story to tell, even if they don't think so.  working in a nursing home, I have meet some wonderful people and gotten to know some great men and women who have taught me lessons and things about myself.  I am blessed to know many great Veteran's from various wars.  Seeing pictures of my old friends in thier younger days in uniform can make you sad. But they are the lucky ones.  They lived to see thier old age.  Many didn't.  Many boys who served with these brave men didn't come back.  Seeing the pictures of them as handsome, brave, men standing proud in thier uniforms, makes me feel so lucky to know them.  These wonderful men ( and women), have lived a great life and came home for the war to raise families, work hard and be successful.  Comparing the photos of them then, in thier younger days to now, is just proof that they lived a long and mostly happy life.  They are rightly proud of thier service to thier country, and I and many others are proud to know them. 

quiet time

We all need a little quiet time. Sometimes at the nursing home, we wonder why our residents are agitated.  Maybe it is because they need some quiet in their day.  I know working with people all day who makes demands on me, and then going home to my wonderful, but very attention demanding boys, can be exhausting.  I find myself yearning for a day home alone.  We are always encouraging people to be involved, eat in the dining areas, be social, but maybe they just want to sit in their quiet room and have some solitude.  It they chose to do this, then it is perfectly acceptable.   Living in a nursing home is seldom a quiet place.  Our residents are surrounded by people.  They may have more contact with people now then they have in the last ten years.  Sometimes we have to realize that quiet is a good thing.  The brain needs that time to center itself and focus.  It gives us time to center our selves and rejuvenate our being.  Turn off the TV, turn off the radio and just enjoy the quiet. 

Go outside!

With kids you always know when they need to go outside and run around.  With the elderly, we forget at times that they too need to get outside and enjoy the fresh air and sunshine, even if they can't run around in it.  Getting a change of scenery does us all good.  Staying inside all day everyday is a good way to become disoriented and disconnected with reality.  Nearly everyone can benefit from time outside, especially in the beautiful late summer early fall weather.  Being in the northeast, I know sooner than we would like it will be cold and snowing, so get everyone outside when you can.  When the weather first starts getting nicer, there is often an increase behaviors and wandering on dementia units.  This may be related to the patients need to get outside, if only to feel the sunshine on their face. 

Poor Chloe is getting old!

My dog Chloe has been going to work with me several times a week for almost as long as I have worked in the nursing home (nearly 9 years).  For most of that time, she has been able to run around the building and go relatively where she pleases.  She gets on the elevator, and goes up to the 2nd and 3rd floors, visits residents in their rooms and generally making the place feel more homey with a pet wandering around.  All those years, I have never had a problem with Chloe going out the front doors; even though they open automatically with a motion sensor.  Now, the last two times she has visited the nursing home, she has each time, ran out the front door.  Why?  I don't know.  She doesn't want to come in from the courtyard when she is out there, and she just hasn't been acting like herself when she is there.  I don't know what has changed, but she just doesn't seem to like being at the nursing home anymore.  This isn't saying she doesn't want to go each morning when we are getting ready to leave the house.  She follows me around all morning and stands waiting expectantly when we are going out the door to get in the car.  She is just waiting for me to say,"  You wanna go to work?", so she can run out and hop in the back of the car.

Chloe has been, is I should say, a great dog.  She has loved going to work and has brought much happiness to many people there.  Her presence at the nursing home will be missed by staff and residents alike.  I know there are many staff members with dog biscuits in their desk, who will have to find another dog to give them to.  Unfortunately, I think Chloe's visiting days are over.  It is an end of an era.  I must say I was a little sad and sentimental last week when I had to drive her home after she went out the front door again.  It is too dangerous.  If she can't have her usual freedom, I can't bring her in.  So, Chloedog, on behalf of all the residents and staff, thank you for years of visits, and love.  You will be missed.  Come again for a short visit, but not all day.

Routine

If you have kids you know how important a routine can be for them.  Parents learn pretty early on the importance of a good bedtime routine to help babies fall asleep and stay asleep throughout the night.  Routine the rest of the day becomes just as important.  Children need things to be predictable.   I can remember when K was just a baby, his grandparents would visit and it would upset his daily routine. He would have trouble sleeping for several nights after their visit.   They did nothing wrong, and loved him immeasurably, but he was just throw off enough by having different people in the house holding and feeding him, that it had an effect on his sleep.  Now that the boys are bigger, we still try to keep a daily routine, especially about bedtimes.   Our nights are usually dinner, playtime or a little TV, baths, books,and in bed by 8:00 pm. 

As an adult we tend to want variety.  We have routine habits, but crave some excitement as well.

 Life in the nursing home can be pretty routine for the residents I work with.  For some of them it is so important to keep things the same.  If you sit someone in the wrong spot in the dining room you may have hell to pay!  Our residents with dementia need the routine days.  Just like young children, they need the structure and predictability.  It helps to avoid any behavior issues.  This is easy to say, but at times hard to do.   I often wonder if we were more routine at the nursing home, maybe there would be less behaviors.  If I had more time, and energy, maybe I would conduct a research study on this....  

Cherishing the moment

Sometimes we have to remind ourselves to slow down and stop trying to change things and just enjoy our children or our parents the way they are.  We might want them to be different,  to act different, to hurry up or try harder.  But, there are times we have to stop ourselves and realize it doesn't really matter if we walk a little slower or spill the milk or not know the day or the week or remember something else.  At the nursing home, we occasionally see people who have not come to terms with their loved one's quickly advancing dementia.  A few weeks ago, I witnessed a daughter trying in her own way to encourage her mother to try and participate in physical therapy.  The mom was 100 years old and as an outside observer it sounded more like the daughter was yelling at her mother for not  working harder, and in response the mom told her she didn't want to see her there anymore. At this moment I just wanted to tell the daughter to  enjoy her mom for the time they have left together , and stop trying to make her into what she use to be, a person that she won't be again.   

Recently, after a very long winter, it was finally a nice day and I took the boys for a walk in our quiet neighborhood.  K stopped every few steps to look at the dirt, the grass, to play with the fire hydrants, to look in the street drains etc.  It makes for a very slow walk.  I began the walk trying to walk faster to get a little exercise into the outing, but with so many stops it was impossible, and I was getting annoyed.  But why?  I decided to change my mindset and enjoy the exploration through a toddler's eyes.  Then we both had fun and saw new things. 
Sometimes, its all in how we think, and how we feel.  We often need to be the ones to change our attitudes to enjoy the moments that we are given. 

the witching hour

There is that time of day, the late afternoon, around dinner time, when kids get cranky.   My mom calls this the "witching hour."   K and JJ get cranky and then some at times.  They are tired and hungry, and don't want to wait for dinner.  This is the same time of day that "Sundowning" sets in with the dementia residents.  Maybe they too are tired and hungry.  Maybe being tired and hungry makes the elderly dementia resident's confusing level increase....  but I know its not that simple.
Often when they are tired, the boys hit melt down mode.  And you never know what will set them off into a complete frenzy.  There are times when I just have to take a step back and laugh.  (of course never in front of the boys as they are crying!)  My favorite tantrum was when K was younger, and he was hungry.  I gave him a piece of bread, he threw it on the floor, and proceeded to throw himself on the floor just far enough away that the bread was out of his reach.  He was laying on his stomach on the floor crying "Mommy, I can't reach it!"  over and over.  It was like he was in a desert crawling to the oasis and couldn't just make the last few inches.  These are usually the times I have to either walk away or put K upstairs in his room to calm down.  Usually if we ignore him, he will get over it and switch gears back to normal in a few minutes, like nothing happened. 
JJ is just starting to show more of his temper and to throw a few tantrums.    So far any tantrum he has had  have been very short and his is easy to distract.  But... he certainly has a bad temper at times.  He is much calmer overall than his big brother, so it'll be interesting to see what happens in the next few years as he finds his way, and strives for independence!

Say What?

 My little guy,JJ will be two at the end of the month.  Wow, those two years went fast.  He is of course, learning to talk, starting to put words together and all that. But, his speech really isn't that clear yet.  It is impossible for Daddy and I not to compare the boys.  K. was much more advanced in his language skills at this age.  It had me worried for a while that JJ was so far behind, but I think now that he is just normal.  Sometimes I really don't know what he is saying.  Tonight at dinner I thought he was asking for more rice and he was saying "there it is." I only figured that out, because he wasn't pointing at the bowl of rice, he was pointing at the front door, and  "there it is"  was part of a game he and K were playing earlier.
He is getting there, but I certainly am guessing at what he is saying at times.  At least he is expressive and does a lot of pointing so we can put two and two together and figure it out.  Plus, he is still only saying two words or short phrases, nothing complicated.  So usually we can decipher what he is saying, usually.
  Yesterday, when at work and talking with one of my older friends, (she is at least 93), I couldn't understand what she was trying to tell me, and I felt bad.  She was obviously getting frustrated with herself for not being able to get the words out the right way.  She had recently had a stroke, and with her expressive aphasia, it can be very difficult for her to talk to others because the words get stuck in her head and different words sometimes come out which make no sense.   I try my best not to just pretend I know what she is saying, because that won't help her, and she knows that I don't know what she said..
Now, I am by no means comparing here, but as one who listens, you do learn to decipher language in a unique way that is helpful in both situations. I think having a child with poor pronunciation, has helped my ear to listen to others who do not speak as clearly, and vice versa.

Anyone interested in expressive aphasia, should look at a blog by someone who has had it... read expressiveaphasia.blogspot.com.
Pretty cool.