Having Conversations With Dementia Patients

     Page Two Hundred Seventy-Four.
     Some old work supplies were recently returned to me by a friend who borrowed them a couple of years ago. She's a college instructor who used them to show her art therapy classes different ways to interact and have meaningful conversations with people with moderate to severe dementia from Alzheimer's or any other memory impairment. These books were assembled by me for me when I was in charge of activities for two dementia units in a nearby nursing home.     
     One of the books is nothing but photos of people, places and things which people born prior to 1940 or so would be able to relate to. The worlds of entertainment, politics, sports and current events are all included. I copied the pictures from history books and then assembled them in a binder and used it over and over again for the years that I was on that job. Just showing people the pictures conjured up old, buried memories and subsequently, conversations began. I'd strongly recommend any care-giver to a demented loved one consider creating a similar book. It can help provide hours of stimulating conversation. Of course, it helps if the care-giver has done a little research on the various topics so as to prod the conversation along. 
     These photos are an example of ones in my book. Admittedly, I'm a grand risk-taker. Not all of these pictures would be appropriate for all audiences, but in my racially and religiously integrated nursing home, I used photos quite similar to these with great effect. You know your loved one, I don't. But, you'll be surprised what gets the juices going.

Meeting Mabel

     Page Sixty-One.
     When I was new in the activities department of Fancy-Shmancy Nursing Home in 2003, it took me a few weeks to meet all the residents. Gradually though, I met everybody and started establishing some pleasant relationships. I was told in advance that one particular woman, Mabel, would be very entertaining. She'd moved into the home about one year earlier at the age of 98 and she'd lived at home by herself until moving into Fancy-Shmancy.
     So one afternoon, I went to her room and knocked. I'd already worked in the hospital for a few years, so I knew what to expect. I knew that Mabel would be taking a nap, doing a puzzle, watching a soap or some such thing. After all, like I said, I'd already done this type of thing a thousand times. So, anyhow, I knocked. "Just a minute. Be right there." At least I didn't wake her up, I thought. (I hate waking old people up.) After a long moment, a bright-eyed, small-framed, gray-coiffed, graciously-dressed, very old woman opened the door and with many teeth showing said, "hello, may I help you?" I introduced myself as Jeremy, the new activities assistant, and explained that I was trying to meet all the residents of the home.
     "Oh, yes. I heard about you. Please come in." She led me into her her room. "Please forgive my delay in opening the door. I was in the middle of emailing a friend in China when you knocked."  That told me everything right there. This 99 year old lady, in 2003, was emailing a friend in China. I realized right then that this was no ordinary, old lady. She was hip and knew what was going on. She wasn't scared of any technology or new gadgetry. Her attitude was "Bring It On, Baby". She amazed me. Today, I know people half her age who are substantially more intimidated by technology than she ever was.
     We would go on to become quite friendly. I visited her regularly, even after I got my promotion to activity coordinator of the dementia units. She would have to give up the computer about three years later (age 102) because her eyesight would fail. She would die four years after that (age 106). The last couple years of her life, I only saw her on Christmas. I'd eventually quit working at Fancy-Shmancy, but continued volunteering there. One of my regular volunteer gigs was covering Christmas; I visited all the residents in the home on that day and Mabel always gave me some See's chocolate which friends sent her for the holidays. She never lost her faculties either.
     I'll never forget the 99 year old lady whom I interrupted on the computer.

Nursing Home Fashion Shows

     Page Thirty-Three.
     While working at Fancy-Shmancy Nursing Home, from spring of '03 until autumn of '06, I ended up making a name for myself on a couple different fronts. I was technically in charge of activities for the two dementia units. But, I also started some new whole house activities; created some unusual Christmas decorating and established a vintage hat collection. Concerning the whole house activities: I started a series of fashion shows and I established a series of high teas. Today, I'm going to talk about the fashion shows.
     I actually discovered the concept of nursing home fashion shows while working at University Hospitals, my previous job. U.H. had an association with one of the local private girl's schools whereby the students came in once a year and strutted around in their finery. Where that tradition began, I'm not sure, but I then ran with it. 
     At Fancy-Shmancy, I was bored one day and told my boss about these shows and suggested that we do them. "Sure, Jeremy. Wonderful idea! Get right on it."
     "Who me? That's way too much work for MY delicate system."
     "Yes, you."
     So I called around and got in touch with the headmaster of a local girl's school, explained my need and he put me in touch with the student council president. She simply LOVED the idea. I forget if this was spring or autumn so I can't tell you if the initial offerings were prom or homecoming fashions but either way the girls and the old ladies all had a "simply marvelous" afternoon. I have a theory: all teenaged girls love to show off their clothing and all old ladies love to look at pretty teenaged girls who are dressed beautifully. If you disagree with my theory, that's okay. It's just a theory.
     My shows were always on Sunday afternoons and had light refreshments accompanying. Also, to elongate the afternoon's entertainment, I created a series of  slides. I would then supplement the live models with a slide show which illustrated more fashion: current, old Hollywood or ridiculously high-end - anything fun and exciting.
     I was always the host and commentator but the girls wrote out my cheat sheets in advance so I didn't have to work too terribly hard. Occasionally, I had help hosting. I had a co-worker who, in a previous career, worked in high-end fashion retail and she helped me comment on at least one occasion and maybe more. As a team we were great. For another show,  I phoned around and got a well-known fashion expert who used to own one of Shaker Heights' finer dress shops to come on in and comment.
     It got to the point where I printed up flyers and advertised, letting family members know about the shows. A lot of family showed up too. People had a great time. All in all, these shows, for all the work they took, were original and entertaining and the old ladies loved them. They were also low budget, always a plus in a nursing home.
     

Tea With Brini

     Page Thirty-Two.
     Around '90, I received a phone call from a woman named Brini. She'd gotten my name and info through word of mouth and was interested in having me do her hair. She lived sort of far out, in South Russell actually. S.R. is about thirty minutes east of me but a pretty drive and I was taking new clients at that time so I went out and met her. By the time someone greeted me in person for the first time, they already knew the story: I came to them and did their hair in the kitchen, or wherever. Considering the service, I was dirt cheap but I didn't care 'cause I was in college and was just trying to make some money 'till graduation.
     Brini's husband worked with some of my other clients so that was the connection. He was Vice President in charge of public relations and advertising of a large national company. Their home illustrated his worldly success, it was sheer glamor, as was she. She had to have been in her sixties and quite beautiful. In fact, I once told her that she looked a lot like Myna Loy. She took that as a compliment, as it was intended. We took to each other instantly and I would go out and cut her hair every third Friday afternoon for six or seven years.
     My long-lasting memories of her are absolutely dominated by the tea that we would sit and drink prior to cutting. Most visits would see the two of us simply sit together, drink hot tea and chat for up to an hour, before any scissors were picked up. We would talk about anything: my classes, her daughter, her mother, the Shapiro boys, etc. I now know that we talked about what people talk about when they sit and have tea together.
     She was of the generation and station that invited visitors to sit and enjoy a refreshment prior to any business being taken care of. I was on the receiving end of that twentieth century, upper class hospitality for those years. Brini would have had great similarities to Brooke Astor or Jackie Kennedy in that regard.
     It was quite entertaining for me and I think for her too. She got a kick out of me and told me so. During the eighties and nineties I was sort of punky/grungy/tacky/trashy looking; very different than my personality; which was then inconsistent with my living position (male live-in nanny). This disconnect really mystified people and kept many mouths babbling endlessly like beautiful Vermont brooks. Brini told me that she liked talking with me 'cause I wasn't boring, like so many people in her circle.
     So tea with Brini was just one more of those pleasant memories that I look back on and think, "how did I get here? Just luck I guess".
     Eventually Brini got a new colorist who insisted on cutting and styling as a condition to coloring. So we had to part. That was okay. I understood. Some years ago I heard that she had pretty bad dementia. Then a few months ago I saw where her husband died. I wanted to go to the funeral but couldn't make it.
     We meet so many people in our lives. We know some for only five minutes, others we know for decades. We're blessed when people who aren't with us for a very long time have a long-lasting and positive effect.

Denial

     Page Five.
     I've done a lot of elder care in addition to child care over the years. In 1998, I was hired to be a companion to a gentleman who wasn't old, only mid-sixties, but who had a bad form of Parkinson's. I forget the exact name of his type, but it really eats away at the brain and causes severe dementia as well as the typical shakiness. He was a retired psychologist and his wife was a geriatric researcher of some type. They were quite pleasant and hired me on as she realized more and more that she didn't want him home alone while she worked full time.
     After a couple of months though, I was getting nervous because whenever he and I went out, he drove. He turned in front of oncoming traffic and made other such boo-boos that I felt endangered our safety. These boo-boos happened a few times over the course of some weeks before I finally mentioned them to his wife. She told me that she would talk with him. The next day she called me back to say that he didn't know what I was talking about and that he was going to continue driving when we were together. She said further that she trusted him and I should just calm down. I was stunned that she would take that stand, but as I needed the money I decided to keep my mouth shut and pray deeply whenever we drove together. That job wouldn't last long, only a couple more months, this was just as well.
     Some years later, I'd be the Activities Coordinator for two dementia units in a fancy shmancy nursing home. I would come to realize where this wife was coming from. She came from a land called Denial. Denial is a wonderful and effective defense mechanism some people employ when they simply can't cope with reality.Whether it's the reality of a husband's dementia, a son's drug problem or a mother's terminal cancer it protects us from terrible pain. Problem is, in the long run it ends up causing more problems than it solves. It prevents healthy decision making and proper treatment plans from being introduced into the life of the loved one in question.
     In the nursing home we once had a family move their mom onto my unit and we were given the standard "Mom's forgetful" as the forms were being filled out. Turns out that Mom was so advanced in her dementia that she'd forgotten how to feed herself. Whom did this family think they were going to fool? (They were really trying to fool themselves.) At the end of the first day, Mom was transferred to a different unit where she could be cared for properly, and family had to endure a double trauma: placing Mom in a nursing home and then receiving a phone call saying Mom was much more advanced than they realized. I would implore anybody with a demented loved one to be as honest as they possibly can be about the situation, painful as it may be. In these situations, family denial really can make it worse.