New Year, Big News!

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I’ve been stalling, but I have to update my occupation.

If you know me, you know I eat, sleep, and breathe senior living. Serving the elderly means so much to me both personally and professionally. Being an Executive Director has been an absolute honor, but for now, I’m taking a break..

Instead of midnight calls to the community (always watching those pendant response times🤪), I’m doing midnight feedings.

Instead of reporting a fever to the DOH, I’m alerting the pediatrician. 🤒

Instead of daily standup, we’re working on rolling over. 😉

Instead of managing labor (and covering open shifts 🫠🆘), I’m scheduling naps.

Instead of dreading snow, I’m actually looking forward to it this season. ☃️

I’m taking a step back to be home with my babies, my two under two😵‍💫🥰, and to shift my focus in what I consider to be the most fulfilling line of work there is: elder care. More on my next venture to come.. 👵🏼👴🏼

Fingerprinting Kit

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This morning, I had the pleasure of speaking about memory care to a virtual caregiver support group. I explained the various options for those living with dementia, including day programs, assisted livings, and nursing homes. We also reviewed how to know when it’s time to make a move, as well as different approaches to the transition itself. A recurring theme throughout our entire discussion was meeting the individual where they are cognitively and, perhaps most importantly, validating their feelings.

I’ve written about validation before: it’s the acceptance of the reality and personal truth of another’s experience (even if, as is often the case with dementia, it’s not accurate). Validation therapy aims to help individuals with dementia be as happy as possible; when their struggle is respected and validated by a trusted person, withdrawal is halted and dignity restored. According to the queen of validation therapy herself, Naomi Feil says:

“Validation is a way of communicating with very old people who have Alzheimer’s-type dementia. … It’s a way of being with them, feeling what they feel. You pick up their emotions and reflect them back. People who are validated feel safe.” –Naomi Feil

I gave a few examples, one of which happens to be a favorite memory of mine. It involves a couple I’ve referenced before – they certainly kept me on my toes! 😉 Both husband and wife were living with dementia and when one had an idea in their head, they’d rile the other up and fixate on it together. To say they were willful would be an understatement. One afternoon, this headstrong nonno had an upset stomach and a subsequent accident, which was not common for him. It was both embarrassing and a bit rattling, resulting in a swift cleanup process and no further mention of it. Unfortunately, while receiving help to get washed up, his watch ended up in the trash along with his soiled clothes. We didn’t realize it was missing until it was too late and the garbage had gone out, at which time we apologetically explained the mishap and collectively moved on. Or so we thought..

The bathroom accident was (thankfully) quickly forgotten, but the watch itself was not. When gently reminded of the incident, my love vehemently denied that it could have possibly occurred. A few days passed, and both my spirited nonno and nonna were livid that his watch was “stolen”. I “conducted investigations”, searched the apartment on my hands and knees, and even recruited backup – their kids. It wasn’t enough. Finally, I asked two friendly police officers from town (and by “friendly” I mean the best of the best, clearly) to pop in and speak to him. In other words, I asked them to validate his feelings.

Let’s just say they well exceeded my expectations, and I (along with my favorite couple’s children) are forever grateful. The officers were greeted in the lobby by my angry, justice-seeking loves and explained how the process would work: they’d go up to search the apartment with their “fingerprinting kit” and track down the thief, who would obviously be arrested and charged. They didn’t have to spend much time at our community, nor did they need to follow up – it was enough. Their empathetic, genuine validation was more than enough. We never spoke of the watch again.

Bridge the Gap Podcast

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This month, I had the pleasure of (virtually) sitting down with Joshua Crisp and Lucas McCurdy, co-hosts of Bridge the Gap. The senior living podcast aims to help shape the culture of the industry by being an advocate and positive voice of influence. Hearing about their mission and values was like music to my ears, so when they asked me to join them for an episode, I was ecstatic. Full interview (which is about more than our wedding, I promise ;)) in the attached video!

Operation Green Sheets

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One of my favorite nonnos of all time passed last week. He was hands down the most spirited, loyal, fun-loving resident I’ve had the pleasure of serving, and he adored his wife. No matter the circumstance, he’d support her blindly. They’d dance to any song and, if separated, he was beside himself. During a brief stint in the hospital (for her), he sat in the lobby from morning until night awaiting her return. Literally, he didn’t move (except to yell into my office every hour for an update).

My “boyfriend” was also extremely headstrong, and he and his beautiful wife both lived with dementia. When she had an idea in her head, she’d rile him up and they would fixate on it. Dementia is so f’ing weird – they’d forget that they ate breakfast but despite my prayers and redirection, they’d remember every detail of these delusions. I’m cracking up at the thought and at the memory of them standing in my office, him raising his voice (& sometimes his middle finger) and her egging him on.

One of my favorite stories of Mr. & Mrs. M came to be fondly referred to as “Operation Green Sheets”. One morning, they came to alert me of a probable theft: their daughter-in-law had bought them a set of green sheets, which were now missing. Thankfully, I had a great relationship with their two sons, who were insanely understanding and supportive. I know it’s horrible to say (but I always say it anyway) – I’ve seen a lot of amazing, involved daughters, but those really good, patient, helpful sons.. they’re a dime a dozen (sorry, boys). These two are exceptional. A quick text confirmed there was not, in fact, a green sheets delivery. We laughed it off, reassured them that they were in the laundry, and hoped they’d be forgotten by morning.

To our disappointment, these were the most memorable made-up sheets in the history of fake bedding. A few days passed with constant calls, visits, and middle fingers. I was out of excuses and there was no appeasing them. I sent the boys two shades of green and by the grace of God, they picked the right color – they arrived via Amazon Prime the next morning and when delivered, my loves shouted in unison, “That’s them!”. Crisis averted, and this time without the help of the police (I’ll save that story for another post 😉).

I was only lucky enough to spend a brief time with Mr. M. However, I don’t need to have known him forever to be certain the world will be a duller place without him. I will be always grateful for his lessons, laughs, love, and even middle fingers. May he rest in the sweetest peace. ❤

Face Value

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When caring for a loved one with dementia, you’re often faced with situations that don’t seem logical; they’re far from “normal” and can be downright confusing. In fact, most lack “common sense” altogether… at least at face value. Working in the field, one of the most important lessons I’ve learned is that nothing is as it seems. Today, for the millionth time, it was reiterated by one of my favorite nonnos.

In the senior living world, the word investigation is part of our everyday vocabulary. Unusual behaviors? Investigate the unmet need. Frequent falls? Investigate environment, meds, and other risk factors. As time consuming as they can be, investigations are also super practical, especially when faced with puzzling scenarios. There’s a level of formality we associate with them that isn’t always necessary or applicable. Sometimes an open mind, creative thought, and a little digging are all you need.

There have been some concerns about the hygiene of the nonno I mentioned. Other residents have been complaining that he stinks and he always looks unkempt. Though in the earlier stages of dementia, he is fiercely independent and doesn’t let us help him with anything; we can’t so much as lay out his outfits in the morning without a fight. Oddly enough, when by the grace of God he lets us do routine skin checks, everything looks good. His hair and beard aren’t oily, either, but the odor he emits is pungent. He swears he showers regularly, but how could that be?!

Cue investigation mode. I thankfully have a good rapport with my sarcastic, headstrong love, so I felt comfortable being honest with our concerns (in an extremely kind, empathetic way, obviously). It was immediately apparent that his clothes were filthy. He admitted to keeping them on for a few days and thinking nothing of it, which is not uncommon with dementia. When I affectionately offered to pick out a fresh outfit for dinner, though, I discovered the most pressing issue: he has nothing to wear. Aside from a pair of cargo shorts and a ripped, medium-sized t-shirt in his closet (he’s an XXL), there was next to nothing to choose from. In his mind, however, that didn’t matter – he had clothes on his back and, thankfully for him, a poor sense of smell & self-awareness.

A pep talk, some hand-me-downs, and a phone call to his POA later, I left him with the agreement that he’d continue bathing regularly and change his clothes every day. I held my breath for the rest of the afternoon until I heard him roll out of the elevator. To my most pleasant surprise, he changed for dinner! Had we continued to take this situation at face value, I’m confident that it would’ve gone an entirely different route.

The fact that this nonno never mentioned his dilemma makes no sense, but with dementia, nothing does. Whether he was too embarrassed to bring it up or just flat out unbothered is irrelevant; what’s important is that we gave him the benefit of the doubt and dug deeper. We nixed face value and investigated, and I can confidently say we’re all better off for it.

There’s a First Time for Everything

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It’s no secret that I’m a big proponent of therapeutic fibbing. I’m also known to use obituaries in my favor, especially when comforting residents and referencing family members (seriously, what a resource). Last week was a first for me, though – I not only Googled the obit of a nonna’s recently deceased boyfriend, I edited it. I copy & pasted it into Microsoft Word and made some subtle (yet major) alterations, and it was a game changer. It sounds way worse than it is, I promise!

On Monday, the daughter (“D”) of one of my feistiest loves came to my office beside herself. Her mom’s partner of nearly 25 years had just passed, and if that alone wasn’t stressful enough, she had a rocky relationship with his family. If I’m being honest, his kids despised her. She unfortunately wasn’t welcome at his funeral (nor was she mentioned in his obituary), and D had no idea how she’d break the news. While her mom has dementia, she’s in those earlier stages; she understood he died and was calling constantly to find out service details (and, of course, about her obit shout-out).

After a quick search, we pulled up the article together and put it into a blank document. Thankfully, D was on board with my unconventional plan; though there was no malintent, I knew the suggestion to doctor an f’ing obituary could be taken either way. She agreed the truth would do more harm than good, causing Mom some serious heartache (and resulting in a ton more phone calls). Ten minutes and one “in lieu of services..” signoff later, D was off to break the news. Different news than she’d planned, but news nonetheless.

I visited with mamma the next morning and my heart sank as I walked in to this:

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On her kitchen counter displayed proudly was a photo of the two of them and our infamous obituary. “I must’ve rubbed off on him,” she said – “I always told him funerals were a waste!” Our approach had been unusual but its results were extraordinary. With the purest intentions and her feelings at heart, we spared my love of some serious (and frankly at this point her life unnecessary) anguish. Once again it was confirmed that therapeutic fibbing can be a savior (as can the Internet and an obituary shout-out).

Can We Stop Being Weird About Death?

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When I talk about my job, I often liken it to working in a school: I’m the principal, my department heads teachers, and the residents our students. Structurally, we’re like a dormitory with its own caf and extra offices. Apartments feature mini-fridges, lack overhead lighting, and are separated by walls that are way too thin. Assisted living is surprisingly comparable socially, too: there are cliques, residents hook up, and newcomers need some time to settle in. Rumors spread like wildfire and most rules are taken as light suggestions, especially those pertaining to alcohol and hot plates.

Some things are drastically different, though. Over the past two months, an alarming number of residents have died – 11 people passed away. Most were on hospice and all were very sick, but it’s still been brutal. Unfortunately, such is the nature of this line of work; in elder care, death itself is not unusual, but the way we handle it is socially so bizarre:

“Death and its companion, grief, have a profound presence in long term care facilities. Residents may wake up one morning to find someone they saw every day in the dining room gone. Nursing aides may arrive at work to find an empty bed, occupied the day before by someone they’d helped for months. But the tides of emotion that ripple through these institutions are rarely acknowledged openly.”

–The Washington Post

Naturally, we view death as something that will upset our residents. When one of their neighbors pass, we’re adamant about keeping doors closed and wheeling the body discretely out the employee entrance. As devastating as it can be for us as staff, we hold it together for our seniors, offering support and encouraging strength. We justify their deaths and rationalize them as being timely and fair. I repeat, we justify their deaths and rationalize them as being timely and fair. Honestly, how insane does that sound?

Had even one student passed away at school, I can almost guarantee that classes would be canceled, vigils held, and grief counselors on sight immediately. We would openly mourn the loss together; we’d communicate how it made us feel. Grief for deceased elderly individuals is different – it’s referred to as being “disenfranchised” by society. Disenfranchised grief is experienced when people incur a loss that is not being/cannot be openly acknowledged, publicly mourned, or socially supported. In an effort to not upset or frighten residents, death in elder care facilities is structured to have minimum impact.

As I’m learning and growing in my role, I’m finding that there’s so much wrong with this approach. When we don’t acknowledge our feelings, especially sad ones, they can lead to a myriad of both physical and psychological symptoms. We (residents and staff) can become depressed, isolated, and exhausted. Health consequences aside, downplaying death is flat-out unnatural (and therefore uncomfortable) for us as human beings.

On Tuesday, I drove a van full of my loves to a fellow resident’s wake for the very first time. It wasn’t exactly a typical outing and it’s not something we’ll add to our daily activity calendar, but it was so, so worth the trip – our presence was cathartic, respectful, and normal. For once, we didn’t downplay our friend’s passing or the feelings it provoked. Going forward, there needs to be a shift in our approach: hosting candlelit vigils might be overkill, but we’re definitely done with rationalizing.

Let Me Live My Life

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I like to think of myself as a really laid back person; I’m a simple girl who rolls with the punches and is easy to please. However, like everyone else, I have my quirks. Over the past 31 years, I’ve naturally developed habits and preferences. Nothing unreasonable – I like to sleep in on weekends, I keep my thermostat at ~76 degrees, I hate eating breakfast, and underwear makes me claustrophobic. Obviously I’m flexible, but if I had to go an extended period of time out of my quirk comfort zone, I’d probably start to crack.

This past week, I had three of my evening shift employees come to me with concerns about a resident. Her usual caregiver had been struggling at bedtime, as this nonna (who I’ll call “S”) refused to join her and head up to her apartment from our lobby. Her teammates tried to help, thinking maybe it was that she simply didn’t care for aide but would be more willing with someone else. No such luck, though, and they were both stumped and upset: “How can we leave at 11 without putting her to bed?” While I appreciate their concern and eagerness, I, too, was confused – who’s to say she has to be asleep before they leave? & why? What’s the harm in letting her hang on the couch until she’s ready to head up? There are caregivers in the community around the clock – what’s the rush?

In most senior care settings, sleep and wake times are typically driven by staff. Sure, we ask about preferences, but caregivers have schedules to keep and tasks to complete. Residents are expected to conform to the needs of the community, which means not only that their needs may not be adequately met (or in a timely manner), but also that the setting itself may be a source of distress. As a result, like in the case of S, care is rejected and “behaviors” displayed.

S is headstrong, to say the least. If she’s not happy, she’ll let you f’ing know, and she won’t forget you made her mad. Dementia has a sneaky way of not causing troublesome behaviors, but preventing people from expressing the source of their anguish. Sometimes, it’s as simple as not being tired or a disruption in routine. If one’s reaction seems irrational, put yourself in their shoes: if someone woke me up too early, dressed me in granny panties under my outfit, and forced me to eat breakfast in a chilly dining room, I’d be cranky and uncomfortable. I’d suck it up for a while, I’m sure, but not forever. If, on top of that, no one was honoring my preferences or understanding my requests for change, I would, without shame, pull those undies off and push my plate away.

Situations like the one experienced by my night-owl-nonna arise all the time, and we as caregivers have a few options as to how we can respond: we can fight until someone surrenders, chalk it up to symptoms of the disease and (gasp!) medicate/sedate, or change our own approach. We can step into their world and adjust accordingly. Our front door locks at 9PM and there are caregivers staffed through the night; there’s no reason that S can’t hang until she’s sleepy (or that I can’t sleep in until I’m hungry).

Plan B

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In the assisted living world, we often say we’re in the “wellness business” as opposed to the “illness” one. Our approach is more person-centered and takes into account not only physical needs, but emotional and social ones, as well (to name a few). The focus has shifted from diagnoses and limitations to capabilities and what’s preserved. After all, no one wants to be defined by their health needs, and they certainly don’t want to simply exist:

“That would be the aim of good senior care: the aim to live, live, live until you die – that you’re dancing when you die. That would be the dream of most people. They don’t want to sit around and die slowly.”

– Mary Tabacchi

The above doesn’t have to be a pipe dream; it’s time to really practice what we preach. Too often, we concentrate on what our nonnas can’t do anymore as opposed to what they can. To worry is natural, especially when it comes to our more vulnerable loved ones. However, if we hone in on that fear and highlight limitations, we only disable them more. Keeping your nonno active in hobbies he enjoys is not only necessary, but with a little creativity, it’s also totally doable.

Maybe your nonna doesn’t remember her recipes, but she can certainly be your sous-chef. The washing machine may be complicated to work, but odds are she’d be happy to help fold clothes. As is the case with one of my favorite residents, the mall is overwhelming, but catalog shopping is both stimulating and fun (for both of us, obv). Rosie’s too big for some to walk, but many help to “watch” her for me and practice all her tricks. Regardless of how the activity’s tailored, what matters most is that it happens:

“I appreciate and sometimes immerse myself in the process rather than only or mostly on the outcome. I like doing things. I like and appreciate the doing. Doing is how I know I am alive, and how I appreciate being alive.”

–Dr. Richard Taylor

Life is for the living. Avoid leaving things at “can’t” and be creative with your plan Bs. Offer encouragement, not dissuasion, and don’t ever let the dancing stop.

Is It Physical or Mental?

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Contrary to what my social media may portray, working in assisted living is not all bus outings and puppy kisses. A decent amount of my time is spent not with my residents, but communicating with their loved ones, whether in person, over the phone, or via email. While I really enjoy that part of my role, too, it can sometimes be extremely challenging. I held a family meeting yesterday with one of my favorite nonna’s son and daughter-in-law. She’s currently rehabbing at our post acute care and will likely end up staying there long term. When conveying our nursing home recommendation to her family, my coworkers and I were met with sadness and confusion. “Is it physical?” her son asked. “Is that why she has to stay here? Or is it mental?” The short (but complicated) answer: it’s kind of both.

This particular nonna, who I’ll call M, is physically in pretty good shape. Granted, she’s in a wheelchair, but she can self-propel and get around on her own. She can bear her own weight and really just needs someone on stand-by when she does things like shower and get ready in the morning. Cognitively, she’s in the earlier stages of dementia and is pleasantly confused. She knows exactly who we are and has no problem telling us how she feels (read: she can be super cranky). Her reality orientation is a bit off and we have to remind her when it’s time for lunch, but she has more good days than bad ones. Doesn’t sound like M’s necessarily nursing home appropriate, right? Here’s where that confusion and the “kind of” come into play.

M is both prideful and forgetful. She not only wants to do things on her own, she forgets that she can’t. If she tries and fails, she’s not sure how to call for help; though she has an emergency pendant and pull cords throughout her apartment, they’re essentially useless as she won’t remember how to use them. Assisted living, in her case, is a recipe for disaster; despite the fact that she’s not too clinically or mentally compromised, she has very poor safety awareness and, as a result, falls constantly. It’s no secret that one bad spill can be incredibly dangerous for someone elderly and in her condition.

Dementia affects various parts of the brain differently. The frontal lobe, which is responsible for things like judgment, impulse control, and spontaneity, can be a game changer if impaired. There’s no reasoning with someone who lacks judgment, either. I wish with my entire heart that I could convince M it’s not safe to try to walk, to shower by herself, or to keep her door locked. I want her to stay with me for so many reasons, and I know her family does too. Safety is always top priority, however, no matter how or why it’s compromised (physically, mentally, or kind of both).

Me Too

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Not only is today the Friday of Labor Day Weekend, it’s the last day of an insanely challenging month. I had hoped on sneaking out of work early and possibly jumping on Parkway South, but my afternoon (and, subsequently, most of my evening) was spent otherwise: for about an hour before I clocked out, I spoke at length to one of my favorite residents regarding our hemorrhoids. Yes, our hemorrhoids. Hear me out…

This particular nonna is going through a difficult transition as she moves [reluctantly] from our assisted living into long term care. She’s the new kid on the block and just as she’s getting to know the staff, they’ve still got to get to know her. She tearfully explained that she’s been in excruciating pain and that her unfamiliar caregivers just don’t get it; there’s no way they understand how much it hurts. She’s probably right – they likely have no clue, and truthfully, neither do I. I do know, however, how powerful and important empathy can be.

The concept of empathy is generally implied to mean that an environment is created in which a person feels understood and accepted, due in part to the demonstration of kindness and warmth. It involves support, sharing, and acceptance, in turn helping others to feel understood and not alone. It fosters universality, or the idea that one’s problems are not unacceptable or entirely unique to them. Empathy squashes labels and depresses stigmas.

Stigmatization of things like dementia (and obvi hemorrhoids) can foster judgment. Even worse, it can impact attitude and, as a result, care. My now great friend and I still laugh about our early days together at my first assisted living job. We had a particularly worrisome nonna who would constantly fret over things like her bowel movements and the corns on her feet. To comfort her, I’d share my own experiences and assure her we were in this together and that we’d both feel better soon. Barely knowing one another at that point, Kaitlyn turned to me and said, “Do you even know what corns are? Do you actually have them?!” I admittedly did not, but pretending I did led to instant relief for our frequent visitor.

Interpersonal relationships are important because our own self-concept is defined by others and what info we get about ourselves from those connections. Simply put, the way we view ourselves is based in part on how we believe other people perceive us. Having a sore on your rectum is not only painful, it’s embarrassing! My nonna wasn’t seeking physical assistance from me tonight, but she did need some emotional validation and support. She was eager to know she was not alone and that her pain was understood.

Put yourself in your loved one’s shoes and treat them accordingly. Disregard the stigmas and lose the labels. Tell a *therapeutic fib* or two if fitting, even if you feel embarrassed. Dementia, like my AL, is a judgment free zone; all conditions (both real and imagined) accepted.

So Embarrassing

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I’m not the type of girl who’s easily embarrassed. Earlier this month, while exploring Ireland with my best friend, there was a makeup incident that resulted in a stained shirt and impromptu shopping trip. I offered to trade; her white crop top was super cute and, in my opinion, the bronzer was barely noticeable. She was mortified. Weeks later, we’re still laughing about our Logan’s detour and her refusal to be out in public with that shirt, even if I was the one wearing it and not her. As silly as it sounds, it got me thinking.

The lessons my loves teach me are uncountable. Some are intentional and others by example. Dementia is known to lower inhibitions, leaving those with the disease more carefree. Dr. David Hilfiker, who is living with mild cognitive impairment, confirms:

“With this disease, much of my fear of humiliating myself has shriveled. When I do something outrageous, I apologize. Most people understand that I’m doing the best I can and that these kinds of things are just going to happen in Alzheimer’s. I’m still embarrassed, I suppose, but I no longer feel humiliated; this illness has given me the great gift of acceptance.”

Similarly, Cary Henderson writes:

“Somehow I learned to cope with it. First of all, you know you’re going to screw up a good many times, so just don’t let it bother you. There’ll be another time to screw up, and there might be a few times when things go right.”

Unfortunately, this attitude doesn’t always translate to caregivers. A diagnosis alone can be enough to spark embarrassment. In the 2012 World Alzheimer’s Report, researchers noted that one in four families hid their diagnosis from others, much unlike those with loved ones fighting cancer. Symptoms, I’ve found, are even more shameful; it’s incredible how many articles there are with tips on how to avoid embarrassing situations (i.e., “entertain friends at home”) and diffuse them. One caregiver suggested passing out cards that read, “My loved one has Alzheimer’s – Please excuse their behavior.”

Humiliation is exhausting. Yesterday afternoon, I had a long talk with a nonno whose wife has dementia. Despite both living in my community, he insists on helping, and it is evident he’s burning out. I was both saddened and confused to hear him say that he can’t bear to see her pick out mismatched outfits or order food she would have otherwise scoffed at. Why? Perhaps her decisions now are not those she would have made when she was well, but why do they embarrass him? His wife is happy.. She is safe, well cared for, and content. Her choices may not align with his, but they’re her own and she should make them. As Dr. Taylor (also living with the disease) confirms, it’s even good for her:

“I appreciate and sometimes immerse myself in the process rather than only or mostly on the outcome. I like doing things. I like and appreciate the doing. Doing is how I know I am alive, and how I appreciate being alive.”

As caregivers, it’s essential to accept that most elements of this disease beyond our control. Stepping into our loved one’s world means not only going with the flow, but also embracing change and ditching shame. Embarrassment is useless at any age and in any country (including Ireland).

Show Me the Money

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It’s no secret that senior citizens can be preoccupied with money. They worry not only about what they have, but where it’s kept, who can access it, and how it’ll be distributed once they’ve passed. Those fears can heighten tenfold with dementia.

I never really got it; money is of course important, but I couldn’t relate to the fixation (…or so I thought). Recently, while volunteering in the Philippines, I caught a fraudulent charge from Sprint on my credit card. When I saw the $816, I lost it. I was on a paid-off trip with a $30k credit limit, money in the bank, and Chase promising me I wasn’t responsible for the charge, but I was beside myself. Long story short, I trolled Sprint’s Facebook page like a crazy ex girlfriend and they paid me back in full. I eventually got over it, but to say it was an eye opener would be an understatement.

My loves are billed monthly to live in our community and the rates are basically all-inclusive. They don’t need as much as a dollar on them, yet the money struggle is real. They’re constantly panicked about it in some capacity, whether they’re convinced it’s been stolen, determined to change their Will, or simply needing to know what’s left. I learned very quickly that assuring them they don’t need cash is useless, just as Chase’s words to me fell on deaf ears in January. Actually, I learned that any degree of rationalizing is impractical. Here’s what I do instead:

  • If a nonna is convinced money has been stolen, I “review the tapes.” We have cameras everywhere and I’m calling a detective. Whoever took it will be terminated and maybe even jailed, but not before that money is returned. It will never happen again. Did she need me to loan her some in the meantime? What is she up to today; did she have shopping plans? I’ve made the mistake of swearing that the cash didn’t exist in the first place, that it had not been taken. Not only was I not helpful – I became the culprit.
  • If a nonno is convinced and angry that his kids are spending his hard-earned money, I’m “going to call and give them a piece of my mind.” The audacity! It’s not theirs to spend! How many kids does he have again? Is everybody local?
  • If a nonna wants it just in case and feels better knowing that it’s there, I grab it from the safe. I “keep everyone’s money locked up in my office.” I even hold IDs! For those who need more reassurance than my words can offer, I have backup: Amazon sells double-sided play money that has been an absolute lifesaver, as has my iPhone camera for fake ID photos. What a pretty picture, by the way! I look so silly in mine.

I’ve heard countless opinions on this matter. Some say not to reassure them, not to lie. Everyone is different and no advice is one-size-fits all. The recurring theme is that I validate their feelings, and I follow up with redirection. Kudos to my CC company for doing just that as they talked me off the ledge. As for Sprint: thanks for the lesson, but I still hate your guts.

Thoughts on Aging by a Girl Who Works With the Aged

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It may be the psych major in me, but I’ve always found it interesting to think about the things that stick with you from childhood. I have a distinct memory of a conversation with my mom about birthdays: she was indifferent about them then, but she’d admittedly had a really hard time with turning 30. Parting with her 20s made her sad – depressed, even. An impressionable kid, I held on to that. I’ve dreaded the big 3-0 to the extent that I booked a trip alone (at least initially) as to not have to acknowledge it. The only party on the agenda was a pity party, and there’s obviously only room for one on that guest list.

Ma perché?! The more I think about it, my apprehension is not only silly but irrational. I’ve dreaded 30 not because of its consequences (which, by the way, are nonexistent – you don’t even need a new license) but because that’s what I inadvertently learned you’re supposed to do. So much so, in fact, that I f’ing ran from it.

Working in the senior care field these past few years has been nothing short of incredible. It’s insanely difficult at times, heart-wrenchingly sad at others, but always, always fulfilling. If there’s one thing my loves have taught me, it’s to embrace every single day. Our body is like a vessel; it simply transports us through life. Yes, it grows old – there’s no denying that (we put it through a lot!) but that’s the only thing that really changes. The “growing up” we talk about? The part when we’re supposed to suddenly feel like responsible, accomplished, brave, composed adults? That’s the myth. Nobel Prize winning novelist Doris Lessing said, “The great secret that old people share is that you really haven’t changed in 70 or 80 years. Your body changes, but you don’t change at all.” The famous “age is just a number” adage is corny but so, so true.

My loves have taught me (both outright and indirectly) that doing anything short of all you’ve ever dreamt is ludicrous. To wait for better timing or less responsibilities is dumb. To take risks when you feel more courageous is an oxymoron; courage, after all, is not an absence of fear but rather doing what you’re afraid to do. Things will work out as they should – they always have:

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.’ You must do the thing you think you cannot do.”
– Eleanor Roosevelt

The point is, who we are inside is not what changes, not at our core. Only our bodies do (speaking of, when does the good stuff happen..? Like no more pimples, for instance?!?). We’ll never feel like we’ve learned it all or that we have it completely together, or that we’re ready for whatever it is we’re scared of. The emotional constraints of growing old are self-imposed and the limits we set for ourselves the real tragedy, not our actual age (even if it’s the dreaded 3-0).

Hurricane COVID

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Have you ever been on vacation somewhere and gotten in a few great days, only for the rest of the trip to be completely rained out? I’m talking rain rain, not just drizzles – enough of a downpour to make you stay in your hotel room, praying for some sun. Such a crappy feeling, isn’t it? When I reflect on the past three (!!) years and what we’ve experienced in senior living, that analogy comes to mind; the pandemic has been a storm, washing out the final weeks/months/years of people’s lives. Truthfully, it’s been more of a hurricane, whose aftermath has a ripple effect that seems impossible to clean up.

I’ve worked in some questionable senior living communities, from a new build that ran “lean and mean” (read: with dangerously low staffing ratios) to, most notably, one that was on the verge of bankruptcy. Still, nothing holds a candle to what I’ve seen COVID do to assisted livings. I’d go back to bankruptcy in a heartbeat if it meant we could erase the below realities:

  • If time is a thief, COVID is Doris Payne. The past three years have been like a time warp, only the elderly don’t have any extra time to spare. Many had their lives cut short, succumbing to the virus and passing away. Others were robbed of enjoying what little time they did have left, spending their final months/years in a very lonesome and unusual solitude.
  • Speaking of solitude, I can’t imagine anyone having been more isolated during the pandemic than those in senior living. For longer than I like to recall, they weren’t permitted to leave their small apartments for any reason, even to get some fresh air outside. Window visits with family members were only allowed on milestone birthdays. What constitutes a milestone when you’re toward the end of your life? Isn’t every year a gift? The windows were sealed shut, no less! It breaks my heart thinking of not only what was implemented for their safety, but how terrified we felt and how desperately we wanted to keep them safe to implement it all in the first place.
  • There is no doubt that the precautions put in place to keep COVID out of our communities resulted in significant physical and cognitive declines. Remaining sedentary isn’t good for anyone, let alone those who are already in less-than-ideal shape. I witnessed firsthand the rapid progression of dementia in some and the debilitating weight gain & de-conditioning in others.

The above is the tip of the ice berg. No one person or organization is to blame for how the pandemic was handled in the senior living world; no one knew what we were up against, let alone how to battle the virus and keep our most vulnerable safe. We also had— scratch that, have — no idea how long it’ll last. Everyone did and continues to do their best, learning as they go and cleaning up the mess this hurricane has left behind. Here’s to hoping that 2023 is a year of healing, change, and rebuilding.

Quality Over Quantity

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I may still be on maternity leave, but I had a taste of “work” this week as I connected with some colleagues. Someone very special to me was faced with making difficult decisions on behalf of her dad, who is terminally ill and no longer eligible for chemotherapy. We spoke at length about hospice care, which tends to carry a certain stigma; I explained that it in no way signifies giving up on your loved one, nor does it mean they’re expected to die tomorrow. Hospice is an incredible benefit (paid for by medicare) with the goal being to improve one’s level of comfort as they navigate through end of life, focusing on the quality of the time they have left (vs quantity). It even covers supplies like incontinence products, hospital beds, and medications, if necessary, as well as visits from clergy members and grief counseling for families once someone has passed.

In order to qualify for hospice services, an individual must have a terminal diagnosis that they are no longer seeking treatment for (i.e., cancer without chemo). That’s not to say the symptoms aren’t treated – they’re the main focus! It’s the disease itself that is no longer being treated. A doctor must also certify that they feel the person has less than six months left to live. As we know, no one (earth-side, at least) can predict with absolute certainty how much time someone has left; this is truly an estimate, if not even a formality. I have known many people who have been on hospice for years!

Once evaluated, hospice determines what they feel an individual needs in terms of services. Some have round-the-clock “continuous care”, whereas others are visited once a week – it really varies and is person-centered. My dear friend’s father, for instance, will be visited by his aid biweekly, which for him is plenty. His pain will be monitored and managed closely, with hospitalization avoided whenever possible. 

Despite its incredible services, its stigma persists; my friend is adamant that her dad not know he’s on hospice. He would be devastated and give up, she explains. He would lose hope. This would be the beginning of the end for him, they feel. Her mom is different, she says – she would absolutely want to know, as there are things she’d want to do.. people she’d want to talk to.

Working in senior living/healthcare, I’ve learned it’s so not uncommon to feel the way my friend’s father does. Hospice nurses and caregivers are used to being rather discrete and, of course, remaining positive. As the saying goes, ignorance is bliss. But lately I’ve been thinking.. would I want to know? What loose ends would I need tied up? What am I putting off? As I’ve also learned working in the field; don’t wait until it’s too late.

Baby Luca

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I feel like I have deja vu, having just posted about the arrival of Leo 16 short months ago! 😉 As I pointed out then, the subject of my June 2021 post was ~80 years younger than those I typically write about. The same goes for today’s introduction of baby Luca, Leo’s little brother and the second much-anticipated bonus grandson to the nonnas and nonnos I serve. Luca arrived four days past his due date on October 6th. We are exhausted but settling in!

Throughout my pregnancy, I had countless conversations with my loves about parenting, family planning, and the like. One of my favorite ladies reassured me that I’d be ok with two under two, sharing stories of her life with four under five (!!). Ever calm, cool, and collected, I proposed that she likely thrived as a mom of four due to her temperament and nature. She corrected me: “Oh no, I was a screaming lunatic for years.” Talk about validation and encouragement!

Cheers to the *loud* years to come. 💙

8 Years Later

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I can’t believe it’s been eight years since having traveled to Italy for the three-month volunteer trip that kick-started my career (and this blog). Reflecting on some of my original posts, it simultaneously fees like yesterday and a lifetime ago. Each message holds strong, though; I’m so grateful for all I learned (and am able to apply in my work every day) during my time in VV.

Below is one of my original posts from September of 2014. Re-sharing as I reminisce.. 🙂

As I’m taking notes from work today, I can’t help but sneak a picture of where I’m writing:

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I am so in love with this town (& with Italy in general)! Though I studied abroad in Rome and have been back since, I still find myself struggling with the language; when you don’t use it for a while, you definitely start to forget! Thank God for iPhone apps and Google translate :-O

Working with my loves, I’m realizing, requires me to learn and practice two languages: that of Northern Italy and of Alzheimer’s disease. The latter is more complex and multifaceted than even the most ridiculous Italian verb conjugations.

In one of many insightful essays, Dr. Taylor writes:

“If I call you “Mom” or “Dad,” I am probably not confusing you with my mom or dad; I know they are dead. I may be thinking about the feelings and behaviors I associate with mom and dad. I miss those feelings; I need them. It’s just that I so closely associate those feelings with my mom and dad that the words I use become interchangeable when I talk about them. I don’t take the time or I can’t or won’t make the distinction between the people and the feelings.”

Similarly, Dr. Robbins goes on to stress that:

“Almost always, though, what’s said in the moment does NOT reflect how the person with dementia has always thought.”

Not only are we listening to (and, in my case, translating) what’s being said, we must also attempt to decipher its true meaning. Much like learning Italian, this requires patience and practice coupled with both empathy and understanding.

My phone can help me hold a conversation, but not to interpret unspoken messages. Aside from the always-entertaining hand gestures, most of what I’ve had to learn in Italian is verbal/written. The language of Alzheimer’s, however, is often primarily unspoken.

According to Bob DeMarco, when spending time with his mom it’s important for him to “speak the local language.”

“Eventually I realized I was drowning my mother with too many words. Sometimes, all I needed to do was smile. Or put my arm around her shoulder and my head on her head. Instead of a long explanation about what we were going to do (like go to the bathroom before lunch), I’d stick out my hand and say, ‘Let’s go.’ And she’d come along willingly, even before asking, ‘Where are we going?’ To which I’d just smile and say, ‘To have fun.’”

In my experience, it’s the nonverbal that has been most powerful. It’s the smiling, hugging, kissing (often on the mouth 😐 why do Italian nonnas and nonnos LOVE to kiss on the mouth?!?!), and just being together that have sparked incredible responses and opened seemingly glued-shut doors. It’s the respect, patience, and empathy.. the looking up instead of talking down.. the face-to-face instead of over-the-shoulder.. these are what I’ve seen to brighten days and open flood gates.

Weaponizing Bingo

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If you’ve ever worked with seniors in any capacity (especially senior living), chances are you’ve witnessed firsthand how important the game of bingo is. In every community I’ve served, at every resident council meeting I’ve attended, there have been cries for more bingo. It doesn’t matter how often it’s played – it’s never enough. Recently, there was an incident involving allegations of cheating (it’s still a mystery to me how one could possibly cheat at bingo) that escalated into a full-blown fight. It was so out of hand that we took the game off the calendar for an entire week in order to reset, recenter ourselves, and debrief together on what occurred and how we could ensure it never happens again. It was the mature thing to do, I thought. My loves, however, alleged that I was “weaponizing bingo”. Che cosa?!

As we were all trying to figure out what this borderline obsession is with bingo, our activity director made a great point: it’s often one of the very last programs that those living with dementia are able to participate in. It’s one that really doesn’t need much modification, and that can be played amongst a group with greatly varying cognitive abilities. I’ve noticed this myself as I’ve called it weekly; bingo always has a great turnout, even especially amongst those nonnas who are most forgetful. But how? Why? As it turns out, I’m not the only one who’s curious about this.

 Studies have actually been conducted on the effects bingo can have on the cognition of those living with dementia. Results have shown that continuous play can improve memory, mood, and engagement.  It’s a game that does not require seniors to rely on memory, but rather skills like listening and hand-eye coordination. It’s great for reinforcing concentration and, due to its social aspects, triggers the release of endorphins, which create an overall sense of wellbeing and even can even have some pain-relieving effects. The ever-popular bingo can foster connections and relieve stress, both of which help to boost the immune system. It truly is so important, both subjectively and objectively! Maybe even enough so to fight over.

Our post-brawl meeting was calm and productive, at least to those who could recall the incident in the first place. Bingo’s back in its regular time slots and all are content. Going forward, now that I really get it, I’ll be sure to keep it that way.

What’s in Your Rollator?

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I’m a big fan of rollator walkers. Not only are they more stylish, but they’ve also got nifty little seats (for when you need a quick break) with a small storage area underneath. Those baskets are deceiving; while concealed by design, they’re actually pretty deep and can hold quite a lot! When I take residents out on our bus, I have to empty the rollators in order to fold them up, so I can personally attest to how much they carry. A recent lunch outing spanned nearly four hours, not because we lingered at the restaurant, but due instead to the extra time it took to unpack and re-pack the walkers (x2). It got me thinking.. what’s up with all this stuff?

Senior citizens, especially those living with dementia, tend to hoard/value/always carry with them certain items. Material objects can help to maintain connections to past social identities and roles, as well as to provide a sense of comfort and security. They can be so comforting, in fact, that we fill shadow boxes outside apartments with such items. One of the most common I’ve noticed are purses. Regardless of contents, nine out of 10 nonnas are adamant about carrying their pocketbooks. Most are either empty or strewn with tissues and reading glasses, but they’re always slung over shoulders or tucked safely under elbows.

Money is another focus item, and understandably so; it signifies things like security, control, independence, and participation with society. No money is exchanged in assisted living, so there’s literally no reason to ever carry cash. Most still do, though, regardless of the kind or the amount. We recently had to make a fake credit card for a favorite nonna of mine who was fixated on having hers handy.

Tangible objects can provide my loves with a sense of safety; being able to touch them and know they’re close at hand offers reassurance, especially when feeling vulnerable. Losing or having them be thrown away, then, can be rattling. I have a resident who, for whatever reason, is borderline obsessed with cans of ginger ale. A staff member with the best intentions recently cleaned out her mini fridge, taking out 10 of the 17 sodas to make room for other items. To say she was beside herself is an understatement. They were friends, she said, and she just couldn’t understand why she’d do such a thing to her. Needless to say, she apologized and returned them.

Discarding or trivializing someone’s possessions can contribute to feelings of loss of identity and independence. It’s one thing if we choose to throw things out ourselves, but if it’s forced, it can be devastating. So, we’ll stick with longer outings. I’ll unpack the walkers, fold them up, then re-stock on arrival, repeating the process when we head back home. We’ll make “credit cards” and offer ginger ales. Most importantly, we’ll provide comfort and foster security.

They’ll Grow Out Of It

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As a (relatively) new parent, I’m developing a new appreciation for the phrase “grow out of it”. During the infamous fourth trimester, you pray for time to fly by faster and difficult phases to quickly pass. Sleepless nights, for example, are brutal, though the days are just as long. I remember simultaneously counting down until bedtime while also dreading nightfall, when I knew we’d get no rest. “He’ll grow out of it”, I heard. “He’ll be able to distinguish day from night, and he’ll learn to self soothe.” I’d imagine that as baby Leo grows, we’ll experience an infinite amount of these situations, holding onto hope that with time they’ll diminish. But what if they don’t?

Working in senior living, I’ve honestly been surprised to learn of how much we don’t grow out of. It’s kind of taboo to talk about, since we’d never want to infantilize our residents or compromise their dignity. Let me be clear: I’m not pointing out my observations with malintent, but rather with surprise and even a bit of relief. As a kid, it seems we feel like adults and elders have it all together – that they’ve outgrown it all. In a sense, it’s comforting to know they haven’t, and that no matter how old we get, we’re still so young at heart. Below are some favorite (and most prevalent) examples of things we most certainly do not grow out of:

  • Gossiping: I’ll never forget reading the 2015 New York Times article entitled Mean Girls in the Retirement Home. It was published super early in my career and I thought, “This can’t be accurate.” Turns out, it totally is. In a way, gossip seems even more prevalent in senior living than it did in high school, and my theory is that it’s because it’s less secretive: my loves are hard of hearing and though they think they’re whispering, they’re usually not.
  • Bickering with Roommates: It’s not easy living with someone at any age, whether they be a spouse, partner, family member, or nonrelated roomie. I would’ve imagined that with age comes more effective communication and, in turn, more mature, successful relationships and living arrangements. Not the case. I once had to draw up a contract for two roommates to sign and agree to (with witnesses!). Some terms included one nonna not using the other’s tissues, each agreeing to never leave the bathroom without TP, and both pitching in to help empty the trash. Neither were open to moving to a different apartment, yet they couldn’t stand one another. Official agreement can be found below. Spoiler alert: they parted ways.
  • Competing: In this case, I’m referring to competing for guys. I went to an all-girls high school that was on the same campus as a coed university. Boys cutting through our courtyards to get to class were like fresh meat. Since there are so many more women than men in senior living, the same holds true for my loves: eligible nonnos are hard to come by and nonnas will compete for their attention. Ugh, brings me back.

Leo did outgrow his sleepless nights (thank God), but I won’t hold my breath when it comes to everything else.

Dignity or Pride?

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As the years go by and new experiences arise, I’m learning that there’s such a fine line between dignity and keeping up with appearances. Actually, one is often disguised as the other; pride and caring what other people think is totally a younger generation thing. We might call it dignity, but that’s not what we’re really trying to preserve.

If our loved one doesn’t care about something anymore and is happy and safe, why do we hone in on it? Why do we obsess over their weight or their hairstyle if they no longer give either a second thought? If our nonna is 90 years old and blissfully ignorant to or, even better, accepting of those extra pounds and thankful for the good food she’s enjoyed, why shame her? Why punish her caretakers?

I was recently told about a particularly cheerful, blissfully confused nonna, “My mother would have never let herself get to this weight – she’d be mortified.” Well, thankfully, she’s not, and you shouldn’t be either. Please let it go. The daughter of a friend of hers from down the hall was equally as upset about her mom’s haircut, which looked gorgeous and was even more practical in that it avoided constant hair in her eyes. The nonna herself? She loved the fuss we made over her new ‘do and thought nothing of her fresh look.

Nine times out of 10, the appearances we keep up for others are just that: facades. We don’t look like our filtered selves in real life, sometimes not even close. Our relationships aren’t always strong and loving, they’re broken. We’re not as happy as our Facebook posts depict – sometimes, we’re miserable, and misery loves company. Let your nonna change her hair, dress down, and gain a little weight. If “letting herself go” means giving up the pressures and the pride, embrace and praise her for it. Be open to learning from her example.