What’s in Your Rollator?

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

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?

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.

Revisiting March 2018: Show Me the Money

Today has been an absolute rollercoaster in every sense of the word. I had every intention of posting about the exciting morning I had, only for things to take an incomprehensible turn by afternoon. Details will be revealed in time, but for tonight, I’m reflecting on past March posts. A favorite (below) brings back such fond memories of some beloved former residents and the most helpful local “detectives”. Though we’re slowly returning to normalcy, I really miss these times – I miss the days when these were our most pressing concerns. I yearn for them.

On this day four years ago, I wrote the following:

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.

[Out of] Control

As a “new” mom (8mos postpartum), I’ve been learning a lot about control. My baby literally relies on me for everything: to be fed, nurtured, changed, put to sleep.. all of it. Even when they’re tired and sleep seems like the only answer, little ones can’t figure out what to do without help. A routine has been key – another thing I obviously control (he couldn’t if he wanted to at this age!). I imagine that while this part of motherhood is only a season, it’ll last for quite a bit of time. What I can’t understand, however, is at what point we’ll switch places; when do adult children decide it’s appropriate or beneficial to control their parents?

Let me be clear: ensuring our loved ones are safe is of utmost importance. It’s top priority and I already know as a daughter (and the first born), I’ll be all over whatever it takes to keep my dad safe as he ages. Controlling him is another story.

I have endless examples of attempts at managing an elderly parent’s everyday life, all of which baffle me. Most recently, my team and I were talking about a budding relationship between two residents. They’re exceptionally respectful of and caring toward one another. They’re both noticeably happier since having found each other, and we feel honored to be witnessing their love story unfold. This nonna’s kids, though? If they knew, they’d be devastated. I don’t like to assume, but I believe in my heart that they’d make her feel absolutely awful and ashamed about the relationship if they found out about it. The thought alone is heartbreaking. Why?

I once had a resident who, well into her 90s, was no longer interesting in keeping Kosher. That was of course her choice and her right. Her attorney daughter, on the other hand, was livid. She drew up an agreement that she wanted me to sign stating that we would only serve her mom Kosher style food. The attorney daughter that I am, I amended our contract and promised to offer her Kosher food. Whether or not she chose those options was entirely up to this nonna. Again, why?

A fellow director shared a story with me last week about a nonna of hers who likes to occasionally sleep in (same, nonna, same). She recently snoozed until almost noon, and her children were beside themselves. Per the key card records from said resident’s door, it was determined that her caregiver checked on her five times throughout the morning, each time being shooed away so she could catch more Zs. Her daughters went as far as to say it was neglectful that they let her rest. Why?

I can’t stress enough how much I understand and appreciate the innate need to do what’s in our power to keep our loved ones safe. What I can’t comprehend, though, is how, why, or when we decide it’s appropriate or beneficial to try to control certain aspects of their lives. While he can do no wrong (love that little mamma’s boy!), if Leo tried to pull that with me, I know I wouldn’t be happy.

Fingerprinting Kit

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.

2021 Reflections

Happy New Year! Though today may not be a normal day of celebration (thanks, COVID), it’s nevertheless a great opportunity for reflection.

I’m still on maternity leave and have been missing my community immensely. My grandmother-in-law also resides in an assisted living, so I’m thankful to feel somewhat connected through her. My MIL recently asked my opinion about her Christmas gift, one of those digital frames that connects to WiFi and rotates photos. Let’s just say I have mixed feelings about them (more on that below), but our conversation got me thinking about my role as Executive Director. I’d be lying if I said I thought fondly of financial reports, census calls, or Department of Health reportables. What I lovingly recalled were all the responsibilities that won’t be found in my official job description. A few favorites (that I can’t wait to get back to after leave!) include the following:

  • IT Magician: those frames I referenced above.. man, do they take up a lot of my time. They inevitably either come unplugged or disconnect from WiFi, so I’m constantly tending to them. Same goes for TVs, which “break” and 9 times out of 10 are fixed by the magical input button on the remote. I know these don’t sound too appealing, but I love being able to save the day, step away from my office, and hear the stories behind the photos (even if I could recite them myself by now).
  • FaceTimer: throughout most of the pandemic, in-person visits were prohibited, so we did a LOT of FaceTiming with family members. The team was stretched thin as it was and I never minded doing them, so I was responsible for coordinating those calls. While I’m thrilled visits are allowed again, I honestly miss them! It was such a great way to get to know my loves’ families on a more personal level; in-person I may pop in, but it’s not the same as being present for the entire exchange. Many honestly made me feel like part of the family.
  • Bus Driver: God, this one’s so fun, despite/especially wearing 4” heels! I’ve made it a point to bring residents on at least two outings a month (usually to restaurants) in order to spend more quality time with them and to kind of humanize my role, if that makes sense. During the past two years, I’ve driven them one on one to doctor appointments, to get vaccinated, etc. Recently, I drove one of my favorite nonnas who hadn’t been on a ride in years. I’ll never forget the one we took together.
  • Hypeman: this one’s so special, too. According to Urban Dictionary, a Hypeman is someone who will always hype you up with compliments. I especially look forward to beauty parlor days and fussing over what knockouts my ladies are, as well as seeing my wheelchair loves walking during physical therapy and cheering them on. It’s true what the say: when you look good, you feel good, and it’s so important that they feel their absolute best.

Did I mention how much I’m missing work?! Here’s to returning in 2022 and fulfilling all of my responsibilities, required or not, to the best of my ability and with an abundance of love.

We’re Doing This.. Different

Last month, I referenced my time volunteering in Italy and how it didn’t exactly prepare me for working in the field at home. There are so many differences between how we do things here versus there. I’ve narrowed down to five of the bigger contrasts (and included some photos for comparison).

  • Aesthetics: Our senior living communities are gorgeous, but their design is geared more toward adult children than the actual seniors who will ultimately reside in them. We say they’re “home like”, but according to who? I’d love some of the decor in my own home, but I’d never find it at my grandma’s. In Italy, they’re much more practical and definitely more appealing to the residents themselves.
  • Grounds: Obviously, few communities stateside will be in locations that hold a candle to some of the settings in Italy. Panoramic views aside, though, I was pleasantly surprised by a few things: gardens and outdoor sitting areas/walking paths. One thing I’m not crazy about here are our second and third floor outdoor patios, as they’re so limiting and, in my opinion, a bit claustrophobic. In the italian communities I’ve visited and worked at, the outdoor space is so impressive (and you don’t need a passcode to get to it!).
  • Food: I meannnnn.. this one goes without saying! Nothing compares to the food in Italy, even in senior living communities.
  • Uniforms: This is another point of contention for me, right up there with upper level patios. What I particularly loved about uniforms in Italy was that they were neat and professional but not super clinical. Overnight, for instance, there was a pajama-like uniform that was especially helpful for residents with dementia who may have trouble deciphering between day and nighttime. On that same note, they also dimmed all the lights in the communities overnight to further clarify time of day for those who otherwise may not be sure. I don’t know how we keep ours on so bright 24/7 then wonder why some residents confuse their days and nights!
  • Dignity: Don’t get me wrong, dignity is huge here too (it better be!), but it’s on another level in Italy. It’s considered to be an honor and a privilege to work with seniors overseas. People like me and the countless others I’ve volunteered with even pay to donate our time! This isn’t an employee issue, though – it’s a societal one. It’s also something I’m trying to change.

We’re Doing This Wrong

For being such an innovative, resourceful nation, there’s so much room for improvement in regards to how we care for our seniors. Honestly, we stink at it, especially in comparison to other countries. My career began in Italy where I lived and volunteered in a dementia care facility. I obviously expected communities in the US to differ aesthetically, but naively thought they’d run the same. I was completely wrong. I’ll save my list of differences for another post, but there’s one in particular that’s intrigued me since becoming a new mom: intergenerational care.

Sure, we have intergenerational programs in American facilities. We’ll invite Girl Scouts in for a craft activity and have toddlers come trick or treat on Halloween. At best, we’re doing these things monthly (though quarterly is much more common). So far in my career, I’ve never seen a program involving babies, and I certainly haven’t come across a shared nursery/nursing home space. In the US, there are allegedly ~110 such facilities (the majority being day centers, not live-in communities). In the UK, on the other hand, there are over 500.

I’ve brought baby Leo to visit my current and past assisted livings several times since he received his first round of shots. It was immediately evident that his presence was so meaningful; residents (both nonnas and nonnos) light up when they see him, even if he’s snoozing in his carrier. Frankly, he’s not much more interactive when awake – at only four months old, the most he’s doing is smiling, cooing, and pulling mamma’s hair. Apparently that’s enough because they absolutely adore him.

Human connection is as basic as our need for food, shelter, and water. It’s innate. Growing old, we know, can feel so isolating. Both children and adults can benefit from each other’s company. As a Stanford study points out, the elderly are one of the best groups to spend time with young kids, not only because of their wisdom and insight but also due to their patience and availability. They’re able to provide the kind of stimulation that little ones need to thrive. They welcome meaningful, productive activity and engagement. They seek purpose in their lives.

Today, one of my favorite nonnas’s purpose was to calm a tired, fussy Leo. Without hesitation (or my asking), she sang to him. She held his fat little hands and recited lullabies, as nearby residents (now surrounding us) chimed in. God, it was a beautiful moment – and it worked.

I’m still on maternity leave, so for now these visits will have to suffice. But I can’t silence this voice telling me they’re not enough. We need to do better on a much larger scale. Intergenerational care should be more than the occasional recital or holiday treat. Little Leo, we’ve got our work cut out for us.