Little Mamma

As if it wasn’t already evident from previous posts (and my Instagram bio), I am a huge dog lover. I worked through undergrad and grad school at the most incredible kennel, and I grew up with Shepherds and Labs. I’ve always hoped to somehow combine my love for dogs and seniors – to do meaningful work that involves both. This weekend, I took the first step toward doing just that: I rescued a three-month-old puppy. I know, I know…I work 65+ hours a week, I’m never home, and to say I travel often would be an understatement. I promise there is a method to my madness.

It’s no secret that the effects dogs have on people of all ages are immense. Within an instant, they can make us feel happy, loved, and safe – simultaneously excited and calm. Physically, they keep us active and in turn help our hearts. Dogs reduce stress (except during the housebreaking stages perhaps) and teach us lessons. For seniors especially, they can be pivotal in decreasing loneliness and improving mood; dogs live in the here and now. They don’t worry about tomorrow, and according to Dr. Jay Granat, tomorrow can be very scary for someone who is elderly:

“Having a pet helps the senior focus on something other than physical problems and negative preoccupations about loss or aging.”

And focus on them they do. That goes for both physical impairments and cognitive ones. Individuals with dementia (particularly in earlier stages) tend to be extremely stressed, and understandably so; they recognize that something’s wrong but can’t necessarily distinguish it from what is right. They’re not only confused, but also frightened and embarrassed. Here’s where my little mamma comes in:

“I sort of think that anybody with Alzheimer’s could benefit by a friendly little dog. Somebody they can play with and talk to – it’s kinda nice to talk to a dog that you know is not going to talk back. And you can’t make a mistake that way. … My dog knows things about me before I know them myself. … The one thing I know is that the dog is with me, and when she’s with me I at least have some solace, even if I don’t know the way.”

– Cary Henderson, Partial View

Rosie, that’s your cue. Introducing the newest member of our team and family:

 

The impact this little girl has had on our residents in three short days is immeasurable. I’m completely blown away. I have no doubt she will continue to amaze me. She is, after all, a dog ❤ one of the only beings that will ever love us without condition or complication. Mamma, we are so thankful for you already.

Was Your Husband Jealous?

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I’m admittedly a very here-and-now kind of girl, neither a planner nor nostalgic. There’s something about both the honesty and spontaneity of living in the present that just draws me to it. That and I 1) have an awful memory and 2) was brainwashed by Dr. Yalom as a grad student. :/ When it comes to my loves, however, I’m finding more and more that there is an incredible benefit to reminiscing.

Reminiscence therapy involves recalling personal experiences from one’s past. Its purpose is to improve functioning by decreasing demands on impaired cognitive abilities and capitalizing on those that are preserved. The most prominent memories I have of my early RT days are centered on the question, “Tuo marito era geloso?” Obviously, I had my first taste of reminiscence therapy in Italy.

Often used to help treat depression, RT is particularly beneficial for the elderly for a number of reasons:

  1. Reminiscing doesn’t demand some new or complicated skill. It doesn’t put you on the spot or require you to think on your feet. Because of this, it’s suitable for those experiencing some sort of cognitive decline or deficiency.
  2. Those participating in RT are the main actors in their stories. They’re able to feel comfortable, involved, and in control.
  3. Even when confined to one’s own mind, nostalgia is social in nature. It stimulates feelings of connectedness to others; sharing stories cultivates a sense of universality or togetherness. It helps people let their guard down and become better acquainted with one another.
  4. Reminiscing about the past can foster a great deal of satisfaction and understanding. For my loves, it’s a means of affirming who they are and what they’ve accomplished, as well as a chance to relive happier times. Despite their cognitive state, it’s a way to talk easily about the things they do remember.

So, where does the jealous husband fit into all of this?! & how do I implement RT on a daily basis here negli Stati Uniti? In Italy, I didn’t know my nonnas’ backgrounds. For the most part, I hadn’t met their families and I had no idea how they grew up. What I quickly learned I could assume, however, was that their nonno counterparts were extremely (and stereotypically!) jealous. Asking a question as simple as, “Was your husband jealous?” was enough to spark responses filled not just with detail, but with life. It triggered shared laughs and parallel memories. It got my loves talking, smiling, and feeling close to one another.

It’s one thing to stir up recollections, but another to remember them:

“As a result of feeling shaken up and beaten down, a resident experiences low self-esteem. Part of the rebuilding of a resident’s sense of personal worth comes from my spending time with her, giving her attention, listening to her, and making the effort to help her. Making regular visits to a resident, remembering the content of previous conversations, and offering assistance are generally experienced as caring concern and can help to restore her sense of worth.

The primary factor that promotes loving care in [assisted living] is that the caretaker must get to know the resident personally. … Personal knowledge is likely to engender empathy and connection.”

Simple Lessons for a Better Life

I always want to know the whole scoop. When I meet potential residents and their family members, I ask a thousand questions; I want to know how they met their spouse, what they did for a living, what they loved to do most, etc. This information may seem trivial or unnecessary being that they’re looking for a solution to a problem that is very much in the here-and-now, not related to their past, but this is the most important part of our conversation. It is their story that’s essential, not their diagnoses, med list, or cognitive state. That’s all valuable, but it is no doubt secondary to who they are as an individual and how they came to be.

If I see a nonno crying in his bedroom, I want to know it’s because this would have been his anniversary, not to assume he’s sundowning. I want to hold his hand as we talk about his wife and reflect on the winters they spent in Boca. I want to make each nonna feel heard.. to show her that she’s loved and listened to, her stories appreciated. And when she could use a laugh, I want to bust her about her feisty husband, swearing I don’t envy her yet fawning over his timeless, passionate, inspiring (albeit fiery) love for her.

Kiss Me Like You Mean It

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Full disclosure: I am not a PDA kind of girl. The above title is actually a direct (and frequently used) quote from a college boyfriend who was contrarily very into public displays of affection. He was super huggy and kissy regardless of where we were or who was around, and the fact that I wasn’t drove him nuts; a quick peck to appease him was clearly insufficient, hence the “kiss me like you mean it.” Don’t get me wrong, behind closed doors is a completely different story – I am beyond affectionate, playful, and even huggy-kissy. There are only two instances in which you’ll witness that side of me in public, however: with dogs (surprise, surprise 😉 ) and with my loves.

I am a huge advocate for touch. Numerous studies have proven that it’s not only essential for our development, it is also necessary for us to grow, learn, and literally survive and thrive. From infancy, touch is used to both communicate and to heal; a loving caress releases oxytocin and instantaneously boosts one’s mood, strengthens the immune system, and reduces stress. It’s not one-sided, either: there is evidence that the person doing the touching gets just as much benefit as he or she being touched. Incorporating even the simplest pats with other forms of communication increases connectedness, improves attitudes, and calms nerves. We are biologically wired to the need to connect with others on a basic physical level, and it’s something we don’t grow out of.

I’m not alone in being anti-PDA; we are a seriously touch-phobic society. The resultant touch deprivation in the elderly is alarming, especially for those who are frail or demented. Such deficiency leads to feelings of isolation, anxiety, poor trust in caregivers, a greater decrease in sensory awareness, and insecurity – the last thing they f’ing need. As if dementia didn’t leave one feeling frightened and alone enough, our lack of intimacy just kicks a nonna while she’s down, as to deny it is to deprive her of one of life’s greatest joys and deepest comforts.

It’s not just our nonnos we’re depriving, either: a study from the 1960s looked at café conversations all over the world. In France, friends touched each other 110 times per hour. Puerto Ricans beat them by 70 – a whopping 180 touches were recorded in the span of 60 minutes. In the US? Twice. In “bursts of enthusiasm,” we touched each other twice. 😐

Touch is the universal language of compassion. When words are no longer understood, there is no better substitute than a gentle hug or holding hands. In old age especially, the need for physical affection is more powerful than ever, for it is one of the only sensuous experience that remains. It is one of the few persisting methods of communicating with a nonna of limited cognitive function, and its effects are both physically and emotionally favorable. In a study that examined the impact of touch on appetite in picky elderly eaters, all participants had a significant increase in caloric intake when given a gentle touch and spoken to during mealtime. Additionally, a study on dementia patients proved that touch is calming; all residents who received hand massages presented significantly less agitated than those who did not.

Sources of proof are endless; there is no question that affection is insanely beneficial to seniors (and to the rest of us!). How we choose to implement it in our daily practice is subjective. In my own experiences, I have found that while being huggy-kissy with boys makes my eyes roll, doing so with my loves is invaluable. I greet nearly every resident with a kiss.. I don’t care if they’ve got half their lunch on their lap or if they’ve had a cold for days, I’m wrapping my arms around them and kissing their cheeks (don’t worry Dad, I wash my hands). If a nonno’s in a wheelchair, I crouch beside him and rest my hand on his knee. I’ll walk arm-in-arm with nonnas and cozy up on the edge of their recliner when we rest. I’ll sit right on that hospital bed, my fingers locked with theirs, regardless of cognizance or how tightly they grasp back. If there are tears (God, I hate when there are tears), I softly wipe them dry. I kiss them like I mean it, and honestly, the impact is immeasurable.

You Know You Work in Assisted Living When…

  • you have an immense appreciation for your should-be-canonized, superhero front desk receptionists
  • you engage in regular conversations about things like back aches and bowel movements
  • you can recite the names, without thought or hesitation, of each resident’s children and grandchildren (and likely those of their spouses and everyone’s latest accomplishments) because you hear about them constantly
  • despite your actual role, your job responsibilities include fixing/teaching TV remotes, cell phones, and “the computer”
  • your “inside voice” is audible outside (and possibly across the street)
  • you’ve learned that affectionate pats on the butt are not just a sports thing (*note* this is a signature nonna move, don’t worry)
  • your relationship status is a daily topic of discussion
  • on a similar note, you’re also not-so-subtly told about single, tall, dark, & handsome grandsons.. and by “told about” I mean “pressured into an arranged marriage with”
  • you’re well-versed in acronyms (ADL, PPD, DNR, SNF, etc.)
  • you’ve witnessed genuine, lifelong, awe-inspiring true love – the kind that takes your breath away and brings you to [secret] tears
  • you’ve learned the value of positivity and how therapeutic it can be (which is why you cry those sappy love tears in private, you big baby!)
  • you know what Depends look like IRL and you’ve fully accepted the fact that we’ll likely all be in them one day
  • …actually, you know what a lot of stuff you read about and see illustrated on funny birthday cards looks like IRL
  • you’ve mastered the art of going with the flow, even if it’s more of recurring wave than a fleeting stream
  • you’ve gotten crucified at Resident Council for things like two-ply toilet paper
  • hand sanitizing is part of your daily (hourly?) routine
  • …but so are kissing, hugging, arm-locking, and hand-holding ❤
  • you’re regularly floored by how much you’ve yet to learn and blown away by the wisdom that surrounds you
  • patience pulses through your veins (& if it doesn’t, this post likely won’t apply to you for long)
  • you call your nonna. Not only because you love her, but because you see firsthand how a mere “Thinking of you” can be so powerful
  • you can always count on honest, filter-free opinions and advice, the kind you wish you had the guts to give yourself
  • you’re unavoidably kissed smack on the lips pretty regularly (and you’re okay with that)
  • your source of #inspiration and #goals (relationship & otherwise) is not the Instagram popular page – it’s your incredible residents
  • you have a blast. Of course you will be busy and some days sad or stressed, but a lot of the time, you’ll have the most playful, affectionate, fulfilling, heartfelt f’ing fun.
  • you learn to truly live your life. Not necessarily by inference, either – I’ve found that this kind of lesson can be taught (and is explicitly encouraged).
  • that love you witness? The unconditional, nonjudgmental, unwavering adoration? You feel it every single day.

Assisted Living: An Insider’s Guide to Tours

Having officially been in the field for just over a year, I’d hardly call myself an expert on senior living. I would, however, confidently say I’m an insider. Aside from working in the sales department of two assisted living communities, I’ve lived and volunteered in Alzheimer’s facilities in Italy. In addition, I traveled to the Netherlands *by myself* for the sole purpose of touring and spending time at Dementia Village. Though still a rookie, I’d like to use what I’ve learned and experienced thus far to offer some advice on what to consider when exploring AL options.

  1. Schedule a tour. I know, I know: “Let’s catch them off guard so they can’t warn everyone we’re coming and put on a show.” While I’m all for the authenticity that comes with unexpected surprises, I think making an appointment is in this case important; you want to be sure you’re able to spend time with your tour guide and not feel rushed.
  2. Stay for lunch. Does free food even need an explanation? 😉 Not only are you being fed, you’re also meeting and observing current residents, dining room staff, and the general vibe in the community. Plus, mealtime is huge for residents, so you want to be sure that what they’re served is tasty, nutritious, and presentable.
  3. Take note of the details. Speaking of presentable, how are the residents dressed? Are they neat and well-groomed? What about the community itself – is it clean? Do the caregivers look tidy? Do they greet those they pass? & my biggest pet peeve: anyone on their phone?!?! Honestly, having to even consider moving your nonna into AL is so disheartening and stressful that I just know I would look for any excuse to rule a place out, and that’s okay. Be picky…
  4. …But don’t be selfish. Ugh, this one’s essential. I know you probably prefer granite countertops, stainless steel appliances, and crown molding, but does your nonno care about any of that? Is that even his style? I think we can safely assume it’s not.
  5. Like, not even a little selfish please. Location is of course important, but please take distance into consideration within reason. Don’t choose a community based on convenience alone; if you have to travel an extra twenty minutes or pay a Parkway toll to visit your nonna at a truly good, honest place, make that sacrifice for her. Per favore, focus on what matters most…
  6. … & Don’t lose sight of what’s important. If you’re touring ALs in the first place, it’s obvious that there’s a reason: your loved one needs help (that or you’re broke and want the free food, in which case I totally support you and you can stop reading after tip #2). While those fancy salons and in-house theatres are awesome, remember that they’re a bonus, not a necessity. The only thing that truly matters is care. Seriously, I cannot stress that enough.
  7. Ask questions. Unfortunately, your two-hour tour can only offer so much insight into how a community runs. Asking questions, then, is extremely important. Do residents wear emergency pendants around their necks? What about their apartments – are there pull cords by the bed and in the bathroom? When a call button is pressed or an emergency cord pulled, what’s the average response time? Don’t just ask your guide, either; chat with residents. When you’re sitting at lunch, engage with them. See how they like the community and what, if anything, they’d change. Do they feel safe? Are they happy? **Disclaimer, nonnos and nonnas love to complain, so it won’t be all rainbows and butterflies. Pay attention to what they complain about, though; does their food take too long or are they rushed in the shower? Is the toilet paper rough or are their call bells unanswered?
  8. Then ask a few more. You can never ask too many questions! Or make too many observations, for that matter. Notice some caregivers out of uniform? Ask your tour guide what their deal is. Do residents have private aids? How come, and how many? While we’re at it, what’s the staffing ratio? If you’re able to make a decent connection with your sales rep and some trust has been established, ask them honestly, “Would you move your loved one here?” Gage their response and, as a general rule, go with your gut.
  9. Bring your loved one back. Finally, once you’ve narrowed your choices, return for a visit with your nonno himself. Let him have a say and, more importantly, try the food. B-) Don’t expect certainty or full-blown enthusiasm, because they’re unfortunately unrealistic; trust me, nobody arrives high-fiving us on move-in day. However, it’s important to include your loved one on such a huge decision, and to be sure they feel secure and their opinion valued. After all, it’s their last stop, not yours.
  10. Take the plunge. Your nonna’s 97 but still not ready? Your nonno broke one hip but is still kicking with the other? To reiterate, if you’re even looking into AL, there’s a reason. It is alarming how many people I’ve spoken to who had excuses to wait and whose loved one ended up seriously hurt or in a nursing home. Please, please, please have their safety and best interests at heart, even if that means making tough decisions.

 

*7/2016 Edit* I realize that I made no mention of $$ in the above, and while the cost of senior living can take up a post and a half on its own, I’d like to at least bring up one point: I tell every single tour that unless they’re a multi, multi millionaire, a question they should always ask is, “Does this community accept Medicaid at all?” There are many misconceptions regarding the way in which residents pay for AL, and Medicaid is an important factor to consider. Once all of your money runs out and you’re eligible, it’s not a guarantee that your facility will let you stay. Make sure you ask about the “spend-down period” if there is one, as you’ll otherwise be forced to move if and when you run out of funds. This isn’t information that’s presented without prompting, as those communities who don’t accept Medicaid of course won’t want the thought of having to move twice deter you from joining them! See, I wasn’t kidding with numbers 7 and 8.. ask as many questions as you can possibly think of!

Un’amore Così Grande

couplesSome favorite couples at il Rifugio ❤

Last week, I was able to play my favorite reminiscence grab bag game again. I offered a workshop on “Keeping Your Mind Strong” to some loves at an assisted living facility and we had an awesome time. Though I didn’t necessarily hear any super-insightful responses like I’ve written about before, there was one nonna who really got me thinking. One of the prompts is “greatest role model.” When reading it aloud, I offered examples: a parent, a mentor, a former teacher. The nonna who’d picked this one, however, specified that her greatest role model had been her husband. Davvero?!

Amongst the countless things we learn from elders, it’s been my experience that love is of the most profound. To be clear: unless I’m crazy about you, I am not a lovey-dovey person. The word “relationship” gives me anxiety. I am the epitome of Humphrey Bogart in Casablanca when he replies “I never make plans that far ahead” to Madeline LeBeau’s “Will I see you tonight?” I can tell you with confidence that I am not writing this post as a sappy 20-something girl whose five-year plan is to find a husband and start a family.

That being said, the love these nonnos and nonnas have shown me blows my cynicism to pieces. It floors me. I, like everyone else, have a general idea of what I want and what I look for in a partner; I’ve got the standard mental checklist that I refer to and that changes as I grow. While some criteria remain, I’ve tweaked or eliminated others. Does he need to let Max sleep in bed with us? Yes. Will he have to be as obsessed with traveling? No. One condition that persists: he has to be there. Like, really be there. Not in the sense that he’s breathing down my neck; I mean I have to know that this guy would stand by my side through thick and thin, and that I would proudly, without hesitation do the same for him.

I’m cynical, but now I’m spoiled. I’ve seen a love that withstands both physical and intellectual decay – the kind of crumbling that leads to pureed meals & empty stares, to alarming confusion & hurtful claims, and to incontinence & immobility. It’s this love that plows through hurdles and persists. The man who’d talk to me despite my silence, who’d care for me without applause, who’d lie beside me on my bathroom floor to ease my painhe would be my role model, and me [hopefully] his.