Green House Blog

Deep Knowing for a Person Living with Dementia Changes ‘Behaviors’ into Messages

Laurie Mante

Joe moved into to Eddy Village Green (EVG) in early December 2017. His wife had been caring for him at home with great devotion for several years but was completely exhausted. They had four children who were all very involved and supportive of their parents. Joe moved in with the diagnoses of Parkinson’s disease, dysphagia, delusions, adjustment disorder, anxiety, dementia and hallucinations.

Joe was came to EVG after a fall at home where he lost consciousness and spent several days in the hospital. Joe’s biggest stressor in life was his retirement. Joe had a long career in law enforcement. His life was his career, and he was forced to retire due to his Parkinson’s disease. His wife reported that he never made peace with his retirement. Two of Joe’s sons were also in law enforcement.

Upon move in, Joe was very outgoing and friendly, and had a great sense of humor. But the first day Joe was in the home, he had two falls!  We knew right away that this was going to be a difficult journey. Joe also became very anxious as soon as his family left and was wandering around the house asking repeatedly where he was. Staff reassured Joe that he was safe and tried to engage him in some reminiscing. Joe had huge swings in his cognition throughout the day, so staff really had to adjust their approaches to meet him where he was. Sometimes he was very alert and lucid and could speak very well, and other times he was very confused and could not string together cohesive words. This was extremely frustrating and anxiety-producing for him.

We learned a LOT about Joe in the first few days from both him and his family. We learned that his routine used to be to work all day, come home and have a cocktail and some cheese and crackers with his wife, and then go back out on patrol with his son at night. This explained a lot of Joe’s roaming around the house in the evening hours – he would get restless after dinner and often be found rummaging in drawers of other Elder’s rooms looking for “contraband”. Joe would eat very well at breakfast and lunch but by dinner he was “on the go”. Shabazim brainstormed with Joe’s wife and began leaving out a plate of cheese and crackers and fruit at dinner time so that Joe could walk around and be “busy” but still get some calories in him. He had good and bad times of the day due to the Parkinsons, but when his meds were on board, he wanted to be moving, not sitting – so “snacking” for dinner was much better for him than sitting at the table.

A couple of weeks after moving to EVG, Joe was very agitated and walked out of the front door of the house. He was wearing a wander tag, so the door alarmed, alerting the shahbaz. The shahbaz followed Joe out of the house, but he was jogging through the parking lot, dodging among cars, as though he was engaged in a “chase”! Luckily, a staff person driving on campus saw the situation and offered Joe a ride, so he hopped in her car and she drove him around for a bit before returning him to the house. The team was wondering if getting him out more often would help, but the family was very against this as he had tried to jump out of the car with their mother driving during a hallucination.

Again, our partnership with the family was valuable in learning key information. We think Jim was hallucinating when he left the house and was running through the parking lot.. We were concerned about his speed when he exited the house, the winter weather, and the wooded areas on the campus, so we were able to place a gps-tracking devise on Joe’s ankle in case he exited the house like that again. I want to emphasize he was not exiting the house to get some fresh air or take a stroll, he was having a delusion that he was chasing bad guys and we were quite afraid he would get lost in the woods. We also instructed staff to call 911 immediately as Joe would not be threatened by a police response – these were his friends. There were other times, when Joe was calm and curious about the weather, when he would exit the house and come right back in when he was satisfied that it was cold, snowing, etc.

We also set up the den of the house with a desk for Joe, bringing case files and official forms, so Joe could do some work. Shahbazim also created a clipboard and would have Joe accompany them on rounds to inspect things. This helped to engage him, give him purposeful work – and seemed to keep the delusions away during the late afternoon and evening, which were very challenging for him.

We tried yellow signs on other Elder’s doors who did not welcome Joe’s visits, but this didn’t work at all – Joe  had spent his whole career walking through crime scene tape! So we put up a big “DO NOT ENTER – KEEP OUT!” sign, and this, interestingly enough, worked most of the time!

The Shabazim and nurses were so creative in their approaches to engage Joe and honor his law enforcement background. We ran ideas by his family regularly, and they were wonderful. Shahbazim also figured out that every time the weather got bad Joe would get particularly anxious. They figured out that Joe was worried about his family – especially his son who was out patrolling the road in the snow. So whenever there was ice or snow, the Shahbazim would call Joe’s sons and let him talk to them. They would assure him they were home and safe and Joe could settle down for the night. They also asked his wife to call whenever she left after visiting to let Joe know she arrived home safely. Joe had always been the “protector” of his family and it was important for him to continue to play this role.

Joe also enriched the lives of staff and the other Elders in the house in countless ways. His smile and laugh were infectious. He greeted visitors, and many people coming to the house called him “Sheriff”. He watched over everyone in the house. There was another Elder who sometimes was very sad and Joe would sit next to her and quietly hold her hand. This was a poignant reminder of the gifts people have to offer even when they are struggling so much themselves.

These are just a few examples of how deep knowing, listening to Joe, paying attention to his behavior when he couldn’t use words to express his needs, and partnering with his family, helped us to help Joe live his Best Life.

Joe’s life was very hard – he fell a LOT – but what to do? Restrain him? Absolutely not. We managed the environment as much as we could to prevent injury. His family was adamant that Joe be allowed to be as mobile as his disease would allow him to be. Sometimes he was so jerky from the Parkinson’s that he couldn’t have purposeful movement OR rest. This was very hard on Joe, his family, and the staff. In early March Joe experienced a very rapid decline – he couldn’t ambulate independently at all and was very lethargic most of the time. We suggested to the family that it might be time for hospice – and that their expertise could support Joe, the family and the house. The family agreed and hospice was added as another layer of support. Joe came down with a respiratory infection in mid-March. He was running a temperature and was very weak. He was having a lot of shortness of breath. He had lost weight. Three weeks after his admission to hospice, Joe died, in the house, with his family and Shahbazim surrounding him with love. Family was there 24/7 for the last week of his life, and the whole house grieved when he died.

Joe was not with us long – just a little less than four months. But in that short time, he taught us a lot about living his Best Life, and caring for others, right up until the end.

A Son Expresses The Need for Green House homes in Every Community

A son’s personal experience shapes his support for bringing The Green House model to Maplewood Nursing home, in Cheshire County, NH.

As someone whose father greatly benefited from living in a Green House cottage, I feel compelled to lend my voice in support of the concept as the proposed alternative to the deteriorating Maplewood nursing facility which now serves many needy elders of Cheshire County.

Paul JenkinsMy father was a well-educated, highly respected writer and clergyman who, in his final years of life, had the misfortune to develop Lewy Body Dementia, a disease that resembles a devastating combination of Alzheimer’s disease and Parkinson’s disease. It was one of the most difficult experiences of my life to watch this highly articulate man robbed of his joy, his speech, and, eventually, his mind.

When it became evident to our family that my mother could no longer care for my father in their home, we were blessed with the opportunity to be part of a Green House community in Holland, Michigan. The Green House concept is light years ahead of the type of care that has typically been given in places such as Maplewood Center. Maplewood has been a valued and effective facility for many years, but it simply cannot compare to a Green House setting. Green House residents live in private rooms with private baths. They are always treated with respect and dignity. They are referred to as “elders” rather than “patients.” Living, recreating and dining among a small community affords them with companionship that is so vital to their continued health. Family members are always welcomed at meals and other activities.

Before my father entered the Boersma Cottage, he was sinking deeper and deeper into depression, withdrawing from life, and was rapidly losing his desire to live. What struck me as miraculous is that, within a few weeks of his arrival, he started to regain his sense of humor and even had a playful quality about him that had been lacking in recent months. It is true that, because of his dementia, he was no longer fully the man I had known and loved. But the person that he became in his final months was well cared for and enjoyed a quality of life that, in my experience of such care – which is quite extensive – is unparalleled. My only regret is that he didn’t come to a Green House home earlier so that he might have enjoyed even more of its benefits. In the end, his death was a good one and for that I will always be grateful.

The Green House concept is, I believe, at this time the best way to provide quality of life for those in need of long-term care. It respects the dignity of the person and values the gifts that they still bring to the lives of others.

It’s time for Cheshire County to embrace this truly remarkable approach.

The Rev. Mark A. Jenkins

Rector, St. James Episcopal Church, Keene

More than Pampering. More than Relaxation. Therapeutic Massage as Medicine?

Compassion. Empowerment. Well-Being. Comfort. Engagement. Those are some of the ideals that describe The Green House Project. These concepts also define what therapeutic massage can provide to aging adults.  It’s beautifully simple…therapeutic massage can enable older adults to extend the vitality and quality of their lives. At its core, massage gives the natural pleasure of a reassuring human touch, lowering the risk of anxiety and increasing feelings of comfort.

Massage can increase relaxation, improve circulation, relieve pain, accelerate healing from injury and illness, strengthen the immune system, and improve sleep quality.   In addition, when performed by appropriately trained and licensed massage therapists, it can provide symptomatic relief from many conditions that occur with age.

For example, the Arthritis Foundation reports that therapeutic massage can decrease joint and muscle soreness, reduce muscle pain and spasms, and improve grip strength.

Incorporating regular therapeutic massage into the treatment protocol for Parkinson’s Disease can have a positive cumulative effect on managing symptoms. In fact, the National Parkinson’s Foundation reports that massage can reduce rigidity and tremors, increase daily functioning and stamina, and increase feelings of relaxation.

How can you bring massage to your community?

Therapeutic massage for older adults is a growing niche industry. Increasing numbers of senior living community administrators are exploring ways to bring a therapeutic massage program to their residents. Increasing numbers of current and likely future senior living community residents are seeking this therapy.

Family and Nursing Care began offering therapeutic massage in 2011, as a complement to our home care services and to support our vision for wellness and whole-person care.  In one community we work with, interested residents sign-up each week for a short seated massage. On the day of the massage, the residents come to the massage area at their designated time.   In another community, management wants to show the health and wellness impact of the massage program. They asked for volunteers who wanted to receive a 30-minute massage session each week. Residents were selected on a first-come, first-served basis. Because we are working with the same residents each week and the massages are of a longer duration, this expanded program includes an initial intake, assessment and development of massage plan, goal setting, regular massage in accordance with the plan and goals, SOAP (Subjective, Objective, Assessment, Plan) Notes, follow-up assessments, consultations with the medical team as needed, and submission of progress reports to management.

These are only two possible options. There are many variations on what a program could look like. First, identify the nature of your interest in a massage program. What value do you want to bring for your residents and for your community?

After you have identified the foundation for the program, there are many other factors to consider:

  • What outcome would you need to consider the program a success?
  • How many of your residents would be interested in participating in a massage program?
  • Would your residents’ level of interest be enhanced by education about the benefits of massage? If so, how can education be provided?
  • Is your medical team knowledgeable about the benefits of therapeutic massage? Would they be willing to refer residents for massage?
  • Will your community make an investment in the success of the program? In our experience, the program will be most successful and reach the largest numbers of residents when the community foots the bill.
  • Does your community have a private room that could be dedicated to massage or would the residents get a massage in their own rooms?
  • Would it be important to you to have massage therapists who are trained specifically to work with older adults? Who can give your residents the option of staying fully- or partially-dressed during the massage? Who can give your residents unable to get on a massage table the option of getting their massage in a hospital bed, their regular bed, or even a wheelchair or even their scooter?
  • How many hours per week or month would massage be available?

These are only a few of the questions to take into account. Consider partnering with an experienced organization to help ensure the success of your massage program.

 

About Family & Nursing Care

Since 1968, Family & Nursing Care has specialized in helping older adults get the most out of life. Whether it is a caregiver to help with activities of daily living, a nurse to assist with more skilled needs, or a licensed massage therapist to ease aches and pains or the symptoms of an illness, Family & Nursing Care meets each client’s individual needs. Service is provided in Maryland (Montgomery, Prince George’s, Howard and Frederick counties) and Washington, DC. Learn more at www.familynursingcare.com.