At breakfast this morning, the question was raised, “Are the people in memory care happy?”
This struck a responsive cord. I have noticed a difference in caregiver behavior in the past few months. It is more than forewarning new hires to allow my wife “her” time to respond; to avoid a sound smack.
It is more than the extra work needed when several residents show behaviors we thought, last year, were related to our 3-month flood evacuation to skilled nursing at South Hampton Place. There is something different in some of the new hires.
As I am writing this, Maggie gets up and goes to the bathroom: 9:05. A lady who has been with us from the beginning happens by to check in to see how things are going.
Without little more than a friendly greeting and hug, she changes my wife out of night clothes and into day cloths in a well rehearsed ritual; perfect timing in sequencing and spacing of each necessary step. I did not hear a single word spoken by either one after I left the bathroom: 9:10 and ready for the day.
“Your gown is wet. Pause. We need to change it. Pause. Sit down. Pause, etc.”, in her gentle commanding voice. Each garment is displayed. Pause. And put on (often she will do this herself when sitting on the daybed and not rushed).
There is something different about Provision Living. We are all two years older for sure. There will probably never be another man like the guy who could do every thing when we first moved in. He made memory care and the dining hall a circus. But we are two years older now. And nearly 100 residents; double when we moved in. Both caregivers and residents have changed.
Happiness is most easily detected in the interaction between radiant caregivers and residents. The caregivers create the climate and situation for happiness to occur. The long-lost-friend hug (in many forms) is the best example; often proceeded by, “May I give you a hug” or “May I hug you.” The positive head node and/or smile are indicators of happiness.
This week everyone in, memory care one, was at a table with every chair filled at an evening meal. After serving everyone, the caregivers did not have a spare seat to share tables with the residents.
The group dynamics of 24 residents is different than for a smaller number. The optimum number that changes behavior from a big family to a restaurant/hotel seems to be between 16 and 20 residents.
Indicators of unhappiness are easy to observe, especially in a resident’s first few days. The patience and skill of the best radiant caregiver can be taxed.
The breaking point is running out of patience or taking something in the event personally (loosing that sense of detachment needed to remain a good observer). “Are you just bugging me?” Now, neither person is happy.
“I have no money to pay the bill”, is frequently stated by more than one resident. “The food is free.” “The food Is part of your rent.” “Your (brother, mother, father, sister, son or daughter) paid the bill.” All delivered with or without a hug.
Two years ago the delivery of our meals in the main dining hall and in memory care was accompanied with, “Miss Margaret”; “Miss Maggie”; “Mr. Richard”; “Dr. Hart”; etc. It was a welcome to the meal and a way we all learned the names of others for the umpteenth first time. And those who could said, “Thank you.”
That greeting is a reaffirmation that this is real for all residents. It is a feel good moment. I will never forget when I first understood this. A memory care resident asked me, “Dr. Hart, how did you know my name?”
This is just one case of, how it is done, is as important as what is done. The gracious performance of formal dining changes eating into a positive event. Positive events promote better health, even though they may be quickly forgotten.
In memory care, a resident’s fleeting moments of happiness are often a reflection from a caregiver. Feeding and fitness (stretching, strength, balance, tai chi, yoga, and meditation) are the main communal settings in which happiness occurs at Provision Living. These are modified for memory care residents.
In general, an adaptable, radiant, huggable caregiver who can step into the theater of residential care by anticipating the needs of residents before hand, can deliver a positive performance with a minimum of stress. In my wife’s case, this is a painless “no hit” performance with a minimal use of “calming” drugs.
The flood of 2016 produced a natural experiment. We were evacuated three months to a skill-nursing site. Xanax was put on daily dose of 0.25 mg, 0.25 mg, and 0.50 mg when my wife’s behavior became too “aggressive” (top chart). The unexpected effect was six falls, every other day, until Provision Living took control of her medications again.
|8 Days and 8 mg|
|48 Days and 4 mg, 1/12 the Above Dosage|
Now a year later, with comparable behavior in the holiday period, and in memory care, where diversion and distraction replace drugs, we see an entirely different pattern of drug usage (bottom chart). Only once was a 0.25 mg pill used more than once a day (red). No pills were used for a 12-day period.
Happiness is possible when free from “anxiety” and “agitation”. Skilled caregivers, familiar with the resident, reduce the need for medication.
9:35, and several days later. A greeting, a hug, a pill and yogurt. Some conversation. “You want the rest of that yogurt?” Pause. “Come with me.” A long pause as Maggie finishes working on the refrigerator. At the very instant her attention changes: “Come on with me.” A long pause. She turns toward the door. Stops. “Ok, come on with me.” She drifts out the door. “We’re out of here.” Pauses. Then, on her way. A perfect match of caregiver and resident. A perfect performance. It still brings tears.
Happiness is in a spontaneous expression and interaction with patient, experienced, caregivers. It also seems to be in quiet moments, playing with keepsakes, doing things you now have the time to do. In meditation it is in mindless “being”; existing as a milkweed plant or a chrysalis rather than a butterfly.