Saturday, January 20, 2018

Are They Happy?

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.

Wednesday, January 17, 2018

Cultural Smoker Rescue

I need a webpage to hold easy to find information for this blog. The following draft pages have been prepared. Your comments will be appreciated. I now have something worthwhile to do in winter when I cannot work out on the Monarch Butterfly Sanctuary.
1.    New Website.
2.    Tobacco Free Pledge
3.    Definitions
4.    Together We Can
5.    Terminology
Two years at Provision Living at Columbia show a need to rescue smokers and residents from tobacco smoke. Nicotine addiction is not a private matter using cigarettes.
Cultural norms over the past 50 years have changed from ancient customs of ceremonial use to a society becoming fully aware of the health consequences of cigarettes designed for maximum addiction that thus yield maximum profit.
The new norm is no exposure. Instant elimination of exposure is now legally available from nicotine sources other than smoke.
The long term approach is culturally imbedded. It took 30 years for hospitals to discover they were health care facilities. And longer for airlines to be smoke free because it was more profitable. And 50 years for MU Health Care to be smoker free.
The general public is now smoking less, but 75% of smokers still want to quit. Many do all by themselves. A pack-a-day smoker can save the equivalent of a $1/hr raise. But most smokers need a close knit support group: church, club, job site.
I think the following homework allows me to make a valid comparison between tobacco free (if it exists) residential care in San Antonio and a plan to develop such here if we remain in Columbia.
1. New Website            13Jan18
Three years ago I started www.residentialcarefortwo.blogspot to record our search for a place for my wife and me. We have now lived for two years in Provision Living at Columbia, MO, in assisted living and in memory care.
Our family situation has changed. We are looking again. Columbia, MO, is not a tobacco smoke free city. Employees can smoke on the job in designated areas. San Antonio, TX, is a tobacco smoke free city. Many workplaces are smoke free.
This time we would like to find a site that is free from third hand tobacco smoke. Tobacco smoke: first hand, second hand, and now third hand, has been found to be equally damaging to health, in comparable amounts (with the exception of triggering my allergies). Tobacco smoke has no place in health care facilities including assisted living and memory care.
Unfortunately, big money still controls tobacco use at the federal and stage level. Current smokers finance the infamous tobacco settlement that pays states for 25 years for damages to health and to promote non-smoking. That money, however, is not used to promote non-smoking but put into the state general fund.
The tobacco tax is also seen as an important revenue source for states; when governors worry about a loss in the tobacco tax as the price of cigarettes is increased to reduce sales to minors. Missouri collects about $20,000 per 20 cases of cigarettes. Most states collect about $180,000 for 20 cases. That is the value of one life lost from tobacco.
Protection of the general public then falls to the general public, and to the advantage, companies see in declaring; first, smoke free, then tobacco free, and finally, totally, smoker free (first hand, second hand, and third hand smoke).
Provision Living at Columbia is a good [candidate]. It was constructed with no tobacco use in the building. It is just two years old. It has a skilled, experienced work force that includes many former smokers. It has only one resident smoker who diligently goes outside, come whatever weather, each morning.
This is a college town. This helps promote a high turnover rate. The opportunity exists to expose a large number of people to an effective smoke secession program as new hires are welcomed into productive [groups] (or rejected).
Now to explore the status of tobacco in residential health care facilities near Columbia, and not waste the effort, by posting what we find on this [website]. We may move to San Antonio, for a year or two, or work at clearing the air here.
--DRAFT--                           2. Tobacco Free Pledge                              --DRAFT--
Your residential health care facility will be tobacco free soon, if it has not already been established as tobacco free. Also help the 75% of smokers who want to quite, to quite. This is easier to do in a model Smoke-Free City.
San Antonio City Ordinance: 2010-08-19-0697, Chapter 36: (Bold my emphasis.)
WHEREAS, numerous studies have found that tobacco smoke is a major contributor to indoor air pollution, and that breathing secondhand smoke is a cause of disease in healthy nonsmokers, including heart disease, stroke, respiratory disease and lung cancer; and
WHEREAS, secondhand smoke is particularly hazardous to elderly people, individuals with cardiovascular disease, and individuals with impaired respiratory function, including asthmatics and those with obstructive airway disease; and
WHEREAS, the United States Surgeon General has stated that there is no risk-free level of exposure to second-hand smoke (U.S. Surgeon General’s Report – 2006, The Health Consequences of Involuntary Exposure to Tobacco Smoke);
Company: _____________________________________
          Independent Living    Assisted Living    Memory Care    Skilled Nursing
Beds:            _____                    _____                _____                 _____
Date to be tobacco smoke free: _____________

Date to be a tobacco free site:   _____________

Date to be a smoker free site:   _____________

Date to be a clean air site:        _____________
Address: _________________________________________________________
Phone: __________________ 
Email: __________________________________
Name: __________________________________  Date: ___________________

Post to: [] (near Columbia, MO, and San Antonio, TX)
3. Definitions
As detailed as these three definitions are, they still do no state clearly current situations. This leaves the code open to interpretation.
Is a residential care facility such as Provision Living ranked as a health care facility?
The tobacco free status of the MU campus includes the medical center and all outdoor areas, including parking lots and sidewalks.
Health care facility means an office or institution providing care or treatment of diseases, whether physical, mental, or emotional, or other medical, physiological, or psychological conditions, including but not limited to, hospitals, rehabilitation hospitals or other clinics, weight control clinics, nursing homes, homes for the aging or chronically ill, laboratories, and offices of surgeons, chiropractors, physical therapists, physicians, dentists, and all specialists within these professions. This definition shall include all waiting rooms, hallways, private rooms, semiprivate rooms, and wards within health care facilities.
Place of employment means an area under the control of a public or private employer that employees normally frequent during the course of employment, including, but not limited to, work areas, employee lounges, restrooms, conference rooms, meeting rooms, classrooms, employee cafeterias, hallways, and vehicles. A private residence is not a “place of employment” unless is is used as a child care, adult day care, or health care facility.
Public place means an enclosed area to which the public is invited or in which the public is permitted, including but not limited to, banks, bars, bingo facilities, educational facilities, gaming facilities, health care facilities, hotels and motels, laundromats, public transportation facilities, reception areas, restaurants, retail food production and marketing establishments, retail service establishments, retail stores, shopping malls, sports arenas, theaters, and waiting rooms. A private residence is not a “public place” unless it is used as a child care, adult day care, or health care facility.
Smoking means inhaling, exhaling, burning, or carrying any lighted or heated cigar, cigarette, pipe, or any other lighted or heated tobacco or plant product intended for inhalation.
The code does include exhaling tobacco smoke; which may include third hand smoke: out-gassing from body, hair, and clothing.
My one-week trip to San Antonio, nest week, should provide some answers. What is said and what actually happens can be very different. The following provides no protection from third hand tobacco smoke; only tobacco free does that.
“As for the smoking free environment. Yes, we are smoke free and nobody can smoke in the building. The only place that associates can smoke outside is in designated area outside.”
--DRAFT--                        4. Together We Can                                       --DRAFT--
Employers and employees have an obligation to assist fellow employees and new hires to gain control of their addiction to nicotine. It gives a pack a day smoker about a $1/hr raise at little cost to the employer.

A. Set the terms for employees to be free from nicotine addiction (as is, all other drug addictions are illegal and/or grounds for dismissal).

There is no, risk-free, level of tobacco smoke.
Nonsmokers enjoy better health and more productive time.
Employer support includes nicotine management supplies and services.
All new hires must take an active part in a support team.

B. Organize employees to support one another and recognize progress.

Organize employee support teams by job locations.
Try to include a former smoker in each team.
Award periodic prizes for progress.
Make provision for new hires.
Recognize arrival at smoke free and tobacco free site rankings.
Celebrate success when smoker free (except for new hires).
5. Terminology
Tobacco use has been a part of our culture for centuries. Life was short. Baseball players spit tobacco. Cowboys smoked Marlboro. In the past century they lived long enough to develop mouth cancer and lung cancer.
In 1964 the United States Surgeon General declared that tobacco was the greatest cause of preventable illness and death in the country. Our cultural assumption was it only involved tobacco users.
In 1994 seven tobacco company executives lied to congress, “I do not believe that cigarettes are addictive,” and lost their jobs but avoided jail time. Our culture learned that tobacco use is not a habit but a means of delivering a powerful addictive drug. The cigarette is optimized to addict and therefore to kill.
By 2006 the United States Surgeon General had determined that there is no risk-free level of exposure to second hand smoke. Our cultural response was to increase the isolation of addicted smokers and to declare tobacco free areas.
A cultural response is needed today to assist tobacco addicts to regain control of their own behavior. Tobacco companies and federal regulations are of little help to addicts. The task of becoming tobacco free falls to communities and work groups. I have experienced five levels of concern in the past two years:
*Unregulated: San Antonio, TX, lives on top of its water supply. Cigarette buts can contaminate that water.
*Smoke Free: No active smoking in the area (indoors and outdoors). Dividing a room into smoking and nonsmoking was a political maneuver. Addicts are temporarily provided an isolated smoking area (indoors or outdoors) with self-extinguishing butt collectors.
*Tobacco Free: No tobacco products allowed on the area. No butt collectors. Active therapy provided for addicts by health care services, employers and employee support groups.
*Smoker Free: No smokers!! End of air quality problem? NO.
*Clean Air: The continuous injection of air contaminates that mask or alter odder in residential care space without the consent or knowledge of the occupants is not only unethical but a health hazard. It is one more stress on people in poor health (our laundry can be marked: no softeners). The marketing pitch is they increase sales in boutiques by about 10%. They may have a clean air or fresh air effect for some people but I know of none in use that actually clean or refresh air.

Sunday, December 31, 2017

Dreams and Meditation

Yesterday I was the first person at breakfast. I selected the table that Margaret and I used, near the kitchen, next to the table our 104 year old resident usually sat. 

At 6:42 I should make it again today. I am feeling unusually well again and need to make the most of it.

Last night I woke up at about 3:00. That is not unusual. To my awareness, I never went back to sleep!! Instead I had two of the most vivid dreams.

The first was completing the cheat checker software for answer clickers used in the classroom. I was offered the job the same week that we moved into Provision Living two years ago.  My computer had crashed so the PC part of this Mac was destroyed and I did not have the energy to totally reinstall the Windows operating system.

Also I had no idea how I would edit my paper test cheat checker to work with a dynamic answer clicker system. The dream laid out the way to edit the connection between the clicker and my cheat checker.

SO, after James and I sorted out all our stuff in storage last Tuesday and I discarded about everything I had left from my programming days, I will now find the clicker file. For some reason I could never toss it.

The second dream was a replay of an article that found me yesterday. I have been using Google Chrome and Safari web browsers the past few months. I have also bought several books and eBooks from Amazon.

My interests are now known. I have a library that tells me what is new, exciting, and different as well as the next thing on the “shelf” related to what I have looked at and/or bought; as well as what other people of “like mind” have been doing. I have my own book club.

The article is not entitled meditation. It uses terms that seem a bit strange. But it includes a table that conveys in practical terms what, I believe, span the range of meditation topics. 

It is a long ways from Columbia to Grey Summit for Christmas without mile markers and no one to discuss interesting things. It seemed less than 30 minutes with these features. Meditation needs “mile markers” for topics and time.

That same time stretch occurred last night. To me, I was awake from 3:00 until about 3 minutes before the alarm at 6:00. The Sleep Number bed rated my sleep quality at 91; just one point less than my highest. So I must have been asleep. I feel like I had a good nights rest. Meditation time also seems unrelated to clock time.

The Positive                  Radiant Thankful Person who is open to the needs of others and makes you feel good just to be around.
The Negative Self Centered Person who needs some help forgiving real and imagined problems.

The David Hawkings levels of consciousness, on a scale of 0 to 1000, can be split into two parts: Things we should learn to forgive (but not forget) and things we should be thankful for (including about everything). Most people commonly understand these 17 simple terms. They can be used in guided meditation.

Forgiveness frees us from the destructive control the lower ranking terms have on us. Thankfulness opens us up to more things to be thankful for. 

Simply put, this is mind over matter; self awareness over self centeredness. These terms provide an effective way to use guided meditation.

It also follows, to choose friends and associates who radiate the positive upper levels of consciousness and avoid (or retrain) those that are stuck in the negative lower levels. This is the practical task of screening and evaluating new employees at Provision Living.

A radiant person, who is fully aware of the needs of a resident, performs markedly different than a non-radiant person. The same person can, at times, switch roles given circumstances of the moment.

Last week my tablemate was looking for her favorite strawberry jam at breakfast. There was no jam on any table in the dining hall. “The night crew did not finish setting the tables up properly.”

When we were about finished eating, two plates arrive at the next table, with jam on the toast. We enquired again about jam. “Here it is. Oh. Sorry, you like strawberry.” The server even remembered the correct flavor upon being disconnected from negative lower levels of consciousness.

The Hawkins Levels of Consciousness terms provide 17 different views of the same thing, each of which can also be distorted in time when dreaming and during meditation.

Friday, December 15, 2017

Provision Living Monarch Butterfly Therapy

Tagged Monarch Feeding on Mexican Sunflower
Everyone seems to like butterflies. They make people happy. Residents associate them with the bright sunny days in which they were found as kids.

Monarch butterflies have very durable wings. They can be tagged in late summer and early fall with a resident’s ID. Then wait until spring to see if the tag has been found over a 1,000 miles away in Mexico.

The plan was simple: raise milkweeds, collect eggs, raise caterpillars, and release butterflies; as my wife and I had done for many years. Let each interested resident have a rearing container to watch the show. ["The Community reserves the right to determine the appropriateness of your pet." Page 4 of 13]

That did not happened. Instead a program evolved in which caregivers and memory care residents took part followed by assisted living residents as spectators (“I don’t want those ugly worms!”).

The area is no longer several half-gallon butter pecan ice cream containers with five caterpillars in each, and 300 milkweed plants in our back yard. It now includes 1.5 acres of Ozark mountain terrain that is being naturalized with milkweeds and nectar sources for monarch caterpillars and adult butterflies.

Provision Living Monarch Butterfly Sanctuary
Memory care residents spent an afternoon, May 17, on the patio repotting 50 milkweed plants provided by the city of Columbia from Monarch Watch. They helped water them in the memory care patio garden. About two months (July 14) later they helped repot the plants into root bags.

The plants attracted monarchs. One afternoon we had a good 1/2 hour egg laying show with over a dozen eggs found. Daily collections were made by residents, relatives, and caregivers. In total, these potted plants attracted over 120 eggs.

Leafless Common Milkweed in Root Bag
The caterpillars would have eaten these small plants into the ground if we had not removed them.

My wife had a three-day period in which she did not talk. A caregiver accompanied her to look for eggs. By the time she had found a dozen eggs and two caterpillars she was smiling and talking.

The dormant common milkweed roots were moved to the south end of the 1.5 acre sanctuary this fall by a crew of 30 from the Legion of Black Collegians. This species of milkweed will next grow tap roots over six feet down, instead of six inches down in the root bags. I wind-sowed over a thousand seeds on a barren area to the north. Both areas are visible from the resident areas.

Tropical Milkweed from Seed
Tropical milkweed, seeded in a large “self-watering” pot, attracted both monarchs and humming birds. The pot was moved on and off “stage” as needed. [These seeds were, by luck, in a package of butterfly milkweed seed from Walmart.]

Our assisted living spectators saw very little of this as they lacked an area like the large memory care patio or our little apartment garden with common milkweed, french marigold, and later, Mexican sunflower.
September 12
May 26

Their primary interest was in large caterpillars, the beautiful chrysalides, and releasing the adult butterflies. Many were fascinated by the rate of growth, the metamorphosis, and the behavior of the caterpillars (feeding, and head bobbing in response to the voice of some residents).

This lead to a display in the lobby that visiting children and adults, and residents found fascinating. My activities in tidying up the display each morning (fresh leaves and a new diaper for caterpillar poo) attracted attention at breakfast.

August 7
September 7
Inspired visitors commented on the amount their caterpillars ate and the amount of poo. (They did not see me change the paper towel in the bottom of the display boxes each morning before 8:00.) One lady reported she had to take her untidy rearing box off her dinning room table.

September 29, Boarding Last Flight to Mexico
We now had too many chrysalides for the rearing boxes, holding 10 caterpillars each, in memory care. This lead to the addition of an emergence flight cage in the lobby for all residents and visitors.

Several of the caregivers recorded a pupating caterpillar and an emerging adult butterfly. A very supporting article was in “Inside Columbia’s Prime Magazine”, August, 2017, pages 26-30, by Jack Wax and photos by LG Patterson, “Richard & Margaret Hart Create Sanctuaries”.

The entire memory care community parked itself on the patio to observe the release of the first two monarchs. (See Provision Living at Columbia on Facebook.)  Each butterfly climbed high into a bright blue sky and then headed into the top of trees, accompanied with cheers and applause. It was a perfect show.

Our memory care poet in residence, Sylvia, handed me this note:
August 15
The Halloween contest produced this:
October 15
As time passed I learned the thing that most residents liked to do was to hold the butterfly before it flew away. Feeling a butterfly walk on their hand, feeling the little claws grasp their skin, was a memorable experience.
October 6
September 28

I also learned how to make it happen: Release the butterfly about five hours after emerging from the chrysalis. Too soon and they will not fly; too late (next day) they fly on release. We scheduled departure time each day as about 3:00 pm, weather permitting.

September 28
We learned to release the butterflies on the south side of the building near the entrance flagpole. We could watch them fly back up along side of the building.  When reaching the roof above the three-story building, they then took a southwesterly course: On to Mexico for the winter; about a month and over 1,500 flight (or bicycle) miles away. (See Memory Care Butterfly Rearing Box for details)

What has happened this year was a bit of a surprise. It was a preview of what we expected to experience next year. The durable rearing box (previous post) should make it easy for anyone to provide monarch butterfly therapy for individuals and for groups. But first get a good source of common milkweed leaves and a refrigerator (Do not serve as salad). Several of the caregivers can repeat the therapy given a supply of milkweed leaves.

Residents like to see things that grow and that change. They like to take part. Thank you to all who assisted me to manage the display and to make the releases possible. And thank you to Provision Living for letting us have all this fun.

Residents, monarch butterflies, and humming birds liked the flowers on the tropical milkweed and the Mexican sunflower. They put on good 2-30 minute shows several times a daily on the memory care patio. We will grow these plants from seed next year again. They are durable and an easy way to move the show about. We look forward to feeding caterpillars from our own milkweed next year.

Common Milkweed with Big Leaves
to Feed Caterpillars
Tropical Milkweed with Ornamental Flowers
and Very Attractive to Monarch Butterflies

Memory Care Butterfly Rearing Box

Inverted Storage Box
A 6-quart, $1 plastic, made in the USA, Homz, storage box from Walmart became a rearing box after it fell off my computer desk onto my lap upside down. It as total view of contents; easy for residents to handle; and space for 3 eggs to become adult butterflies or 10 eggs to become chrysalides. It had twice the size of the butter pecan 1/2 gallon ice cream container my wife and I used for several years to raise 5 caterpillars.

Half-Sheet Paper Towel Water Source Folded to Control Humidity
It took several weeks to find the balance between a two-three week water source and the humidity control we had with the ice cream containers. The chrysalids fail to attach properly in high humidity.  
Inverted Box with Holes Drilled
Drill holes to provide ventilation and lower humidity at the top of the inverted box. (Dremel rotary tool. Ended up with 12 1/8 inch holes but will try 16 next year.)

Cover lid with one 1/2 sheet of wet paper towel folded for eggs and hatchlings, for small caterpillars, or for large caterpillars.

Place leaves (or parts) with eggs and hatchlings on the wet paper towel.

Hatchling and Egg
Second Stage Caterpillars

Do not place in direct sunlight near a window.

Reduce condensation by removing from sunlight or increasing ventilation around the box (or drill more holes if room air has poor circulation or high humidity).
After a week, all the eggs will have hatched. Development takes place faster in warmer air. The monarchs in the lobby took 3-7 days longer to develop than in our apartment.
Quintuplets, the Last Eggs Laid  

Fold a wet 1/2 sheet of paper towel once on a clean lid (lowers humidity).
Add enough leaves to feed for 3-4 days or observe and, as needed, feed daily.
Transfer caterpillars onto new leaves.

After another week the caterpillars will start eating more, lots more.

Big Eaters
Fold the wet 1/2 sheet of paper towel twice on a clean lid (lower humidity).
Add enough leaves to feed daily or longer.
Remove the paper towel when feeding stops.
Change paper towel as often as needed for odor and tidiness. (Daily in the morning in the display.)
A Sleepy Chrysalis
The caterpillars will assume a J shape before becoming chrysalides. 

The Quintuplets with Development Almost Tied
and in Near Perfect Spacing

Casting the last caterpillar skin is one of the most watched stages of development. A number of residents became skilled in judging the time for this to happen; about after breakfast.

Emergence chamber.

Taped by Dental Floss and Silk
For few monarchs, fasten a full sheet of paper towel up the backside of the box and over the floor of the box for the new butterflies to climb up on.

For any number: Gently remove a chrysalis and silk webbing with forceps.
Tape or pin the silk webbing into an emergence chamber.

If the webbing fails, tie the uppermost black end of the chrysalis with a length of dental floss and then fasten into an emergence chamber (flight cage for large numbers).
Two Chrysalides Ready to Emerge

The adult will emerge shortly after the chrysalis becomes totally transparent. Seeing the wings inflate is the most watched stage of development. Again residents became skilled in judging the time of the event. A good show is to have 10-20 emerge on the same day.

Adult release.
Box Open with Dry Paper Backing

1.    If the wings feel cool, they are not dry for tagging or release. It takes about five hours. We released them about 3:00 pm.
2.    Put one butterfly in each rearing box for group releases. Butterflies fly up and to light. This makes it fairly easy to put a hand into the box below a fluttering butterfly.
3.    Assist each person to open the box (unsnap the lid) and to let the butterfly walk up onto an upturned hand.
4.    Gently remove the box without disturbing the butterfly.
5.    Most butterflies will remain on a hand for several minutes.
6.    We let slowpokes walk up onto a nearby tree leaf or just picked them up by grasping the front of both wings with thumb and forefinger.
7.    A good show is to assist several residents to hold the butterflies at the same time. It took me a bit of practice to do this quickly and quietly enough that four residents had a butterfly on hand at the same time. Hold the box only at the lock point with one hand and release the lock at the other end. This permits complete control of the opening and closing of the box.

When things go wrong.

A dropped chrysalis is a broken egg.
Damaged caterpillars and adults bleed green.

Dark off-color caterpillars and chrysalides are usually sick and die from many causes. This increased as the season progressed.
What Happened to You?

Caterpillars and chrysalides with slime strings reaching the bottom of the box have been parasitized with a tachinid fly larva (maggot). The white maggot or the dark brown puparium will be found undercover among the fecal pellets.

One to Three per Caterpillar Kill

Running out of food overnight only extends the development period.
Don’t mash a butterfly between the box and lid. Let an escapee go.