Why Dementia?

I was thinking about this last night, and then talked about it with a friend (hi Annie!) on the phone today; not everyone likes being around people with dementia and taking care of them, so why do I?

First of all, I don't always like all my residents. There are a few who really only react to anyone with physical aggression - no matter what you do, they're hell bent on hitting, scratching, spitting on, and choking you. Those few, I figure I just missed the window where they were able to get through their disease enough to react better, and now all I can do is provide the minimum care needed to keep them safe without either of us getting hurt. I don't get all fancy and try to put makeup on them or anything, because I know they won't enjoy it. And I don't have to like them, I just need to do my job and take care of them, so I do.

That's a very small percentage though. The rest have their quirks and behaviors for sure, but I genuinely really like them and enjoy taking care of them, even as they get further into their diseases.

It's hard to explain exactly why it doesn't really occur to me to think that watching someones dementia progress is depressing. The best I can liken it to is that my husband used to be a special ed. teacher, and would get all kinds of idiotic comments when he told people what he did for a living. "That's so sad! I would cry every day because those kids aren't fixable" or "That must be so HARD" or "You must be really special to be able to handle THAT all day". He'd always get mad because he didn't view his students as broken or worthless or burdens any more than any other kid. The kids don't hate their lives; they don't know any different, and have always been who they are. And sure sometimes they were pains, but every kid is sometimes. And sometimes they were very funny and fun and loving, just like any other kid.

I feel pretty similarly about my residents. I didn't know them before they got sick so I don't know any better than to expect them to be however they happen to be right now. And I pretty much like them how they are right now. And will still like them even as they decline. Knowing them when they're only somewhat confused makes the end/rageful stage (not everyone does this) easier to handle.

I think it's pleasanter to take care of someone who is in the permanently-combative stage if you know a little more about who they used to be. I always appreciate when I step out of the bathroom after getting a beat-down, my hair all askew, nametag crooked, covered in sweat and disinfecting myself like mad, one of my coworkers says "You know, Lily never used to be like that. When she first came here, she used to play the piano and try to tuck the other residents in at night. She was a cool lady." It makes it easier to go back in and face the Lily that's kicking me, if I can hold that picture in my mind and be trying to care for that past Lily even though she's gone already.

It's sad when someone is in the self-aware stage of the disease, and knows they're losing their memory and is powerless to stop it. It's sad because they're sad. But once they pass that phase and are living in the moment, they're often pretty content, and if not, then I can help them feel better usually. So that's not sad anymore.

With the rare residents/clients that I knew before they got so confused, it's more sad to me. Mainly just because I miss them, and I know that if they were aware of the whole situation, they'd be upset that they were missing out on so much. And I do understand that's where most family members are coming from, and it's really hard on them. It's easier for me because I usually get to live in the moment with my residents without mourning the past.

I think my favorite thing about working with people with dementia is the immediacy. I don't have to spend a lot of time building a relationship with a resident before they will trust me. If they like the way I interact with them, they'll probably go ahead and help me do what we need to do. If they like me, I get kisses right then. It's great, and very clear. And if they don't like me? I can go away, come back, and try again with a clean slate.

That probably sounds really lazy on my part. But it's true - I like the simplicity of my relationships with my residents. Affection flows freely and quickly, and anger vanishes fast, for the most part. Who wouldn't find that personality type easier to care for than someone who bickers and holds grudges? Right?