Patience

One of my favorite, and oldest, little old ladies died recently at the GreatRep (the dementia care facility that I still work part time at).

Patience was seriously a bad-ass. She was the oldest living person I've ever met, at several years past 100. She still walked, fed herself, and talked when she died. She was chronically cranky, hated to get up early in the mornings, so we always let her sleep in and woke her up after everyone else had eaten their breakfasts. She was known for her particular style of combativeness - Patience would grab your scrub top's neckline, haul you in, and scratch the bejesus out of you while she shrieked "ouch! Owww! Hurting me!!".

But that's not all Patience was, of course. She still had a great sense of humor, and often seemed aware that her increasing deafness was a good source of entertainment. One day, in the dining room, she incited a food fight with another resident, a man. When the med tech on duty approached her to redirect her, she said "Patience, you're such a rascal!" and Patience stared at her for a beat, then said "I'm such an asshole?!?" then laughed maniacally.

Patience would constantly sing in a low, grumbling monotone, similar to her speaking voice. Very old songs, like Springtime in the Rockies, or The Battle Hymn of the Republic. She'd also talk out loud, verbalizing her thoughts, which she may or may not have been aware she was doing. If you were walking by her and stopped to say hello, give her a kiss, or wave at her, she'd often mumble "that one smiled. That one smiled. That one was happy." in her repetitive, robotic voice.

My favorite ever moment with Patience was when I was trying to put her to bed one night. She was being very resistive to standing up, not wanting to leave her comfy couch in the living room and walk down to her room. Patience had never had children of her own, but was a devoted aunt whose nieces and nephews still visited her until the end of her life. So, trying a different approach, I said "Auntie Patience, I want to go to bed but I'm scared to walk there by myself. Will you take me?". She grudgingly pulled herself up with her walker and headed to her room with me. She used the bathroom, brushed her teeth, put on her nightgown, and then, to my surprise, plopped down on her coffee table! She leaned back, pointed at the bed, and said, in her deadpan way, "Go ahead. You sleep now, I'll watch you. You go to bed. I'm here." Just thinking about that is enough to make me cry.

It's not often that the staff at a nursing home really loves and adores a combative resident, but we all loved Patience. Who else would repeatedly strip in the common area, to the point we had to go plunk her in her room where the nudity was more appropriate? And then when we checked on her later, we found her wearing only panties and a bedsheet tied around her neck like Superman's cape, singing Take Me Out to the Ballgame!

So, Patience, you were a delight. I miss you already. And I know you would understand that it's with great affection that I share the following photo of what you reminded me of at the breakfast table every morning, since you never mellowed out enough to get your hair combed until you'd been up for a few hours.

Dignity

There are different buzzwords that you hear a lot when you start learning about the world of senior care. "Aging in place" refers to someone staying in their own home. "Cognitive impairment" is the newer polite alternative to saying someone is confused, demented, brain-damaged by stroke, or senile. And any discussion about where/how/who will care for old people is bound to include opinions about how to "preserve dignity."

It's an emotional topic for families. They are used to seeing Grandma or Mom as a capable woman, and know that she worked for years as a nurse, or teacher, or Air Force pilot, or whatever it is she did. And even though she may not really be that same woman anymore in many ways, they want to have the stage set as if she still is the same as ever, as much as possible. Some families are against the use of mechanical lifts for that reason, because they think they are "dehumanizing." Some dislike certain terms; I have one client whose daughter doesn't like me to call myself her father's Caregiver. She prefers the term "escort" which I hate because my job is this:

and is NOT:


All in all, I'm not very sensitive about dignity. The truth is, getting old isn't a dignified experience. You lose abilities you used to have, and rely on others more. Your body is deteriorating. But you know what? It happens to EVERYONE who lives long enough. So there's no point being embarrassed about it. I think we may as well just be practical and do things the way that's the easiest for the old person. It's more comfortable and safer for them to be transferred with a mechanical lift? Use one. They need to be wearing diapers/briefs? Get some. The dickering about what to call someone's caregiver or whether or not Grandpa should wear a life alert pendant is more about the families than the person, lots of times.

But this week, at my job, I turned into the one saying "That's not dignified!" And it surprised me. What finally pushed me into that camp?

My facility's new policy that when we change someone's disposable brief, we must write the date, time, and our name ON THEIR ACTUAL BRIEF. Now that's impractical enough, but add to that the fact that if I check their brief, and it's clean, I must cross out the previous time and add the new one. Seriously. Which means that instead of a 2 minute trip to the bathroom to check, I need to decide if I want to be the jerk that writes on someone's butt while they're wearing the brief, the jerk that makes them take it off so I can write on it and put it back on, or the jerk who avoids the first two options by throwing away a perfectly fine one so that I can write on a new one in the other room where they aren't watching me autograph their underwear and then put that one on them.

Ugh.

I agree that not changing people when you're supposed to is horrible and can lead to health problems. But a small chart in their bathroom for staff to initial? Dignified. Writing on someone's underwear every 2 hours? Not.