…when his children finally talk him into moving her into a nursing facility near their home, Pasquale weeps with sorrow and guilt, but also with relief, and guilt for his relief, sorrow for his guilt… (from Beautiful Ruins by Jess Walter)
My Mother in a nursing home;
I was terrified.
Ripped from the headlines images
Seared in my brain.
My hands trembled;
my Mother in a nursing home;
Her stay was meant to be short lived; just long enough to do therapy for her newly replaced knee.
But after surgery, dementia made its unanticipated, irreversible, full-throttle debut. The anesthesia had obliterated her mind. My Mother could no longer cover her missteps and misstatements.
My Mother could no longer care for herself.
We were completely unprepared. We knew nothing about her rights or our responsibilities. Armed with worry and trepidation, sorrow and guilt, we sought advice from social workers, clergy, doctors and friends.
The chorus was unanimous: see an eldercare attorney.
We peppered her with questions. What is the best home in Los Angeles…Should we move her east… How much does it cost…How do we ensure compassionate care…that she won’t be abused…that she will be safe?
From her well-heeled perch in a stylish office, the attorney offered one observation worth recounting. And while only partially accurate, her words shaped our decade:
It doesn’t matter where your mother lives; it doesn’t matter how much it costs.
She can be in the most expensive facility in the city and still
there is just one rule:
The only thing that matters is that your Mother has a visitor every day.
It is simple. It is inevitable.
If the staff thinks family or friends might show up, she will be the first to receive attention.
They must think someone is coming.
It was cynical; it made sense;
And from our perch in the east, we orchestrated our visitor-a-day strategy. We enlisted cousins, parishioners, work colleagues, even our high school teachers; generous friends all who incorporated visits with our Mother into their already busy lives.
And the backbone of our strategy: we continued to employ our Mother’s home aide. Hired part-time a few years earlier, Grace became an almost daily presence at the nursing home, devoting more hours than we could ever reward. She became an astute observer of my Mom’s condition; I relied on her eyes and ears. As my Mother succumbed to the ravages of dementia, Grace repeatedly experienced the worst of her dramatic mood swings,
And was back by her side the very next day.
While the staff might have anticipated Grace’s schedule, I never told them when I would arrive. I wanted to see my Mom without any special preparation; to catch them off guard if I possibly could. But time after time, I found my Mother dressed beautifully; hair combed; lipstick in place; participating in activities; dining with fellow residents.
As I watched the staff in action, I slowly began to trust them.
I watched as the head nurse began her day, moving bed to bed, consulting nurses, studying charts, holding hands; her serious purpose belied by the frequent sound of her crackling, big-hearted laughter.
I watched as her nurses juggled competing demands, gliding seamlessly through the halls; maintaining a quiet,steady pace; responding to call buttons that weren’t allowed to ring more than once.
I watched as nurses, therapists, aides, and social workers spoke to their patients in gentle, measured cadences; I never once heard a raised voice or frustrated tone.
I watched as janitors cleaned spills immediately and thoroughly, not masking smells with bleach, leaving no lingering odor.
I watched as the activities director greeted each resident by her formal name;
How are you this afternoon, Mrs. Swift?
She shared studies that guided her approach. Of course, it seems obvious that being welcomed into a room and addressed by your name could improve your mood, but when the new activities director introduced this simple innovation, the place became lively; invigorated; happy.
And when we commented on her enthusiastic efforts to entertain, engage, and stimulate her elderly charges, she responded with surprise
I love my job. I’ve wanted to work with old folks since I was young. When I’m home, I can’t wait for tomorrow.
Take a sad song and make it better.
I slowly began to understand that my Mom’s care was the result of an intangible mix of education and expertise, quality and depth, energy and commitment– available right there– at the nursing home.
And even late in the decade, when I thought I knew how to interact with my Mother, I came to realize that I did not begin to approach their level of understanding.
This reality was underscored a few days before our last Christmas. My Mom and I were visiting in the garden. She had gone inside for just a few minutes. As the attendant wheeled her back, my Mother became frenzied;
Where are my packages? My packages are missing!
The packages that were sitting right here! Those are presents; presents for everyone!
Mama, there weren’t any packages.
Oh no OH NO. Hallie, you lost my packages!
My Mother began to cry.
Her imaginary packages were missing.
I thought I could handle it. I had been doing this for ten years, right? I ran to my Mom’s room, grabbed several boxes, and returned to the garden, announcing proudly,
Here they are! Here are your packages!
(Aren’t I clever?)
NO! Those aren’t my packages. You lost them YOU LOST THEM YOU LOST THEM!
My Mother sobbed
Now I won’t have Christmas presents for anyone!
I ran to the nurses’ office. I could not breathe.
She’s missing! Her packages! Not Real–Packages–Missing!
The charge nurse jumped out of her chair.
She raced to my Mother’s side.
What happened what happened what happened?
Head in her hands,
My presents for everyone.
Oh, I know where they are! The security guard took them to the safe. I saw them—they’re in the safe!
In the safe! THANK YOU THANK YOU! I thought they were lost.
The security guard has them. You will have presents for everyone.
I was speechless; astounded; grateful.
There was, of course,
no security guard;
There was, however, a resourceful, compassionate, quick-on-her-feet charge nurse.
(Take a sad song and make it better.)
As I watched the staff in action,
I embraced the unthinkable;
the nursing home was a great place;
my Mom received great care.
I never completely lost my fear.
I never forgot the attorney’s words;
Someone must visit her every day.
And despite all the good and caring and hard work I had witnessed,
my confidence was laced with doubt;
trust with an asterisk.
Was my Mother’s care the result of the attorney’s advice; our visitor-a-day strategy?
If we became less vigilant, would it change?
Or was my Mother’s nursing home simply run by efficient, compassionate, skilled professionals?
I think it was the latter;
Door number 3;
I want to believe.
my advice is straightforward:
(it’s the only thing that matters)
go see her;
(she will be the first to get attention)
every day you can;
(they must think someone is coming)
Every single day if you can;
Then you will start to make it better.
Beautiful Ruins copyright 2012 by Jess Walter, published in 2012 by HarperCollins. Beautiful Ruins is a fascinating novel which has nothing to do with nursing homes, but of course I found the one passage that applies and like the rest of Jess Walter’s writing, captures the emotion.
The title and closing line is of course taken from Hey Jude, words and music by John Lennon and Paul McCartney, copyright 1968 Sony/ATV Music Publishing. International Copyright Secured. All Rights Reserved.