A client, “Liz,” is scouting facilities that might serve as a home for her mother who, in the past year, moved out of her home for health reasons and, after hospitalization, began to act inappropriately in a rehabilitation facility. Her agitation and anti-social behavior at home turned to confusion, anger, and severe depression in the nursing home. Counseling “Liz” on how to judge nursing homes and assisted living facilities reminded me of an article I read about a year ago by Pam Belluck who, in surveying nursing homes in Phoenix, met “Margaret” who, 96 and afflicted with Alzheimer’s, was “agitated, combative, often reluctant to eat [and] would hit staff members and fellow residents” at a succession of nursing homes. When she moved to “Beatitudes,” a local nursing home, miraculously, Margaret adjusted almost immediately. She loved the fact that she could eat whenever and whatever she wanted and seemed to appreciate that she could decide her own schedule for bathing and sleeping. The facility’s director of research (that the nursing home staffed such a position is interesting In itself) told Belluck that “Whatever your vice is, we’re your folks.” Chocolate, the nursing home learned, was more effective than Xanax, a frequently prescribed “mood enhancer.”
Others have found that compassionate treatment of demented patients can produce startling results. For example, Dr. John Zeisel, who manages the Hearthstone facilities in Massachusetts and elsewhere, writes, films, and talks about how to reach demented patients through art, music, and exercise to “generate positive emotions.” Instead of administering a confusing variety of antipsychotics and anti-anxiety medications, he urges facilities to make simple adaptations such as: cosmetic changes to rooms and hallways, increasing light, and even building fake bus stops close to nursing homes (to keep patients from wandering). Because emotions persist even after cognition deteriorates, the effect of evocative films can last well after dementia patients forget the film’s plot. Justin Feinstein, a researcher of neuropsychological strategies for dementia patients, points out that some behavioral problems may result from sadness or anxiety “that patients [no longer] can explain.”
Ms. Belluck also noted how much staff at “Beatitudes” knew about each patient, particularly their lifelong pursuits. One staff member noted, sadly, “in the old days we knew more about patients from their obituaries than we did from spending quality time with them.”