Let Them Eat Chocolate
Pam Belluck, in The New York Times, writes of a different sort of nursing home, and a different way of caring for elderly patients with Alzheimer's:
PHOENIX -- Margaret Nance was, to put it mildly, a difficult case. Agitated, combative, often reluctant to eat, she would hit staff members and fellow residents at nursing homes, several of which kicked her out. But when Beatitudes nursing home agreed to an urgent plea to accept her, all that changed.Disregarding typical nursing-home rules, Beatitudes allowed Ms. Nance, 96 and afflicted with Alzheimer's, to sleep, be bathed and dine whenever she wanted, even at 2 a.m. She could eat anything, too, no matter how unhealthy, including unlimited chocolate.
And she was given a baby doll, a move that seemed so jarring that a supervisor initially objected until she saw how calm Ms. Nance became when she rocked, caressed and fed her "baby," often agreeing to eat herself after the doll "ate" several spoonfuls.
Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic "nip at night," said Tena Alonzo, director of research. "Whatever your vice is, we're your folks," she said.
Once, Ms. Alonzo said: "The state tried to cite us for having chocolate on the nursing chart. They were like, 'It's not a medication.' Yes, it is. It's better than Xanax."
It is an unusual posture for a nursing home, but Beatitudes is actually following some of the latest science. Research suggests that creating positive emotional experiences for Alzheimer's patients diminishes distress and behavior problems.
Great bit, later in the piece, about German nursing homes with fake bus stops outside. Patients "wait for nonexistent buses until they forget where they wanted to go, or agree to come inside."
And I love what I read about this Beatitudes place -- it seems more focused on alleviating people's suffering than following rigid rules.
My father tried to get my grandmother (75+ at the time, and thank G-d lucid) to lose weight. Moved her into our house, subjected her to the Pritikin Diet (summarized by my mother as "no fat, no salt, no sugar, no enjoyment").
Huge drawn-own fights resulted.
We wound up smuggling the large 10-pound Hershey bars into the house for her. He blew up - but come on, she's almost 80.
I learned from that experience about the mixed motives of some "caregivers".
Ben David at January 1, 2011 11:48 PM
i like it. count me in. i don't know why people obsess on people who are 80+ years old or whatever eat healthy, blah blah blah. eat whatever the hell you want. and what is the point of eating all your vegetables if you are agitated and combative anyway? really? is that the quality of life we want to give grandma?
fyi. my great-grandmother lived to be 103. she never ate anything green in her life and ate nothing but ice cream and chocolate past 90. the nurses at the home had a fit, but i'd like to see anyone try to make her do anything she didn't want to.....it'd be hilarious.
miki at January 2, 2011 1:51 AM
Correct me if I'm wrong, but age 96 is an adult. She's allowed to make her own decisions as to what she'll eat.
Patrick at January 2, 2011 4:07 AM
I work with a SW company that provides tracking SW for nursing homes.
If you go into a nursing home at 500 pounds and honestly want to get back to 190 -- the government actually penalizes the nursing home for the weight loss. Look up MDS 3.0. Medicare and Medicaid use those assessments to judge reimbursement rates for a nursing home.
Anonymous Coward at January 2, 2011 6:17 AM
We have a rest home in my area that has this philosophy about terminal patients. One elderly man was even allowed to go outside with an aid in the morning after breakfast and at night before bed to have a smoke. He only got those 2 a day, but he was a much more cheerful man nonetheless. I don't see anything wrong with it. I don't smoke but I do like to have a Payday bar every now and again and I don't want to be told as an adult (at any age)that I can't have one, even if the stuff destroys my dentures.
Jessica at January 2, 2011 6:50 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/01/02/smart_care_for.html#comment-1813474">comment from Anonymous CowardIf you go into a nursing home at 500 pounds and honestly want to get back to 190 -- the government actually penalizes the nursing home for the weight loss.
Why is that, Anonymous Coward? What would be the rational.
PS Love your name. You're the best Anonymous who's ever been here.
Amy Alkon at January 2, 2011 8:08 AM
Amy -
It all makes sense when you realize that Medicare isn't about people getting better, it's about graft. So many counterintuitive things that are done every day make sense when you "follow the money".
And the day some government twit tells me I can't have a burger, it's gonna come to blows.
brian at January 2, 2011 8:22 AM
Anonymous Coward: is that a "penalty" or intended to reflect the (probable) fact that caring for a 190-lb person is significantly cheaper than caring for a 500-lb person, and therefore less reimbursement is required?
If the reduction in reimbursement is set accurately, there should be no loss to the nursing home. Accuracy in such cases is hard to gauge, since many of the costs of running a nursing home are fixed and the variable ones are hard to separate out, so I wouldn't be surprised if there is a disparity between the actual cost savings of weight loss and the reduction in reimbursement.
Anon at January 2, 2011 8:22 AM
Despite being a Christian establishment, I hope that if I or my loved ones ever have need for of such a facility, this is the one we turn to. Beatitudes is universally admired here in Phoenix. They embody what most Christians say they're all about - compassion, love, doing unto others, caring for "the least among us".
It's in a part of town that's much like a lot of central Phoenix; established, stable, but in decline. The campus certainly isn't fancy, and I hope that wouldn't scare off prospective residents and their families. Look what they'd be missing.
Beth Cartwright at January 2, 2011 8:44 AM
Beth: "Despite being a Christian" home?
Because Christians have been so awful in their hospitals/nursing homes?
It's not like any Christian hospitals/nursing homes have ever forced Christian worship on their patients in the last 50 years [or even longer than that]. Sure, they generally offer it, but I cannot imagine any non-Christian needing to be uncomfortable due to religion, even if being taken care of by nuns.
meep at January 2, 2011 8:59 AM
I'm pretty sure that when I'm 90, prolonging my life isn't going to be my primary concern. More like, milking whatever small bit of enjoyment I can still get out of it, while it lasts. Bring on the chocolate!
Pirate Jo at January 2, 2011 9:37 AM
So, let me get this straight: eat healthy, like we say, until you're __?__ years old, then you can go nuts?
Or is it just after you've been committed to a home?
-----
Gee. Any wizard could tell you the medicinal properties of chocolate when dealing with the effects of dementors...
Radwaste at January 2, 2011 9:58 AM
Good one, Radwaste.
Anyway, why the hell shouldn't people that old get a little enjoyment out of life. I kept telling people to mind their own business when they would tell my mother not to smoke during the last couple of years before she passed away, because we all knew she was just going to keep getting progressively weaker (she had bone marrow failure), so let her have something that keeps her from going stir-crazy.
WayneB at January 2, 2011 10:04 AM
Meep: Because I'm not a Christian, and thus a Christian home normally wouldn't be my first choice.
Beth at January 2, 2011 11:15 AM
Looks like they are not condescending about giving the old folks what they want.
I wonder what their response would be if two residents wanted to have sex (at whatever level they were capable of). It''s a certainty that with the level of supervision (that is obviously required due to the condition of the residents), it wouldn't be possible to do that without being "found out."
I just hate, HATE when people laugh at old people wanting to have sex. It's. Not. Cute.
gharkness at January 2, 2011 12:28 PM
My mother was raised Catholic, but is in a Jewish nursing home. It was the best nursing home available (with the shortest waiting list). They are not forcing any religion on her and as a matter of fact, held a small Christmas service for the non-Jewish residents.
They are taking great care of my mom and I am grateful that they aren't making an issue of her religion, although the fact that they are religious is comforting to me. I'm not religious myself, but somehow I like what I see there.
There is a little old man there who apparently thinks my mom is 'cute'. He wears a yamaka (hope that's the right spelling) and wanders into her room with a huge smile on his face. My mom blushes and I can tell she just loves the attention. She's pretty disabled for sex, but so much of it goes on between our ears anyway that I don't think it matters here.
ie at January 2, 2011 12:57 PM
Why is that, Anonymous Coward? What would be the rationale.
If you gain weight towards end-of-life you are generally retaining water around your heart and are not being cared for your incipient heart failure. If you lose significant weight -- you aren't being fed enough to sustain yourself.
I.e. my wife died -- I moved into an assisted living center at 66 cause I want the support. Part of it is that I'm 300 pounds because my wife fed me well. ;-) So now I want to get it on with the 65 year old -- I want to drop weight to appeal to her. The assisted living center will be penalized if I if follow and Eades/Taubes diet and drop good amount of weight.
Another example -- I come into a facility in a permanent vegetative state at 400 pounds -- they have me on a feeding tube -- so I drop to 200 pounds because they can't put 3000+ calories a day down the feeding tube.
The whole system is set up that if I were to lose or gain more than a certain percent a month -- the facility would get less money.
I'm glad to be your Anonymous Coward every once in a while. :-D Please ask if needed.
Anonymous Coward at January 2, 2011 2:00 PM
My grandma has dementia. She used to be in a large assisted living place with a memory unit, for 6k a month. She wasn't able to converse, had put on about 30lbs and was generally declining. She has type 2 diabetes controlled by diet. She is 4'11, so 30lbs is a lot. She would eat whatever crap they put in front of her. About 6 months ago, we moved her to a small residential place that has 3 caregivers and 6 women living there for 3k a month. She has lost some weight but still gets dessert after dinner. She can converse again, enjoys sitting outside and watching the birds and really thinks it is "her" house.
Giving the patients chocolate because they ask would have been really bad in my grandmas case because of the diabetes. It would be heartbreaking to watch them waiting for a bus that never came. I answer my grandmas questions like it is the first time she has ever asked them because she is really sensitive to vocal tones and can pick up on when you are frustrated. I'm all for them living a little in the small amount of time they have left but not doing somethi g that would hurt their qualify of life, like alllowing my grandma to binge on crap food.
Oh and my sister worked in a memory unit when she was getting her masters in social work. They had issues with residents trying to have sex, so they bought the women vibrators.
Casey at January 2, 2011 6:04 PM
Thank you for the link. I have a family member who may need this level of care. I hope this approach catches on quickly.
Michelle at January 2, 2011 6:55 PM
Amy Alkon
http://www.advicegoddess.com/archives/2011/01/02/smart_care_for.html#comment-1813777">comment from MichelleSorry to hear that, Michelle, but I'm glad it might help.
Casey, they don't know that the bus will never come. It's heartbreaking for you, perhaps, because you know that, along with knowing that formerly vital people have lost function. But, it seems to help them maintain some sort of calm in living their lives.
Amy Alkon at January 2, 2011 7:16 PM
My long term end of life plan is a .22, enough force to enter the skull and bounce around a few times.
lujlp at January 2, 2011 7:30 PM
Maybe more advanced cases wouldn't know the bus wasn't coming, but someone like my grandma, who can't cook or live on her own but can feed herself and still ask for coffee with cream etc would know, even for a short amount of time. We try to minimize any agitation for her avatar she backslides after too much stimulation. My mom used to pick her up and take her when she ran errands so she could get out but it was actually doing more harm. I know dementia is different than alzheimers so I only have experience with dementia.
My mom has said she wants us to kill her if she has memory issues like her mother. My sister and I differ on our thoughts on that subject.
Casey at January 2, 2011 7:53 PM
"It would be heartbreaking to watch them waiting for a bus that never came"
It's the least combative way to let them get it out of their systems, that urge to 'go somewhere'. Locking the doors, putting on bracelets that set off alarms, or chasing them and forcing them back inside is SO detrimental. You can go out after a few minutes and say that the buses aren't running today, they've tried and are satisfied.
'therapeutic fibs' go a long way to alleviating the stress of dementia. If you tell someone 100 times their mother is dead, they grieve that death for the 'first time' 100 times. Tell them 100 times Mom's on a trip, out shopping,with relatives, then all that stress is avoided.
crella at January 2, 2011 8:40 PM
Patients "wait for nonexistent buses until they forget where they wanted to go, or agree to come inside."
This is sort of like what they do at my mother-in-law's facility. They have circular hallways, so when residents wander, they end up back in their own rooms.
Rex Little at January 2, 2011 9:01 PM
"My long term end of life plan is a .22 [...]"
~lujlp
You'd need to remember the plan, *and* where you left your tools - which might require being willing to leave while there are still many, many good days left. I wish there were better choices.
Michelle at January 2, 2011 10:49 PM
"They have circular hallways, so when residents wander, they end up back in their own rooms."
~Rex
I have a horrible sense of direction. I'd like to work in an office with that floor plan *now*.
Michelle at January 2, 2011 10:51 PM
@Pirate Jo: if I live to reach 90, I will believe that I have lived too long. Bring on the Afterlife!
mpetrie98 at January 2, 2011 11:01 PM
My grandmother's 90, and she's doing great. I hope I have her genes. She's blind in one eye, and her short-term memory is a bit spacey... not gone, just a bit flakey. But she lives in a nice apartment in an assistant living facility, where she can cook for herself or go to the dining area, where she can play bridge, and she still reads intellectual books to keep herself stimulated, and watches documentaries, and socializes, and goes on outings, and goes for walks.
90 is not too long!
NicoleK at January 3, 2011 12:02 AM
I love this. If one of your few joys in life is a smoke, have at it.
My father's quality of life is minimal and he's still at home, but we've decided to give him whatever he wants within reason. Reason being: He has only five teeth and we need to change the colostomy bag, so whatever goes in needs to come out easily. For Thanksgiving, he downed half a bottle of wine all by himself and regaled us with tales of his secret cocaine habit. He can eat a ton of chocolate because he forgets he just ate it, but we let him eat until he's stuffed.
When he was more mobile, he used to try to drive to the hospital to see my mother. After he escaped from his caregiver and caused a minor accident, I switched his car keys with the house keys. After that, he could sit in the car for hours trying to start it without me having to worry about him. He thinks my mother, who has been dead for a year and a half, is forever in the kitchen making lunch, and we are happy to let him think so. He also thinks his own parents are still alive.
He's 89 years old, so whatever keeps him happy is fine with us.
MonicaP at January 3, 2011 6:45 AM
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