Years ago I worked in a long term care facility where a man with dementia often would fall into a deep, deep sorrowful period of grieving over the loss of his late wife. The wife I knew was still living but the wife he grieved had passed away many years before. Each time the grief overcame him it was, for him, as fresh and new as it was when it first happened. At times he was inconsolable. Many a staff member sat with him, held his hand and tried to distract him from his ruminations, but nothing worked. He would grieve until he was done grieving and then he would be back to his usual self again. After a while I noticed that our staff had become impervious to his crying jags and agony over the loss of his wife. I was even guilty of patting his shoulder, saying, "I'm so sorry, Bert," and then going about my business. We became so immune to his suffering that we barely noticed it anymore. Then one day I realized, his living wife never visited anymore. His children never visited. He was very alone, even in a facility where he sat all day with other residents and staff all around him. No wonder he longed for and missed the familiarity of a close relationship long-gone.
I delved into his history a little more, found out that his second wife did not visit because she was frankly, relieved to be rid of him. Doesn't that sound harsh? We don't always know the whole story when elders come to us after having been cared for by a worn out family which has hit a proverbial wall in caring for them. As I learned more about this man, I learned things that weren't so flattering. I found out that he, throughout his second marriage, was abusive to both is wife and his children from his previous marriage. His family explained how, after he came home from serving in Germany during World War II, he had become a different man. He brought home a European wife who was kind and nurturing to his children, but treated her very poorly for years. She took care of him as long as she could before the family convinced her that placing him in a skilled nursing facility would be best for everyone involved.
There is a huge benefit for those of us who only meet seniors where they are when they come to us. We are able to merely see them as human beings in need of care. We often have no knowledge of who they once were, which allows us to accept them and care for them in the present moment without a shred of ambivalence. At first, when we saw Bert grieving for his wife our empathy was engaged but over time we became hardened to his suffering and more concerned with moving on to the next patient whom we felt we could help, rather than spending time with one who seemed stuck in a loop of bereft helplessness.
Armed with so much more knowledge of his life, his character and his relationships with family, I found I was able to let go of some resentment I was harboring towards his wife and children for not visiting him. The reality is, they were traumatized by this man and that trauma made it difficult for them to be at his side as his mind drifted away and he frequently got emotionally immersed in the far away past--a past that they had no memory of themselves and could not connect with him over. We were in a unique position then, as his facility caregivers, to be able to meet him where he was in his journey and be the positive presence he needed to find comfort and healing in his last days.
Eventually he became too ill to sit in the dayroom and became bedridden. I would drop by his room every day and speak to him about the weather, try to comfort him on days when his grief was at fever pitch. I would try to not think about the stories his family shared with me and just be with him in that moment of time, even if just for a few minutes, to allow him a chance to embrace the man he once was and the love he lost before the war. As I sat with him, often in silence, I would try to concentrate on his life, the experiences he had that changed him over the years. What must it have been like to go off to war and find out his wife had passed away while he was fighting for his country? What human suffering had he witnessed? Did anyone ever even try to help him process those traumatic events, or did he suppress his sorrow and traumatic memories only to have them ebb out of him in a way that caused his family to take on his suffering? There were days when I sat quietly, reading a book to myself, or maybe reading aloud to him. Days when I sat in silence and tried to clear my own mind of all the racing thoughts that filled it up, so I could make room in my own head and heart for his suffering.
Bert passed away eventually, in his sleep one night. His wife and children never reconciled with him but I hope that somehow, in some small way, the quiet connection we had brought him some form of healing before he passed away. I know that experience taught me some important lessons about living in the moment, about being mindful and present not only for every minute of my own life but for those who are distant, alone and perhaps suffering in silent isolation.
As a Volunteer Coordinator, I trained many a volunteer who was extremely uncomfortable visiting patients who were non-verbal. We fill our worlds with so much mindless chatter, meaningless small talk and unproductive communication that we are utterly beside ourselves when we are forced to sit with silence for a few minutes. Most skilled care facilities have at least a handful of residents who are no longer able to carry on a conversation and sometimes they seem to not even register the words someone else is speaking to them. Those are the very residents who get ignored, forgotten, left in their rooms in front of TVs or rolled out into common areas where people are constantly walking by, averting their eyes because they don't want to see the helpless old person who can't talk or even understand conversation anymore.
Silence is not an evil. Silence is not the absence of intimacy or communication, but it takes an effort on our part to reach past our comfort zones and embrace it, make the most of it. For elders who are isolated due to health limitations, like loss of vision and/or hearing, we often have to reach far past an assessment to find a connection. We have to learn how to build positive relationships with elders who may be distrustful, uncomfortable or even embarrassed by their limitations. Just like my experience with Bert, sometimes we have to let go of or preconceived notions and allow our elders to guide us into a closer connection with them. We have to open ourselves up to the idea that our constant chatter, our insistence that "you'll love this activity!" is the best intervention for every single person, and just allow them to be who they are. You may never be able to connect with an elder based on a previous hobby or life experience, but sometimes, you can build a bridge to them by approaching them with something new. Something that inspires you or fascinates you might very well inspire or fascinate them as well. There are times when opening ourselves up to others in a professional setting and with proper limits, is a good thing. It builds a sense of authenticity and trust that encourages our elders to connect with us.
You know the silent resident. She sits in bed with contracted, drawn up hands. Maybe she drools and stares off into space, never making eye contact with you. Walking into her room is uncomfortable for you because you don't know what to say or what to do. You feel useless, ineffective, you wonder what's the point?
The point is, that person lying there with little or no control over her body is still a human soul. Whether or not she ever looks you in the eye or answers a question or even gives you a half-smile, she is inside that human shell and she needs someone to reach for her. We can't connect with a non-verbal patient if we allow our own discomfort to distract us. We cannot make a difference for her if we hurry by her room with a pat on the hand and a quick smile. That elder needs our time, perhaps even more than the one who meets us in the hallway every morning for a ten minute conversation about the weather. People who cannot reach out need us to reach in, to bridge the gap that hey cannot fill for themselves.
To that end, here are a few ideas you might want to try with your non-verbal or severely limited elders or people with disabilities:
- Learn about Mindfulness and practice it, both on your own and with your elders. Check out Mindful.org's Five steps to Mindfulness and practice these alone and with your elders who are not able to carry a conversation. The practice of Mindfulness helps us keep our lives in perspective, helps us remain in the moment, both with ourselves and those for whom we care, and can forge a bond between two people without either ever having to utter a word.
- Learn to meet your elders where they are in their journies. You might be privy to an unflattering history of an elder for whom you provide care. By practicing mindfulness and by accepting a person for who they are NOW, you can create an atmosphere of peacefulness and support that could lead to healing, even in the latter years of a person's life. Radical acceptance of others is an imperative when working with seniors and their families. You cannot change the past, you cannot change who they are, but you can be a catalyst for the healing process.
- Engage your empathy in tactile ways. I know that sounds kooky, right? Using your empathy tangibly for another person as a way of silently connecting and supporting them can be cathartic for both the elder and the caregiver. You can try breathing exercises along with mindfulness and empathy. As you sit with the elder, focus your thoughts on him. How must he feel in this moment? Is he in pain, physically, mentally, emotionally or spiritually? Can you imagine what that pain must feel like for him? Can you feel his losses, his grief, or even is inexpressible joy? In your breathing exercises you can either hold his hand, or sit beside him, and imaging that with every breath you inhale, you are taking his pain into yourself. Hold his pain for a moment, empathize with his struggle, and then as you exhale imagine that you releasing that pain back into the universe. You do not have to spend hours on an exercise such as this, even 15 minutes a few times a week can make a huge difference. Your PRESENCE is the goal--your undivided, focused, mindful positive presence is the best intervention you can offer for an elder who is isolated from the rest of the world.
- Read aloud. Many staff and volunteers find that bringing a book, a magazine, a book of poetry or even scripture that aligns with the elder's beliefs is an easy and comfortable way to be present with a non-verbal or non communicative resident. One volunteer brought a copy of J. M. Barrie's Peter Pan and read a chapter aloud to her resident every few days. The resident didn't always respond, but we knew that she enjoyed the sound of the volunteer's voice because she would close her eyes and lie back as she listened. After a few weeks we caught a sparkle in her eye whenever the volunteer came in to read to her, and on weeks when the volunteer didn't come she was more lethargic and unresponsive to the rest of our staff. If reading aloud is not your thing you can bring a book to read silently as you give your physical presence in the room. Sometimes all it takes to break the cycle of loneliness is to have someone else nearby who is accessible, but comfortable with complete silence.
- Employ appropriate spiritual interventions. This is where you will need a solid assessment of your resident's spiritual past and belief system. Playing church hymns for a patient who grew up in a church that did not sing hymns would not be comforting to that resident. Saying a Catholic prayer with a Baptist resident would likely not garner you any points with that person. Find out what spiritual beliefs give your resident comfort and then search out ways to provide experiences that enrich their spiritual lives. Can you read to them from the Bible? Could you arrange a visit from a Rabbi or Priest? Are there other sacred texts, art, or rituals that you can make available to them? Do you have other residents or staff members who share the same faith who would be wiling to spend some time with them reading or singing or just silently meditating with them on the things that give them strength and connection to a higher power?
In order for anyone to effectively use any of these suggestions, we must get past our own discomfort with silence. Once we are able to set aside our own feelings of awkwardness in silence, we can become more available to our elders as a supportive, caring presence that gives them strength and encouragement. We pressure ourselves and give in to pressure from administrators to get more bodies into group activities, when often what our elders need is just a little of our uninterrupted time. This is what person centered care is all about!
I hope that you will find some things here that are helpful to you and your elders. Learning stillness and mindfulness benefits us all, especially those who are not able to communicate their need for companionship or intimacy. It's worth building these life skills both professionally and personally.
So get out there tomorrow and find that resident that you tend to avoid and spend a few quiet moments with her. Give her your spirit, your empathy, your time. Know that in every silent moment that you spend with your elders, you are making a difference.
This is a great read, very eye opening. Miss seeing and working with you. Christy
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