Behind the Old Face: Aging in America and the Coming Elder Boom
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Behind the Old Face: Aging in America and the Coming Elder BoomSee a book preview http://www.dreamsculpt.com/behindtheoldface/
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By Angil Tarach- Ritchey RN, GCM
Angil Tarach-Ritchey RN, GCM is an author, speaker, consultant and national expert in senior care. With over 30 years experience in senior care and advocacy Angil is very passionate about eldercare and is well respected in her field.
Angil has written for several websites including NurseTogether, the Alzheimer’s Reading Room, Wellsphere, the National Senior Living Provider’s Network, Ann Arbor News, and her own blog, Aging in America. Her passion and expertise have led to being published in the Chicago Sun Times, Maturity Matters, Medpedia, Vitamins Health, Medworm, Alzheimer’s New Zealand and several other publications. She has been featured on Nurse Talk, WE Magazine for Women; Women on a Mission, Life Goes Strong, About.com/Assisted Living, The Caregiver Partnership, You and Me Health Magazine, His Is Mine, and Abec’s Small Business Review and quoted in several publications, such as Reuters, CNBC, Consumer Affairs, PTO Today, Women Entrepreneur and more.
The Nursing Home Love Letters
My story in the nursing home
What would you title a defining moment in your life, the moment that
changed everything? My earliest defining moment came in a box of love
letters. No, not letters to me. It all happened with a box of love letters I
found in a nursing home.
My love for the elderly began when I started working as an aide in a nursing
home in 1977, when I was seventeen years old. My girlfriend’s mother,
Mrs. Berry, was a registered nurse and the nursing home administrator.
She was a tall, fairly thin woman with blonde hair. Although Mrs. Berry
was “cool” most of the time, it was apparent when she was angry or had
enough with teenagers in her home. She would make it clear she’d had
enough just by the look on her face. I liked Mrs. Berry and respected her,
but I also feared her. I never knew if she really liked me or not. Her daughter,
my friend Marcy, worked for her mom at the nursing home as a nurse’s
aide. She would tell us stories about the residents at her job, and most of
the stories were amusing. I needed a job, so I thought I could do what
Marcy was doing. I approached Mrs. Berry several times asking for a job.
I think she was passively ignoring me, but I was persistent . . . when Mrs.
Berry was in a good mood, that is. After a month or two of asking her
repeatedly to hire me and give me a chance, she finally agreed with the
comment, “I’ll give you a chance, but I don’t think you can do it.” What
Mrs. Berry didn’t know was that I am highly motivated by disbelief. I have
accomplished more in my lifetime because people told me I couldn’t do
something than because people told me I could.
It was a warm, humid day in June 1977, and I was about to begin my first
job as a nurse’s aide. When I arrived at the nursing home at 7:00 a.m.,
never having cared for an elderly person before, I assumed there would
be some sort of formal training. My training was to follow another aide
around, and basically do what she did. I wanted to follow Marcy, because
we were friends and her mom ran the place, but Mrs. Berry wouldn’t allow
that. I know she expected we would be goofing off or doing some kind
of foolishness if we worked together, so she had me follow a nurse’s aide I
had never met. I have to say, I was a little intimidated by the ninety or so
residents, some walking through the halls with canes and walkers, some
being wheeled down the hall in wheelchairs, and others yelling or talking
to themselves. But I had to prove to Mrs. Berry I could do it, so I just took
it minute by minute. There was no way I would confirm her notion that I
couldn’t do the work.
My first day seemed to be a test of my physical and emotional endurance.
I worked sixteen hours that day, and within a few hours on the job I
was involved in a medical emergency. We were passing lunch trays when
the whole room turned chaotic in response to a resident choking on her
lunch. The whole situation seemed to be happening in slow motion,
even though it only lasted a few short minutes. I realized the resident was
choking, because her table mates were yelling and I saw her gripping her
throat. Since it was my first day and I was not ready for a situation like
this, I looked around the room to make sure an employee knew what was
going on and would react. I had never expected to see something like this,
especially on my first day of work. As my eyes quickly scanned the room,
I saw my supervisor frozen in position, fear evident on her face. The experienced
nurse’s aides were either screaming for someone to do something
or trying to ignore the urgency of the situation.
Residents began yelling and getting out of their seats, waiting and watching
for someone to help her. It seemed everyone was waiting for someone
else to react, and no one was moving towards her. As seconds passed, her
face started turning blue. I just knew if no one helped her, she would die.
I had never received training for the Heimlich maneuver, or any other formal
training, but when she began turning blue and no one acted or seemed
to know what to do, I knew I had to do something. I could not watch this
woman die in front of me without doing something! I remembered seeing
the Heimlich maneuver done on TV and figured I had to try it. I ran to
the table and grabbed her now lifeless, thin body and pulled her against my
chest. I clenched my fists around her tiny waist and forcefully pulled her upper
abdomen toward me. I pulled once, twice, and finally the third time she
coughed out the food that was lodged in her throat. Her body then regained
life, and her blue skin began changing back to a light pink pigment. She was
going to be okay. I was flooded with emotions: disbelief, shock, fear, relief,
gratitude, anger, and pride. Of course, I was relieved and grateful, but I was
angry that my supervisor had no idea what to do and didn’t even attempt to
help this lady. I wondered how she could be the person in charge. I wondered
what would have happened to this lady if I hadn’t at least tried the Heimlich
maneuver or if it hadn’t worked. The truth is, I was not sure I could do anything
to help. I was in shock and petrified that I was going to see someone die
right in front of my eyes. This was a lot more than I had bargained for when
I asked Mrs. Berry to give me a chance. After the adrenalin dissipated, I felt
very proud for having saved the resident’s life and that I had lost the intimidation
I felt just minutes earlier. I also lost respect for a supervisor I barely
knew. This was my initiation into senior care and advocacy.
The facility was supposed to support independent to semi-independent
living, which today we refer to as assisted living. There were three floors:
the first floor residents were independent; the second floor residents were
mostly semi-independent with a few dependent residents; and the third
floor housed all the residents who shouldn’t have been living there. I believe
it was set up that way so when visitors or potential new residents’
families came, they would see the very best in independent living. There
were no tours beyond the first floor to my recollection. I continued working
as a nurse’s aide on the afternoon shift. I was responsible for all of the
residents on the third floor.
My residents were either totally physically dependent, or had Alzheimer’s
or some other form of dementia. Back then we described a person with
dementia as being senile. My responsibilities were to keep my incontinent
residents clean, to get everyone to the dining room for their dinner
and medications, to pass dinner trays, and to feed those who could not
feed themselves. I was also responsible for entertaining the residents after
dinner, which meant sitting them in the day room to watch TV while
I cleaned up dinner trays and tables, changed residents, gave baths, and
started getting residents ready for bed.
The day shift was responsible for half of the residents’ baths and grooming
each week, and I was responsible for the other half. I was the only aide on
the third floor afternoon shift. I don’t recall how many residents I had to
care for; I just remember it was a lot of work. I had responsibilities and experiences
on this job I never would have imagined: shaving a man with a nonelectric
razor; being with a person with dementia; cleaning an incontinent
person; tying people to their beds to keep them safe from falling; feeding an
adult; and, convincing someone to take a bath when they refused.
There was no training to teach me how to do these tasks or to deal with
dementia patients. Nurse’s aides were just hired and put to work, until
1987 when Congress passed the Omnibus Reconciliation Act, commonly
referred to as OBRA. Safety concerns and the lack of quality care
in our nation’s nursing homes inspired OBRA, which required training
nursing home staff. Talk about old school; I was doing this work for ten
years before the U.S. required training.
One night, a few months into my job, I started my shift looking through
the bath book to see who was scheduled for a bath. I also looked through
the documentation from the day shift. There were residents on the dayshift
schedule who hadn’t had a bath in a month or more. I was outraged
and saddened. I gave thirty-two baths in one night. I worked a couple of
hours of overtime to get it all done, but all the residents on the third floor
were now clean and cared for. Was this the first night of a lifetime of senior
advocacy? Looking back over thirty years, I think it was. I couldn’t understand
how anyone could let this happen. The residents were people, and
they needed help. What if these lazy nurse’s aides were deprived a bath for
a month? What would they want?
I had no idea at the time how significant the bath night and another experience
I had would become in how I have spent my life caring and advocating
for seniors. The experiences clearly had their own purposes. One
began my life as a senior advocate; the other was the major contributing
factor to the empathetic care I have provided all of my life. Thirty years
later, there are many patients I still remember, think about, and hold dear
to my heart. I remember a retired teacher who had dementia and filed
things in her bra. She said they were her files, as if she were still teaching.
I remember a couple who walked the halls holding hands; the husband
wore the layers of men’s and women’s clothing his wife dressed him in. I
remember a tall thin lady with dementia, who was either glowingly joyful
while singing in her high-pitched, out-of-tune voice or so angry she hit
and scratched anyone who came near her. I can still picture these residents
clearly, and I hold fond memories of them in my heart.
One evening, our assignment was to clean our residents’ closets and
drawers. One of my residents was a lady named Ann, who couldn’t
speak or do anything for herself. She quietly lay in bed day after day.
Ann never had a visitor, so I knew nothing about her. While I was working
in Ann’s room, I found a box in her closet. In it were no less than
thirty letters and cards. I sat on the floor and started to read them, one
after another, as tears fell from my eyes. They were love letters from
a husband to his wife. Never had I known, or even heard about, such
profound and amazing love. This woman, lying there alone seemingly
unloved, had actually shared a fairy-tale love, rare and amazing, with
an adoring spouse. I can still vividly recall sitting on the floor with her
box in my lap, tears dripping from my face, reading the letters while frequently
pausing to look at Ann lying in that bed, almost lifeless, wishing
I had known her sooner.
I wished I knew about her life when I started caring for her. For many
months, I had looked at her as just some old woman lying in the bed who
needed help. Truthfully, until that day I didn’t give her much thought other
than the duties of keeping her clean, dry, and physically comfortable. Not
that I didn’t occasionally think how sad it was she never had a visitor or
any indication that someone cared about her, but that was the extent of
my thoughts and involvement with her. Before I left my shift that night, I
acknowledged Ann. She was no longer just some old woman. I went to her,
and while gently stroking her cheek and forehead I said, “Your husband
sure did love you.” I said goodnight and went home. That was all I could
say, given the emotional state I was in after reading all those letters. I’m
not sure if I was more sad about Ann’s loss and being alone in that nursing
home or guilty for not seeing her as a real person with a real life.
It was through her letters that I got to know Ann, who couldn’t tell me anything
about herself. As far as I knew, her deceased husband was all she had,
and now I felt more responsibility to take care of her for him. That was when
the meaning of care changed for me. Previous to this night, I felt that I provided
pretty good care given the number of residents I had and the duties
that needed to be done. I kept Ann clean and dry, but I didn’t know how to
communicate with someone who couldn’t acknowledge me or speak back.
Although I gave good physical care, there was no emotion involved, no human
connection; I was very quiet when I provided care for Ann.
I now had something to talk to Ann about. Caring for Ann changed into
something much more meaningful. I felt a special bond with her. Those
love letters gave me much deeper empathy for my residents. I started looking
at all of the residents, wondering what lives they previously had before
they ended up in that nursing home. That revelation inspired me to find
out as much as I could about them. I read their charts, asked questions,
listened to their conversations more intently, and observed their actions.
From time to time, I would read Ann’s husband’s letters to her. I don’t know
whether Ann could understand or even hear anything I said, but I felt that
her spirit heard and understood. I also felt as if her husband was looking
down from heaven, grateful for someone who was telling Ann about his
love in a comforting and caring way and taking care of her physically.
Ann’s inability to speak was due to aphasia, a speech and language disorder
that impairs a person’s ability to communicate It is most commonly the result
of a stroke but can occur from any severe head injury and affects over
one million people in the U.S. Aphasia can be expressive, meaning the person
can fully comprehend language but cannot verbally express thoughts,
feelings, or preferences. Aphasia can also be receptive, meaning patients
can’t understand verbal or written language. People often assume that a person
with expressive aphasia cannot understand or comprehend, but that is
far from the truth. Not knowing whether Ann had receptive aphasia, I truly
don’t know if she understood me when I talked to her and read her love
letters to her. But, I think there is something in our souls that allows us to
connect even when the typical means of communication are not possible.
My three-decade passion has been based on empathy. Can you imagine
being in Ann’s shoes? Can you understand what it must be like to have
lived a fairy-tale life with a best friend, experience a love like no other,
only to lose that person and decline to the point where you are alone and
unable to care for yourself? I don’t know if it was true or not, but I heard
Ann’s decline was a result of losing her husband. We often hear about
couples who have been married for many years dying close in time, so her
decline following the loss of her husband wouldn’t surprise me.
Ann’s is just one story in a countless numbers of stories. There are thousands
of elders living in nursing homes, alone and unable to care for
themselves. What kind of care do they get when their healthcare workers
know nothing about them and don’t even think about what their lives
were like before they ended up helpless and in a nursing home? Just like I
did. I’ve worked in long-term care for decades and never saw any training
programs that focused on communicating with persons with aphasia, or
even explained what it is. I also have never seen any training programs
that elicited empathy—other than The Virtual Dementia Tour®, which
provides a great learning experience. I know from my own experience that
patients like Ann are not spoken to or treated with the compassion that is
essential to providing good care. Instead, they’re regarded as work to be
done rather than a person to whom care is given. It is up to us as a society
to understand that there is a person and a life Behind the Old Face.
In over three decades of spending time caring and advocating for seniors,
many experiences brought me to write this book, but a single experience
at a funeral home inspired the idea and title; I share that experience with
you later in this chapter. Throughout this book, I will share my experiences
and the stories of a few of the seniors I have spent time with, but
my experiences and their stories provide only a small glimpse of what is
Behind the Old Face. This book is intended to tug at your heart strings, to
make anyone interacting with or caring for an elderly person think differently,
and to subsequently improve the way we treat seniors and the care
we provide. Care should never be just a physical-care task. Anyone can
provide physical care, but great care providers offer an emotional component
to their care that makes it great. There are unpaid caregivers, such as
family, friends, and volunteers, as well as a wide range of paid caregivers,
including nurse’s aides, therapists, nurses, social workers, and physicians.
No paid care giving job is more important than another. No care recipient
is more important than another. Whatever your care giving role, you need
to provide care with respect, compassion, empathy, and kindness. All care
recipients should always—without exception—be treated with dignity,
respect, and from an empathetic point of view.
Every single one of us has heard, “Treat people as you want to be treated,”
but how many of us really do? How many nurse’s aides, nurses, physicians,
and family caregivers provide the treatment they would want to receive?
Do you treat every single person you come in contact with, have a
relationship with, work with, or care for as you would want to be treated?
As you read this book and the stories of the people in it, you will and
should experience a myriad of emotions. I will tell you some of the most
amazing stories I have ever heard, from the lives of seniors I have been
privileged to know and spend time with. These aren’t famous people with
amazing newsworthy stories; these are everyday stories. These are the life
stories of your parents, grandparents, neighbors, aunts and uncles, the old
man driving too slow, the grey-haired old woman that you have to wait
on in the store, the patient you have to feed or change, the Alzheimer’s
patient who is difficult, and the dementia patient who asks the same questions
over and over. These people are us. They are us, with many more
years of life behind them. You will hear about their challenges, their
dreams achieved or not achieved, their contributions and accomplishments,
their service to our country or to a cause, their devastations and
joys, their thoughts, feelings, and opinions, and their points of view about
what it’s like to be a senior today.
Even after my decades of spending time with seniors, I still hear things
that are surprising to me, and things I have never thought of. While interviewing
one lady for the book, she told me a secret. At her request, I
will not use her name or feature her story in the book, but she told me
something that gave me another perspective into things that seniors think
about. She was a lovely ninety-one-year old woman I’ll call Susan. Susan
grew up in England, and even years after being in America, she still
had a lovely English accent. I cared for her while her husband was in the
hospital. She was happily married for over seventy years, and she adored
her husband. During interviews, I ask specific questions to initiate further
conversation and to better understand what it’s like to be old. One question
I ask is, “Who is your hero?” When I asked Susan this question, she
said it was her husband, but as we continued to talk about her life from
childhood on, she asked, “Can I tell you a secret?”
Susan started talking about her first love when she was nineteen. Her blue
eyes sparkled as she told me about their weekends spent dancing at a local
hangout. He was a
very handsome man, a man of honor and values, who
could dance “as gracefully as Fred Astaire,” she said in a giddy, schoolgirl-
crush way. They were together a few months when he went into the
military. While he was away, she met her husband. You may think the rest
is history, but it wasn’t. Her entire life, she had thought about her first
love and how things may have been different if she had waited for him.
Imagine spending seventy-two years thinking about a lost love and the
Susan described times they would run into each other after he returned
from the military and she was already another man’s wife. They had an unspoken
bond they both recognized and possibly even longed for. She described
the small bits of conversation they had and said he would always
ask, “Are you okay, Susan? Really? He never married, and Susan wondered
if it was because he wanted to marry her. She thought his “Really?”
carried an undertone of a deeper question. Susan thought he wanted to
know if she was truly happy with another man as her husband. He was
too much of a gentleman to get between Susan and her husband, so she
felt there were words that were never spoken. They eventually lost track of
each other because of her move to the U.S.
Her secret revealed that she never let the memories or the what-if ’s go.
She kept them quietly stored away in her heart for over seventy years. It
was a heartwarming story. I felt a bit sad hearing it. I was sitting with a
wonderful woman of ninety-one who had never gotten over her first love.
I was honored that I was the first one she had ever told this to. I was also
surprised by what I had been told. Susan went on to tell me how wonderful
her husband had always been to her and how she never regretted marrying
him. She kept her thoughts secret her whole life so as not to hurt her
husband, who was her hero.
We talked about her life over the course of a couple days. She shared her
experiences as an elderly woman in the hospital. Susan described an experience
during one of her hospital admissions. A couple of nurses mimicked
her accent. This had happened years before we met, yet had stayed
in her thoughts and feelings. Susan described feeling disrespected, belittled, and treated as if she had no feelings. The mimicking nurses made her
feel like they thought she was stupid because she had an accent. I would
guess there was no mal intent on the part of the nurses, but they didn’t
think about Susan’s dignity or feelings either.
As you progress through this book and read about the lives of the people
described in it, you will read about situations that will warm your heart
and others that are disturbing. Both are intended to cause you to think,
put yourself in someone else’s shoes, and move you to a more compassionate
perspective when it comes to our elders. It is my hope that the
stories will be heartwarming enough to cause you to be kinder and more
thoughtful, and disturbing enough to inspire you to become an advocate
for better treatment of one of our most vulnerable populations.
Funerals reveal who we have been
In my work and life, I have been to countless funerals, home viewings, and
memorial ceremonies. Funerals can be as unique as the individual who
died, but in the last ten to fifteen years, I have noticed increasing numbers