by Sue Halpern
Finally we have a book that we can unequivocally recommend for almost anyone involved in eldercare: from residents to families and loved ones, to healthcare workers at all levels, to regulators and politicians, to anyone who wants to take a few hours to learn more about nursing homes and explore their own humanity in and from that context. But beware that, if you do accept the challenge of this inspiring, insightful and thought-provoking read, you too just may have your eyes and hearts opened to the promise-yes promise, life and beauty-that is present in a nursing home. And, as a result, you just may feel an inescapable tug to volunteer in a senior care environment-even if you don't have a dog. If you DO get to that point, I promise you that you will be better for the experience, as Ms. Halpern and her special dog Pransky are so much better for their experiences, as are the many lives they have touched over the past several years (and will continue to touch in the years ahead) as these two angels continue their "labor of love" at a county nursing home ("County") in a small town in New York state.
First, it should be said that, better than many who have worked in eldercare for much longer than she has been a volunteer, Ms. Halpern understands nursing homes and how she was "lucky" to draw the assignment she did. She describes County as being "blessed with tremendous [albeit it imperfect as a couple of anecdotes about efforts at culture change attest to] leadership, a devoted staff [which she does allude to as being understaffed and overworked], and a larger community that embraces rather than isolates it." She goes on to say that she "would not presume that it is comparable to any other nursing home." She also indicates that it is a non-profit/public enterprise. While most research does suggest non-profit nursing homes often have better quality and fewer bad outcomes than for-profit chains, there are plenty of very good homes out there at all levels of eldercare, both profit and non-profit/pubic. While that is true, it is also indisputable that there are not ANY decent homes out there that do not have the three characteristics she cites that are present at County-great leadership, devoted staff and the support of the surrounding community. Sadly, there are far too many homes out there that are missing one of more of these prerequisites for a good nursing home, meaning there are FAR too many subpar nursing homes out there. Searching out nursing homes desperately in need of improvement, protecting the consuming public in the meantime and striving to bring change to these unacceptable homes is what 4OurElders is all about.
Back to the book. Right up front, the reader is alerted to the fact that is not just another dog book. As great a dog and central a character as Pransky (Ms. Halpern's ten-year-old Labradoodle who is specially trained and certified as a therapy dog) is, she is most importantly a metaphorical window into the soul of people-her owner's as well as the patients, loved ones and staff at County. And not a passive one at that as Pransky, by her actions, interactions and reactions to people and events at County, help Ms. Halpern sketch out some "working answers" to basic human conundrums, such as how to find or sustain the classical and theological virtues (which she adroitly uses as chapter titles) of restraint, prudence, faith, fortitude, hope, love and charity when "death hovers all around?"
Nursing homes are perhaps our best classrooms to learn about how to find, define and apply these universal virtues to our own lives as we are in this sobering and often somber context allowed a unique opportunity to examine the true meaning for ALL of us of several realities experienced daily in even the best nursing homes in America, realities which, as Christian Wiman posits in his new book, My Bright Abyss, seem so inimical to the image of God many of us cling to: limitedness, indignity, contingency, suffering and death. Too bad most of us try to ignore these seeming imponderables until it is too late! Luckily for us, Ms. Halpern has found, distilled, described and now shares with us the wisdom, beauty, meaning and hope to be found in every nursing home setting if we just reach out and embrace the experience that awaits the astute volunteer, resident, family member, loved one, friend or staff member. And, As Ms. Halpern discovered in her journey, it was not nearly as painful or scary for her and Pransky as she thought (and most of us would think if we did think about it) it might be.
Here are some key takeaways and morsels of wisdom we found in the book and want to share (quotation marks indicate that the passages below are Ms. Halpren's words directly from the book-everything else are our takeaways or commentary thereon):
1) Two great fears of most residents entering a nursing home are the loss of 1) "how" they lived before (independently) and 2) "who" they were before (teacher/lawyer/nurse.) "Autonomy is imbued with history. When the bell tolls for the one, it tolls for the other."
2)"Fun is not a word I would have associated with spending time in a nursing home before Pranny and I found ourselves spending time in a nursing home. Depressing maybe, or unpleasant or sad, but not fun or enjoyable or entertaining." (Italics added). But, Sue and Pransky found that their time in the nursing home each Tuesday was NOT best described as depressing, unpleasant or sad. It was best described as fun, enjoyable, entertaining; most of all, their experiences were not a tradeoff-something good done for others at some price to them-but the experiences were mutually beneficial to all involved.
3)One in seven nursing home residents (not counting those in for short rehab stints) are under 65 and that percentage is increasing and will continue to increase rapidly. More and more, "[P]eople in their thirties and forties, whose lives [have] deviated from 'the standard' for any number of reasons, who could not be cared for at home, [are] landing among the elderly because there is no other place for them to get twenty-four hour care…."
4)Aristotle taught Ms. Halpern that "since practical wisdom is gained by experience, the inexperienced were out of luck." Those inexperienced in nursing home life have NO practical wisdom about nursing homes and what is good and bad about them-they have only opinions and sadly that does not keep them from writing articles, speaking and offering "solutions" to problems, both real and imagined. Ms.Halpern did not say this last part, but I bet she might agree with it.
5)Ms. Halpern had an assumption "based on nothing, really, except deathbed scenes from movies…" that "the nearer you are to death, the more appealing the consolations of religion [become]…" People "go out the way they come in" she was told by the County's medical director, "meaning that people did not automatically become more reflective as they grew old, and they did not suddenly become seekers [of God or things to do with God] if they had never been."
6)In the nursing home, "unseen things, whether they were in the mind's eye, which was focused on what may or may not have been, or embedded in visions of a future that did not resemble what was, were not uncommon." These "unseen things," along with "mysteries" that occur only in the mind of a paranoid or otherwise delusional resident, unexpectedly enough are not only not necessarily bad but are actually the very things that keep some residents going-keep them actually in the game of life as they know it.
7)"There's a whole branch of spirituality that trades in angels and miracles, [but] what I witnessed at County, sometimes because of the dog (God spelled backwards of course), and sometimes simply because the dog had brought me there, was NOT like that at all." Ms. Halpern goes on to describe a poignant encounter with "Thomas," whom she and Pransky had visited for weeks without any words from Thomas, when suddenly and unexpectedly Thomas not only started speaking one day but also spoke in a way that indicated that he had been listening to her all along and paying close attention. Sue calls that HER miracle since he had always been able to speak; she calls it "the miracle of waking up to NOT writing people off."
8)Watching her dog Pransky and her "two-year-old friend Ella" taught Ms. Halpern that innocence is lost when we stop seeing people for WHO they are (a random assortment of elders) and [begin wrongly to]see them for WHAT they are-disabled, aphasic, blind, mute. Then we let ourselves think of them as not 'normal" and, therefore, 'other'." Neither Ella nor Pransky understood 'other'….They started from acceptance, unlike the rest of us."
9)"At a different point in my life I would have considered [the unbending facts of my and my dog's own mortality lurking closer to the surface of my consciousness] to be the downside of spending time in a nursing home. [Rather,] [t]he unasked-for gift of being with people at the end of their lives [gave me] a profound appreciation of the here and now of life itself…. [W]atching many of the residents at County bear [their burdens] was a simple lesson in the not-so-simple virtue of fortitude-of…valor."
10)The Chapter entitled Hope is some of the best reading I have had in quite a while. Not just poignant insight after insight about life in a nursing home, as important and rare as that is in today's published works, but the chapter speaks, at once hauntingly and encouragingly, about the bigger existential issues at play for us all the time. Can we find hope in a nursing home? Can we find hope when surrounded by death and all that precedes and accompanies it? Some find it in religious constructs and the "promise of things to come." Nothing wrong there, but Ms. Halpern finds it in "Clyde's tomatoes." "…Here is the cycle of life, growing tomatoes, gave him a stake in the future, which is how hope prospers." Ice cream and children alone can be "beacon enough to keep [one] going." Getting ones hair and fingernails done are important precisely because "people without hope for today, let alone tomorrow, [do] not get their hair done."
11)"Young people and healthy people tend to believe that there is an absolute standard that defines the quality of life. Old people and sick people teach us that is not true." "What [makes] hope an attainable virtue [is] that like quality of life, it [is] not an absolute, not one thing or another; hope [is] potentially available, even under duress." How else could anyone explain how Ms. Halpern's father-in-law (and many others with similarly remarkable stories who stand as testaments to the human spirit), who at 67 was diagnosed with cancer, lost a portion of his brain to surgery and the disease and was no longer ambulatory or fully conversant, yet could still rate his quality of life as a 7 on a 10-point scale?
12)"Human beauty and grace is fitfully encountered," Ms. Halpern quotes a Harvard professor as saying, but then she goes on to say that she encountered it in everyday activities at County, such as when housekeeping staff with the "least pleasant jobs at the nursing home" did small things to make a resident's day better. She encountered it everyday things such as a physical therapist's touching and creative interactions with her patients and in the ways the activity director went about her often thankless efforts to make the residents' days extra special in the most ordinary (depressing?)of circumstances. She concludes that "[f]or an institution that has been painted so grimly in the popular imagination, a nursing home-at least this nursing home-offered an extensive curriculum on graciousness and love, if you were just open to it." This is true at every home I have ever visited, and I have been fortunate to have been in many. The good is there to be found and it IS inspiring and reinforcing of what it is good about this life no matter the hand dealt. And even at some of the worst homes out there-and there are far too many of those-there are "angels"/"heroes" in the best sense of those words that do valorous things every day with too little pay, recognition or support. We need to help them and the beautiful people they serve and care for.
13)"Fran," "Joe," "Lila," "Clyde," the "Carters," "Grace" and many others whose stories she relates in pertinent part throughout the book did not have lives or deaths that Ms Halpern "would want for herself at the end of my days-it was not the life I would want for anyone, all things being equal, but all things were not." She goes on to correctly point out the tragic fact that the cardinal virtue of justice-giving everyone his or her due-is as much a given in her experience at County as it WASN'T. Sadly, at many long term care facilities across the country that do not have the advantages County has in terms of leadership, devoted staff and an active community of volunteers, inequity and injustice for residents is far worse and downright deplorable.
14)"[S]ometimes people need to be reminded to think of others. She goes on to quote Pope Benedict who said "Our hearts should never be so wrapped up in our affairs and problems that [we] fail to hear the cry of the poor…Reaching out to others and opening our hearts to their needs can become an opportunity for salvation and blessedness." She concludes that "[u]ntil Pransky and I started spending time at County, I wouldn't have thought of a modern nursing home as being an incubator of virtue." ALL eldercare homes in this country at all levels of care have the potential for just that-being an incubator of virtue, which we all need more of-- if we just get out of our comfort zones and lend a hand…PLEASE.
15)Perhaps the most enduring gift Ms. Halpern has found in her experience at County: "The difference between death at County and death everywhere else I'd been was that it wasn't hidden, and like other things once out of the closet, it became, in its familiarity, less formidable and less scary, which was a gift." Thank you Ms. Halpern for your gift to us in the form of your latest book on such an important topic for us all.
One concluding thought. While, as I indicate above, Ms. Halpern did not start volunteering at County because of what she could get out of it, she readily admits her "gift" from those she serves is tremendous. Consider these statistics she cites: In a 2010 study of the benefits of volunteering, 73% of respondents said that volunteering lowered THEIR own stress levels; 89% reported that it improved THEIR own sense of well-being; 92% reported that volunteering enriched THEIR own sense of purpose. Moreover, an earlier long-term study by researchers at the University of Wisconsin found a causal relationship between doing good and feeling good. In addition, other university studies have found that those who volunteer live on average 4 years longer than those who don't-and I promise you the quality of those additional years are better for the volunteering. And, I promise you, volunteering at a senior care home-retirement home, nursing home, assisted living or skilled nursing-will bring even more benefits because of what you will learn about the meaning of life-your life-when surrounded by things that become far less scary once you open up to the really good messages they have waiting for you "just behind that curtain."
Check out www.agelessaviationdreams.com to see how one person-a senior executive in the senior-care business--has turned his flying passion into an incredible gift for seniors all across America. Dogs, planes or just yourself-volunteerism takes all kinds of talents and interest to make it work. If you want other ideas about volunteering in a long term care setting, contact us at 4OurElders and we will help you find your niche.