Living Through Windows... Alzheimer's Disease Series

By Mike Bockoven
michael.bockoven@theindependent.com

Third Floor Phillips

"I remember thinking it must take a lot of love to bring them here and let strangers take care of them. I tell people, 'It shows how much you love them to get them the care they need. I also tell them, 'We don't sleep.'" -- Tasha Hamm, registered nurse on Third Phillips.

The wing of the Grand Island Veterans Home reserved for those with Alzheimer's disease and various forms of dementia is on the third floor of the Phillips Building, behind a secure door on the north side. It is home to 31 members, all of whom are not only diagnosed but also advanced enough in their disease that they are beyond the capability of other wards at the veterans home. There has been a waiting list for the ward for some time.

The ward is secure, which entails a push-button system to enter the ward and punching a code on a keypad to exit it. The ward itself is a long and narrow stretch of white speckled tile flooring with a desk, nursing station, television and dining area and offices all contained inside. It also has rooms where members sleep, although it is not uncommon to see men draped in easy chairs, limp and breathing slowly, or women asleep in chairs near windows while others behind them stare into nothingness.

One of the first things a visitor to the ward will see is a sign reading, "They don't live in our facility. We work in their home." It's less of a motto than a simple truth, but it's something caregivers take seriously.

The fact that the ward is secure can be spooky to many first-time visitors, but Luther said it's very much a matter of necessity that members not be allowed to leave.

"Everything we do up here is to keep people safe," Luther said. "A lot of people have the impression they're locked up and here to stay. That's not true. They're here for their security and to preserve their dignity."

Dignity is a concern as Alzheimer's can sometimes lead to socially embarrassing activity, although the main reason is to make sure members don't get into situations where they can become agitated, lost or injure themselves. Paranoia can also come with the disease and, with it, combativeness and accusations to family members and total strangers. Shedding of clothes and trouble using the rest room can also be products of the disease that are best confined to the ward.

Several families have firsthand experience with a loved one wandering away and are largely grateful for the security the ward represents.

"They're nervous about it at first," said Tasha Hamm, a registered nurse on Third Phillips. "It can be tough to have them behind a door, but after a while they come to terms with it. I had one person tell me they can sleep soundly for the first time in a long time knowing their loved one is safe."

The ward is required to have five trained staff members on duty at all times and operates, as one would expect, 24 hours a day, every day of the year. Caring for the patients includes giving medication, feeding, bathing and other jobs familiar to anyone in a nursing home setting. What's different is the monitoring that takes place.

Alzheimer's patients can become agitated fairly quickly. Agitation from one member can lead to reactions from other members, and the cyclic momentum of agitation can be hard to break. The staff tells stories of changes in barometric pressure or right before major weather events when, one minute, everything is calm and, the next, problems seem to explode all around them.

Jessica Whelan, a unit clerk for the ward, has a desk that faces the nurse's station. On one side, she can see the television area, and mirrors are strategically placed so she can see down some of the halls and around corners.

"It's different because, aside from all the other stuff I do, I'm a pair of eyes," she said. "That's important because, if something happens in this area, I'm the one who sees it."

Whelan is also able to give caregivers the moods of individual members and has helped avert possible problems before they escalate. One day on the ward, Dean Gracy, who has been on the ward for several years, believed Whelan's desk was the checkout desk at a hotel and kept insisting that he be given his bill. She printed up an "invoice" showing that he didn't owe anything, and he eventually accepted it and became less and less agitated.

There are myths that Alzheimer's patients are often violent or dangerous. A quick conversation with any of the staff will dispel those myths. It is true that some people with Alzheimer's are angry at times, often stemming from confusion caused by the disease, and there are times when conflicts arise. Luther said little things like lightning during a storm, rapid changes in environment or even floors that are too shiny can often be catalysts for problems. They deal with such problems usually through either distraction or redirection, though some care staff choose to engage the members on a deeper level.

"You do a lot of agreeing," Brooks said. "Sometimes it helps to go into their world. If they think you're their sister, you pretend you're their sister. Sometimes you can ask them what year it is and help them cope that way. Part of the disease is regression, and you can take advantage of that."

A big part of the mix is activities, which can make the difference between a chaotic ward and a ward the staff can handle. Activities range from church services to holiday dinners to "busy bee" activities. Many of them are planned around certain times of day when members are more likely to be agitated.

The more energy expended, Luther said, the less chance of conflict.

The ward is also a place where accommodation is key. Like Whelan creating the fake hotel bill to placate a member, if there's a request that can be honored without becoming an issue, Luther said, they try to do it.

For example, several months ago, Stanley Wright, a member on the ward, had been waiting by the door for someone to pick him up for several hours. He wasn't obstructing the comings and goings of the ward; he wasn't bothering anyone and was fairly happy to sit in his wheelchair and wait.

"The way we look at it, if there's no harm in it, so why not?" Luther said. "Activity is the key to Alzheimer's. You need to keep them recreated, and it makes a huge difference, but sometimes they can do their own thing and that's OK, too."

Activities sometimes take members from Third Phillips outside the ward, but consideration is made as to what stage of the disease the member is in. Those who are high-functioning can go to parades, concerts at the home and more. Others who need constant care are safer in the ward, Luther said. There are times, such as doctor's appointments or special family events, when members are taken off the ward. But for the most part, inside its walls, workers try to create an environment that is safe and comforting.

For Unit Director Deb Watson, it was a complete departure from what she had been doing previously as a nurse in terms of trying to cure a disease or illness. It took her a while to come to grips with the way the ward works, but once she did, it gave her a whole different perspective on how care can be given.

"I thought I was real focused into that medical part," Watson said. "When you start here, you don't treat one acute incident. You really deal with quality of life. I derive a great passion for it because these are people like you and me. They didn't ask to have their memories and personalities stolen from them."

Windows :: Third Floor Phillips :: A Typical Day in an Atypical Place
The Caregivers :: The Members :: The Families :: The Need
Opening the Doors :: Seeing Through Windows