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Monday, August 1, 2016
Sunday, April 24, 2016
Wednesday, April 13, 2016
Disclaimer: this is not PAC vocabulary, this is strictly an article that promotes comfort and engagement and not the language that PAC promotes when describing expressions of PLWD
How to Manage "Sundowning"
When you are with someone who has Alzheimer's
disease, you may notice big changes in how they act in the late
afternoon or early evening. Doctors call it sundowning, or sundown
syndrome.
Fading light seems to be the trigger. The symptoms can get worse as the night goes on and usually get better by morning.
Although you may not be able to stop it
completely, you can take steps to help manage this challenging time of
day so you both sleep better and are less tired during the day. Let your
loved one’s doctor know what changes you have seen, too.
Symptoms
When someone is sundowning, they may be:
- Agitated (upset or anxious)
- Restless
- Irritable
- Confused
- Disoriented
- Demanding
- Suspicious
They also may:
- Yell
- Pace
- Hear or see things that aren’t there
- Have mood swings
Up to 1 out of 5 people with Alzheimer’s get sundown syndrome. But it can also happen to older people who don’t have dementia.
Causes
Doctors aren’t sure why sundowning happens.
Some scientists think that changes in the brain of
someone with dementia might affect their inner “body clock.” The area of
the brain that signals when you’re awake or asleep breaks down in
people with Alzheimer’s. That could cause sundowning.
It may be more likely if your loved one is:
- Too tired
- Hungry or thirsty
- Depressed
- In pain
- Bored
- Having sleep problems
What happens around someone can also set off sundowning symptoms. Some triggers are:
- Less light and more shadows in the house. This can cause confusion and fear.
- Trouble separating dreams from reality. This can be disorienting.
If you feel tired or frustrated at the end of a day
of caregiving, your loved one may notice, even without you saying
anything. This can upset them, too. It’s normal for you, as a caregiver,
to have feelings like that. Try to be aware of how you manage those
emotions if you think that might make a difference.
How to Help Someone Who Is Sundowning
Look for patterns. Note the things that seem to trigger it, and then do your best to avoid or limit those triggers.
Keep a daily routine. Set regular times for waking up,
meals, and going to sleep. Try to schedule their appointments, outings,
visits, and bath time in the earlier part of the day, when they are
likely to feel their best.
Limit or avoid things that affect sleep.
- Don’t let your loved one smoke or drink alcohol.
- Make sure if they have sweets and caffeine that they just do it in the morning.
- Make a big lunch, and keep their evening meal smaller and simple.
Avoid letting your loved one nap or exercise later than 4 hours before bedtime. If they absolutely need to nap, try to keep it brief and early in the day.
Keep things calm in the evening.
- Close curtains and blinds and turn on lights. Darkness and shadows can make them more upset.
- Fix the room temperature so they're comfortable.
- Tell other family members or visitors not to make too much noise.
- Put on relaxing music, read, play cards, or go for a walk to wind down.
How to React
- Stay calm.
- Ask your loved one if they need something.
- Remind them what time it is.
- Don’t argue with them.
- Reassure them. Tell them everything is OK.
- If they need to get up and move around or pace, don’t try to hold them back. Just stay close by to keep an eye on them.
- Keep them safe with night-lights and locks on doors or windows. Use a gate to block the stairs, and put away anything dangerous, like kitchen tools.
Also, consider getting a baby monitor, motion
detectors, or door sensors. They can let you know if your loved one is
walking around.
When You Need a Doctor’s Help
If the above tips don't work, tell his doctor, who
can check to make sure that your loved one’s medicines that help him
relax and sleep don’t cause more confusion the next day.
Take Care of Yourself
Sundowning can make it hard for you to get restful
sleep. And you need to take care of yourself in order to be there for
your loved one.
You can:
- Ask a friend or relative to fill in for you at night.
- Try to get a daytime nap.
- Take breaks whenever you can during the day.
- Hire a home health care service for backup.
Other ways to take care of yourself are to exercise,
eat healthy, spend time with friends, and try to find time -- even if
it’s not a lot -- for your own hobbies and interests. Consider joining a
caregiver’s support group, too.
WebMD Medical Reference
Reviewed by
Neil Lava, MD on December 17, 2015
© 2016 WebMD, LLC. All rights reserved.
Friday, March 18, 2016
"Progressively Lowered Stress Threshold"
Disclaimer: this is not PAC vocabulary, this is strictly an article that promotes comfort and engagement and not the language that PAC promotes when describing expressions of PLWD
Derived from:
http://www.crisisprevention.com/Blog/October-2010/The-Progressively-Lowered-Stress-Threshold-Model-U
The "Progressively Lowered Stress Threshold" Model—Understanding and Minimizing Challenging Behavior
By Kim Warchol |
Posted on 10.29.2010 |
The Progressively Lowered Stress Threshold Model (PLST) can provide a frame or reference to understand and reduce the challenging behaviors associated with Alzheimer's disease and related dementias (ADRD). According to the PLST, people with ADRD have difficulties receiving, processing, and responding to environmental stimuli. These difficulties are the direct result of the progressive deterioration in cognitive, affective, and functional abilities that accompany dementia. Severity and frequency of behavior varies based upon the environmental stimuli and the person's stage of dementia. The more advanced the stage of dementia the more behaviors typically present.
There are many internal and external stress inducers that a person with dementia experiences on a daily basis. These stress inducers are thought to be at the root of behavioral disturbances such as hitting, resisting care, yelling, anxiousness, pacing, and sundowning.
A stress inducer can be internal such as:
- Unmanaged pain or discomfort
- Fatigue
- Hunger
- Unmet quality of life needs such as the need for attention, love, intimacy, success, friendship, purpose etc.
- Impaired ability to communicate and express needs
- Impaired ability to be understood
-
Negative feelings such as feeling like a failure, unwanted, lonely, or scared
- Environmental distractions
- Noise overload
- An impatient, unskilled caregiver
Often there is a connection between the external environment and the internal feeling. For example, a caregiver may perform self-care on "the patient" with the sole intent of getting "the patient" clean. If the only intent of this ADL experience is "cleaning the patient" the person will likely have a negative response such as feeling like an inanimate object in the middle of a task, feeling helpless and unimportant. This then can trigger a negative behavior.
If we think about the typical day of a person with dementia, there are many likely stressors that pile up on one another. I firmly believe that this layering of stressors can cause the sundowning event.
Let's explore what can be a typical day for a person functioning in Allen Level 3:
- A poor night's sleep
- A 15-minute ADL experience as previously described
- Sitting for over an hour waiting for breakfast
- Sitting in a large, noisy, crowded, overstimulating dining room
- Experiencing difficulty self-feeding
- Urinating or defecating in pants and waiting to be cleaned up
- Sitting in an activity that is far too high level and therefore it becomes "noise"
- Wandering alone throughout the hallways and at every corner, being told to "leave that alone" or to "go sit down"
- Feeling pain from arthritis but being unable to ask for pain medications
- Feeling embarrassed, violated, and uncomfortable when showered naked by a stranger in a cold, scary room
- Not being engaged socially, comforted, or loved throughout the day
- Never feeling like a success in anything you do
- And on and on . . .
If you experienced a day with this amount of stress would you have a "melt down" by dinner time? I would. This is what likely happens to this individual. After the layering of all of these stressors the person exceeds their stress threshold and has a melt down or in other words "sundowns."
A SUCCESS STORY
At a 120-bed SNF designed exclusively for persons with ADRD of all stages in which I was the Director of Well Being on a full time basis, I worked with the DON on proactive methods to reduce stressors. We found a significant reduction in the amount of sundowning our residents experienced compared to the average SNF and we also saw a significant reduction for residents who experienced daily sundowning at a previous facility.
Our plan to reduce internal and external stress inducers was to:
- Love on the residents every single day and let them know how important they were to our well-being and to the well-being of others. Our administrator would begin every daily meeting by asking us "what difference did you make in the life of a resident today?" This continued to emphasize the importance of striving for emotional well-being.
- Create feelings of importance and success through meaningful and successful ADL and activity experiences (at the root of this is activity gradation to match Allen level).
- Proactively manage pain by having routine pain med orders vs PRN for those in need, by offering whirl pool baths and massage, and by keeping the residents moving.
- Minimize sensory overload with no overhead paging and radios and televisions used at selective times as a part of the activity program only.
- Provide frequent quiet or rest periods throughout the day on a planned schedule. For example, at 10:00 a.m. and 2:00 p.m., a person who was known to sundown or was at risk for sundowning would be brought to a quiet room for a 15-minute hand massage or the person napped (the choice was made on personal preference).
- Create small dining spaces in which the noise level and other distractions were minimized and closely monitored.
- Use consistent caregivers who developed a loving, safe relationship with the resident—the DON supported the concept of not rotating staff.
- Make certain the bath environment was warm and inviting.
- To train all staff in dementia care (e.g., best communication, provision of positive feedback) and to use care approaches that match Allen level.
- Make sure residents participated in a significant number of small and large activity groups, balanced with rest periods, each day. These activities matched their interests. One of the benefits of the high level of meaningful activity was good sleep patterns. Our residents slept well at night because they were quite active throughout the day.
- Implement bowel and bladder programs and the DON closely monitored.
- Refer to therapy when a person exhibited behaviors that interfered with function or safety.
These are some of the program elements that were designed, implemented, and monitored. I realize it takes a village to implement a plan as comprehensive as this. However, you may begin by using one or two of these ideas and expand your plans as you gain agreement and partnership from others.
Alzheimer’s Care Training: Read more about Alzheimer's care training on our Knowledge Base page and gain access to our free eBook, Communication Tips for Serving Individuals With Dementia.
Dementia Care Specialists (DCS) is the premier dementia training and consulting company. With nearly 60 years of cumulative experience in dementia care training, DCS provides state-of-the-art dementia products, training, and program consultation.
People with ADRD do not have to be victims of these
behaviors. Proactive plans such as the one described can greatly reduce
the frequency and severity of behavior problems. The PLST helps us to
identify the potential behavior triggers as related to internal or
external stress inducers. If we can proactively reduce stress, we can
greatly reduce negative behavior—thereby reducing burden on the
caregiver and increasing the quality of life, function, and safety of
the resident/client. This is the path to reimbursement for OT/PT/ST to
intervene.Dementia Care Specialists (DCS) is the premier dementia training and consulting company. With nearly 60 years of cumulative experience in dementia care training, DCS provides state-of-the-art dementia products, training, and program consultation.
Reference: Hall, G., Buckwalter K. (1987). Progressively lowered stress threshold: A conceptual model of care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1, 399–406.
Wednesday, February 17, 2016
The Hard End of the Day
Disclaimer: this is not PAC vocabulary, this is strictly an article that promotes comfort and engagement
and not the language that PAC promotes when describing expressions of
PLWD
"Sundowning" is a term used to describe the agitation, pacing, irritability and disorientation that many people with Alzheimers experience during the late afternoon, evening or night. (disclaimer:this is not PAC vocabulary, this is strictly a definition and not the language that PAC promotes when describing expressions of PLWD)
For those who work or live with older adults who have dementia, "Sundown Syndrome" or "sundowning" is one of the most challenging situations they encounter on a daily basis. Several years ago, staff at the nursing home on the Beatitudes Campus in Phoenix, Arizona determined they had a serious problem with sun downing and set about finding some solutions.
As Tena Alonzo, Director of Research and Dementia Programs at Beatitudes, describes it, "In the dementia unit, everyday at the evening shift change, the chorus would start: a few people would call out and then everyone in the vicinity would join in. You could hear help me, help me and oh, shut up continuously. Perhaps it wouldn't have been so bad if that's where the challenging behavior stopped, but this was just the beginning of the evening! People who were easy to get along with the rest of day would suddenly want to fight with anyone who crossed their path. Others would pace the floor looking for an exit to escape. Dinner was disastrous as no one could hear themselves think. Visiting families and friends were distressed and upset. After several hours dealing with agitated residents and family visitors who were sometimes inconsolable, the exhausted staff would finally get everyone in bed so the whole process could begin again the next day."
As the staff looked at the frequency and severity of residents experiencing "sundowning", they thought there must be something that can be done about this situation. Is "sundowning" just a part of the disease? Why do some older adults with dementia act so differently in the afternoon? Isn't there something we can do to help everyone be more comfortable? The answers to these questions didn't come all at once, but over time some valuable lessons were learned about older adults with dementia.
In considering possible solutions to "sundowning", the Beatitudes staff had something in their favor. They had recently begun implementing a philosophy where achieving comfort was the overall staff goal. This comfort philosophy was not about an end-of-life hospice focus, but rather about meeting the needs of people with dementia the way they would do for themselves if they were able. This was a big change as it meant stepping away from the schedules and routines that had been established to embrace the routine of the person with dementia.
To begin, the team decided to observe everyone residing on the dementia unit between the hours of 2:30 PM and 9:00 PM. This observation, which occurred over several days, shed light on some interesting scenarios. The staff saw that many residents looked tired and frazzled and wondered if they would be more comfortable if they were to lie down and rest. Much of the time these rest periods were not necessarily convenient for the staff, and it was a little challenging at first to envision the perspective of the resident for some staff members. The team decided if someone looked tired, no matter when that occurred, they would assist him or her to rest either in a comfortable chair or on the bed (some prefer a chair or the couch, some may only lay on top of their bed, with a throw, while others prefer to change and get back into bed--the decision is based on the resident's comfort). After some discussion, the staff also agreed that it didn't matter if the rest period was during a meal or an activity. After a few months, everyone accepted the rest when tired philosophy. As residents started to sleep when they were tired and wake when they were rested, the change was obvious. They were happier and didn't seem to need so much psychotropic medication. The nurses didn't give PRN medication for agitation any longer and felt comfortable asking the physicians to begin tapering the medications. They started with the anti-anxiety medications because almost every resident was receiving one, and then worked on tapering the anti-psychotics. While not every resident was comfortable without psychotropic medication, most were.
This first phase of addressing the issues with "sundowning" had been very successful, but staff felt there was more work to do. Next, they observed the overall unit environment (or milieu as they prefer to call it). What was seen and heard was appalling. At the evening shift change, the commotion increased significantly. Staff were used to speaking all at once and rushing around trying to complete tasks before end of shift or gearing up to begin their work. This cacophony and disruption were compounded by a television in the common area and general noise on the unit. Watching the residents respond to the din was enlightening. Sometimes people covered their ears or tried to get away from it. Some just looked scared and bewildered. It became clear to the staff that they needed to stop talking so loudly and slow down. The television that had been so prominently displayed in the common area, but never really used by residents, was moved. The milieu became quiet, and everyone responded positively to the change in the environment.
It can be easy to forget that being confused and unable to make sense out of the environment can be extremely tiring for the person with Alzheimers, and over stimulation only makes this worse.
The staff was amazed that making comfort the goal of everything had such a positive impact on the residents and on themselves. Once the changes were in place, no one called out, became angry or upset or tried to leave the unit. Staff members became sane again, and many reported they enjoyed their jobs more since the changes were implemented. Families and friends increased their visits in the afternoon and evening. Dining became a wonderful event which resembled a restaurant setting rather than a nursing home dining room.
As Ms. Alonzo relates, It's been almost 14 years since we've experienced the pain of "sundowning" here. We still do the same things, still make comfort the goal of everything, and both the residents and the staff are better for it.
If anyone has any related article that they would like to share, PLEASE share the link in the comment section.
"Sundowning" is a term used to describe the agitation, pacing, irritability and disorientation that many people with Alzheimers experience during the late afternoon, evening or night. (disclaimer:this is not PAC vocabulary, this is strictly a definition and not the language that PAC promotes when describing expressions of PLWD)
For those who work or live with older adults who have dementia, "Sundown Syndrome" or "sundowning" is one of the most challenging situations they encounter on a daily basis. Several years ago, staff at the nursing home on the Beatitudes Campus in Phoenix, Arizona determined they had a serious problem with sun downing and set about finding some solutions.
As Tena Alonzo, Director of Research and Dementia Programs at Beatitudes, describes it, "In the dementia unit, everyday at the evening shift change, the chorus would start: a few people would call out and then everyone in the vicinity would join in. You could hear help me, help me and oh, shut up continuously. Perhaps it wouldn't have been so bad if that's where the challenging behavior stopped, but this was just the beginning of the evening! People who were easy to get along with the rest of day would suddenly want to fight with anyone who crossed their path. Others would pace the floor looking for an exit to escape. Dinner was disastrous as no one could hear themselves think. Visiting families and friends were distressed and upset. After several hours dealing with agitated residents and family visitors who were sometimes inconsolable, the exhausted staff would finally get everyone in bed so the whole process could begin again the next day."
As the staff looked at the frequency and severity of residents experiencing "sundowning", they thought there must be something that can be done about this situation. Is "sundowning" just a part of the disease? Why do some older adults with dementia act so differently in the afternoon? Isn't there something we can do to help everyone be more comfortable? The answers to these questions didn't come all at once, but over time some valuable lessons were learned about older adults with dementia.
In considering possible solutions to "sundowning", the Beatitudes staff had something in their favor. They had recently begun implementing a philosophy where achieving comfort was the overall staff goal. This comfort philosophy was not about an end-of-life hospice focus, but rather about meeting the needs of people with dementia the way they would do for themselves if they were able. This was a big change as it meant stepping away from the schedules and routines that had been established to embrace the routine of the person with dementia.
To begin, the team decided to observe everyone residing on the dementia unit between the hours of 2:30 PM and 9:00 PM. This observation, which occurred over several days, shed light on some interesting scenarios. The staff saw that many residents looked tired and frazzled and wondered if they would be more comfortable if they were to lie down and rest. Much of the time these rest periods were not necessarily convenient for the staff, and it was a little challenging at first to envision the perspective of the resident for some staff members. The team decided if someone looked tired, no matter when that occurred, they would assist him or her to rest either in a comfortable chair or on the bed (some prefer a chair or the couch, some may only lay on top of their bed, with a throw, while others prefer to change and get back into bed--the decision is based on the resident's comfort). After some discussion, the staff also agreed that it didn't matter if the rest period was during a meal or an activity. After a few months, everyone accepted the rest when tired philosophy. As residents started to sleep when they were tired and wake when they were rested, the change was obvious. They were happier and didn't seem to need so much psychotropic medication. The nurses didn't give PRN medication for agitation any longer and felt comfortable asking the physicians to begin tapering the medications. They started with the anti-anxiety medications because almost every resident was receiving one, and then worked on tapering the anti-psychotics. While not every resident was comfortable without psychotropic medication, most were.
This first phase of addressing the issues with "sundowning" had been very successful, but staff felt there was more work to do. Next, they observed the overall unit environment (or milieu as they prefer to call it). What was seen and heard was appalling. At the evening shift change, the commotion increased significantly. Staff were used to speaking all at once and rushing around trying to complete tasks before end of shift or gearing up to begin their work. This cacophony and disruption were compounded by a television in the common area and general noise on the unit. Watching the residents respond to the din was enlightening. Sometimes people covered their ears or tried to get away from it. Some just looked scared and bewildered. It became clear to the staff that they needed to stop talking so loudly and slow down. The television that had been so prominently displayed in the common area, but never really used by residents, was moved. The milieu became quiet, and everyone responded positively to the change in the environment.
It can be easy to forget that being confused and unable to make sense out of the environment can be extremely tiring for the person with Alzheimers, and over stimulation only makes this worse.
The staff was amazed that making comfort the goal of everything had such a positive impact on the residents and on themselves. Once the changes were in place, no one called out, became angry or upset or tried to leave the unit. Staff members became sane again, and many reported they enjoyed their jobs more since the changes were implemented. Families and friends increased their visits in the afternoon and evening. Dining became a wonderful event which resembled a restaurant setting rather than a nursing home dining room.
As Ms. Alonzo relates, It's been almost 14 years since we've experienced the pain of "sundowning" here. We still do the same things, still make comfort the goal of everything, and both the residents and the staff are better for it.
If anyone has any related article that they would like to share, PLEASE share the link in the comment section.
Monday, February 15, 2016
Opportunities
Hi PAC Approved/ Certified Trainer!
Having successfully completed
Trainer Certification, you have the skills and tools to train others in
Teepa’s Positive Approach™. Now imagine
the impact of adding to your organization’s team with additional role specific certifications. Now is the time to build your team!
Your colleague will receive 20% off their registration for
a March or April Coach or Consulant Certification. Tell them to use the disocunt code CERT2
during the on-line registration process.
Do you have a Memory Care Program Director, Resident Care Director, or Executive Director that would benefit from pursuing a
The Coach program is designed for anyone who supervises
caregivers or other team members providing direct care or support to individuals living with dementia. Coach
Certification
equips care team members to help coworkers change their behavior
towards individuals with dementia, leading to improved relationships
and quality of care.
Testimonial
“When I say the Positive Approach™ coaching model has changed my life, it really has changed my life—not
just my personal life, but how I supervise people, how
I appreciate different things from my staff.
Everybody’s personality is as valuable as the next person. So, I think
that as a provider, the light goes off with this training. You’re
meeting
everybody’s needs – staff, family and residents. It was the answer the
whole time.”
Events
Do
you have an Executive Director, Marketing Director, Senior Living
Advisor, or Social Worker on your team who would benefit from pursuing a
The Consultant program is designed for professionals who counsel and
advise individuals and families working through dementia related challenges.
In addition to dementia related awareness and knowledge, learners are
taught effective communication techniques, strategies to connect with
clients in a meaningful way, and methods of providing the right
resources at the right time.
Testimonial
"Since
completing the Consultant training I've noticed that I'm interacting
with potential residents in an important way. Prior to the training when
potential residents
or their family members came in for a tour I not only had my agenda,
which was to get them to move in if they met our level of care, but also
gave my "canned" speech about the facility. Now I listen and not just
to the words they are saying. I listen to see
if they are a detail person or big picture, facts or emotions. I connect
with the person, then reflect. The result? More move ins! I am loving
connect and reflecting, it is becoming more and more natural as I use
the training has proven to be so useful and
is making a difference in our facility, and the coaching calls have been
so eye opening for me.”
Events
Questions?
Please call 1- 877-877-1671 or email info@teepasnow.com
Wednesday, February 10, 2016
Last Ride
Last Ride
I arrived at the address and honked the horn. After waiting a few minutes I honked again. Since this was going to be my last ride of my shift, I thought about just driving away, but instead I put the car in park and walked up to the door and knocked.
Just a minute', answered a frail, elderly voice.
I could hear something being dragged across the floor.
After a long pause, the door opened. A small woman in her 90's stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940's movie.
By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets.
There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.
Would you carry my bag out to the car?' she asked.
I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb.
She kept thanking me for my kindness. 'It's nothing', I told her.. 'I just try to treat my passengers the way I would want my mother to be treated.'
'Oh, you're such a good boy, she said. When we got in the cab, she gave me an address and then asked, 'Could you drive through downtown?'
'It's not the shortest way,' I answered quickly.
'Oh, I don't mind,' she said. 'I'm in no hurry. I'm on my way to a hospice.
I looked in the rear-view mirror. Her eyes were glistening.
'I don't have any family left,' she continued in a soft voice. 'The doctor says I don't have very long.' I quietly reached over and shut off the meter.
What route would you like me to take?' I asked.
For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator.
We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.
Sometimes she'd ask me to slow in front of a particular building or corner and she would sit, staring into the darkness, saying nothing.
As the first hint of sun was creasing the horizon, she suddenly said, 'I'm tired. Let's go now'.
We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico.
Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.
'How much do I owe you?' She asked, reaching into her purse.
'Nothing,' I said.
'You have to make a living,' she answered.
There are other passengers,' I responded.
Almost without thinking, I bent and gave her a hug. She held onto me tightly.
'You gave an old woman a little moment of joy,' she said. 'Thank you.'
I squeezed her hand, and then walked into the dim morning light.. Behind me, a door shut. It was the sound of the closing of a life.
I didn't pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk.
What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?
On a quick review, I don't think that I have done anything more important in my life.
We are conditioned to think that our lives revolve around great moments.
But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.
PEOPLE MAY NOT REMEMBER EXACTLY WHAT YOU DID, OR WHAT YOU SAID ~BUT~THEY WILL ALWAYS REMEMBER HOW YOU MADE THEM FEEL.
Thank you, my friend...
Life may not be the party we hoped for, but while we are here we might as well dance. J.L.
I arrived at the address and honked the horn. After waiting a few minutes I honked again. Since this was going to be my last ride of my shift, I thought about just driving away, but instead I put the car in park and walked up to the door and knocked.
Just a minute', answered a frail, elderly voice.
I could hear something being dragged across the floor.
After a long pause, the door opened. A small woman in her 90's stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940's movie.
By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets.
There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.
Would you carry my bag out to the car?' she asked.
I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb.
She kept thanking me for my kindness. 'It's nothing', I told her.. 'I just try to treat my passengers the way I would want my mother to be treated.'
'Oh, you're such a good boy, she said. When we got in the cab, she gave me an address and then asked, 'Could you drive through downtown?'
'It's not the shortest way,' I answered quickly.
'Oh, I don't mind,' she said. 'I'm in no hurry. I'm on my way to a hospice.
I looked in the rear-view mirror. Her eyes were glistening.
'I don't have any family left,' she continued in a soft voice. 'The doctor says I don't have very long.' I quietly reached over and shut off the meter.
What route would you like me to take?' I asked.
For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator.
We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.
Sometimes she'd ask me to slow in front of a particular building or corner and she would sit, staring into the darkness, saying nothing.
As the first hint of sun was creasing the horizon, she suddenly said, 'I'm tired. Let's go now'.
We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico.
Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.
'How much do I owe you?' She asked, reaching into her purse.
'Nothing,' I said.
'You have to make a living,' she answered.
There are other passengers,' I responded.
Almost without thinking, I bent and gave her a hug. She held onto me tightly.
'You gave an old woman a little moment of joy,' she said. 'Thank you.'
I squeezed her hand, and then walked into the dim morning light.. Behind me, a door shut. It was the sound of the closing of a life.
I didn't pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk.
What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?
On a quick review, I don't think that I have done anything more important in my life.
We are conditioned to think that our lives revolve around great moments.
But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.
PEOPLE MAY NOT REMEMBER EXACTLY WHAT YOU DID, OR WHAT YOU SAID ~BUT~THEY WILL ALWAYS REMEMBER HOW YOU MADE THEM FEEL.
Thank you, my friend...
Life may not be the party we hoped for, but while we are here we might as well dance. J.L.
Teepa Snow, MS, OTR/L, FAOTA
Dementia Care & Training Specialist
Dementia Care & Training Specialist
“Last Ride” originally published under "And where there is sadness, joy” in book: Make Me
an Instrument of Your Peace (1999).
Teepa's quote at the end of the story: "Life may not be the party we hoped
for, but while we are here we might as well dance." is by Jeanne C. Stein from “Blood Drive”
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