First Vist to Fox Hollow Memory Unit

Today I visited my father in the “Memory Unit” of the Fox Hollow Assisted Living Community in Pinehurst, NC. An unlikely place for my father to wind up his life, but there he is. North Carolina, and Pinehurst, in particular, played no part in my father’s life, other than the occasional interstate trek across the Tar Heel State. And the odd visit to my sister’s home in Durham. When he moved to NC he was on the verge of losing the cognitive ability to make a responsible decision about his own future, so we helped him, along with my mother, reach that particular conclusion to relocate to Pinehurst.

It was closer to the average child, drivable in less than 7 hours by four of the six (California and Asia being a bit more distant), reasonably temperate, closest to my sister (which got it my vote), and basically across the street from all required medical services, as opposed to an hour-plus drive from every required medical service. Pinehurst was not as picturesque as the waterfront home my parents left behind on the Gulf of Mexico, but it was a damn sight more amenable to their needs. Still, this move was a rather odd development in their lives. It was not planned on their part, it was not a dream of theirs to be in NC, and it was wholly brought about by the pressure of the family to move themselves from their hurricane magnet of a house to a more benign environment.

So, were we right to do so? Did the benefits outweigh the costs of the move, of the upheaval in the lives of my mother and father? We think so. Even if the move exacerbated my father’s dementia, perhaps accelerating his Alzheimer’s development, the improved care, for both of my parents, more than offset that negative. It might by presumptuous and arrogant to push one’s parents into such a move, but there comes a time when old folks may not be able to act in their own best interests. And that becomes the crux of the relationship between elderly parents and their offspring. The children can find themselves in a position better suited to drive decisions that must be made regarding the well-being of their parents. It is a role reversal, truly, wherein the role of mentoring and oversight is taken over by the younger generation.

Once the average person simply buried his parents, who succumbed to illness or the vagaries of the elderly. With the advent of gerontology and medicines that control the ravages of time, though, many people are being kept alive longer, and, in the case of Alzheimer’s patients, are being kept physically alive even as they are mentally dying. My father signed a Health Directive, luckily, one year ago, specifying his wish to not be kept alive by extraordinary means, and placing the determination of this status in the hands of my sisters. This type of directive, or “Do Not Resuscitate” order, is becoming commonplace, but it deals with purely physical matters. I suppose if my father was legally brain dead we would honor his wishes and not allow artificial life support. The disease he is suffering from, however, will not leave him brain dead. Alzheimer’s will gradually destroy his mind, but there tends to be something of a person left inside, and you have to wonder what is going on inside his head even as his ability to control bodily functions declines.

In the old days, as they say, these people would be unable to fend for themselves, would be a drag on a subsistence level household, and would succumb to their disease relatively quickly. Some Inuit tribes in Canada would abandon the decrepit elderly and move on, leaving them to die of exposure and starvation. Generally, though, the average lifespan was shorter in the past, and many people never lived to the age where dementia and Alzheimer’s disease now strike. The fact that Americans are living longer makes them more likely to fall prey to the diseases of the brain. The larger number of people experiencing these diseases makes it more likely you will know someone who is afflicted. In typical American fashion, as the likelihood of Alzheimer’s increases and looms on the horizon for the Baby Boomers, there is an outcry for research into finding a cure for the disease. No one wants to be the last person diagnosed and untreated for Alzheimer’s.

Which gets me to my point. There is a possibility of getting these dread diseases. You should not focus all of your attentions on this possibility, but a little planning can go a long way. After seeing how this sneaky disease blindsided my family, it is obvious that some consideration of the possibility of Alzheimer’s striking my father could have helped us act more quickly. The spouse of an Alzheimer’s patient tends to hide the symptoms of onset, either ignorant of what they are or unwilling to face the truth. This head-in-the-sand reaction is apparently prevalent and understandable. Losing your spouse in slow motion to the disease is a sad lot, and denial can buy you time until you are forced to accept it. This might lessen the early impact on the life of the patient and his spouse, but ultimately it masks the developing problem and can prevent some meaningful discussion taking place before it is too late.

Because eventually it will be too late, as that is the nature of the disease. My father was an analytical person. He told me so several times today – in fact, that he still is. His current condition, however, precludes making a sound analysis of his life, his situation, and his illness. Although he is aware that his cognitive abilities are declining, in his already progressed deterioration, he is unable to discern how far his mental faculties have declined. In other words, with the brain power he has left, he cannot make an accurate judgment of where he is on the spectrum of mental acuity. He wanted to drive when it was obvious to everyone else that he was mentally unfit for the task. He claims to making grand plans when he is actually suffering from dementia. It is a heart rending thing to watch, and it appears to be inevitable once the disease starts to progress.

And that is why I will make myself some semblance of a plan if I feel that Alzheimer’s might become my personal diagnosis. This does not require minute detail, simply the outline of what is to be done. In my father’s case, my mother and he were stuck in limbo, dealing with daily decay but not doing much about it. The intervention of their children resulted in their successful relocation, but it was very stressful for all involved. With some foresight, some actual rational thought as opposed to wishful thinking (“we’ll never move from here” (our second story walk-up on a little island in hurricane country an hour from medical facilities)), this evolution would have been much less stressful, especially for the children who spend their time second-guessing pushing their parents in these matters. So, that’s an ideal to shoot for – a contingency plan. When you are retired you ought to have the time to come up with one in case your retirement daydreams do not pan out. And after what my family has been through this past year, I hereby promise my kids I will not leave them in the situation where they must make all the decisions with no guidance whatsoever from my (currently) rational analytical self.

So there they are in NC. The Tar Heel State. A nice place to visit, but I personally abhor Pinehurst for what it is to me. Pinehurst is a place we evacuated my parents to, the place my father will likely spend the rest of his days in the “Memory Unit”, nice as it is, and gradually decline to death. There are a lot of active oldsters thereabouts, plenty of people with energy and a sparkle in their eyes, who perhaps need some assistance to get the most out of the days they have remaining to them. With Alzheimer’s, though, it is unclear to me what it is that my father gets out of the days that are still ahead of him. There is still a hint of his personality left, and the occasional burst of lucidity that gives you false hope, which you can enjoy together and take home with you as a keepsake, a meager portion of what once you took for granted, but the person who was once my father is gone. His body is inhabited by a portion of the man he was, and for that I am grateful, but the long gradual descent into Alzheimer’s is essentially a protracted, irreversible, and painfully long goodbye.

So what of the DNR, or the Health Directive? Should I buy a piece of an iceberg from the Inuit and send him off to sea, in a frozen version of a Viking funeral, cracked off from the ice shelf by global warming? Is the intersection of global warming and Alzheimer’s somehow a fitting end to man’s time here on earth?

Less plaintively stated: At what point are we keeping our father alive with extraordinary means?

On the lighter side:

I visited my father in the Fox Hollow “Memory Unit” today. That is their euphemism for the Alzheimer’s wing of the Assisted Living Facility. We decided to “place” our father in a “facility” due to the continued slide into dementia, the decline of my mother’s physical health due to the toil of caring for my father, and the none-too-subtle urging of his doctors. So, Dad has been here since Monday noon. I arrive Thursday afternoon.

I sign in at the front desk after walking through the front foyer of elderly types awaiting rides. Some doze, some are lively, some say hello. I smile at the old people. Say hello. Make my way down to the Memory Unit door.

I suppose I need a nickname for the Memory Unit. “The Unit” is a bit bland. The “MU” is weak. “The Home” has negative connotations amongst the elderly but everyone can invoke a mental image when you say that. My father has a deep seated fear of insane asylums or loony bins or psycho wards, so those terms, incorrect as they all are, are definitely off limits. He is in the “West Wing” of the building, so that is a little catchy, given the TV show and the supposed import of the location, but I currently and probably forever will hate politicians, so I find that unpalatable. I reach the door without deciding upon a name for the Memory Unit. Perhaps they really did look at all the alternatives.

The door opens normally from the outside – to exit, however, you need a code. I crack the door and peek in to make sure there are no potential escapees loitering nearby. I have learned to be suspicious of anyone near the door into such a place, and I want to spare myself the potential embarrassment of running down a fugitive from the . . . Memory Unit.

The only resident I see upon entry through the door is my father. He is leaning on the doorway into the nurse’s station, demanding a snack. He has always been big on snacks. The most basic attributes of an individual seem to stay with Alzheimer’s patients, so this is putatively positive although possibly annoying for the staff. I stand behind him for a few minutes to observe how he is interacting with the staff. Since the nurse, Tanya, deals with Alzheimer’s patients daily, she is very professional but not unsympathetic with him, and eventually several packs of potato chips arrive and a cup of cranberry juice. He is glad to see me, and smiles, but I perceive a bigger smile when the chips arrive.

After chatting for a while about his new digs, my father claims to have tried over and over to get the organ against the wall to work. I step over and note that it is unplugged. The administrator of the Unit promises to get it moved over to a nearby socket, despite my warning that my father will likely try to play something on it. He has already joined in with the devotional singing group, loudly, so Dee, the manager, smiles and says that they actually encourage that kind of behavior.

Eventually my father shows me his room, although there is some difficulty recognizing it. Outside each room is a small window box with mementoes and photographs to help the residents locate their rooms. There are two small A-4 Skyhawk aircraft models and some family photos outside my father’s room. He notes one of the A-4’s.

Inside, the room is large enough but rather Spartan, as the family did not wish to make it appear, yet, that this was going to be a long term stay at the Unit. My father tells me the people are all very nice here.

“What is this place?” he asks.
“It is an assisted living facility,” I say.
He nods. He has a television and a VCR/DVD player with the wires connected incorrectly, so I am unable to get a video to play.

Morra, one of the caregivers from Aging Outreach Services, arrives, with her seven-year old brother and sister in tow. “I had to baby sit,” she says. She is young, attractive, and does well with my father, who likes to talk to young, attractive women. He also enjoys the kids, who are very patient and well-behaved.

Dinner is served pretty early in the day in the Unit. I sat between my father and another resident, Betty, who exchanges pleasantries but does not really converse with us. The food seems pretty good, although I do not eat anything. Eventually I hand off to Morra and go try to fix the VCR. Once I figure out the wiring, everything works, and I feel like perhaps I have accomplished something.

After dinner I let Morra go, as the kids seem a bit antsy and they have not eaten dinner yet. So then my father and I discuss life. He is adamant that I get to the bottom of the doctors plot to keep my mother in the hospital We have lied to him, telling him that my mother is in the hospital for a few days for some tests – that is the premise for him having to be in the Unit. He assures me his analytical mind senses a disconnect in what he is being told. Perhaps we have underestimated his cognitive abilities. Perhaps not. He restates his displeasure with the doctors several times, proclaims his confidence in my ability to get to the bottom of this all and find out if they have any plan at all, etc. Over and over. Again.

Eventually I leave him to his own devices, with an Alfred Hitchcock movie beginning in the common room. I get let out by the nurse, who punches in the code. I walk into the relative normality of the Assisted Living part of the building, then out to the night air which, although drizzly, is most welcome. I drive to my mother’s house and have a pleasant home cooked dinner with normal conversation, as if we were in a different world than my father. Which we were.

On Friday I went to the county court house and registered the AL powers-of-attorney for my parents with NC. Now I was legal to act on their behest in the Tar Heel State. For a mere $85. I was not asked for any identification, but the younger of the two women there was very attractive, in a very young sort of way, so I did not mind. The other woman there was older, almost Pinehurst old. I assumed she had procured the lovely window treatments in the office.

I walked into the Assisted Living Facility, which I will call ALF, with a torchiere lamp over my shoulder. My father’s room had seemed a bit dark, so I brought the lamp that was behind his big brown recliner in the house. We felt that bringing in the recliner at this point would clue my Dad in to the length of his stay in the Unit. The standard gauntlet of elderly women were there in the foyer.

“Hey, that’s a nice lamp.”
“I could use a lamp like that.”
“Why don’t you bring that up to my room?”
I felt like a piece of meat. Only the wolf whistles were missing. I suppose they would’ve whistled if they had had their teeth in.

As I entered my Dad’s room, I found him napping on the bed and Charlotte, from AOS, by his side. My father is very fond of Charlotte and she has grown fond of him over the course of the past year. We have been lucky to have such attentive assistance. Now that he was in full time care, though, in the Unit, we would have to gradually phase Charlotte out of the picture, so that my father would get used to the Unit staff. Charlotte told me her plan to begin decreasing her time with him, and when he awoke, groggy as all get out, she had the Unit staffers assist him with his toilet visit. It took him the entire proceeding to come to grips with where he was.

I sat with Dad at lunch. Betty was semi-conversant.
“How are you today, Betty?”
“Oh, about as good as can be expected in a place like this.”
I did have some iced tea. I forgot I had driven so far south, though, and the sweet tea almost gagged me on the first sip. I wondered how sweet tea affected my Dad’s diabetes, but sweet tea is a God-given right down in NC, so I suspect asking for unsweetened tea for the old man wouldn’t do much good. Dad loved the soup. Betty stomped off eventually, but Dad did not care as they gave him ice cream for dessert. That made his day.

After lunch I called my Mom so she could speak to my father. She told him she was coming home from the hospital but that she had to avoid stress, so Dad could not come home quite yet. After my father hung up the phone, he picked up the stuffed Labrador on his lap (“Tom had this custom made to look precisely like my dog”), kissed it on the nose, and said “We’re going home.”
I took a deep breath. “Dad.”
I explained to him that Mom had to avoid stress, and that he caused a lot of stress to her when he was home. Not intentionally, but taking care of him had taken its toll. Which was true.

He looked at me and said that if that was what the doctors said Mom needed, then he would stay put if it would help Mom.
I breathed out. “Great Dad.”

This was from the guy who had 30 minutes earlier asked me to procure a gun to shoot the doctors.

I spoke with various staffers that afternoon about various details of my father’s schedule. Just before leaving, though, I told my Dad I would be right back, and went to the far end of the ALF to make a barber shop reservation (that beard was getting shaggy). It was closed, but when I came back into the Unit, my Dad looked surprised, and happy, to see me. As if I hadn’t just been there. Hm. I took leave of him when I handed him a pack of Fig Newton cookies, which he had swiped off a desk but I had swiped back. He shoved it into his mouth, dropping crumbs down his belly and on to the floor. There were crumbs in his beard, but I was on a timetable, and, after all, there were staff there to deal with such problems.