Playing with blocks

Mom has been in assisted living since October 16, 2011. I'll recount the difficult decision to move her into assisted living from our home in another posting. However, I can say that her stay at this assisted living facility, located in La Habra, CA, has been mostly uneventful, except for one visit to the ER for a fever and cough. We've been happy with the supremely patient staff composed primarily of women, that look after mom and the other residents. Mom enjoys the food, the companionship from the other residents and from what I can tell, has adapted well.  I visit every Sunday and our routine up to a couple of Sunday's ago involved sitting close to her, holding her hand and listening to music. We listen to Spanish language romantic ballads and rancheras (Mexican country music) on my iPhone. She loves to sing to music from her youth - what is called in Spanish "La Epoca de Oro" (The Golden Age). It always impresses me that as advanced as her disease is at this time, she can still remember the lyrics of many of her favorite songs. Occasionally, we'll walk to the bird enclosure and watch for as long as she is able to enjoy them.

Sunday was a beautiful day. After weeks of weekend rain, we had a warm Sunday, warmer than the previous weekend. I waited til the sun started to peek out of the clouds and I took mom on a slow, forty minute walk, several blocks away from her second home. It was early enough that for the first half hour we really didn't see any cars, which is a good thing because cars upset her when they go by. She was tired when we made it back to the center and was reluctant to enter without some cajoling. I left her seated, waiting for her lunch, content that we had started a heathy habit for our Sunday get togethers.

The day after, on Monday, I picked up a message left the previous evening on my cell voicemail letting me know that mom had hit another resident in the face with a block. The caregiver reassured me in the message that the resident had not been seriously hurt and that all seemed to be ok again. I tried twice to get a hold of the messenger to get more details about the injured resident but at this time, haven't been able to connect. However, this got me thinking about why mom was given blocks in the first place and why certain activities are encouraged in these facilities. Mom's symptoms are not unusual - lots of Alzheimer's patients at her stage act out impulsively when they are upset and lash out with whatever is in their hand (or their empty hand/fist). At home, we learned quickly about the potential that she could hurl an object in our direction so we tried to prevent this as much as possible.

Blocks in the hands of children are excellent learning tools. According to experts and parents, blocks help children learn math, basic geometry and other skills. But why give patients with dementia blocks? I've seen this same play at other facilities and I've also seen that residents are asked to play board games. When I've asked about the reasons why dementia patients would be given these activities I've not received a satisfactory response. Its possible that the caregivers are not informed and are only fulfilling a task but it also seems possible that like many things, that this is just the way its been done.

My mom has an almost constant giggle and laughter that some of her caregivers have noted to be "anxious" in its origin. I agree with them. When we walk together, she doesn't laugh or giggle in that obsessive or anxious way that she does when she is not busy. When she is home with us, and we have her busy sweeping outside or she busies herself plucking flowers or insects, she does not giggle or laugh the same way. At her second home, there are residents that have different obsessive behaviors - scratching a cabinet or the wall, knocking on the wall, pacing. It makes me wonder.

When I was searching for an assisted living for mom, the sites I visited all had locked units for the dementia patients (makes sense) and none of the sites I visited had access to the outdoors. Yes, there might be planned activities once a week or so to go out into the yard for a walk but none of the facilities that I visited had a secured patio, a yard, grass, sky, that was available without a planned activity. The dementia units were usually at an upper floor, or, they were contained to an area without access to a controlled "outside". I have to admit that initially, I found this tremendously reassuring. Our mom had wandered and I wanted her locked up. Secure. I wanted a guarantee that she would not get lost. But now that I've had time to visit, and see her, and the other residents, I do wonder what effect being locked up, without sky, sun or a chill on a regular basis has on a dementia patient. I'm still wondering.