Tag Archives: aged care

Self Care

A recent session with a newly referred lady, “Marge”, at the nursing home, left us feeling rather drained and tired by the end of the day. Not physically, considering all we did was sit in the garden and chat with her, but emotionally. Because all she did was tell us about how she has no one in the world, how she wanted to kill herself, how the only reason why she hasn’t done it yet is because she hasn’t found a foolproof way to do it. For 45 minutes to an hour.

Yet, in between her dismal rants, she sings “Over the Rainbow” in a beautiful quivering voice, she laughs at the birds who hop over to join us, and at the male nurses who have to help another female resident with her knitting.

Her words speak of pain and sorrow accumulated over the years, and carry an unmistakable cry for help. There is nothing we can do except to be there for her, with her. Which is what we did.

But, the fatigue we felt at the end of the session led us to question the aspect of self-care. The fact that we were glad that hers was the last session for the day, that we would not implicate another client/resident with the negativity we felt, shows how much it affected us.

Where does one draw the line between being there for a person and being emotionally implicated? Is it selfish to want to protect ourselves from the emotional baggage spilling out of the people we work so closely with? When our aim is to help them process their emotions and come to resolution? Can we do that without feeling the weight of their sorrow ourselves?

It’s times like these when I wish this placement was supervised instead of being independent. Thankfully there are always experienced people to turn to when we need them.

“It Made Sense” : Thoughts on Existential Fulfillment

Just awhile ago, I wrote about how I found it difficult to see the work we do in aged care come to fruition, and wondered if there we were indeed adding any value to the clients’ lives, given their limited potential and time frames.

This week, an incident took place which made me reflect on this again, and allowed me to see that there is indeed some value in the work we are privileged to do in aged care.

The incident centers around a lovely old lady, one of the residents at the facility who was referred for individual sessions. I’ll call her Penny.

Penny is extremely musical. She used to sing in show choirs, and has a beautiful, amazing voice, despite her age. One can only imagine what she must have sounded like in her prime. During our very first session with her, she took to singing like a duck to water, improvising vocally and singing with us in perfect pitch and harmony. Despite her wonderful state of engagement, after her session, she almost immediately reverted back to her confused, disoriented state, the symptoms of her dementia revealed once more. Hence, my slightly wistful thoughts about how the work we do might just be limited to the moment, and not able to result in prolonged or lifelong improvement. Even though the moment(s) we get is(are) better than nothing, I couldn’t help but wish for more concrete or long term measures of therapeutic success.

Halfway through her second session last week,  just after Penny had finished a few rounds of “Singing in the Rain”, including doing an improvised solo, she suddenly told us: “I have to go.”

She meant the toilet, of course.

Long story short: We informed the nurses immediately, but by the time the nurse came with the proper wheelchair to take her, Penny had already gone. In the chair she was sitting on. Just as it was happening, she said, with full awareness, helplessness and despair: “It’s coming now. You can smell it.” I felt my heart breaking for her.

What is it like to live a life like that? To have to rely on strangers to help you with your basic bodily needs, and having to apologize for your body when it is not able to control it’s own functions? To have to say “sorry” in a voice so small and meek, for something that should be a natural part of life and living?

Because of this incident, I got reflecting and thinking about the role we play in her life. During our reflection and note-writing time at the end of our day, I suddenly said to the Coursemate: “We help her fulfill existential goals. The nurses take care of her basic needs, but the music provides a path to existential fulfillment.” I myself had not thought about it until I actually said it. It’s one of those thoughts.

To elaborate:
The sessions give her a voice. It gives her the opportunity to make decisions within a meaningful context. Whether she wants to speed up or slow down her vocal improvisation. Whether she wants to sing loudly or softly. Whether she wants to copy the patterns initiated by the therapist or initiate her own musical material, and how to respond when her voice is being validated and reciprocated. It provides her a setting in which she can interact with people who are not there to simply take care of her physical needs, but also to take care of her inner-self, expression, and emotional well-being. In a life in which almost every basic aspect has been taken over by others… The music gives her a chance to be a human being with the freedom to make her own decisions, respond in the way she wants to, and steer the boundaries of her own social interaction and co-activity.

Some time after the incident in the chair, Penny was back in her room with a new change of clothes. We went in and saw her looking rather pensive. A 15-minute vocal-guitar-drumming improvisation later, she seemed slightly more perked up and cheerful.

“What did you like about the music?” The Coursemate asked just before we packed up.

Penny paused for only a split second before answering: “It made sense.”

Because sometimes not everything in life does.

Aged Care

My placement this Sem is a totally new experience because:

1. It is at a nursing home – which means I’m interacting with a client population I’ve had no previous experience with

2. It is semi-independent – which means we (Coursemate and I) do not work under a supervisor. We are the main therapists – Or at least we take turns to be the main therapists and co-therapists. I have to readjust my mindset, especially when I’m taking on the role of Main. It has always been easier for me to follow directions than initiate it, and now I have to do it almost every other week. We are being stretched in aspects of planning for sessions, doing assessment reports, coming up with client goals, evaluating them… Basically just getting a feel of what it’s like to be an independent MT, and it is great to feel stretched and feel learning taking place.

If there’s anything I’m still unsure about, it’s about whether I ever want to work in a nursing home, or with aged care populations, permanently. As I was saying to a friend, the moment-to-moment work is meaningful. The old folks, who usually sit in their beds or chairs all day, actually come alive when they are singing, listening to or playing instruments, engaged in social interaction and co-activity. For those moments, their existence is validated, their actions have a purpose, their eyes light up and they are alive and aware of it. According to the head nurse, the level of confusion among the residents actually decrease when MT students come around, and increase during the months when none come.

But with aged care populations, the underlying fact remains that this is probably all we can do. That moment-to-moment validation and interaction. We can’t measure much of their progress, due to the simple fact that they don’t have much time left on the physical plane. For many, the main goals center around temporary respite from their condition, more than any permanent improvement. I’m still trying to figure out how I feel about that. I think I’ll eventually get used to it if I work in it long enough, but I wonder if it’s what I want to do, as opposed to working with children and adolescents, client groups who have more measurable and life-impacting goals and potential. Is this the result-oriented side of me talking?

Time will tell.