Seven years ago when Mary Beth Weaver was in seminary, she recalls feeling nervous at being assigned as the chaplain to a memory care unit in Eugene, OR. “Up to that point, I had worked primarily with youth and I remember thinking I was a little intimidated as to how I was going to minister to Alzheimer’s and dementia patients.”
A few months into her stay, she was surprised at the joy she felt providing spiritual care to this vulnerable population. It was during this same year she discovered the Sacred Art of Living Center in Bend, OR https://www.sacredartofliving.org and learned helpful tools for accompanying the dying in their individual processes. “I find being with people at such a profound time in their lives, to be very meaningful and rewarding. I truly feel privileged; I know I have found my life’s work.”
Approximately 60% of Housecall Providers (HCP) Hospice patients are over the age of 86 and 25% are 96 and older. Over half of them, have a primary diagnosis as Alzheimer’s or advance stage dementia and nearly 30% of the remaining patients show some level of dementia. This can make it incredibly challenging to communicate with, and in Mary Beth’s case, “reach” many of her patients. “Where I have seen my greatest impact in this work, is being completely present with my patients and/ or their families concerning the process of letting go. It is at this point, that I learn how I can respond effectively and compassionately to them.”
As one of four hospice chaplains on the HCP staff, Mary Beth offers spiritual care to patients and their families in whatever way is most helpful. This could mean finding a spiritual leader from their faith tradition to be with them in their passing, listening to families share their stories and reflect back on what their loved one’s legacy will be, and/or providing rituals of letting go and healing. Mostly though, she sits with patients, being fully present for whatever they are experiencing.
One example is when one of her patients was having a delusion during a visit. Rather than re-orienting the patient to present time, Mary Beth joined in her story. The woman, who was nearing death, was harboring anger towards her mother who wouldn’t allow her to marry the man she loved. Mary Beth asked permission to represent her mother and, when she agreed, vented years of pent up rage and finally, released it. The next day the woman passed.
This methodology appears to be an effective way to help patients lost in their memories to also exist in the present. In 2010, a podcast entitled The Bus Stop, from the National Public Radio show RadioLab, http://www.radiolab.org/story/91948-the-bus-stop/highlighted the Benrath Senior Center’s creative way in dealing with patients suffering from delusions.
The nursing home, located in Düsseldorf, Germany actually installed a fake bus stop outside the home, complete with bench, to lure patients who might slip out of the center in a delusional state looking to catch a bus. The stop worked wonderfully – so authentic even a few neighbors were caught waiting for the bus to arrive! Nurses take patients to the bus stop who are agitated because they “need to leave, get to work, meet my mother”, and sit with them waiting for the bus until “another thought comes up and they forget what they wanted.” While some might argue the morality of “tricking” the patients, others see it as a compassionate fix for preventing them from walking the streets searching for the focus of their delusions. By entering into the delusion with the patient, hours of discomfort and stress may be averted.
For now, practitioners like Mary Beth represent the “bus stop” for our patients. They are present for them in whatever ways are most helpful. “I love working with Alzheimer’s patients because it can be very creative work. They live in a parallel world and my job as their chaplain is to find creative ways of connecting with them so they don’t feel so isolated and alone.” When a patient comes on hospice and requests the services of a chaplain, Mary Beth will ask the family or caregiver about the patient’s life. As they talk, she learns what was most important to the patient or about his or her regrets or struggles. In this way, she receives clues as to how best to connect with each patient. It also helps her when a delusion begins, to know what “bus stop” might be best for her patient.