Visiting my Mom at her Memory Care Home requires advance planning to maximize the potential for a good, meaningful visit.  This involves calculating the best time of day to arrive, taking into account the sequence of care activities for daily living.  It also requires anticipating the time for the start of the parade of wheelchairs, rollators, and slow ambulatory shufflers into the dining room for mealtimes.   Depending on what is served,  I know about how long it takes for the meals, which varies with how much assistance will be required (i.e. cutting meat, rearranging silverware, glasses, plates and bowls for easy reach), and wiping up for the inevitable spills.   Because I usually visit midday, I factor in a few minutes after lunch for socializing in the living room before her nap,  and, with all of these things considered, I have determined the best arrival time to maximize the potential for a good visit is 11:15am.

The critical factor that has been more challenging to calculate, acknowledge and accept, is the expectation of what would constitute a “good visit”.  The question I have to keep asking myself over and over again, is “am I assessing the time with Mom as being a good visit for Her, or a good visit for Me?”  Truthfully, this is where I’ve personally experienced the most growth and acceptance of my Mom’s debilitation due to Alzheimer’s.

Today was a great day, and one I can categorically declare was a good visit for both of us.  I signed Dad and I in on the visitor log at 11:15am…..a positive start!   We walked onto Mom’s 3rd floor hall, which is referred to as a neighborhood, and found the residents in the living room.  Some were engaged in coloring simple springtime pictures. Others were attempting to assemble a jigsaw puzzle (which was much too complex for the ladies working on it to make much headway, but they didn’t seem to mind).  They were happily rearranging the puzzle pieces as if they would somehow magically align to form the picture on the box.  Mom was situated in her wheelchair so she could watch the TV, which holds no interest for her.  As we approached Mom from behind, the staff started alerting her to our presence.  “Miss Betty…Mama Bear….look who’s here to see you!”  As we came into her line of sight and our eyes met, the joy in her smile was unmistakable.  She held out her hands and stretched out her arms for a hug.  She had no clue who I was……but I was there to see her.  And she was happy.

After a few minutes spent complimenting her on how beautiful she looked and how smartly she was dressed for the church service she’d attended downstairs prior to our arrival, we joined the parade into the dining room.

Setting up for lunch is something I enjoy assisting with, and the staff truly appreciate it, too.  While most of the time Mom can feed herself, even on her best days she needs some help.  I put on her bib, and lay a cloth napkin across her lap which she immediately started to fold and place back on the table.  Folding is something she remembers how to do, and she will fold anything when given half a chance!

Lunch service started by 11:45am.  The food served looked delicious and Mom ate well.  Soup was served in a handle-less mug so she could hold it to her lips to drink.  It was tomato soup which seems to remain a favorite of hers because she drank every last drop!  Before starting her main course, she managed to tip over her juice glass, but fortunately the flow didn’t go off the table onto any nearby laps.  It was quickly wiped up to avoid a further mess, and eating resumed.  One of her caregivers, knowing how much she loved coffee, gave her a mug just the way she likes it…..black, no sugar, no cream.  Dad was given a cup, too, which he thoroughly enjoyed.  Mom seems to like us drinking or eating along with her.  Otherwise, she continuously tries to feed us from her plate.  Old habits die hard, and she still feels the need to take care of us even though she us unable to care for herself.  Salisbury steak with rice and gravy, garden peas, and tangerine bits with whipped cream was served.  She ate most of it with the occasional bits falling off the fork before reaching her mouth.  Sometimes her fork made it back to the plate between bites, ready to scoop another mouthful.  Other times she placed her fork in her coffee cup.  We focused on the successes, praising her as one would a toddler just learning how to feed herself, while gently and silently correcting the mishaps so as to not frustrate her and halt her efforts.  The expectations have adjusted as we’ve adjusted to Mom’s reality.

After lunch, a surprise arrived at Mom’s place…..a bowl of vanilla ice cream with chocolate syrup drizzled over the top.  One of the caregivers remembered that Mom had mentioned she wanted ice cream earlier in the day, and it meant so much to know that she followed through with the extra treat!   I don’t know how she did it, but Mom managed to eat every single spoonful of ice cream.  Dad and I kept smiling at each other, enjoying watching Mom derive so much pleasure from something so simple.  For the 15 minutes it took for her to eat that ice cream, nothing else existed around her, and she was experiencing pure joy, savoring each bite.

We lingered in the dining room longer than most today.  This was partly due to the extra time it took for Mom to eat her ice cream.  Also I made certain her hands were wiped clean with a warm, wet cloth, and the stray bits of food were brushed from her trousers where they’d fallen between the gap of her napkin and bib.  I unlocked her wheelchair, and Dad replaced the foot/ leg rests that we’d removed prior to her taking her place at lunch.  This is required to allow the chair to park as close as possible for dining and to alleviate an interlocking puzzle of metal parts under the table from the other resident’s wheelchairs.

Thus far, my expectations for the visit had been more than fulfilled, and I could categorically say that it was a good visit for both Mom and me!

I started pushing Mom’s wheelchair towards the dining room door to exit and anticipated her next move before she started the inevitable…….”hands in your lap please Mom.  Lap, please.  Thank you!”  When approaching any doorway, Mom reaches out to grab the door jams as she passes through.  This is dangerous for her because her skin tears and bruises with the slightest friction.  Again, I’ve learned what to expect in this situation.  My anticipation of what she will do helps me to help her.

Deciding to “test the waters” a bit, I asked one of the caregivers if I could share one of Mom’s puzzles to replace the one on the table due to its complexity.  “Sure!” she said, and started gathering the pieces into the box.  One of the only activities Mom used to enjoy in her room, before progression of her Alzheimer’s accelerated, was assembling jigsaw puzzles.  She amassed quite a collection of puzzles, from 60 to 300 pieces.  I chose a 60 piece puzzle from her cupboard, one that pictured a kitten in a picnic basket, with bright flowers and a red and white gingham cloth.  This one had especially large, easy to handle pieces.

Dad and I maneuvered Mom to a place at the puzzle table, and I spread the pieces in front of her.  Several were left interlocked together from the last time she assembled it, and I thought leaving them together would offer a hit of a place to start, something to build on.

Mom looked at the puzzle, and I placed in front of her 2 pieces with red and white gingham checks.  I had just taken them apart, and positioned them millimeters from each other.  “Can you put these 2 pieces together?” I asked her, as I touched each one.  “These 2?” she asked, moving 2 different pieces close to each other.  I picked up the 2 pieces to which I was referring, moved the others away so as not to visually confuse her, and replaced them on the table.   “These, Mom.  Can you connect these 2 pieces?  I believe they will fit together.”   She touched one of the pieces and then pulled another piece unrelated over and asked again “these 2?”  I looked at her face, and at that time realized I’d pushed the boundary of expectations for this visit.

In the book Creating Moments of Joy: A Journal for Caregivers, by Jolene Brackey,  she writes, “We are not able to create a perfectly wonderful day with [people who have Alzheimer’s], but it is absolutely attainable to create perfectly wonderful moments — moments that put smiles on their faces, a twinkle in their eyes, or trigger [pleasant] memories.”

Dad and I spent a few more minutes with Mom, not mentioning the puzzle again.  The tiredness became apparent on her face.  It had already been a full day for her, and there had been many wonderful moments…..moments when she had a smile on her face as she saw me arrive to visit, a twinkle in her eye as Dad kissed her on the cheek, and perhaps, memories of the days when we used to eat ice cream together.

Dad and I signed out in the visitor log at 1:00pm.  As we got into the car, we both smiled and chuckled as we reflected on how much ice cream Mom ate and how much she enjoyed it.  At 11:15, we had arrived with smiles of hope, and now we were leaving, almost 2 hours later, with smiles of contentment.  This was huge, because more times than not over the last two and a half years, I’d left in tears.  But we both left knowing we were all as happy as possible given the circumstances, and the small expectations for a good visit had, for this day, been exceeded.