Ms. Simard is Adjunct Associate Professor, School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia, and a private geriatric consultant, Land O’ Lakes, Florida.
The author is the developer of the Namaste Care™ program for people with advanced dementia and received consulting fees from Epoch Senior Living.
Address correspondence to Joyce Simard, MSW, 2337 Dekan Lane, Land O’ Lakes, FL 34639; e-mail:
I live in a suburb of Tampa, Florida, where the weather forecast the week of February 17 was sunny with temperatures in the high 70s. I, however, was working in Pittsfield, Massachusetts for Epoch Senior Living of Melbourne, where they have a community that offers traditional assisted living and a memory care neighborhood. I have always enjoyed working with this community’s team, but I cleverly had always planned my visits for the spring and fall when the Berkshire Mountains are covered with foliage and the weather is balmy. I had no desire to be in freezing weather with high probability of snow.
However, they were ready to open their Namaste Care™ program and asked for my help. I had a winter coat, scarf, hat, and gloves—but no boots. So, I shopped in Florida for winter boots. I later learned that the “snow boots” I purchased in Florida were actually fashion boots and the result was wet feet. Wet, cold feet! And I am working in Massachusetts because…?
On my desk, I have a plaque with a quote from Ralph Waldo Emerson: “Do not go where the path may lead, go instead where there is no path and leave a trail.” And so I go where I have work that calls to me and where I can hopefully leave a trail. This time it was in the snow!
Melbourne offers special programs for residents who do not have significant problems with their memory, another called “Club Epoch” for residents with mild memory loss, and a full range of programs for residents in a secured memory care neighborhood.
Executive Director Diane Weinstein and her Memory Care Director Heather Lemoine recognized that the number of residents with advanced memory loss was increasing and that these residents could no longer participate in the majority of activities being offered throughout the day and evening. They asked me to spend 2 days implementing the Namaste Care program I had developed for residents with advanced dementia. So there I was, trying to remember how to drive in the snow and hoping that “my trail” would be on the road and not sliding down the mountainside.
On Monday I did many in-service presentations for all disciplines, as Diane wanted to make sure every department understood the program and would be available to fill in as needed. She and Wellness Director Barbara Kelly also realized that some residents in traditional assisted living could benefit from the loving touch approach to care that is the foundation of Namaste Care. Therefore, it was important to make sure that staff assigned to memory care and those caring for residents in traditional assisted living understood the program and could offer suggestions of residents they believed would benefit from the program.
A Namaste Care room had been created by Life Enrichment Director Sherry Pease and other staff in an empty apartment that included making the room homelike and purchasing supplies and comfortable lounge chairs. The day after my arrival, the Namaste Care program commenced and I was able to see firsthand the changes that could occur in just 2 days.
We prepared the room for the day by turning on the aroma diffuser, playing relaxing music, and dimming the lights. The door was opened and we greeted our first resident. Hilda (residents’ names changed to maintain confidentiality), who lives in the traditional side of the community, was escorted into the room and introduced to me. She has mild memory loss and wanders around the community most of the day talking in a very loud, high-pitched voice that annoys other residents. I will admit that I cringed when she greeted me and I wondered how she would fit into the peaceful setting we had created.
We usually have a few life-like dolls around the room, as I know they bring comfort and joy to some residents. Hilda looked at a doll sitting in one of the lounge chairs, walked over to the chair, picked up the doll, and with a huge smile said, “I like this doll.” She settled in the lounge chair with the doll tucked in her arm and rarely used her “loud” voice. Most women who enjoy holding these dolls believe they are babies, but Hilda was seemingly clear she knew it was a doll and held it as though she were holding a baby. I later found out she had been an avid doll collector before she moved to Melbourne. Hilda was delighted to spend all day with us and loved the hand massages she received, having her hair combed, and being with others. According to staff, she never looked happier, as she was not asked constantly to “be quiet.”
Angela was the next woman to enter the room and, like Hilda, was known to continuously roam around the memory care neighborhood. She hummed constantly, loudly enough to grate on everyone’s nerves, and unfortunately did not hum pleasant tunes. It was hard to be around her for any length of time, and her humming was very disruptive during activities. But once again, we saw an immediate change in behavior. Just as Hilda stopped talking in her high-pitched voice, Angela stopped humming after entering the Namaste Care room.
Before residents leave the Namaste Care room for lunch, we turn the lights up and play livelier music. The continuous humming had stopped but I wondered whether Angela would like to sing, so I played The Four Seasons’ “Sherry.” What a transformation took place! Angela sat up in her chair, took my hands (I was on my knees so I was at eye level with her), and sang the song almost word for word, a huge smile on her face as we competed for who could sing the loudest!
Another resident, Gertrude, who lives in the memory care neighborhood, is caught in a very distressing place in her mind. Throughout the day and sometimes at night, she paces up and down the corridor, shouting orders for people to stop and saying a collection of words that together do not make logical sentences but are clearly upsetting to her. On Day One of the new Namaste Care program, Gertrude was brought into the room in the afternoon when she often takes a nap. We settled her in a comfortable lounge chair and immediately she fell into a deep sleep. She slept for close to an hour, and when she woke up I was sure she would bolt. But instead of barreling out of the room, to our amazement she looked around and stayed quietly in her seat for another hour. Namaste Care seemed to transport her from a world of distress to one of peace and comfort. Our goal is that she will extend her time in the room and for that reason, the door will be left open so she can easily wander in and hopefully feel safe and comforted.
Mary was a resident whose memory loss was so significant that she was not able to participate in the activities offered as part of the memory care program. She loved holding a doll (her “baby,” we were informed) and loved everything we did for her. Rather than sitting on the outside of an activity sleeping, Mary’s life changed on Day One when she joined other residents in the Namaste Care room. She was not isolated; she napped occasionally, but when she was awake she smiled, hugged us, and kissed our faces or our hands. She was a delight and clearly pleased to be in Namaste Care. Before she left the room for dinner on the first day, I kneeled beside her chair and told her how happy I was that she had spent the day with us. Mary took my hand and kissed it and said, “This is the best day ever; it should be in the paper.”
Colleen was known to constantly ask to go home. But in the Namaste Care room—settled in a comfortable lounge chair, a blanket tucked around her, and a lollipop in her mouth—she almost completely stopped asking to go home. Perhaps the room helped her feel as though she were at home.
As the person who developed Namaste Care, my work is often not the “hands-on” experience I had in Pittsfield, Massachusetts. I am often speaking or providing consultation services. These 2 days reminded me how quickly lives could be changed and how easily it could happen.
Epoch Senior Living of Melbourne did not hire extra staff; they just reassigned existing staff. One of the part-time life enrichment staff has volunteered 1 day per week and several of the residents on the traditional side have offered to be volunteers. Supplies were not expensive, and staff redecorated the Namaste Care room with items left by families and unused model room items.
And so my 2 days not only improved the quality of life for these special residents, they were a gentle reminder to me that I should continue to “leave a trail,” even if it is in the snow!
- Simard, J. (2013). The end-of-life Namaste Care program for people with dementia (2nd ed.). Baltimore, MD: Health Professions Press.