I have more important things to do than to talk to walls or be yelled at by old men! I thought to myself as I strode out of Whispering Pines Nursing Home and got into my car. It’s going to be a long time before I set foot in that place again. . . and it was.
My frustration was partly due to a sense of guilt over my neglect of the three Alzheimer’s patients I had just tried to visit. Another part was a feeling of futility.
Ulga, Bill, and Gerald just got crowded out of my heavy schedule most of the time, and my visits to them never seemed productive.
Today, I had found Ulga in her room sitting beside her bed. She was rocking back and forth in her chair (it was not a rocking chair), humming and staring at the wall about six feet in front of her.
“Good morning, Ulga,” I said in my most cheery voice. No response. Ulga continued to rock.
I stood in front of her and repeated, “Good morning, Ulga. How are you today?”
Ulga stopped her rocking momentarily, but not her humming. She turned her head in my direction, but her eyes were not focused on me.
I bent down to place my face only a few feet from her face in a vain attempt to capture her attention and raised my voice to a mild shout.
“Hi, Ulga! I dropped by because I thought you’d like to have me read some Scripture and pray with you.”
Ulga didn’t respond; I wanted to leave. Paging through my Bible, I found a short psalm, read it quickly, and rattled off a short prayer.
“Bye, Ulga. I hope you have a good day. I’ll stop by and see you again some day.” A quizzical look crossed Ulga’s face.
“Who are you?” she asked. I didn’t even pause to answer, but turned and marched out the door. I hoped my visit with Bill would go better.
Bill sat dozing in his wheelchair in the hallway outside his room.
“Bill,” I said softly as I touched his arm. “Bill, it’s Pastor Kevin.” Bill’s eyes opened. “Good morning, Bill,” I said. “How are things going with you?”
Bill’s eyes flashed with anger, his body went rigid, and his breathing became rapid and forced.
“You, you, you!” he said going from a stage whisper to a shout. “You took my wife, you bum! You took my wife!” By now Bill was shouting at the top of his lungs, and all eyes in the hallway were upon us.
“No, Bill, that’s not right,” I responded as I tried to regain my composure. “Mabel still lives in your house, and she loves you very much. She comes here every day to visit you.”
My response did nothing to reassure Bill. He only yelled louder. A nurse came over to lay her hand on my arm.
“It might be better to come back another day when Bill has calmed down,” she said. The tone of her voice and the look in her eye told me that she understood the situation and didn’t blame me. But that did not ease my intense feelings of confusion and frustration. I didn’t even try to visit Gerald.
In the next few weeks, I shared my frustration with several colleagues who confessed to similar encounters. We had all allowed our discomfort and hectic schedules to justify our neglect in caring for those in our congregations who suffer dementia.
Yet I had to confess that for me a deeper, more insidious reason fostered my neglect: the unconscious belief that these people were unimportant. Visiting them did not increase the attendance on Sunday morning. They did not serve on the council; they were not large givers; they didn’t call twice a week complaining of one thing or another. Instead, they quietly endured my neglect.
Even their families understood my absence-most of them didn’t visit their demential family members either. Silently, everyone agreed that the visits were not worth the effort.
This conspiracy of silence was everywhere, except in the Scriptures. There, in a glimpse of God’s coming Kingdom, Jesus commends ministry to the forgotten and neglected. He specifically lists the hungry, the stranger, the sick, and those in prison. I am convinced that if Jesus spoke these words today, he would have included the demential elderly who have been shuffled off to nursing homes.
The call to ministry was clear, yet that did not remove my feelings of confusion and frustration, but it ushered me into an area of ministry in which I continue to learn.
Learning about dementia
Often, we view the demential elderly as mere shells of their former selves, unable to care for themselves, of no value to society, and living in a make-believe world. These misperceptions may limit our ministry.
One way to combat this tendency is to learn something about the group. I found a variety of books dealing with the subject of Alzheimer’s disease. Two of the most helpful were The 36-Hour Day by Nancy Mace and Peter Rabins and Understanding Alzheimer’s by Marion Aronson.
The effects of dementia are not confined to one person; they touch entire families. Concerned family members may be exhausted, guilty, angry; relationships may be on the verge of disintegrating. Frequently, the family suffers in silence and isolation.
Pastoral care is often the initial opportunity for family members’ healing. A few visits with the family enable me to see the elderly individual in a more personal light and to converse on a more meaningful level.
Ministering to an individual
Before I visited Ulga and Bill a second time, I did a little homework. I wanted to make sure I was doing more than visiting an Alzheimer’s patient; I wanted to minister to an individual.
I learned that Alzheimer’s disease and some other forms of dementia are degenerative diseases. The disease progresses in stages.
The early stage of Alzheimer’s lasts from two to four years. Its symptoms are loss of memory, confusion, and impaired judgment. During this stage, reality therapy is effective.
The middle stage of the disease lasts from two to ten years. It is characterized by further memory loss, behavioral problems, and swift mood swings. Validation therapy is useful in this stage.
The late stage lasts one to three years. Often the individual is confined to their bed or wheelchair during this time and needs complete care.
From the social worker and the nursing staff, I discovered Ulga was in stage one. In this stage it is useful to help the patient identify reality.
Reality therapy can be used by anyone who interacts with the individual. The visit is usually short with a simple routine. During the visit a person introduces one’s self, identifies the day, location, and purpose of the visit, takes time to answer the questions of the individual, and gently corrects disorientation.
A better way to visit
The nursing home staff told me Ulga was usually more alert in the early morning. So I arrived at Ulga’s room early the next morning. She had just returned from breakfast and was busy tidying up her room. “Good morning, Ulga,” I said as I entered the room. A puzzled look crossed her face. “I’m Pastor Ruffcorn from your church, Grace Lutheran,” I continued.
“Oh,” Ulga responded. Then her eyes glimmered in recognition. “Ohhhh, you’re my pastor.”
“That’s right. I’ve come to visit you this bright, sunny, Tuesday morning at the nursing home. I wanted to talk with you and, if you want, give you Communion.”
With that introduction, I sat down for a short, pleasant conversation. Ulga told me about her family and her opinion of the food at the nursing home. We talked about her frustration over not being able to attend worship services and her previous involvement in the congregation. Toward the end of my visit, we celebrated Communion, read Scripture, and prayed.
When I left her room, I sensed that Ulga was encouraged and strengthened in her life and faith. I know I felt more positive about our visit and rejoiced that with a bit of preparation, several obstacles to the movement of the Holy Spirit could be overcome.
My next stop was Bill’s room. From my chat with the social worker and nursing staff, I had learned that Bill was in stage two. He was confused most of the time and often relived different times of his life. It was suggested that if Bill was in “a different reality” at the time of my visit that I share that experience with him rather than attempt to correct him. This is called validation therapy. As the name implies, it seeks to validate the experience of the individual by giving positive feedback, empathetic responses, and caring touches. The staff also hinted I shouldn’t tell Bill who I was so as not to trigger his anger.
When I entered Bill’s room, he was talking to himself anxiously. I caught a few of the words: Anzio, Rome, squad, and rifle. Bill was reliving one of his battles in World War II.
Entering his world, I called out, “Hello, soldier. How are things going?”
Bill looked up. Confusion crossed his face and then recognition. “Oh, Sarge,” he said, “am I glad to see you!”
I stepped fifty years into the past. I was in Italy, sharing Bill’s fear, his concern for his buddies, and his horror over the ugliness of war. I became an empathetic sergeant (a rarity in World War II), discussing his feelings, reinforcing his self-worth, and even giving him a reassuring touch on the shoulder. I simply chose to be with Bill and to share a part of his life with him.
My trip to Italy did not take more than fifteen minutes. Bill grew quiet and thoughtful. The battle was over, at least for a little while. I rose to leave, but Bill grabbed a hold of my arm. “Who are you?” he asked, now back in the 1990s.
I placed my hand on his and looked into his eyes. “I’m just a friend,” I replied, “who wants to tell you that God loves you very much.”
My final visit that day was with Gerald. Gerald has never responded to me when I have visited. He lays quietly in his bed or lounges in a chair. Often he is sleeping. Gerald is in stage three of Alzheimer’s.
When I visit Gerald, I have two goals. Whether he responds or not, I want to be present with him, and I want to tell him I care for him and God loves him. I sit down and carry on a one-sided conversation. I share a few passages of Scripture and pray with him. Occasionally, I sit quietly with my hand on his arm or shoulder. I will never know if Gerald is aware of my ministry, but I do know that I did my best to be Gerald’s pastor.
These experiences have given me a fresh and realistic perspective on ministry. Too often, I’m tempted to do only those things that will be noticed by the greatest number of people. Gerald, Bill, and Ulga remind me that ministry is a calling to be with people, no matter what their situation in life, and to remind them of God’s loving presence.
-Kevin Ruffcorn
Grace Lutheran Church
Oconto Falls, Wisconsin
Copyright © 1993 by the author or Christianity Today/Leadership Journal. Click here for reprint information on Leadership Journal.
