An Introvert in Memory Care

My aunt was quite introverted. She lived at the end of a 16-mile long peninsula far from town in the middle of nowhere and liked that just fine. When she moved into MC, she blossomed and enjoyed the activities and outings and looked forward to them.

My dad had been the life of the party pre-dementia. Once placed, he immediately recognized that the other residents had dementia, but not his own. He wanted nothing to do with any of them nor any of the activities. He could be coaxed out for live music, but would scuttle back to room as soon as it was over.

@M1 may have some perspective on this.

HB

Daisie this has become a theme of sorts for me and think it's an excellent question to raise with the administrators. For background, my partner was an extremely bright, successful business woman who had a lot of different careers-teacher, college psychologist with a masters degree, landscaper, craft store owner, ultimately spent the last thirty years of her working life as a custom builder/contractor, known for taking on challenging ridgetop building sites and completing about sixty multimillion dollar homes. One of a kind, very few women with similar experiences, especially in her generation. Being unique is not an advantage when it comes to aging however. A perfectionist and introvert by nature, she was always a loner and a nonconformist, never suffered fools gladly, yet was one of the most successful people I ever met in working with all types of people, from the roughest fly by night construction guys to bank presidents. She used to tell me that you had to be able to tell them all to go to hell and make them look forward to the trip. All of her subs both feared and adored her, and she could get the best out of them. When her houses are up for sale now they still use her name to advertise them.

She has had an extremely hard time adapting to a group living situation. She always told me she'd rather be shot- and meant it. And yet the irony is that her extreme individualism made it more likely that i had to place her, as she would not willingly accept help from me, and certainly not from anyone besides me-and we all know that advanced dementia is not a solo enterprise. She was unwilling to accept outside help at home- very territorial and unable to realize that help was needed, and when she started not recognizing me and being combative, i really had no choice. Had she been more adaptive, i might have been able to keep her home longer- although home help was also very hard to come by in our rural area. Fortunately, she made good money in her building career and was conservative with it, so we could afford private memory care placement. That's a luxury not everyone has and i don't take it for granted, by a long shot.

But I have been very struck by how much memory care is geared towards extroverts. This really shouldn't have come as a surprise, as extroverts dominate the general population (50-75%) and certainly all business and school environments. Group meals and group activities, while convenient and really necessary for staff, are excruciating for an introvert (me included). The only group activity she might at all tolerate was the occasional musical concert- but only if concert format, not requiring interaction or singing along. At meals, there were no seating arrangements where she could sit by herself if she wanted to. Add to that the dynamics of having to socially deal with other impaired residents too, and it's been a very tough go for her. Even in late stage 6 I am very struck that she can easily distinguish who is staff and who isn't. This does not appear to be true for all residents but is exceptionally true for her; she has somehow retained the high level of emotional intelligence she's always had.

Anyway: it's been a slog and a steep learning curve to try to figure out what works. Her first year was uniformly awful. She was so unhappy and so anxious to leave that i could rarely visit, and never solo. This was a relatively small, corporate affiliated facility. During the first winter, it dawned on me that part of what she was reacting negatively to was the clautrophobic nature of the indoor spaces- there was no place other than her room where she could be alone, and all of the common areas were small and crowded. Not being clautrophobic, i hadn't taken that into account. There were other issues with the care there so after a year i undertook to move her. Her second place (which was always my first choice, but that's another story) is bigger, with more residents but also much more open space, interiorly and exteriorly, where she can roam when she feels like it without constantly being in a group, and she has been somewhat happier there and more accepting of my visits. She accepted the premise that she was there for extended therapy after a hospitalization.

Nonetheless it has taken extraordinary effort on my part to provide activity for her, since she has zero interest in group activities with other residents. There is a conservatory, where she and i could spend time with the plants, and a small aviary, where we could sit and just watch the birds. There are walking trails. There are picnic areas where we could share a private meal; for a while I was taking a picnic lunch every Sunday. When she was healthier, i took a lot if simple art projects that she and i could work on in her room. We painted bird houses and wall hangings, made a mosaic stepping stone for the garden, things like that. But all of these solo activities generally still require supervision and my initiation, which has generally meant that we do them when i am there to visit. Doing them at other times would require a one on one companion which at $37 an hour on top of the standard MC fee $10,000 per month in our case) quickly becomes prohibitive. When i am not there, she spends the vast majority of time in her room. Only once did I ever show up for a visit to fjnd her sitting out in the courtyard.

So no, memory care is not easy for a true introvert. At first we all had resisted putting a television in her room, since she cannot operate it independently, and the thought was that it would just make her isolate all the more. But now that her physical health is deteriorating too and she is spending more and more time in bed, we have put one in there. She will sometimes watch it a little bit with me, but she mostly sleeps through it. She can still get out of bed at this point and will unplug it if she wants to turn it off; she can't operate switches or the remote (I'm kind of amazed that she still knows to unp!ug it. She does this to her lamps too). I think the television just mainly gives me something to do now that my visits are mainly feeding her lunch and sitting by her side while she sleeps. Since her bad fall in early June she has rarely left her room, and she is allowed to take her meals there by herself. She vastly prefers this, although there are downsides- i found discarded French fries in her towel warmer this week, which she frequently mistakes for a trash can.

I continue to communicate with the staff about ways to accommodate introverts, but I don't know that we've been very successful overall. It sounds like your mother could go either way. I do think that being aware of introvert/extrovert dynamics is important though in trying to respect each resident's needs as much as possible. My partner is likely at an extreme of the spectrum, which has been especially challenging.

sorry this is so long, probably more information than you wanted, but it's something i do have strong feelings about.

I find this thread interesting as a topic in general. Everything I’ve read encourages socialization for those with dementia, to keep the brain stimulated. It makes me wonder if an introvert would deteriorate faster. My mom was more of an extrovert than introvert but her keeping herself holed up in her room I do think is causing deterioration of her language skills. Then of course how is one to know what’s fast or not. It’s such a confounding disease.
At the ALF my mom will move to they tell me they won’t force her to do activities and if she just wants to stay in her room she can , although I am praying she won’t.

M1 said: "Maybe group home for introverts is an oxymoron. But it's a very real issue i think."

Many places I toured purported that a MCF with a home-like model was dementia-informed care. The resident's suite was meant as their bedroom for sleeping/resting and the rest of the time they were meant to be out doing things in communal areas.

That said, my house doesn't operate that way. We adore one another, but life here is more parallel-play.

fmb— that was a blisteringly accurate description of many, but not all, MCFs.

Another thing that irks me about some facilities is how little consideration is given to the roommate situation. In the spring, high school seniors are all busy filling out questionnaires to best match dorm roommates with options to tweak things as needed once on campus. In a semi-private bed room, the "open bed" is the only consideration.

Anonymous— your model sounds lovely but given the difficulty staffing such places and costs involved, the monthly fees at such a place would be astronomical. One option a few folks at dad's MCF employed was to bring in a private-hire aide to do activities with their LO. Often this aide had been one who helped the family when the PWD was still at home. One lady at dad's place had an aide come do hair and makeup daily. Another had one come do puzzles or play cards with their dad in his room. This isn't inexpensive, but great if you can afford it.

HB