As I exited the car, I dodged a large “shoe magnet”, as we affectionately call the remains from dog walkers who don’t bring a baggy for their dogs in the morning.  Another nurse and I approached the entrance of a homely, flat-top stucco building. I was aware of the sounds of dishes clanking- coming from the industrial kitchen to my right.  A friendly face greeted us at the front desk.

People mention the “smell” in a nursing home and yes, even an assisted living, (mostly due to years of caring for incontinent people- and the odors sometimes permeate flooring and furniture).  I’ve been in waaaay worse, but was still cognizant of that “old” smell.  The staff was curious and open.  I noticed the water container at the nurses’ desk held sliced strawberries to sweeten the flavor and thought, “nice touch”.  

The other nurse and I entered the room of the patient who had the day before been moved to the facility, on a respite stay, (to give her caregiver a rest).  One of the first things she said was “Thank God you helped me get here, I feel so much better today.  The girls are so helpful,” and I found myself a little surprised that she didn’t have complaints: about sharing her room with a stranger, or the lack of refinement in her surroundings. She had been more and more confused while forgetting her medications at home; and her spouse was incrementally more ill with his own health issues. 

A couple of days following our visit, I discovered that her spouse had suddenly died in their home, almost as though he knew she would be cared for now.  The facility was happy to keep our patient and provide the care she needed, as she, too,  moves forward in her own dying -without worrying about who will care for her. 

I thought back, to not so long ago, at a visit I made in the “big city”.  While I stood waiting for the valet to bring my car around to the front of a circular drive, I took in the meticulously landscaped “welcome area” of a multi-story classic brick building.  I glanced through the floor-to- ceiling windows at a fireplace lounge with overstuffed chairs on either side, while noticing the “concierge” at the front desk behind an artful flower arrangement.  I was pretty sure I was actually at a plush 5-star hotel, not an Assisted Living Facility in downtown Seattle.

I chuckled to myself a little.  Is that the way to an elderly person’s heart, making them feel as though they enter the Waldorf and not a place where people need to wear a bib while eating lunch?  Well, not everyone wears a bib, just the people on the upper floor who have memory issues and require considerable assistance with their daily care.

 I have a sense this “assisted living concept” is a lot like people who LOVE to go on cruises, versus the people who have a huge dread of being cooped up with hundreds of other people, in the guise of vacationing.  Either you
love it, or you hate it.  Sometimes I think I know too much, because even though there are Chihuly glass art objects in the foyer, this is still a place where a number of people are sick, progressively more infirm, and will need a lot more than valet service. 

Or perhaps, the ultimate valet service?….a hospice team to help usher them in to their next destination?

So, although the outward details seemed very different, and the big city is replaced by a much smaller community, my patients here and there felt cared for and secure, knowing the facility staff and their hospice team would be there for them in the final chapter of their lives.  I’m glad people have options, and loving hands that help them move from the here and now to the next step along their journey…and I’m glad to be part of their end of life valet service.