How does it feel to be washed by strangers, fed and put on the toilet? A German journalist spends a day in a nursing home.
COLOGNE - It’s still early in the morning, and from the dining room of the nursing home I can hear the clinking of dishes and cutlery as the staff sets up for breakfast. But before I can join them, I have to be washed. Nursing student Mustafa wheels me into the shared, wheelchair-accessible bathroom where a toothbrush, facecloth and towel are set out.
"Do you have to use the toilet?" he asks. Yes, I nod. He says: "Okay, I’ll lift you on."
Seeing the look on my face, he adds that it would be impossible for me – were I really paralyzed on my left side, as we are pretending for the sake of this one-day experiment – to heave myself from my wheelchair onto the toilet seat. So with my one functioning arm I hang on to his neck, and lean on my good leg, while he pulls my pants and underwear down.
Mustafa himself seems embarrassed by this, and keeps repeating: "I’m not looking, it’s okay, I’m not looking," turning his head the other way. Once I’m seated he hands me a rope with a bell that I can ring when I’m done. But no sooner has he left the cubicle than I encounter another problem. The toilet paper holder is mounted to the left of the toilet. As I try to fish for paper with my right hand, I lose my balance. I have to ring the bell.
By then, I’ve been at the nursing home for 20 minutes, after checking myself in for the day. At 7:30 a.m., the head of this Catholic establishment in Cologne was there to welcome me and to talk through what "limitations" I would have for this self-imposed experiment: inability to move my left arm and leg, and thus confined to a wheelchair. We also agree that I am no longer able to speak.
What is life like in German nursing homes? How much human dignity do you forfeit when you move into such a facility? In Cologne, future nurses can get at least a partial idea at the Sacred Heart Home run by the Franziska Schervier Altenhilfe group: the home offers them the possibility to role-play for a couple of hours and see what assisted living feels like – looking at it from the patient’s point of view can be useful in helping them decide if they want to pursue this line of work or not.
I talked Wolfgang Dyck, the home’s director into letting me, too, try it for a day as part of my research for my book Endstation Altenheim (Last Stop: Nursing Home).
Too hard to communicate
Mustafa returns, and explains that he’s going to wash my face and brush my teeth. I start brushing my teeth myself with my one good hand, but then let him help me. Mustafa runs the brush forcefully over the chewing surfaces. "Don’t press down so hard!" I think. My teeth are very sensitive. But of course I can’t say anything, since I can’t speak. So I dismiss the thought – probably like many residents, who just learn to put up with small things they find disturbing because it’s too much trouble, too complicated or possibly even impossible to communicate.
In the dining room, the first arrivals are already at the table, eating their breakfast rolls. Nobody speaks. I smile warily. Mustafa says: "This is a newcomer. She’s checking us out, to see if she likes it here." I write what I’d like for breakfast on a piece of paper: a roll and cheese, coffee with milk. Mustafa brings me a small pot of thin coffee, and then disappears into the kitchen.
Five minutes pass. The room is completely still. All you hear are the clinking sounds of cutlery.
None of the residents address me, although some of them stare at me intently. Is this what it’s like for all new arrivals? Mustafa comes back bearing a roll, butter, and cheese. He has to hold the roll so I can butter it. For everything he does I think but can’t say "Thank you." This must be the 20th time already this morning, and I find it annoying. I wonder if one ever loses the habit of thinking "Thank-you" all the time.
The food tastes dry and sticky, and I don’t feel like drinking a lot because I’d like to put off the moment that Mustafa has to hoist me back on the toilet seat for as long as possible. Not only don’t I like it, but I find I’m concerned about giving him too much work. I assume that people in assisted living around the world have similar thoughts.
According to experts, an old person should drink 1.5 liters of water per day. But for somebody who has to ring for help every time they have to use the lavatory, and may even need help to lift a glass, that must seem like an unbelievable amount.
Dementia patients acting out
Mustafa now takes me on a tour of the premises. He assures me that on their first day all newcomers get the tour. We take the elevator up to the section where dementia patients live. The smell of urine hits me the moment we get out of the lift. The dining area here is full, and there’s barely room for my wheelchair. One woman is complaining loudly about something, but I can’t understand exactly what she’s saying. The others sit on their chairs, looking vacant; some sway the upper part of their bodies back and forth continuously. One old woman sits on a sofa stroking a plush rabbit.
Mustafa tells me he spent several weeks working in this section and has worked in the dementia sections of other old-age homes. He recalls that when he took one male resident to the toilet, the man wanted him to touch his penis and that, as a trainee without much experience of dealing with dementia patients, he had been shocked. But other nurses had later explained to him that such sexual acting out was not unusual, and that many male patients masturbated in front of nurses or other residents. He also remembered one female patient who used to smear her excrement all over her room, even in the drawers of furniture.
"It’s not a lot of fun, first thing in the morning, to have to clean a room like that," he says.
I was relieved when Mustafa said we had to leave to get to gym class, where some 15 residents were already sitting in a circle in their wheelchairs. Once a week, two staffers roll a shopping cart full of bright rubber balls and pool toys through the various sections of the home. Mustafa sets me up in the circle, too close to the other wheelchairs for my liking. I smile at the group but get no response.
Vibrantly colored rubber dumbbells are now handed out by a staffer who calls them "little peanuts." Everybody except me gets two. I only get one, since I have use of only one hand. Once again, I have the disagreeable feeling of being the different one. We’re supposed to press the dumbbells to exercise the joints in our hands, and then hold the dumbbells up and make circular motions with them above our heads. At the end of the session we get to throw the rubber balls back into the basket, after which we’re given a glass of sparkling water. The water is refused by a number of the participants, who say they’re not thirsty. But the staffer insists: "Please," she says. "As a little favor to me?"
An opportunity for nurses
When I was organizing my day at the Sacred Heart Home with Wolfgang Dyck, who’s a theologian by training, he had explained to me that the reason he had decided to introduce the trial-test project was to give nurses an opportunity to reflect on their role. Dyck was also a member of the committee that several years ago set up ethical guidelines for caring for the elderly that were put together as a Nurse’s Charter for the German government's Ministry of Family Affairs, Senior Citizens, Women and Youth. One of the rights the charter defends is the upholding and protection of a person’s privacy: for instance, nurses are not supposed to enter a patient’s room without knocking on the door first, and those who bathe residents and see them naked are supposed to be rotated as infrequently as possible.
Mustafa finally returns. In a half hour, it will be time for lunch. Food again. But there’s still time beforehand to go on a tour of the park – a luxury, not part of a resident’s daily routine. As he wheels me along, Mustafa tells me about nursing school and his fellow students. One trainee, he says, sometimes had to do uninterrupted four-week stints at the Caritas home where she worked. He knew of others who – even though they were still trainees – were given the workload of an experienced nurse from the first day onward, without any kind of guidance, looking after 10 or more patients, getting them up, washing and dressing them every morning. I signal to Mustafa to take me back inside. The pitying and sometimes skeptical looks I’m getting from passersby make me uncomfortable.
For lunch we have the choice of baked noodles with tuna, or meatloaf. I go with the tuna. There are two others at my table, a man and a woman, who weren’t there at breakfast. The man is wearing a large bib, and to me this seems degrading. Mustafa asks me: "Would you like a bib too?" I shake my head in a very firm No. Once again, nobody speaks. The woman sitting opposite me has a phlegm-filled cough that seems all the louder because there is no conversation. I start to feel unwell. I force myself to keep eating. The other two chew on. Is all this really just because of old age? Do you ever get used to this sort of thing?
After lunch, Mustafa brings me back to my room for a nap. I’m in a double room. As nobody lives here at the moment, it has the look of a hospital room. I look out the window; the sun is shining. I’m filled with a sense of yearning, and cannot sleep.
After naps, it’s coffee time, with cookies and pastries available to those who wish them. And then it’s time for me to be "discharged," as the staff put it. Mustafa wheels me to the door. My left arm and leg are stiff as I climb out of the wheelchair. With huge relief I walk outside into the sun.