//4 R’S FOR DEMENTIA: Recourse, Routine, Recognition, Reserves

4 R’S FOR DEMENTIA: Recourse, Routine, Recognition, Reserves

Summoned by the head nurse, I walked hurriedly to the care center wondering with every step what could have upset Dad so much that the staff could not calm him. With the whoosh of the front doors still in my ears, I spotted my 87 year old father leaning on his walker at the front desk. No reserve and dignity today! His bushy white eyebrows were lowered, his jaw jutted forth, and his right hand insistently patted his back pocket. His body language demanded that someone do something—now! His audience, however, was mystified. Agitation made the raspy whisper of Parkinson’s disease incomprehensible. Seeing me soon calmed him enough that I could decipher the problem. Someone stole my wallet! His agitation puzzled me. He didn’t have or need cash or credit cards. He no longer drove. Why was this important? It just is. A man needs his wallet in his pocket to feel like a man.

The staff assured us they would investigate, and investigate they did. Mr. Wilson’s wallet was found—in the laundry. This might be amusing had it not happened again, and yet again, with Mr. Wilson being equally agitated each time. Dad forgot he forgot, so each time he was sure there was a thief involved.

Understanding a person impaired by Parkinson’s can be quite a challenge, but I inquired again about the importance of his wallet. Dad humbly persevered. I like to go on field trips. I can’t remember the name of this place. If I get lost, I’m helpless. Even if I  knew my address, no one can understand me. An ID is my only chance. Aha!

#1 RECOURSE: I then typed all Dad’s identity information—including the phone numbers of each of us kids—on one card, inside a water proof badge, secured to a lanyard. Thereafter, his identity was safe and secure around his neck. He was our dad, and we were available by phone. My father wore it with no shame, like a security pass, wherever he went including the shower! Field trips resumed, and Dad was not afraid. If people could not understand him, he held up his badge.  Dad had RECOURSE!

#2 ROUTINE: We had moved our animal-loving father into an assisted living facility where he could still enjoy petting his affectionate, purring cat. My brothers and I scheduled our visits so that one of us showed up daily. The kitty was fed, her box cleaned, and Dad saw the face of one of his adult children every day. When it was necessary for two of us to be gone over a long weekend, other family members visited in our absence. In response to this loss of ROUTINE, however, Dad’s level of functioning declined noticeably. Surprisingly, it took him weeks to recover. ROUTINE is crucial.

#3 RECOGNITION: Dad handled the loss of his hearing, the loss of his vision from macular degeneration, as well as the loss of his mobility and voice from Parkinson’s disease with the moxie so prevalent in his generation. The dementia was much more difficult for him and thus for us. While the loss of his senses diminished his ability to relate to others, dementia threatened his very identity. In our family culture, the men gather around new gadgets—like cell phones—to learn and to conquer. How sad were my two brothers when the simple act of retrieving voice mail stumped our brilliant dad. Short-term memory loss finally made new gadgets an insurmountable challenge. For a geek and a former engineer, this was a huge loss. Daddy was a geek before we even had that term in our vocabularies. A major portion of my father’s sense of worth was wrapped up in his analytical, problem-solving intelligence. Years earlier, he had confided to me that he prayed every day not to lose his “faculties.”

Some residential facilities post bios of their tenants just outside their door. The purpose is to help staff and other residents recognize this person with the respect they deserve. I hung such a bio outside my dad’s “apartment.” He was proud and delighted to be RECOGNIZED as a WWII veteran, a man who had been married for 57 years, the father of three, the grandfather of eleven, an electronics engineer, a former musician, and a lover of animals. When I learned the men at his table referred to him as “The Mayor,” I was relieved. Dad had found his niche. He still conducted himself as a business executive who just assumed he was in charge.

#4 RESERVES: In caring for Dad, I observed the different types of memory I had studied in clinical psychology.  Obviously, he had lost his short-term memory. Dad’s long-term memory, however, was still accessible. Tell me about your Navy days, Dad. He would, gladly. There is a third kind of memory that is rarely mentioned, our procedural-memory. It is formed by repetitive, physical actions like using tools or playing an instrument. My grandmother played the organ long past the time she was able to discern who was who in her life. Her fingers held memories her brain could not. Thankfully, the RESERVES of procedural-memory can be tapped.

One of my brothers got along better with our father under a car than anywhere else. Since Dad had begun working on cars in his teens, auto mechanics was logged into his procedural-memory. My brother conversationally walked our father through the souping up of his jalopy—an overhaul in which Dad had not participated. My father couldn’t learn his address, but he climbed under the hood of a car in his mind and knew how each black, greasy part related to every other one. He followed the engine overhaul step by step and admired his son’s innovations. That day, Dad was again a knowledgeable man able to converse in car mechanics.

As my brothers used procedural memory, I focused on the deep RESERVES of long-term memory. Dad and I had wonderful visits. We were very gentle with each other, so that last year was most precious to me. Dad would share from his past . . . sometimes stories or feelings I had never heard before. I described to him childhood events he had missed with a busy, demanding career. Those sweet, unhurried visits filled in some of the empty places in our relationship. Dad had prayed not to lose his faculties, but the vulnerability of dementia and our protective responses brought a new sweetness into our family.

As he aged, Dad lost his vision and his hearing. He lost mobility, and he lost much of his cognitive abilities to dementia. However, he did not lose his sense of well-being when he had us. The three of us adult children teamed up to provide the essential daily visit. Our spouses and grown children played strategic roles as well. Together, we gave him recourse and a sense of security. Together, we provided routine and brought recognition into his life. Together, we preserved his identity. Together, we pulled up his reserves from deep storage with unhurried visits.

“Honor your father and your mother,” which is the first commandment with promise: “that it may be well with you and you may live long on  the earth.” Ephesians 6:2 NKJV 


About the Author:

A retired counselor, Melody was thrust into disturbing end of life issues by an emergency Guardianship and Conservatorship of her father in 2005. She realized many of her family’s difficulties could have been avoided with more extensive Pre-planning on the part of her parents. Subsequently, it became Melody's passion to help people organize their affairs so that their families could honor them. Accordingly, the HERITAGE OF HOPE Video Series, the HOH Workbook, and the HOH Website ( all work together to inspire and equip adults of all ages to identify the crucial decisions and complete the essential tasks . . . TO FINISH LIFE WELL.