Showing posts with label nursing homes. Show all posts
Showing posts with label nursing homes. Show all posts

Tuesday, August 25, 2020

Back to school?

It’s been very quiet here in Rome this month. The relentless hot sunny days, when you barely hear a dog barking, the deserted city with neither tourists nor residents, lend an eerie quality to the few left behind, sweating in their face masks and just trying to get through another day.

Against this backdrop, and the daily rituals of caring for my mother who continues to show signs of improvement from a fever and possible lung infection a few weeks ago, I have been thinking about the whole business of reopening schools and universities. Although I now wear the eldercare hat, my teacher identity can’t stop thinking about the impending nightmare of what will happen when and if children, adolescents, and educators return to their school buildings this fall.

 

Let’s recap first though. The short term solution during the height of the COVID-19 worldwide pandemic was a stay-at-home-lockdown, forcing workers and students to do everything online. For some, it was an easy transition. Italians called it “smart working” but most parents struggled to do both work at home and tutoring of students online. Some found the humor in the awkwardness, like this Italian actress who taped some scenes with her two children (watch even if you don’t understand the Italian, the humor is universal) and others who created hilarious commentary on the new busy-at-home-schedules like Italian comic Paolo Camilli. Aside from humor, there were a few other unexpected positive aspects to the world coming to a screeching halt. We discovered the planet could heal surprisingly quickly. We found ways to be grateful despite our fear, and to reach out more in our isolation to others.

 

For some it was a dark time of grieving and loss without the customary comforts and rituals. Many lost their jobs, and some saw their careers in peril, with no clear sense of what would happen next. Theaters, restaurants and bars, stadiums, tourism all shut down; our social lives suddenly existed only in a virtual sense.

 

But I think no one was prepared for what it would mean for our way of life, and for the health of our economies, to shut down schools and universities. These are places we take for granted, like supermarkets and pharmacies (which mostly remained open during the lockdown). We entrust our children to the people that work in education for almost more time than we spend with them at home. The age at which we send children to school keeps dropping too, so that parents of even young babies can return to work. Schools are engines of socialization, humming with group activities from laboratories to sports fields, places for quiet reading or writing, for conferring with a teacher or colleague, for eating and playing and laughing together. Meetings on Zoom and other platforms were a very poor substitute, but everyone tried to make the best of it, if they were able to get online access, which many could not. It was only meant to be temporary. 

 

Now as the death toll from COVID-19 nears 200,000 in the United States, and the economic toll the lockdown has taken comes starkly into view, even as indoor dining and sports stadiums remain forbidden, schools and universities are starting to reopen. The justification has become politicized, with the incompetent administration in Washington D.C. claiming children are not so likely to get or spread the virus, while we know that some are at risk of MIS-C, a severe sometimes fatal complication. The president continues to lie that outbreaks are under control, that plans and procedures for reducing risk are in place and will be effective. UPDATE Sept. 19: College and university cases are growing nationally. New York City's schools delayed reopening again, causing anger, frustration, and confusion. 

 

Some teachers have decided to quit, others to retire early. Some are preparing to go on strike. Many are torn between wanting to return to the work they love and to serve their students, and wanting to protect themselves and their loved ones from the risk of illness, even death. Most are justifiably terrified that they simply don’t have the resources to handle the situations they will face, and that administrators haven’t carefully thought through the scenarios that are likely to play out immediately, leading to chaos and confusion. They fear they will bear the brunt of the blame. No one is really prepared for what to do if there is an outbreak of COVID-19 cases. In fact a freshman at the University of Iowa who tested positive days after arriving faced a horrifying lack of support when she was forced out of her dorm room. 

 


In some countries, provisions have been made for plexiglass cubes around individual desks, for headgear with propeller-like extensions to train children to keep each other at the right distances, even for adjacent classrooms connected by video cameras so the teacher is with half the class and an assistant with the other half, allowing students to spread out. Some districts in the US are proposing hybrid schedules with students alternating in person and at home days, which creates a nightmare for teachers with children of their own, and for those parents who are expected to return to a work environment that is not home-based. Universities, who were already moving many courses online for the convenience and ability to register more students in courses, are more prepared to shift to computer-based classes, even though it is widely acknowledged that learning that way for many subjects is less than ideal. Teacher and renowned blogger and author Mercedes Schneider put it bluntly:

 

I am the teacher, and I am supposed to limit my movement in my own classroom. Is every conversation with a student to be said loud enough for all to hear? Am I to teach without being able to walk up to my students or have them walk up to me? Apparently that is the expectation. But let’s not pretend that what I will be able to do for my students in my COVID-era classroom is remotely on par with normal teacher-student and student-student interaction.

In short, what I will be offering in my room is a form of distance learning to students who happen to be seated in a space in which they can see me and I can see them.”

A retired teacher friend, Gail DeBonis Richmond, posted on Facebook some comments she has been hearing from colleagues in New York State: 

“We were told we can’t wear scrubs.”

“The ventilation in our school is old and horrible.”

“They’ve laid off custodians and are not rehiring.”

“I have to buy my own cleaning supplies.”

“Kids don’t have to wear masks during instruction.” 

“I was told I WILL be having choir. Instead of 100 kids in choir, they’re breaking it up. I’ll have 85 in one, 15 in the other.” 

“Our faculty was just told there isn’t enough money for sanitizer in classrooms. There will be a dispenser at entrances.”

“I was told I have to clean every student desk in between classes. I’m not sure the PPE I bought for myself is medical grade and will protect me. I’ve never been trained in infectious disease cleaning.”

 

It’s probably even more dire in other situations where extreme funding cuts, political pressure to get back to business as usual, and propaganda believers that the COVID-19 is somehow a hoax abound, make for a toxic mix. Leaving everyone to fend for themselves, coupled with a lack of expert guidance and leadership, is going to lead to many more deaths. How do I know? Look at what happened to the elderly in nursing homes. When the virus arrived, it swept through those places leaving mayhem in its wake. Yes I know we’d like to ignore such unpleasantness. But we know it is true. If this happens to our children and youth and those who seek to educate them, we truly may not recover from the grieving and trauma this will inflict on our society.

So what alternatives are being proposed? Predictably, some administrators are just trying to kick the can down the road, such as this report of principals in Brooklyn from Chalkbeat New York.  In Iowa, where schools defied the governor’s order to reopen, the Associated Press was reporting that administrators could face having their licensure revoked. It’s about to get really ugly out there.

One of the emerging ideas among affluent parents is to create a local pod. I first learned that podding was a trending education jargon term of the moment from the excellent Jennifer Berkshire and her podcast partner Jack Schneider in an August 6th episode of Have You Heard?. Sit down with a strong drink of choice, listen and learn all about the craze for pandemic pods, opportunity hoarding, worsening inequality issues, and more from the hosts and their superb guests, Jessica Calarco, L’Hereux Lewis-McCoy and Jon Hale. There’s also the June episode on distance learning to listen to after that where they explore present day and historical efforts to teach individuals by correspondence or online. As they say, “learning alone has never worked for the vast majority of students.” I fear that we are already moving backwards thanks to standardized testing. Take, for example, this quote from a 2011 Washington Post article by Marion Brady:

My school board member-friend concluded his email with this: “I can’t escape the conclusion that those of us who are expected to follow through on decisions that have been made for us are doing something ethically questionable.” 

He’s wrong. What they’re being made to do isn’t ethically questionable. It’s ethically unacceptable. Ethically reprehensible. Ethically indefensible.

Think of where we are now nine years later. Drowning in a void.

I think it would be irresponsible of me to leave you on such a bleak note. So here are some of the ideas I have been thinking about, given what we know from researchers like Barbara Rogoff about group learning, especially for children from underserved minority backgrounds:


Outdoor education! We need to rethink the potential of the great outdoors. Forward-thinking schools in places like Reggio Emilia here in Italy, in Sweden, and Finland are taking even very young children outside to learn and to immerse them in exploring the natural world. A recent NYTimes piece on history of educating New York’s children outdoors during flu pandemics from Ginia Bellafante explores whether such ideas would be feasible today in New York City. I am not just talking about laptops outdoors, but creating curriculum and experiences based on outdoor environments both urban, rural, and everything in between. Study wetlands and woods, rivers, tidepools and beaches, help advance awareness of climate change and how to conserve and protect nature and animal habitats. 


Massive effort to involve non-teachers in education! Paid or volunteer, working adults (and those out of work) have much to offer young people. Create a new civic sense of duty to help save public education, appeal to parents, aunts and uncles, grandparents, even the childless. Maybe hours accumulated could count towards greater public assistance for those seeking employment. Have the volunteers work in tandem with expert support; don’t set them up for failure, and you could create an international movement that would energize learning globally.


Cross-grade partnering and tutoring! We know there is much learning in teaching others, even for children. Under adult guidance and supervision, these partnering and tutoring experiences could even count for course credit. Partners can be established online across diverse communities. Check out the AMAZING Creative Arts Team Youth Theatre and their  international collaborations.

 

Learn about food and where it comes from! Inspired by Edible Schoolyard, create vegetable gardens and outdoor food preparation sites for making school meals a curricular opportunity. Learning to prepare food safely during a pandemic is a vital skill for everyone to obtain. 


Arts education is more important than ever! With so many theaters and concert halls and museums closed or with reduced access, now is the perfect time to partner with arts and cultural institutions to create online and in-person outdoor learning experiences that are interactive and designed for group activities. See for example this 2013 video introduction to the work of Lincoln Center Education, which has a long illustrious history of partnerships with artists and schools across the globe. The Lincoln Center YouTube channel has a wealth of resources for at home use from concerts and performances to pop-up workshops. 

 

Now, go get some kids outdoors where there are flowers growing, bring along some simple collage materials and your laptop/tablet/phone, and follow along with teaching artist Barbara Ellmann to make collages of spring flowers. Don’t you feel a little bit better?

Thursday, October 11, 2018

The view from the terrace

Somehow every time I stumble on a journalistic essay on dementia or Alzheimer’s and eldercare, I hit the full spectrum of negative emotions like a head-on collision: despair, outrage, depression, anxiety, dread. One would think that being glued to the news of hurricane devastation in the southeast and the Senate Judiciary Committee’s confirmation hearings for Brett Kavanaugh would be enough emotional punishment this month, but I had to read Larissa MacFarquhar’s New Yorker article just days after his confirmation to the Supreme Court. Each day over breakfast my mother wanted to review the previous day, so just like Bill Murray in Groundhog Day, I’d start again with how the news had been unfolding, because she was already forgetting who was who, and what they wanted, and what it all meant.

After the hurricanes both real and metaphorical, she returns to her sunny spot on the kitchen terrace. For the past two days, she has been carefully watching the workers who have returned to a nearby terrace to complete the restoration that has been ongoing for almost a year. “You’re doing that painting so carefully!” she remarks across the driveway separating our building from the adjacent one, and I gently remind her from inside the kitchen to speak in Italian. It is not unusual for us to chat from the terraces with our neighbors,
Maureen watches from the terrace 
and since the workers must have seen her watching them I suppose they did not find it odd that she called to them. It is true that some people with dementia lose their inhibitions, and may talk to strangers more readily than was the case prior to their diagnosis. My mother has always had the gift of engaging others in conversation; perhaps it’s in her Irish blood, or is a benefit of a lifetime career in teaching.

The New Yorker article describes a trend in nursing homes to create stage-like settings that simulate a small town, with faux storefronts and fake facades of clapboard houses. At the heart of her reporting is a dilemma she describes in the video “backstory” available in the online version, namely if a woman’s husband died a decade ago but she doesn’t remember, does one tell her again and again, only to have her bereave his loss each day? Or does one simply say oh he’s not here, he’s at the office, ostensibly to comfort her? Apparently the consensus and practice in most places dealing with such patients is that lying is easier, the kinder thing to do, but MacFarquhar says, “I just think there’s a price to be paid for lying all the time.” The people doing the care are changed by the lying, she writes. It wears them down.

I visited an upscale, newly renovated nursing home with two floors dedicated to memory care back in New York, and am still haunted by the experience. I felt as though I were visiting the set of a science fiction horror movie. Details of the “tour” are etched in my memory, like the person at a slightly out of tune upright piano in the common living area playing a Yiddish folk tune while residents sat silently, heads drooping, and an aide remarked on how the music made some of them feel sad. Perhaps to balance my permanent feelings about the existence of such places (and probably much worse than what I witnessed) I sometimes joke with my mother about the “chicken and broccoli place” where the daily menu rarely strays from the elder-friendly combo. It seems to me that the protocols of care in many of these places entail not only the prevalent it’s-kinder-to-lie belief, the medicate-don’t-agitate rule of thumb, but also the assumption that someone experiencing the effects of dementia is less aware, less capable of thought and emotion than the rest of us. I’m sure there are some exceptions to my characterization, as in this heartbreaking piece about a man with early-onset Alzheimer’s who finds a program for two days a week where “the walls are covered in exquisite artwork created by clients, there are real bowling shirts for the raucous Xbox live bowling league” for example.

But we need far more radical departures, deep cultural shifts. “Many of the residents were quite restless, and there was nowhere else to go,” writes MacFarquhar of the fake town with fake grass, fake lighting. Is it any wonder that patients in nursing homes beg to go home? How can we condemn them to a drug-induced solitary confinement, boxed in by walkers and wheelchairs, code-protected elevators and doors, and pretend that perpetual lying is an act of kindness?

In Anne Basting’s work with Time Slips, you can see the power of a simple idea. Instead of a focus on memory, she advocates engaging the imagination. In this clip showing her use the approach with a couple, the man shares that his favorite expression is, “If you’re honest you don’t have to have a good memory…you tell the truth.” Using a photograph, they create a story. It’s not a masterpiece, but it has charm and humor and more importantly, it engages the participants in an exchange of lively ideas and laughter. The result is something that is better than any of the individuals could have created alone, and not just because of what ends up written down on the paper. It’s the shared experience of creating it that matters most.

Towards the end of her article, MacFarquhar shares a quote from the late psychologist Tom Kitwood of the Bradford Dementia Group. “People who have dementia, for whom the life of the emotions is often intense, and without the ordinary forms of inhibition, are inviting us to return to aspects of our being that are much older in evolutionary terms: more in tune with the body and its functions, closer to the life of instinct.” Living in such intimate and close proximity to my mother, day in and day out, has provided many illuminating lessons, moments of grace; it requires of us patience and understanding, being present in the moment and with each other.


Still, I wasn’t expecting any exciting developments on her terrace observations when I returned from my exercise class. She shared that the workers' boss had come to check on the terrace restoration work, and from her observation spot she had gotten his attention and used some Italian and hand gestures to convey her informed opinion that the men had done exceptionally good work. The faces of the workers, she said, showed joy and pride, and a good deal of surprise too.