April 2019 | Immanuel Foundation

On Sunday, March 29, the newest (eighth) season of BBC’s Call the Midwife began airing on PBS. I was very excited because, dear readers, this is my favorite show currently on television. One of the many reasons I like it so much is that it tackles truly intergenerational themes. The main characters live in an intergenerational community, and this isn’t always easy, but everybody learns from each other. Regular characters include both lay midwives at the beginning of their careers and nuns nearing the ends of theirs. And since these characters are nurses and midwives, every episode features births, and many feature deaths as well.

If you haven’t seen Call the Midwife, it follows the adventures of a group of midwives, some of them Anglican nuns, based at a convent called Nonnatus House in London’s impoverished East End. The first seasons are set in the late 1950s, but by this point, we’re in 1963. It took me awhile to start watching, as I was afraid it would be a downer of a show. After all, poverty and childbirth don’t exactly make for an uplifting mix. Except when they do. Once I started watching, I fell in love, because the midwives of Nonnatus House spend their time making unbearable conditions bearable. The show isn’t afraid to tackle hard things, and it manages to avoid being sugary, but I almost always finish an episode feeling good.

One of the hard subjects the show tackles is aging, and it’s the only show I’m aware of that has a regular character with dementia. Sister Monica Joan is not a “story of the week.” She appears in almost every episode and plays key roles in quite a few, including the season premier that aired on Sunday. One theme that repeatedly recurs around Sister Monica Joan is that as she ages, she feels more and more useless. She is no longer a practicing midwife, and her dementia makes it hard for her to contribute even in more minor ways. At the beginning of the series, she’s able to knit and crochet, but as she declines even those tasks become harder. Even when she could still do these things with ease, Sister Monica Joan would often exclaim that she was not useful. She knew she was being given busywork, and she hated it.

This issue was on full display in the Season 8 premier. At the beginning of the episode, the Midwives get new work bags to replace the bags they’ve used for decades. The old bags are shabby and in need of replacement, and National Health (the British agency that regulates midwifery and other medical services) regulations have changed. Fred, the midwives’ handyman, takes the old bags out back to burn them. When Sister Monica Joan sees this, she is very upset, especially since one of the bags he is burning had once belonged to her. When Fred is called away, she takes it and hides it.

When Sister Monica Joan falls ill, boundaries between past and present blur even more—as they so often do for those with dementia. She takes her bag and goes off in search of a mother and baby she believes require her services. The other nuns and lay midwives are frantic, of course, and they search high and low for her before finding her, shivering and terrified, in an abandoned building. It’s clear that Sister Monica Joan ran away because she believed she was needed elsewhere and because her identity was so tied up in her work that when her cognitive abilities were at their weakest, she went to do her job.

Sister Monica Joan is a beloved character for many reasons, not least of which is her ongoing dedication to the profession she once pursued. She loves helping women give birth, and she sees that, in addition to her religious vows, as her calling. Call the Midwife reminds us that people with dementia do not lose their core selves, even when they lose their professional skills.

Those who have loved ones with dementia or work with seniors will certainly notice that Sister Monica Joan’s dementia is not entirely realistic. To be sure, she improves and worsens as the plot requires. I’m sure many viewers wish their loved ones with dementia would bounce back as well as Sister Monica Joan often seems to do. That’s part of the problem with television, of course—while the marvelous Judy Parfitt would surely be up to portraying the decline, it would eventually become very painful to watch. Charlotte, my coworker in the Foundation office, has already mentioned that she starts every season with the fear this will be the year we lose Sister Monica Joan. If we were seeing a more typical progression of dementia,* we’d probably be a lot sadder.

If you want to join me in watching this wonderful show, all the previous seasons are available on Netflix. If you decide to take the plunge, you’ll probably find yourself binge watching, so I recommend stocking up on the following:

Popcorn (a binge-watching staple)
Hot chocolate (the midwives drink a lot of it, so it’ll start to sound pretty good after a few episodes)
Tissues (just trust me—buy them at Costco)

Season 8 episode will be up to stream on the PBS website as they air, and they stay around for a week or two before they go behind a paywall.

*I feel sure my colleagues who are experts in dementia support would want me to mention that every case of dementia is different and there is no typical case. However, most types of dementia are progressive.

Pretty much everyone has a model in their head for what aging looks like. Almost anyone who works—no matter how young—has probably had at least fleeting thoughts like, “When I retire, I’m going to spend all my time traveling” or, “When I retire, I’ll have all the time in the world to knit/read/build things/run marathons.” Especially as grandkids arrive on the scene, others imagine themselves prioritizing family in ways they haven’t previously been able. In our imaginations, retirement is a time of leisure and a different kind of engagement with the world.

However, the positive conceptions of retirement I outlined above contrast sharply with many public portrayals of aging. The word “aging” tends to be associated with negative things like dependence, decline, and disease. And it’s something we’re told every day we should avoid, as if that were possible. How many ads for “anti-aging” products do we see every day? I’ve never counted, but I bet it’s a lot. Even generally positive actions we’re encouraged to take—like saving for retirement—tend to pose a pretty alarming model of aging (if you don’t save the right way, those commercials tell us, you are headed for disaster, or at least misery).

It turns out that this difference in our ideal picture of aging and what we believe to be the reality is very common. It’s so common that The FrameWorks Institute’s 2015 report on “Mapping the Gaps between Expert and Public Understandings of Aging in America” names it as the number one issue in public perceptions of aging. According to the report, for many Americans, aging is “a positive ideal that is always thwarted by the reality of the issue.” So, most of us have it in our minds that aging could be great, but we don’t think that it is great.

At Immanuel, we do our best to reinforce the ways in which aging is great. This is probably easiest to see in our independent living areas, where you’ll find residents who go for bike rides, tend plants, paint pictures, attend lectures, and travel regularly to new locales as well as their favorite vacation spots. In skilled care, residents generally have less capacity to leave the building on their own, but that doesn’t stop them from enjoying painting, crafts, reading groups, time in the courtyard, or outings with family or on Immanuel’s bus.

“Nursing home aging” is probably, in many imaginations, the polar opposite of “active aging,” so it’s harder in that case to fight the perception that aging is inherently negative. It’s simply true that most of us will experience some physical decline as we age, and if we decline enough, we will need nursing care. But that physical decline doesn’t mean we need to stop being who we are, and it doesn’t mean that we should try to push aging from our minds until it inevitably stops us in our tracks. Immanuel emphasizes that aging doesn’t have to stop us—we want aging to be positive, regardless of what level of care a person requires.

As I read the FrameWorks report, I thought a lot about the Passions Project photos that hang in the hallway of Buffalo Hill Terrace. The photos feature residents from across campus who live active, positive lives. They’re wonderful examples of the ways in which our ideals of aging can, in fact, become real. Whether they’re riding a bike or painting a watercolor, the Passions Project participants are spending their time joyfully, and that’s something we all strive to do, no matter how old we are. If you’d like to think more about how the ideal and real pictures of aging intersect, I encourage you to look at these beautiful photos!

Immanuel Skilled Care Center resident Donna Mallery has been playing the piano for eighty-one years. It’s no surprise, because she comes from a musical family. When she was growing up in Minnesota, Donna’s entire family would gather around the piano while her mother played. By the time she was twelve, Donna had decided that she wanted to play, too, so she started taking lessons.

Donna grew up on a farm and is one of eleven children. Because she was born during the Great Depression, her family didn’t have much to spare for luxuries. Everything they had, they spent on necessities for the large family. One of Donna’s brothers even left home and joined the Civilian Conservation Corps to help the family out. Hard economic times didn’t stop the family from enjoying music. Often, they would sing together while Donna’s mother played the piano and sometimes, they would listen to the radio together.

At times, the radio played music, but at other times the family listened to the news, including news of World War II. Singing was one way they coped with the difficulties of war. While Donna’s father and some brothers were exempt from military service because they were farmers (farming was an exempt occupation), one of her brothers was a mechanic for the Navy Air Corps. As the radio informed them of the battles overseas, Donna’s family gathered around the piano and sang and prayed for peace.

As she grew up, Donna left this happy family to form a happy family of her own. At first, she headed to St. Paul, Minnesota, where she attended Bible College. She studied music as well as regular academic subjects. While she was there, she met and married Bob Mallery. Bob was a minister, and one of his first posts was in Savage, Montana (in the eastern part of the state). As time went on, Donna and Bob moved west, first to Columbia Falls and later to St. Ignatius, Shelby, and finally Plains, where Bob had his final ministerial post.

Donna and Bob eventually had five sons. Their family continues to grow; Donna has over forty grandchildren and a number of great-grandchildren and great-great-grandchildren (Bob passed away in 1990). As of this writing, Donna has over one hundred descendants! When they make music together—as they do at large gatherings—it’s quite the event. At their family reunions, they always have a piano and recording equipment available.

Though she can read music, Donna often prefers to play by ear. She’s also not afraid to put her own spin on familiar tunes and prefers “living music” or “active music.” “If I started playing ‘What a Friend We Have in Jesus,’ I might jazz it up a little bit,” she explains.

Music and worship are so important to Donna that when it became time for her to move out of her house, her sons chose Immanuel because of the emphasis our community places on both. Frequent musical performances by area groups mean there’s always something for Donna to listen to, and there are worship services and/or Bible studies at least twice every week. Immanuel and Donna really are a great fit. Donna still practices every day she can. She plays because music moves her. In conclusion, Donna sums up her love of music: “I just want to go over and play and enjoy myself. It’s part of my life. And it’s my way of worshipping the Lord, as well.”

A few months ago, a woman approached the director of our Memory Support community. Her husband had dementia, and she was worn out from caring for him. Like many people with dementia, he was prone to wandering and to approaching her repeatedly, often for the same needs she had only just addressed, though he couldn’t remember she had done so. Keeping an eye on him was basically a full-time job. She needed just a little bit of time, she said—just enough time to go grocery shopping, clean the house, and maybe take a nap. She’d correctly heard that we offer day services for people with dementia, and she was hoping she would be able to bring her husband to our community for a few hours every once in a while so she could get things done. There was a problem, though. This couple was living on a fixed income, and their budget just wouldn’t stretch to the fees.

This couple likely came to us because Immanuel has long been a leader in services for people with dementia. In the 1970s, we opened one of the first specialized environments for people with dementia in the Immanuel Skilled Care Center. These days, the Lodge at Buffalo Hill, our Assisted Living Memory Support community, provides a secure, vibrant environment where seniors can thrive. 24 residents live there, but we know that’s not nearly enough capacity to fill the need in our valley. We also know that dementia is in most cases progressive, and there’s often a gap between when a person first starts experiencing symptoms and needing support and when they’re ready to live full-time in a specialized community.

We started our day program to address these needs. Now, community members can bring their loved ones with dementia to the Lodge for only a few hours—or a day—at a time. These guests still go home at night. There are a couple of benefits. First of all, caring for someone with dementia is exhausting, and it’s particularly exhausting when that person is a spouse, parent, or other relative. Many family caregivers get hardly any time to themselves because they need to make sure that their loved one is safe at all times. Daily tasks like shopping, cooking, and home maintenance can be challenging—and forget time for relaxation or socialization. Second, having dementia can be isolating for a person who has it, as well. Especially in the early stages, people with dementia know they are not themselves, and because they can’t do everything they used to do, they can feel embarrassed and depressed as well as confused.

Respite care provides relief for both the person with dementia and the caregiver. This can be a huge benefit to both individuals. But it costs money, and not everyone can afford to pay even the moderate fees the Lodge charges for these services. In some ways, the couple I told you about in the opening paragraph of this post believed that respite care was a luxury. Their budget wouldn’t stretch to anything that wasn’t absolutely necessary, so we haven’t been able to help them—yet.

To help people like them, we would like offer a different payment model to make the program accessible to our Valley’s seniors in need. While no one would ever pay more than the regular rate (currently $15/hour), families in need might pay less according to their income. Because our costs remain the same regardless of a guest’s ability to pay, we need your philanthropic support to help us get this new payment model off the ground.

When making decisions about necessities, most of us prioritize things like housing, food, and medical care. Rest breaks and socialization tend to be some of the first things eliminated when we’re making decisions on tight budgets. That’s the calculation our visiting couple had to make. But studies show that respite is more of a necessity than a luxury. In a recent study by the Commonwealth Fund, 60% of caregivers reported at least one of three problem indicators related to their health (having one or more chronic conditions, being in fair or poor health, or having a disability). Since only 33% of the non-caregiver general population reports such indicators, caregiving clearly has health impacts. Respite programs like the Lodge Day Service lets caregivers take time to take care of their own health. This isn’t a luxury, it’s a necessity.

You can be part of providing this necessary service by giving to Immanuel. Simply click here and choose “Memory Care Program” from the dropdown menu to designate your gift. Your gifts will make a real difference to our area seniors in need and their caregivers of all ages. Thank you.