“This is your first time?” asks Jan Merling as an unsuspecting student enters the classroom at Tuomey Regional Medical Center.
“Well, where have you been?” Merling good-naturedly chides.
“Trying to find you,” the student responds.
“Good answer!” Merling replies.
And with that Merling launches into another fast-paced, 90-minute Dementia Dialogue class. For 12 years, she has used her brand of no-holds-barred humor to teach and inspire nearly 20,000 graduates to go out and perform one of the most difficult jobs imaginable — dementia caregiver.
“She makes what shouldn’t be a fun topic fun,” says Vicki Carty, community training coordinator at Tuomey, which has been one of several frequent stops on Merling’s statewide treks. “If they enjoy it, they’re going to retain more information.”
Merling, who works out of the University of South Carolina Office for the Study of Aging, sort of fell into what has been her fourth or fifth career. She learned about dementia-care problems as a consultant for a major nursing home company. She honed classroom skills as a college instructor. Then one day she “ran into somebody who needed help in talking about dementia, and I was in the right place at the right time,” Merling says. “It was not a big personal mission of mine. It’s where I ended up, and I liked it.”
And she’s good at it.
Anyone tasked with caring for someone with dementia – or an assisted living facility full of people with dementia – might find it hard to imagine that anything about the job could be fun. They need to sit through the five-session program with Merling, who cuts through tense situations with smack-your-head-simple solutions.
She helps people see the silliness of a patient stuffing dozens of surgical gloves down her shirt every day, and the staff wondering how to solve the problem. It’s not by changing the patient’s habits; it might be by moving the surgical glove dispensers inside each room rather than outside in the hall, where anyone can pull one out as they walk past.
In this session, Merling is making the point that too many people look at something as a patient problem when it’s really a caregiver problem. If patients with dementia want to pick up their food with their fingers or scream profanities, it bothers the caregivers, not the patients. Fixing that should be less a priority than something that’s a true patient problem, such as wandering away from a building.
“If what they’re doing is dangerous, stop them,” says Merling, who paces frenetically throughout the class and picks on her favorite students by using their names in examples. “The rest of the stuff is not a problem.”
She tells about a nursing home staff perplexed by a certain patient eating scraps out of trash cans near the cafeteria at 4 p.m. each day. The administrators considered buying trash cans that were harder to get into. Merling suggested that the much less expensive solution was to offer the woman a snack every day at 4 p.m.
If a patient hoards rolls of toilet paper, don’t just try to take away the rolls while the patient is around. Wait until the person leaves leave the room. The stash will be forgotten by the time the person return.
The 28 students in the class shake their heads knowingly at each example. Some work in assisted living centers. Some are preparing for those types of jobs. Some take care of relatives with dementia. They laugh at her examples, and they appreciate her favorite T-shirt slogan: “Is it time for your medication or mine?”
More importantly, they come away with a better understanding of dementia.
Sara Coulter of Sumter dealt with her grandmother’s dementia, and now she’s dealing with her mother’s. Merling’s classes have reminded her to deal with a situation when it’s happening and not fret about the big picture, to avoid multiple changes in routine and mainly to respect the person with dementia.
It also helps to see the humor in situations. Merling tells of a facility that put up eight-sided, red stop signs at exits, intending to prevent wanderers from going out the door. The patients would treat it like a road sign. They would stop, look both ways, then walk out the door.
Sadly, Merling is nearing a personal stop sign. She plans to retire at the end of the year. (Her last Midlands class begins Oct. 23.) She has trained a dozen or so new trainers, but it’ll be hard for them to replicate her unique approach.
At the request of others, she has transcribed her lessons and will post them online, but she has resisted audio or video of her classes. “Even on a good day,” she says with a laugh, “I’m inappropriate.”
Dementia care help
Dementia Dialogue: A free program for caregivers, five 90-minute sessions, next in the Midlands begins Oct. 23, http://www.sph.sc.edu/osa/programs_dementia_schedule.html
EssentiaALZ: An online caregiver education program put together by the Alzheimer’s Association, $24.95, http://www.hcinteractive.com/essentiALZ
Local support groups: Caregivers Coalition of Midlands meets the second Tuesday of each month at noon in the Palmer Building at First Presbyterian Church, 1420 Lady St., Columbia; details on other local groups can be found at http://www.alz.org/sc/in_my_community_support.asp#Support_groups_listed_by_county