Keys to the Mind
(Reprinted from The Almanac, June 11, 2003)

Music and Art Programs at Menlo Park's Rosener House Unlock Possibilities for People Living With Dementia
By Rebecca Wallace, Almanac Staff Writer

Because of dementia, the man could no longer talk.

In an art therapy group, he painted a tropical fish. When his wife came in, he simply looked up and smiled. She cried when she saw his painting.

"He had collected tropical fish," said Angel Duncan, who leads the group. "It was a communication that only they could know."

Art and music speak to the soul, but sometimes their whispers carry even farther. For people living with dementia, creativity can be a lifeline, a key to a hidden area of the mind that still thrives.

A woman may not remember that she was a musician, but if she sits at a piano she suddenly begins playing. A main paints rural scenes and remembers his childhood in Louisiana.

These are typical occurrences at Peninsula Volunteers Rosener House in Menlo Park, a 25-year-old program that provides adult day services.

"It's such a privilege to be able to offer this service. We're just touched all the time," Rosener House director Barbara Kalt says.

People with Alzheimer's disease, Parkinson's disease and other forms of dementia have traditionally been thought of as fading away, as family members grieve over what their loved ones can no longer do. Nowadays, longer life spans have made dementia more common, and views are evolving.

"We think of it as a chronic condition that people live with. We're changing the way we look at it," says Bill Fisher, CEO of the Alzheimer's Association of Northern California and Northern Nevada. "There's no indication that the disease starts earlier, but we're recognizing it more and we're living longer."

According to the National Institutes of Aging, about 4 million Americans have Alzheimer's disease, he says. That number is expected to jump to 14.5 million by 2040.

The goal of the Rosener House staff is to make the time living with dementia more meaningful, Ms. Kalt says. Along with physical and speech therapy, creative programs such as painting and woodworking session, sing-alongs and song-writing keep the brain active.

Rosener House started a dementia services program six years ago, and since the facility moved to a new building at Middle Avenue and Arbor Road in 2001, there has been a dedicated space for the program. Still, staff try to have participants mingle with the others as often as possible.

Most importantly, the activities show people living with dementia that they can still express themselves and create, Ms. Kalt says. They can still contribute to the world.

"We have people who have been neurosurgeons, firefighters ...they're not that anymore. They are who they are today to us," Ms. Kalt says as her dog, Shayna, who is popular with Rosener House patrons, frolicked around the office.

Mr. Fisher said Rosener House is a "star" in dementia care, pointing out that his chapter of the Alzheimer's Association began as a support group there more than 20 years ago.

"They're extremely skilled at dealing with people with dementia and celebrating the remaining function," he says. "All too often Alzheimer's for families is an experience of loss... A place like Rosener House turns that around."

Making Memories

Cupcakes dot round tables during a birthday party for a Rosener House patron. Some elderly people chat amicably, while others sit without speaking as the smiling staff members circulate. Everyone wears large name tags.

In a corner, one woman in a wheelchair gazes into space. She doesn't move until dementia services coordinator Shawn Evans begins strumming his guitar and singing "Home on the Range." Then her lips move silently, mouthing the words.

Mr. Evans asks another woman to help him. "I don't know how to sing," she says stubbornly.

"Can you hum?" Mr. Evans coaxes. Eventually the woman hums along, and then suddenly breaks into song.

At another table, a woman named Leatrice sways with the music. "I love y'all," she says to everyone. "I like to dance."

"Gotta shake it?" Talya Onorato, a young activity leader with two perky braids, asks with a grin.

"Don't break it," Leatrice shoots back.

Rosener House staff members say there's a common misconception that dementia care is a depressing thing. But music and art bring in liveliness and reassurance, particularly classic songs that are familiar to the elderly.

"Music is one aspect of memory that is not necessarily affected the same way within dementia," Mr. Evans explains. "Even if they can't speak, they might be able to sing."

Mr. Evans, 28, graduated from the Berklee College of Music in Boston as part of the school's first class of music therapists. In small sessions, he mixes old tunes with new, and encourages improvising.

"I'll throw out a phrase and people will make a song," he says, snapping his fingers. "It's amazing how on the ball and quick on their feet people can be."

Mr., Fisher says these types of active programs are key. Staff members must work hard to draw people out, make eye contact and engage them.

In song-writing sessions, Mr. Evans sees evidence that disputes the myth that people with dementia can't make new memories.

"We can write a song one week and come back and people will remember it, whereas they may not remember my name," he says.

The following week, a brand new song takes shape in a music therapy session, in honor of participant Ella Mae, who dances in front of her fellow group members.

"Ella Mae, gonna take that money away," Mr. Evans croons. Some of the participants watch blankly, but others sing along or play percussion instruments. Tambourines, a ukulele and drums fill nearby shelves.

One woman, who used to wander the halls and cry for her husband every day at Rosener House, now calmly plays the piano. Ella Mae beams and stamps her feet, the strings of beads around her neck shimmying and clicking.

Support for caregivers

Down the hall, Bruna Silvani is all concentration as she paints flowers in watercolor. Another woman, once a botanist, carefully creates a mushroom.

The paintings are vibrant, but artistic ability isn't the point, says Angel Duncan, an Alzheimer's Association intern who is studying art therapy at Notre Dame de Namur University in Belmont.

"While they're painting, I ask them, "How does this make you feel? Have you ever seen this flower before?' It's an exercise for brain activity," she says. "Bruna claims she's never done art in her life, but she looks forward to it."

Ms. Silvani, 91, lives down the street with her caregivers and comes to Rosener House regularly.

"It's heavenly for me," she says. "I have lots of friends here."

Kathryne Blair, Ms. Silvani's daughter, says she started noticing a year or two ago that her mother couldn't keep track of her finances and was forgetting things. The memory loss hasn't been diagnosed, she says.

Ms. Blair says she's thrilled with Rosener House's activities and other assistance, such as lending her a wheelchair after her mother had a fall.

She also points out that adult day services give a break to family members who care for loved ones with dementia.

"Between Rosener House and the caregivers, I have a life of my own," she says. "There's a niche for her there."

Recognizing what a responsibility family members bear, Rosener House also offers support groups for them, in conjunction with the Alzheimer's Association.

The burden is especially difficult for members of the so-called "sandwich generation," people who care for parents and children, Ms. Kalt says. This dynamic may be growing more common as people have children later in life.

"When you have teens, they really need you to be there for them," she says. "You're pulled in all directions."

Information:

Several organizations and Web sites offer assistance to caregivers and people with dementia, including:

• Rosener House, 500 Arbor Road, Menlo Park, 650-322-0126
• Alzheimer's Association, 2065 West El Camino Real, Suite C, Mountain View, 650-926-8111. 24-hour help line: 1-800-660-1993
• Family Caregiver Alliance, 1-800-445-8106. www.caregiver.org
• Peninsula Parkinson's Support Groups, 408-734-1593

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Peninsula Volunteers, Inc.
800 Middle Avenue
Menlo Park, CA 94025
Telephone: 650-326-0665
Fax: 650-326-9547