Happy New Year! I hope everyone had a good holiday. My dad tested positive for Covid on December 24th, so my plans for a cozy, hot-chocolate-filled Christmas were dashed. Womp, womp.
The good news is that this was my father’s first time getting the virus, and his case was fast and mild (he didn’t even spike a fever). Still, it sucked. I put a lot of pressure on myself to make this a special holiday for my dad and grandma, worrying on some level that it might be our last. And then it unraveled.
I may share more about our Covid Christmas down the line, perhaps in an essay about the futility of expectations. But for now, I’m leaving my disappointment in 2022, where it belongs.
This week’s newsletter features an interview with a nursing-home psychologist. I got a lot out of our conversation and hope you do, too. I’m excited to be back!
Talking With a Nursing-Home Psychologist
What’s it like to be, say, 90 years old? To reflect back on your life and think, “Wow, I did good,” or to grieve the loss of your independence? “It’s a privilege to get old,” we say, but how much do we really know about the interior lives of our elders?
A few weeks ago, I spoke with geropsychologist Pat Tomasso, Ph.D., to get some answers—or at least some perspective.
Dr. Tomasso has been working with older adults for nearly three decades, since landing a position by chance at a nursing home. “I didn’t know whether I had an affinity for the job, but I realized quickly that I did,” she tells me over Zoom. She went on to practice at the facility for 18 years. Today, she’s president and clinical director of Aging Matters Psychological Services, a company she founded to hire, train, and supervise psychologists for long-term care facilities. She also continues to treat residents herself.
“I’ll go to a cocktail party and tell somebody what I do and they look at me with pity, like, ‘Oh, that must be so depressing,’” Dr. Tomasso says. “But it’s the opposite. When you can sit down with somebody and enjoy their company and listen to them tell their story and learn something about yourself in the process—I mean, what’s better than that?”
Below is an edited and condensed version of our conversation.
Do you see every new resident who comes into a home? Or how does that work?
No. In fact, that’s considered Medicare fraud. At the nursing home that I worked at for 18 years, for example, they had a very airtight system. Any of the staff could recommend that somebody be seen, but the referral was funneled through social work.
What might prompt a referral?
Usually a resident comes in with a diagnosis—they’re on an antidepressant or an anti-anxiety medication—or they’re exhibiting [concerning] behaviors. They’re noncompliant with their meds or their plan of care. They’re amotivational, so they’re not interested in participating in activities. They push people away. That’s not a time to go, “Okay, we’ll let you sit in your bed and not do anything.”
Do you get patients who are resistant to help?
It’s like any other patient—you always have to find a way in. I did treatment with this woman for a few months. She was an old Italian lady, and we talked about recipes a lot. That’s how I made the connection. I remember her saying to me, “I’ve never done this before, and I never would have thought that I would like this—but I’ve really liked this. Thank you so much.” I was very touched by that. She didn’t necessarily come across as somebody who was going to benefit because she was so skeptical.
What else is challenging about this demographic?
When people think they’re too old. They give up on themselves emotionally. That’s frustrating. I just want to shake them and say, “You’re still alive! Do you want to still be alive?” Sometimes they’ll say to me, “I just want God to take me.” So I’ll say to them, “Before or after dinner?” And they always crack up. If they’re really serious, they’re going to say, “I don’t care about dinner. I want to die.” The laugh tells me that they don’t mean it. That’s simplifying it, I know, but I try to use humor with people.
Do you treat residents with dementia? If so, what’s that like?
I’ve heard people over the years say, “You can’t work with anybody with dementia, right?” And the answer is, “Wrong.” It depends on the person and it depends on how far the dementia has gone. I’ll give you a really interesting example. A social worker referred this woman who was using racial slurs to the people of color on staff, and it was causing a lot of consternation and hurt. I didn’t know what [the patient] was like before she had dementia, but sometimes you do see a flip in personality, so somebody who was sweet and kind, through their Alzheimer’s, will change.
So I saw this woman, and she was pretty demented. It was hard to get through, but I realized that she liked to drink coffee, so our session consisted of taking her off the floor and going down to an area that was empty, where we could have privacy and sit at a little table and have coffee for 45 minutes.
She was able to talk about her family and her life to some degree, and she used to be in the restaurant business, so I tried to draw her out about how she treated her staff. And then I would say, “Wow, that’s really great. You sound like you really cared about your staff.” We’d sometimes have the same conversation over and over, because that’s what happens with dementia—but she stopped yelling at the [nursing home] staff.
I always tell that story to the people who interview with me, because they think they’re going to come in and use Freud or they’re going to be very erudite—and all that shit goes out the window when you’re working with dementia, when you’re working with older adults who just want to talk.
How did Covid impact your work?
I had to call all of my psychologists and say, “Stop going in. We just got permission from HHS [the U.S. Department of Health and Human Services] to do teletherapy.”
All of my psychologists were wonderful. Some of them loved it, some of them didn’t like it, but they did it, and they found a way to connect with their residents. Because these people were all upset: Why are they shutting things down? Why can’t my family visit? What’s going on? Why are all these people dying? Why are they coming in with masks? All of this stuff was creating more problems than had existed with residents, so we all got more referrals because of that.
I don’t think we’ve really come to terms with how tragic that period was for nursing-home residents in particular.
They were all isolated. And I saw people just go from here [puts hand above her head] to here [puts hand down]. Way down. It was very sad to behold. Very sad. And still is. It’s not as bad. But it’s been an ongoing thing.
Loneliness is an epidemic among older people. How do you see that manifesting in your clients?
I see most of the loneliness around Covid. Because a lot of people who go into assisted living and nursing homes are not that lonely, because they’re in a social setting. The ones that are lonely are often the ones who isolate themselves—they’re not forced to isolate. They just don't want to go meet people. And that’s a problem. We are social beings.
Why might an older person self-isolate?
So many times I’ve heard from nursing home residents—I’ll say, “So tell me about your friends.” They’ll say, “Well, I had this one, but she died. I had this one, but she doesn't want to come visit because she’s afraid of nursing homes.” They’re lonely for the people that were in their lives. Sometimes they’re lonely for their relatives, because sometimes they don’t get along with their kids. And the ones who don’t, the kids don’t necessarily come to visit as much.
How do you help them come to terms with a kid who doesn’t visit?
They’ll say, “They never call me.” And I’ll say, “Do you ever call them?” Oh no, they should call me. And I’ll say, “Well, you can take that stand and never hear from them. Or you can swallow the pride a little bit, pick up the phone, say, “How are you doing?” and see how it goes. Because sometimes your kids are depressed and they don’t wanna pick up the phone.
Many older people struggle with loss of independence. How can caregivers, whether they’re paid or not, help with that?
To me it boils down to empathy—putting yourself in someone else’s shoes. And I do staff training about that. Because residents often feel like the staff isn’t able to [empathize] well enough. If I’ve just lost my husband and my home, and they took the car keys away and I can’t walk because of x, y, or z—that’s a boatload of loss. I don’t want somebody to come in and say, “Come on! What’s the matter with you?” I’m struggling. I need you to understand that.
A lot of the work of running a nursing home is making sure that the people who are on the front lines are able to have empathy.
What might you say to an older person who’s struggling with loss of independence?
Independence comes from you. Alright, so you can’t drive anymore. Your husband’s gone. You can’t walk. But I always say, “You’ve still got this” [points to head]. And this is what makes anything happen in your life. You don’t have to talk yourself into feeling like you don’t have any independence.
It’s really about trying to help them find a new way to be independent. You can find a little bit of independence by getting to know someone down the hall. Then you become friends. Then you two meet somebody else. Now there’s a clique. And you eat lunch together.
In a nursing home, there are people who are more independent than others. And it’s not necessarily all the people who are ambulatory—sometimes it’s somebody in a wheelchair who can’t wheel it.
In other words, they may not be able to handle their own showering or this or that, but they can decide, “I’m going to bingo today.” And that’s an act of independence.
Yes. “I’m going to listen to the musician come, and I’m going to ask him to play x, y, and z.”
What has doing this work taught you about how you want to age?
I want to continue staying connected to the family I choose. So, keeping close to me the people who I truly find endearing, and pursuing them and caring about them. Being there for them when they need me to be. And I hope that some of those people will do the same for me—I know some of them will. And that will help me to feel better as I get older. But I want to keep this [points to her head].
Your mind?
I need to keep that. If I can just keep that, there’s a lot I can do without.
How would you describe the prevailing attitude towards aging in the U.S.?
It’s terrible. People are so ageist. I see it in my own family. I want to slap any niece or nephew—or son—who says to me, “But I told you that already.” Or, even worse, “You already told me that.” I say, “Yes, maybe I told you already—I talk to a lot of people, and I don’t keep record of what I say to whom when it comes to storytelling. So cut the crap.” There’s a lot of ageism, and it’s something I call people out on all the time.
What do you wish people understood about aging?
It’s not something to be dreaded. Yes, you’re going to lose some of your beauty and some of your intellect and some of your mobility. But the majority of older adults I’ve worked with, they’re not afraid of dying—and they like themselves. People who look down on aging don’t spend enough time with older adults.
What can younger people get out of spending more time with older adults?
Wisdom. “Don’t sweat the small stuff, honey,” that kind of thing. You tell an older person a story, and they’ve been there, done that—and come through. They’ve jumped through a lot of hoops, they’ve dealt with a lot of anguish and loss, and the ones who have the fighting spirit come through and are breathtakingly wonderful.
Spend time with the older people in your life. Continue to use them as elders who can help you. Because they want to help you. They want you to be happy. And there’s so much they can teach you if you’re just willing to listen. Even if they repeat themselves.
Bonus: Song Lyrics From Dr. Tomasso
In addition to being a geropsychologist, Dr. Tomasso is a singer/songwriter. She sent me the lyrics to one of her songs, “Reservoir,” which she gave me permission to share here. You’ll see how her work has influenced her songwriting, which I appreciate.
Reservoir
Lyrics & Music by Pat Tomasso ©2016 All Rights Reserved
Life is a very long minute
With many episodes packed in it.
Life is a very long minute
With many crossroads tracked in it.
Why are certain memories so painful to behold?
Is it just a side effect of growing older?
A jolt of recognition for a slice of life that’s past?
Or a desperate bid to make the moment last?
Is it a reminder that I cherished the time?
Or that I failed to honor fully what was mine?
What was too much to grapple with once upon a time
Is now a reservoir to tap, a source of the sublime –
scenes worth reliving, gifts that go on giving
where emotions past and present intertwine.
If I ever lose myself inside a tunnel of decline,
If I ever lose the way to know what’s mine,
Please understand my need to live within the past
And join with me to help those moments last.
What was too much to grapple with once upon a time
Is now a reservoir to tap, a source of the sublime –
scenes worth reliving, gifts that go on giving
where emotions past and present intertwine.
Life is a very very long minute
With many, many episodes packed in it.
Life is a very very long minute
With many, many crossroads tracked in it.