1. Jacobson, Joy Managing editor

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It was late February when I accompanied my 80-year-old mother, Doris Jacobson, to Al'z Place, a dementia day care in Gainesville, Florida, where she lives with my father, Ronald, her caregiver. That morning, at a large, circular table, she sat with Susan, Paul, Edie, and Louise. Most of the clients have Alzheimer disease; a few, like my mother, have Lewy body dementia. All have memory impairment. They sat quietly, eating doughnuts, having just completed a 48-piece jigsaw puzzle.

FIGURE. Jean Wood, B... - Click to enlarge in new windowFIGURE. Jean Wood, BSN, RN, coordinator of Al'z Place, a dementia day care in Gainesville, Florida, walks with a client as a flock of migrating sandhill cranes passes overhead. Says Wood, "Our clients return home every evening. They're back in their security, back in that unit. So many of our caregivers say to us, 'We'll do anything to keep Mom at home.'"

As an editor at AJN, I've observed that the best nursing, like the best editing, is often undetectable, yet as critical as a cardiac muscle. Jean Wood, BSN, RN, who at age 56 has been a nurse barely 10 years, is the very strong, and very wise, heart of Al'z Place. "With memory impairment, there's such a loss of independence," Wood says. "At Al'z Place we modify the environment to meet their needs, but society doesn't do that."


Wood talks a lot about society's obligations toward the elderly, but she's no sentimentalist. Rather, she has borne witness to the splintering that can occur in families who can't care for aging parents. "If you can keep the family together, then the community is strong and the nation is strong," Wood says. "The way to do that is to provide services to those in need in their homes or in the least restrictive environment. Our clients return home every evening. They're back in their security, back in that unit. So many of our caregivers say to us, 'We'll do anything to keep Mom at home.'"


The daughter of a woman who entered psychiatric nursing after raising children, Wood married young and reared two sons (one of whom is now an orthopedic nurse). She also worked for 22 years at the University of Florida's Naval ROTC unit, a job in which she took on many roles, including that of "substitute parent" for the students, gaining the patience, she says, to work with older adults. When her youngest boy left home in 1986, she entered community college, and when her mother-in-law was diagnosed with Alzheimer disease in the early 1990s, she determined to learn all she could about memory impairment.


Wood says her mother-in-law's initial signs of dementia, although harmless, were frighteningly uncharacteristic-she used twist ties as barrettes and tried to tip the priest after mass-and as the disease progressed Wood was instrumental in her care. In 1994 Wood resolved to become a nurse-a decision that led to the end of her marriage (her husband "was very threatened" by her independence, she says). In December 2000, shortly before earning her bachelor's degree in nursing at the University of Florida, she saw a newspaper advertisement for an "Alzheimer's disease initiative coordinator." Within a month she was in the position. She now lives alone, works full-time as coordinator of Al'z Place, and is enrolled in the online graduate program in psychiatric-mental health nursing at the University of South Alabama.


In the moment with them.

Housed in a specially designed hall of the First Christian Church in Gainesville, Al'z Place was founded in 1987 and maintains a strict 3:1 client-staff ratio. Wood is the staff RN, case manager, and coordinator; Judy Johns, a certified therapeutic recreation specialist, designs "failure-free" activities; two full-time and two part-time certified nursing assistants act as "therapy aides"; and a host of volunteers from the First Christian Church assist on a regular basis (Wood refers to them as "Al'z Angels"). Meals on Wheels brings lunch daily. There's a monthly support group for caregivers, as well.


"Most people think that if you have memory impairment you can't learn new things," Wood says. "And we absolutely go against that." She and her staff work vigilantly to ward off the despair that can accompany degenerative illness. And they succeed in this-despite the incontinence, confusion, delusion, and physical debility these diseases can produce-by stimulating their clients cognitively, physically, and socially. They may be elderly and frail, but these people can sing, share a meal, toss a balloon, reminisce, stroll in the sunshine. "They are in the moment and we are in the moment with them," Wood says. "If in the moment they are in Virginia, talking about things that happened when they were 20 years old, we go there with them."


And they do it with respect. "We never talk about Alzheimer's disease with our clients-ever," Wood says. "We're a club." For example, if a client says that she is an employee at Al'z Place, that's just fine. In fact, Wood says, the "higher-functioning" clients can help out others during the cognitive activities.

FIGURE. Doris Jacobs... - Click to enlarge in new windowFIGURE. Doris Jacobson, a client at Al'z Place and the mother of

"Medicare should cover this," Wood says, but it doesn't. In addition to private donations and clients' sliding-scale copayments, Al'z Place receives funding through ElderCare of Alachua County, a part of Florida's Department of Elder Affairs, which is managed by Shands HealthCare, at the University of Florida. Twenty or so people are on a waiting list at any one time; clients are selected as spaces open, according to a "lower-function-first" standard.


That day in February at Al'z Place was the first time I saw my mother in a wheelchair. She was so pleased that I was there, taking her picture and talking with her friends, that I didn't panic at the sight. I could see that my mother was all right. She has been a painter, a gardener, a letter writer, a reader, a jazz aficionado, a volunteer, a friend to many: what she has lost can't be measured. Still, she has gained something at Al'z Place. Jean Wood and her staff make sure of it. That morning my mother tossed a plastic bowling ball and knocked over a few plastic pins. And when her friends broke out in uproarious applause, she laughed and laughed and laughed.