Senior Living Story: Neal - Part I

To look at him, seated at his kitchen table reading the newspaper, calm and undisturbed, Neal appeared to be a healthy, strong man. He was oblivious to me and it was only as I spoke to introduce myself that this mountain of a man raised his eyes. 

“Hi Neal. I’m Cortney.” I smiled, extending my hand.

His blue eyes shone as he studied me - so intense that, for a moment, my breath caught. A few beats of silence passed while he decided whether I was worth engaging. Then, Neal got up from his chair and gave me a strong handshake. 

“Who are you?” he asked. He towered over me at six and a half feet tall, coming in at somewhere around 250lbs. A shock of whitening hair was the only give-away that this seventy-five year old, former NFL star and marine corps vet, might not be closer to his mid-fifties. He wore cargo shorts and top-siders, and looked every bit the retired sailor, save only the odd layering of too many shirt collars sticking out from under his polo.

“I’m a friend of Catherine’s,” I said, gesturing to his daughter. She hovered a few feet away.

“My name is Cortney, and this is Pat." My Director of Nursing stood beside Catherine in a floral, tunic blouse and offered a friendly wave. "Can we visit with you for a bit?”

Neal had been diagnosed with Lewy Bodies dementia, one year prior. His daughter, in her late forties, was his sole care-taker. She also worked full-time and was preparing two children for college while navigating a nasty divorce. 

“It’s just too much,” she’d confided during our first meeting. “The stuff with Dad…it’s not good.” She told me about his recent displays of aggression. “It’ll just happen out of nowhere. One minute, he’s fine - happy. The next, he’s angry about nothing – yelling and throwing things across the room. Sometimes, he wakes up from a nap and I think he's still dreaming. It’s like he’s back on the battlefield, or something.” Like her father, Catherine was a Marine vet. She was tough. But, she was drowning under the weight of everything happening in her family.

“Do you think you guys can handle him?” A quilt of hope and uncertainty was stitched across Catherine's face.

Rightfully so, I thought. While my community specialized in providing memory care, Neal presented a unique challenge. Aggression and hallucinations are common enough in Lewy Bodies, but Neal's professional history - both as a military man and as a pro athlete - meant that his predisposition to physical aggression was higher than most. And, despite his age, he still possessed the strength of body and physical stature to actually hurt someone, if he wanted to. 

“I'm not sure yet,” I told her in earnest. "I need more information." But, I was hopeful. After all, working with people with dementia was what my community and team were built for. And she’s been successful in caring for Neal. I told her the best thing would be for Pat and I to come out and meet him in person. And, so there we sat, in Neal's kitchen.

“Woo! You have a mighty strong handshake, Sir.” Pat smiled. “You know, my dad always told me you can tell a lot about a person by their handshake.” Neal tightened his grip in response and Pat feigned dramatic defeat. “Give! Give!” she said, turning her face up in mock-agony. Neal chuckled, seeming to enjoy the theatrics, and I laughed - impressed as always by Pat's bedside manner.

“You wanna go in the leftover side?” Neal said, training his eyes on me, once again.

I looked at him for a moment, confused and wondering if I’d misunderstood the question. I glanced at Catherine, who had busied herself rearranging a stack of newspapers on a nearby end-table, then at Pat, and finally back at Neal. “I’m sorry, what?” I said.

“In the leftover. You know there’s a bear out there.”

Without looking up, Catherine interjected. “Dad, why don’t you tell them what you like to watch on TV?”

“Oh." Neal chuckled. "Well, you know…” He struggled to come up with the words. 

“Do you like Survivor?” she prompted. Neal looked at his recliner and chuckled again. “You like Survivor, don’t you Dad?” Catherine rephrased for him.

“Oh sure,” He said and resumed his seat at the table. I settled into a chair beside Neal. Pat and Catherine grabbed seats opposite us. 

“How long have you lived in this house?” I asked, curious as to the extent of his aphasia. Neal looked at me blankly. I decided to follow his daughter's example and try something simpler. “Catherine tells me she has two older brothers. Are they all marines, like you?” 

A small chuckle and then, “Yea.”

“What are their names?” I ventured. Pat would need an idea of Neal's recall anyway, and making conversation would pare down the length of the more formal assessment. 

“Under the bastards will try to kill you,” Neal said. His eyes had suddenly changed. They weren’t twinkling with humor or mischief, now. 

“What bastards?” I asked, trying in vain to infer what he might actually be trying to tell me. 

“The ones from the iron grade. Yep, come watch out.” Neal put a large paw on top of mine. 

“Ok, I’ll do that,” I said.

Neal eyed me intensely. “I’ll take their fuckin’ heads off.” 

I glanced at Catherine.

“He’s back in war-time, now,” she interpreted with nonchalance.

I trained my eyes back on Neal and smiled reassuringly. “Well, hopefully it won’t come to that." 

“It’s just a big center. You know how to go outside?”

Pat interjected. “Neal, I hear you’re quite the fisherman. What kind of fishing do you do?”

But he didn’t go for it. “You gotta ring the outside and kill those bastards,” he said, blue gaze fixed on me.

“Is it lake fishing or deep sea fishing?” she persisted

Neal stared at me, completely ignoring Pat, waiting for my response with brows furrowed. His expression said, Aren’t you fucking listening to me?

“Dad, why don’t you read one of your magazines?” Catherine slid the local Park District newsletter across the table in one, fluid motion. Neal’s eyes immediately fell to it. He picked it up and began flipping through the pages. Catherine propped her chin in one hand with fingers pressed gently to her temple as if to say, That’s how it’s done.

An hour later, Pat had completed her assessment and we'd said our ‘goodbyes.’ Catherine helped to fill in the blanks of her father's personal and medical histories, and day-to-day routine. By the time Pat was scribbling the last notes of her assessment, Neal was showing me around his house and chuckling. He pulled me, and then Pat, into big bear hugs as we turned to leave. Catherine followed the two of us outside.

“I’ll be right back, Dad,” she called over her shoulder. She closed the front door and the three of us stood in a loose huddle halfway down the sidewalk.

“So, what do you think?” Catherine said.

I looked at Pat, giving her the floor, but hoping that she felt as encouraged by the visit as I did. Regardless of my being her boss, I trusted her judgment. And, while I might have debated the issue with her, I would ultimately never have overruled her expertise if she felt Neal was unmanageable.

“I think we can do it," she started, smoothing her short, greying, but otherwise black hair behind one ear. Inside, I did a silent cheer. "I think we need to have a very strategic game-plan in place. We’ll need to make sure the team understands the best ways to approach and redirect Neal, but after meeting him - seeing the way you interact with him, and the response you get - I feel good about it.” Catherine looked hopeful as she glanced from Pat to me, and back. “The hardest part will be his initial transition. It’ll be a brand new environment with a lot of new faces. It tends to be disorienting for everyone, at first. That’s why I wanted to get as much detail as possible from you, about his day-to-day routine here at home. We’ll want to try and replicate as much of that as possible.”

Catherine nodded, as if to say, That makes sense. 

I knew Pat well enough to know that if, without discussion, we were in agreement about a transition strategy, she likely also felt the way I did about preparing for the possibility of exacerbated behaviors. I added, “We’ll also want to have a contingency plan in place - just knowing the type of dementia your dad has and that there is some aggression in his history. For those first two or three days, while he’s getting used to new surroundings, we'll ask you to be on stand-by to come in – even stay a night with him - just to provide extra reassurance if he needs it.”

Pat nodded, but Catherine looked at me like a deer in headlights.

“I’m not saying he's going to need it, but sometimes it can be helpful to have family around and I just don't want you to panic if you get a phone call from us. This is normal," I reassured her. "The first few days are hardest for everyone, and it’s better to have a plan and not need it.” 

Catherine nodded. “OK. Let’s do it.”

A week later, Neal moved in. It went better than expected. The team was prepped on ‘do’s and don’ts’: “DO ask, suggest, and encourage. DON'T order, command, or force. DO back off if he seems to become agitated, frustrated, or angry, etc.” They knew his likes, his dislikes, and his routine. It was just a matter of seeing how Neal responded to the new environment, and responding to him in turn.

His first night, he didn’t sleep. But, he didn’t fight or get aggressive either. I’ll take it, I thought. He didn’t object when Catherine dropped him off and he even ate a good portion of his dinner while chatting up other residents in the dining room.

But, at two am, the ring! of my phone jerked me awake. I tried to ignore the slight pang of adrenaline I’d come to associate with the sound as I fumbled for the glowing rectangle in the pitch dark room.

“This is Cortney,” I answered, propped up on one elbow and trying to sound less groggy than I felt.

“Hi Cortney. It’s Latrice. We got a situation here.”

“Hi Trice,” I said through half-opened eyes. “What’s going on?”

“It’s that new resident – Mr. Neal.” She raced through a smattering of details I couldn’t quite follow.

“What do you mean the CNA’s are hiding?” I asked, reaching for the bedside lamp.

“They hiding from Mr. Neal. They hiding in empty apartments.”

“Why?” I swung my legs over the side of the bed and sat up, absently massaging my temple as I listened.

“He was chasing them. He threw a boat at Amber’s head.”

“A boat?”

“You know, one of them little wooden ones?”

“Like, a decorative one?”

“Yea. He went to sleep on one of them couches – you know, in the big living room? But, I guess he musta took all his clothes off first ‘cause Amber found him layin’ there naked.”

“Uh-huh.” I smirked at the mental picture.

Latrice went on. “I told her to put a pull-up on him in case he wet the bed, err – you know – have a accident on the couch. But, he musta felt her tryin’ to put it on him ‘cause he woke up and start swingin’.”

“Oh boy…”

“He threw the boat at Amber and started chasing her. So, she and the other girls – they hiding. I’m out here because someone has to be, but it’s not feeling very safe. He is a big man.”

I sighed. “I get it,” I started. “Is Amber OK?”

“Yea, she fine. Just scared. She took off quick when she saw him comin’ at her.”

“That’s good.” I paused to think. “How are you doing? Do I need to come out there?”

“No, we OK. I just wanted you to know what’s going on. I wasn’t sure what you want me to do.”

I nodded to no one in the dark of my room. “Gotcha.” Latrice was a good nurse - seasoned and level-headed. I was grateful she was the one at the property. “Where is Neal now?”

“Uhhh…I’m not sure.” She paused. “Hold on.” I waited for her to check the resident-tracking software - commonly compared to "the Harry Potter map." “Looks like he in the 200 hallway.”

“Is he moving?”

“I don’t think so. Wait – he might be walking around.” I could imagine the little dot that represented Neal, slowly moving down the virtual hallway in little blips - probably unsure of where to go or what to do next.

“Ok. Well, whatever he’s doing, it doesn’t sound like he’s still running after anyone.”

“Oh no. Like I told you – they ain’t no one out for him to chase, now,” Latrice reminded me.

“Right. Well, first things first – I’m glad everyone is OK. And, I do understand Amber and the others being a little scared. If a 6’5 naked marine chased me down the hall in the middle of the night I’d probably be scared too.” Latrice chuckled. “I don’t want them to feel unsafe. But,” I paused, “we also have to remember that this is Neal’s first night with us. Everything is new and he probably doesn’t even remember how he got there or where he is. I’m trying to think how I would feel if I woke up in a strange place – naked – with a stranger’s hands on me. I think I’d start swinging too.”

“That’s true,” Trice said. 

“I think the only thing we can do right now is just let him have his space. Just have everyone keep their distance for the time being. He doesn’t have any nighttime meds does he?”

“No,” she confirmed.

“OK, good.”

“But what if the other residents wake up and see a naked man in the hallway?”

“Oh yea, he’s still naked isn’t he.”

She chuckled again. “Yes.”

“I’d say, still give him a little time and then, if you’re comfortable in like a half hour or so, go offer him a robe. Maybe he’ll even let you guide him back to his apartment and sleep in his bed. I don’t remember him having any incontinence issues, so as long as you can get him in sight of a bathroom, having an accident shouldn’t be a problem.” 

“OK,” she said. “I’ll check on him in a little bit.”

“Thank you, Trice.” I remembered the CNA’s. “The girls have to come out of the apartments, though. They can’t be hiding out all night. We’ve got sixty other residents who need their attention.” 

“OK, I’ll let them know.”

“I appreciate it.”

“OK, have a good night Cortney.”

“You too, Trice. Call me if you need anything else.”

Three nights later I adjusted my schedule and came in, to see for myself, how Neal and the night shift were acclimating to one another. I’d caught wind of some commentary that he was still wakeful at night, though no behaviors had warranted another midnight phone call to me.

At 10:15pm I arrived at the community, dressed comfortably in yoga pants and tennis shoes. I stashed my purse and keys in my office and made my way down to the nurse’s station. The hallways were dark aside from some muted track lighting, just bright enough to find my way without bumping into an odd piece of furniture. The night shift should have arrived at 10:00 and completed their shift-change report with the afternoon shift by now.

At the end of the hall, the dining room and nurse’s station were brightly lit. Trice stood talking with one of the assistants. Two other figures sat at a nearby table. Otherwise, the large room was empty and the building, quiet. 

As I drew nearer, it became evident that one of the seated figures was a resident - hunched over the table, with feet tucked under the chair and face buried deep into his arms. The broad shoulders and silvery crew-cut told me, This is Neal. 

Tamara, a petite, timid, girl in glasses, sat across from him, hands in the pockets of her zip-up hoodie. 

I’d be lying if I said a pang of nervousness didn’t flutter in my gut as I approached. I’d developed a fair amount of skill in the years spent working with residents, and I had solid knowledge of memory loss, but every person's dementia is a unique case, and I honestly didn’t know how the night might play out. It would have been easy to just stay at home. After all, I’d received no other phone calls. There was nothing that said I had to be there. But, I couldn’t shake the memory of Catherine’s face, on the day she’d stood in her father’s driveway and agreed to put her trust in us. I wanted to make good on everything Pat and I had promised. And, if our newest resident still wasn’t sleeping through the night, something told me I should be on the floor investigating why. 

“Hey, Guys,” I said, walking up.

“Cortney!” Amber turned her wide smile and round cheeks away from Trice, mid-conversation. 

Tamara too, from her seat at the table, smiled and said, “Hello.” 

“What are you doing here?” Trice asked, looking pleasantly surprised and reminding me that it was the first time I'd done a "pop-in" since she was hired.

“I just came to check in on you guys. See how everything’s going.” I hadn’t mentioned that I’d be coming, preferring not to have some “prepared” version of things performed for me. “I get to see days and PMs all the time, since I’m already here, but I don’t get to see you guys as often.” They all nodded, pleased with the explanation. “So,” I prompted, “how is it tonight?”

“Pretty good,” Trice said. “No major issues, other than Neal.” She nodded at the sleeping resident. “The day-shift nurse left notes that he’s been fighting her on taking his morning meds.”

I nodded. I'd been made aware of the issue in my daily Manager's Meeting. And, it made sense. I'd be less agreeable to taking anything from a stranger if I was grumpy and poorly rested. “Is there any reason why he’s asleep out here instead of in his room?”

“He won’t go to his room,” Trice answered.

I felt my brows knit together as a lineup of questions began to form in my mind. “Well, what time has he typically been going to bed?”

Amber chimed in, her ceaseless bubbliness slightly tempered. “He hasn’t been.”

“What do you mean? He hasn’t slept in his room at all since he’s been here?” All three heads shook in unison. I looked at poor Neal, fast asleep at a dining room table for what looked to be the fourth night in a row. “Has anyone tried to get him into bed tonight?”

“I tried earlier,” said Tamara, adjusting the thick, black-rimmed glasses on her face, “but he wouldn’t go.”

“After he fell asleep here, we’ve been afraid to wake him,” said Trice. 

Their faces told the story clear as day. Of course they were hesitant to wake him. Look what happened the last time. I nodded. My eyes drifted back over to Neal. This bear of a man, dressed in four layers of shirts that he’d put on himself - looked so lost in his new “home.” 

“I get the hesitancy – I do,” I said. “But, we’ve got to figure out a way to do better for him than this.” I waited for a response, but no one spoke. “He is in a totally unfamiliar place with no idea why, or how he got here.” I considered the medication refusal. “It’s no wonder Barb is having a hard time with meds. If he’s up all night long, that can’t be doing much to help his mood or confusion by the time she gets here. Why would he take something he doesn’t recognize from a person he doesn’t know?” 

Before anyone could speak, I gestured to Neal in one, sweeping motion. “Look at him.” Their collective gaze found its way to the sleeping resident. “He is lost. He doesn’t have a friend in the world here. Doesn’t recognize any of this as ‘home.’” I decided the best thing was to be earnest. “I know it’s scary because of what happened the other night, but we have to do better.” Amber and Trice looked at me with hesitation etched into their features. “It is our job.” 

No one spoke, but I could see their next thought collectively forming and responded in-kind. “Where else is he supposed to go? He can’t go back home. He’s here because that wasn’t working. We’re specialized in dementia care and in our knowledge of this disease. Every single person here has had training. So, what else can we do for him, that might help him acclimate?” 

Still, no response. “I’m not looking for a magic bullet,” I said. “ I’m just asking for ideas.”

After what felt like an eternal pause, Trice finally spoke on behalf of the group. “We don’t really know,” she admitted, cautiously. 

I blinked at them. Well that changes things. It was suddenly clear that, at least where Neal was concerned, there was a disconnect between what had been learned in the classroom and how to apply it in real life.

“OK,” I said. “Well, I’m gonna try some things.” I started down the dim hallway toward Neal’s apartment. “I’ll be back,” I said over my shoulder, and they watched me disappear into shadow.  

Neal’s room was pitch dark, as I entered. The door had been left open, But who, I thought, would walk into a random, dark room and think it’s a place they belong? I flipped on the overhead light. In the fluorescent glow, all of Neal’s most personal belongings looked sterile. His daughter had decorated the small studio to feel reminiscent of home, but the photographs of family, stacks of newspapers, and lovingly stitched throw-pillows couldn’t overcome the cold, lonely ambiance of the space. It wasn’t a huge wonder that Neal had rejected it for the common room's couch. At least our living room area had been staged to feel like a home. 

I didn’t have any relatives who’d personally suffered from dementia, so I couldn’t put myself in the shoes of doing for Neal what I’d have done for that person - the way so many people in my field, did. All I could do was think about what might make me feel OK about going to bed in a place that felt so unfamiliar and unwelcoming. 

I set to work on the room, turning down the covers on Neal’s double-bed, switching on his bedside lamp, and dousing the overhead light. I flipped on his television and set it to low volume. I seemed to remember Catherine mentioning that it was his routine to read the paper and then watch TV in bed. I folded a paper on Neal’s nightstand and tucked a pair of slippers just under the bedside.

In all honesty – nothing I did was rocket science. They were little things. And, I didn’t know for sure whether any of the changes would really have an effect on Neal’s willingness to sleep in this room. But, it felt homier to me, and I figured I had nothing to lose by trying. 

Neal was in the same spot I’d left him in when I returned to the dining room. Trice was in the med room punching pills out of a card for Irene, who had gotten up and was wandering the dark halls. Amber was off responding to a resident call-light.

“Hasn’t moved?” I asked Tamara, nodding at Neal. 

She shook her head. “What are you gonna do?” She watched me eyeing the sleeping giant.

“I am trying to decide on the best way to wake him,” I said, more thinking out loud than instructing. I decided just to go in slow, and gently try to rouse him. After the boat incident, I was cautious to avoid startling him. I placed a hand softly on his shoulder, stacked in a tall, muscular hunch over his forearms. I positioned my stance wide so that I could lean closely to Neal, but also quickly step backward out of his way if he stood up swinging. 

“Neal,” I said softly. He didn’t stir. 

I ventured a few inches closer to his head of thick, silver hair. “Neal,” I repeated with a gentle shake of his shoulder. He began to move. Tamara got out of her chair and moved a few feet back from the table. I kept my hand in place but shifted my weight to my back foot. Then, Neal was still, again. 

The third try did the trick as I gave Neal one final shake and a slightly louder beckon. He sat up groggily in the chair and I backed up just a step, not wanting him to wake and see a stranger standing too close. 

“NEAL,” I called again as he squinted around the room, his eyes adjusting to the brightness. I couldn’t tell if he’d heard me or not. I moved to stand more directly in his line of sight. “Neal,” I said, this time with a small wave. His head whipped, his bloodshot eyes locking on me. 

“Hi Neal,” I said, smiling warmly. He blinked for a moment, working to focus his tired eyes and determine if I was someone he recognized. After a beat, he seemed to decide I was ‘OK’ and returned a smile. I bent into a half-squat, guessing that his smile meant I was safe to get a little closer. 

“How are you doing?” I asked, now at eye-level with the lumbering Marine. Neal mumbled something I couldn’t understand. “What’s that?” I leaned a little closer, but he didn’t repeat himself. His eyelids sagged heavily with exhaustion and I decided the best thing to do was to take the lead and try to keep the momentum going toward getting him up. 

“Are you tired?” I placed my hand gently on top of his. He jerked his head up and I could see the effort it was taking just to look me in the eye. 

“Hi,” he half-sighed.  

“Hi,” I mimicked with a small chuckle. Neal was endearing to me, and suddenly I felt sure he wasn’t going to give me a bad time. “Hey,” I said, moving to stand beside him. “Why don’t we go to bed?” His head turned to search for my voice but he didn’t move to rise from the chair. “Can you stand up for me?” He looked at his lap as if he understood, but still did not move. The man was so exhausted, it was clear he was going to need some help. 

“Tamara,” I called. “Can you help me pull his chair out?” Tamara was by my side in an instant. She looked uneasy, but together we slid the dining chair a couple of feet back from the table so that Neal would have room to stand. “Thank you,” I said, one hand still perched on the man’s slumped shoulders.

“Neal,” I got right in his ear and gave a more direct cue this time, “Can you stand up?” He began to move, lifting his head and instinctively raising his arms. “That’s good - hold onto the armrests. Yep – just like that.” I quickly checked that his feet were flat on the floor and with a quick adjustment, made sure they were stacked directly beneath his knees. “Great job, Neal. Now, scoot forward, just a little bit. Yep – keep holding onto those armrests.” I watched until he was seated at the front of the chair and then gave the cue to rise. “OK Neal, push up off those armrests as you stand. That’s right – push straight up.” I kept one steadying hand on his back. 

Neal wobbled for a moment and Tamara stepped in to steady him from the other side. “Ya’ alright?” I turned to face him, happy to have gotten this far without issue, and grinning like a fool as I patted his shoulder. “Nice work, buddy.” We paused while Neal’s body got acquainted with standing and I mouthed another, "thank you," to Tamara. 

“You’re welcome,” she said in her quiet way, looking as surprised as I was elated.

“Ya feeling OK?” I asked the man, not wanting to rush him to walk until his balance was solid. “We’re going to go get you ready for bed now.”

His response was unintelligible, but he waved his hand and then began to shuffle away. Tamara and I exchanged a look that mutually asked, Now what do we do?

I had an idea. I approached him as though he were my oldest friend in the world. “Hey Neal!” I said cheerfully. “I was just about to take a walk. Do you wanna take a walk with me?” I stood beside him, looped my arm through his, and gave his arm a gentle tug. He stared, silently at me. “C’mon,” I prodded, giving his three shirts and additional tug. "Catherine called and asked me to stop by and see you.”

“Catherine?” He perked, wearily.

“Yea!” I gushed. 

“Catherine called you?”

I didn’t want to lie, so I reached for the closest truth I could think of. “She asked me to come in and check on you. Make sure you don’t need anything.” He processed that for a moment. 

“Catherine is coming here?” he asked.

“I think she’ll be coming to see you in the next day or two,” I said.

I could just make out, “She’s not coming now?” through Neal’s word-salad.

“It’s too late, now.” I gestured to the dark windows. “It’s the middle of the night.”

Neal mumbled a response I couldn’t understand, aside from the words, “go home.”

“I understand,” I said, brows knitting into a thoughtful wrinkle. “I just don’t have a way to get you home at this hour. But, I do have a place you can sleep for the night." Neal stood quietly and I couldn’t tell if he was processing or trying to piece together the bits of recent memories that were within his reach. I tugged on his shirts, again, and offered the warmest smile I had. This time, Neal smiled back and began to take steps with me.

Now that we were in motion, I just had to keep him in motion. I glanced at Tamara, a look of surprise plastered on her face, as Neal and I exited the dining room, our arms inter-linked. 

As we trudged together toward his room, I asked questions about Neal's life - the better to keep him distracted from the heaviness of each tired footstep required to advance down the long hallway. I asked about his time as a sailor and about deep sea fishing. I couldn’t understand everything he told me, but I filled in the gaps the best I could and he didn’t seem bothered when I got things wrong. Combined with a little encouragement, we eventually we reached our destination. 

His room was lit in a warm glow when we entered. The bedside lamp and turned-down bed looked cozy and inviting, and the soft chatter from the TV offered a current of life. 

“Neal, can you sit down for me?” I gestured to the bed, thinking it would be easier for me to help him put on pajamas. But Neal stood frozen in place. I cued him a second time. “Neal, can you sit on the bed, please?”

Still, nothing. 

I crossed the room and sat down on the edge of the mattress, patting the open sheets beside me. “Neal, can you come sit by me?” Without hesitation, Neal followed and sat beside me. “Thank you,” I said and handed him a set of striped pajamas his daughter had packed. Neal recognized the items and immediately began to change clothes. I ducked into the bathroom so that he would have some privacy, and returned to find Neal seated where I’d left him, staring at the television. 

“Neal, can you lay down?” He didn’t move. I tapped him gently on the left knee. “Neal, can you lift your leg and swing it that way?” I pointed across the mattress. 

Neal lifted his leg and began to pivot on his bottom. He didn’t quite have the strength to swing both legs over, after so many sleepless nights, so I leaned over and lifted his right leg to rest beside the left. Then, I pulled up the covers and tucked him in. 

“Do you want me to leave the TV on?” I asked.

He pointed and said something about “the show.” I took that to mean, Yes – leave it on. 

“Volume OK?” I said, gesturing a thumbs-up? Neal just looked at me. “Loud enough?” I asked, cupping my ear? He nodded and waved me off. 

I stood to leave the room thinking, Mission accomplished, then quickly noted, in my periphery, that Neal was lifting his blankets, preparing to get up. “Neal, what’s wrong?” He pointed at me - or, maybe at the door behind me – I couldn’t tell which. I made a guess. “You want me to stay?” He didn’t respond, just sat there half-covered by blankets, one leg dangling over the edge of the bed. 

I noted that Catherine had brought a small, two-seat bistro table and chairs that had been pushed to one side of the small room. I dragged a chair over to Neal’s bedside, readjusted his blankets, and sat down in the chair beside him. Neal settled easily back against his pillows, seeming content with my response. Then, he reached a big paw toward me, palm outstretched, the way you do when you want someone to hold your hand. 

It struck me as endearing that he would want for such a tender comfort, and I was happy to give it. Despite his size and his grays, in that moment he felt childlike, to me. His expression, though tired, looked peaceful for the first time since he’d come through our doors. It wasn’t ten minutes before Neal was fast asleep and I was able to quietly douse the light, replace the chair, and let myself out of the room. I closed the door silently behind me and returned to the nurse’s station where Tamara, Trice, and Amber were all waiting, expectantly. 

“What happened?” Tamara prompted. 

“He’s in bed, asleep,” I said, proud but trying hard to sound matter-of-fact.

“HOW did you do that?” Trice asked.

“Seriously, Cortney!” Amber added, hands on her hips. 

I chuckled. I hadn’t really realized how impossible they believed the task to be. I walked them through each step of what I'd tried and how Neal had responded – both, to the things that had worked, and to the things that hadn’t. Overall, they agreed that everything sounded easy and like things that they could replicate. 

"Great!" I said, and returned home that night pleased with the knowledge that both Neal and I would sleep well.

Over the next week I checked in a few times, but the reports all came back the same - Neal slept soundly in his room from then on.

I never had formal leadership training prior to becoming an ED, but it was important to me to do right by the residents, family members, and staff I was serving, so I read anything on the subject that I could get my hands on (check out the Resources page for a list of favorites), and I treated my communities like my own, personal laboratories. I discovered what worked through trial and error. Turns out, as I learned from working with residents like Neal, a willingness to roll up your sleeves and lead by example goes an awfully long way.

Names and other identifying details have been changed or omitted in order to protect the privacy of individuals referenced in these stories.