Sundown. For many of us, it’s the most beautiful time of day. Some call it the magic hour – when the sun bathes everything in its path with a golden glow – and just looking at it makes you feel at ease.
But for those living with dementia, it can actually have the opposite effect.
As the evening approaches and the sun starts to set, these individuals have a tendency to return to lifelong habits. Some feel the need to head home and start preparing supper; others, to pick up the children and get them ready for bed. They long for familiarity and comfort, and, most of those living in long-term care facilities realize that the unit they live in is not the home they once knew. So, they wander and look for an exit – a way back to the familiar; a way back to the years gone by.
It is a behaviour referred to as ‘sundowning,’ the time of day in which several symptoms of dementia – restlessness, confusion, and wandering – intensify.
Those at the Private Josiah Squibb Memorial Pavilion (PJSMP), the long-term care facility in Carbonear, are no strangers to the effects of sundowning. The PJSMP has a modern protective care unit and a wander guard unit, both of which are home to residents with dementia.
Often, staff on these units spend the ‘golden glow’ hours comforting residents experiencing emotional distress and directing them away from doors. It can be disheartening for everyone involved; residents, families, and caregivers alike.
Catherine Tee is the recreation specialist for both of the dementia care units at the PJSMP. Like many of her co-workers, Catherine was concerned about the negative effects of sundowning:
“It became clear that we needed to look for ways to lessen the impact of sundowning. We wanted our residents to feel comfortable.”
Determined to find a solution, Catherine approached a recreation therapy worker onsite, Charlene Rogers. Several discussions later, the two adopted the idea of disguising the exit doors of each unit. The thinking was that if the residents couldn’t easily see the doors that prompted them to leave, the units would feel more like home for them.
Catherine and Charlene had noted the tendency for individuals living with dementia to reflect on ‘days gone by’ and speak about cherished memories of their childhood and early adulthood.
“Their short-term memory may be impaired, but these memories – many of which happened decades prior – are very much intact,” says Charlene. “A goal of ours was to transform the exit doors into something that provoked some of their happiest memories.”
To make this happen, the two turned towards art, which has been known to have therapeutic effects on individuals with dementia.
They began searching for an artist who was willing to ‘camouflage’ the doors with images that would be colourful, representative, and relevant to the residents.
As luck would have it, they didn’t have to go far. Not only did this artist create beautiful paintings, but she was also well versed in caring for those with dementia – including the PJSMP residents.
Personal care assistant by day; artist by night
Christa Hogan started working as a personal care attendant (PCA) with Eastern Health in 2014.
She also happens to be an exceptional painter – just ask the staff who recommended her for the project.
“Everyone knows that I paint,” Christa said with a tiny chuckle. They also know how much she cares about the residents.
When she was approached about painting the mural, Christa did not hesitate. Her immediate reaction was to ask when she could start. Painting the mural was a way for Christa to brighten the spirits of the residents and enrich their daily lives.
It took four days for her to transform the main door of the wander guard unit into a captivating aquarium scene.
Shortly after, Christa began working on the second mural. This time, she was given a much larger canvas – seven walls – located on the protective care unit.
For the protective care unit mural, Christa was determined to create a scene that resonated with the residents on an emotional level.
No two PJSMP residents are alike. While some are native to Carbonear and the surrounding areas, other residents grew up in small, fishing communities or the St. John’s city core. But living in Newfoundland and Labrador gives all of the residents one common memory: the ocean; the salty, sea breeze and the echo of waves gently tapping the shore.
A harbour scene fit flawlessly into Christa’s plan.
“Knowing the residents’ history and the ways of life in Newfoundland and Labrador that many of them grew up in, I knew it was important to paint scenes that preserved their past,” she adds. I’ve seen the impact that reminiscing of days gone by and talking about Newfoundland culture can have on the residents.”
Christa made sure to include the residents in every aspect of the mural design, seeking their input and listening carefully to what they would like to see painted on the walls.
The residents were overjoyed.
Salt-box houses, sea-gulls…and fish
Boats, icebergs, and rugged hills.
While Christa painted, several of the residents admired her intricate work.
They would often reminisce about what she painted in the scene, sharing stories about long evenings spent fishing on the sea. The painting process was a happy distraction. The residents, many of whom typically became restless as the day progressed, seemed content and at ease.
“One man, in particular, could sometimes be a little aggressive,” Christa explains. “But, while I was painting, he was calm; he would sit and watch me in amazement. All he would say was ‘wow.’”
The families of the residents became involved as well. While visiting their relatives, they would share stories of their own with Christa. Many spoke about the residents’ favourite activities and beloved memories.
One family showed Christa a picture of a boat that a resident had owned during his years as a fisherman. Christa eagerly incorporated a replica of that boat into the mural. She even included a replica of the man’s home in the mural. He was thrilled – and so was his family.
Christa says that his reaction was one of her favourite memories:
“When I finished painting the boat, the resident pointed at it. He looked surprised and then he said ‘I built that.’ He recognized that it was his boat from years ago.”
The mural was a family affair, in more ways than one.
Christa’s mother, Josephine, was an integral part of the project. A former recreation therapist and current Eastern Health volunteer, Josephine spent hours chatting with the residents and their families.
“The residents loved watching me paint – they were always there,” Christa smiles. “Mom was there every day, helping us all. I couldn’t have done it without her.”
Christa emphasizes the importance of including everyone in the process, and considers the mural a joint effort between herself, the residents, and their families.
“This project was a wonderful way to build a sense of community,” said Rod Hayward, Program Manager for Long-Term Care in Carbonear. “It was wonderful to see the staff on the units take an interest in what Christa was doing, while family members of our residents offered suggestions to Christa and incorporated personal touches into the mural.”
The mural has had a profound effect on everyone: the residents, their families, and the staff. Family members comment on how the paintings have brightened up the units; residents admire the scenic views; and staff members have the satisfaction of knowing that the residents in their care are more comfortable and relaxed.
The success of the mural project has inspired an even bigger goal.
With the support of administration, the recreation staff at the PJSMP now plan to paint a mural on every long-term care unit in the building. Another mural is in progress and Christa continues to get ideas and feedback from the residents and their loved ones.
As for Christa, her paintbrush is still in hand. Thanks to her creativity, the walls have a vibrant glow, not just at magic hour, but long after the sun has set.
For more information about sundowning, please visit The Alzheimer’s Society of Canada. ■
This article was written by Catherine Tee, a recreation specialist at the Private Josiah Squibb Memorial Pavilion, and Sarah Greening, communications assistant at Eastern Health.