Communication By Facial Expression

When I visit Gregory during meal time, which I often do, Manny and I take turns helping him with his meal.

When Gregory is with Manny, I help the other people at the table with their cloth napkins (do not call them bibs,) open and pour their thickened juice drinks, get a glass of ice water for Gregory and Martha (they seem to prefer it to the juice) and sometimes I help with feeding those who cannot do it themselves.

Directly across from Gregory is Alvira (close but not really her name to protect the innocent.) She is blind from what I can tell and when she does feed herself it is usually with her hands. Most often she waits patiently until one of the CNAs can help her, but on very busy days, I chip in.

She opens her mouth very little and therefore it is hard to get any food in. It is kind of like a balancing act but if one pays careful attention, one can get the spoon to her mouth at the right time and unload most of the food. She is on a "Puree Diet" so the food is creamy, moosey, custardy and it goes down easily.

When she is ready for the next bite, she will put her gnarled hand on your arm and stroke it. When helped patiently, she eats quite a full meal.

Yesterday I was helping her eat and I noticed that Gregory was watching us. He had such an engaged, empathetic, grateful look on his face watching me help Alvira. He needed no words to communicate to me that he was happy I was helping her and in some ways wished he could. His empathy for those around him is great and it is beautiful to see.

Good Will Ambassador

When I visit Gregory during meal time, which I often do, Manny and I take turns helping him with his meal.

When Gregory is with Manny, I become a good will ambassador in the dining room. I circulate among all of the tables chatting with the residents. I know almost all of them by name.

 I free free to tap a shoulder or hold a hand. I have even been brave enough to offer a kiss or hug now and then to a few of them.

I ask how they are feeling, I ask after their day. I  listen to their comments and complaints. I  compliment their clothing or their new hairdo.

Sometimes they will ask me for more juice, or a bit more food. Sometimes they will ask for, or I will suggest,  a PBJ or toasted cheese sandwich if they do not like the day's food offerings.

I offer to help a resident cut up the chicken into easy bite size peaces. Sometimes the resident will refuse. I respect their refusal but quality by saying, "I used to be a waiter, you know!" Often she will relent and push the plate toward me for cutting.

Sometimes I will let a CNA know that "so and so" hasn't eaten any of her meal or "so and so" is so sleepy that she is nodding off into her mashed potatoes.

Sometimes a residents feel frightened or confused and I can help calm them, sometimes if only for the moment with their returning to the same fears moments later. But at least for the moment of our interaction, they felt peace.

Sometimes they mumble or gesture and I behave as though I know what they are saying with a nondescript: "Uh huh" or "I see!" or "I know what you mean." If they are mumbling with a happy face I know that I should enjoy with them. If they are mumbling with an unhappy face, I know I should empathize or comfort them.

Often I will lie. Lie to a resident about when their son is coming to visit, how they can get home before dinner, if their husband is still at work, if they can go down to buy a new pair of shoes.

I have found that the "lying" comes fairly easily if I have no expectations of solving a problem or understanding what the problem is. Also my background in writing "Creative Non-Fiction" helps me weave stories for the resident that meets their needs, even if incorrect or a lie.

Notice that I have used the words OFTEN and SOMETIMES a lot. This reflects that day by day, hour by hour, sometimes moment by moment perceptions; needs, moods etc are in a constant state of change for many residents. For some residents, they are not at all present but still will respond to a touch, or a song, or the taste of food on their lips.

I get great joy in my role of Good Will Ambassador and feel that this should be a role on the unit. One person could be available just to chat, interact, smile, tap, shake a hand, tell a story, listen to a story. Wouldn't that be lovely?

Mealtime Help

A woman designed tableware to help people with Dementia/ Alzheimer's better deal with mealtime.

http://www.buzzfeed.com/fionarutherford/a-woman-designed-tableware-for-people-with-alzheimers-inspir?bffbfood&utm_term=4ldqphi#.ohE1ZrAwEG

Keith Jarrett

Listen to Keith Jarrett play "Somewhere Over The Rainbow" while you read this post.



By now a number of years ago, as Gregory's Dementia/Alzheimer's was getting worse and fairly quickly, dinner time would prove to be a difficult time for Gregory and me. For him to figure out how to navigate the food on his dinner plate and in the beginning of this new loss for me, losing my patience with him.

On one particularly difficult night, I do not remember all the details, but I was not only impatient but also mean. I yelled at Gregory for not knowing how to use his fork and for sitting there staring at his plate. I encouraged him to eat but he was really having difficulties. I grabbed the fork and began feeding him. But not with love. With anger and saying something like, "OK then I guess I am just going to have to feed you like a baby!"

Can you imagine how I feel now remembering back and writing this. In some ways, writing it as an apology to Gregory. Now, at Lieberman, he is unable to feed himself and I will help him to eat dinner (or lunch.) Now I do it with love, and care, and patience. As I carefully wait for him to have finished his chewing I bring the next portion to his mouth announcing what I am offering: "Here is a bite of roast beef now." "Here is some delicious mashed potatoes." "Mmmm, this creamed spinach is one of your favorites." I repeat my monologue (or is it a dialogue?) with each bite. Sometimes I'll just say, "Ready?" or "OK?" or "Do you want more?"

Several times, at Lieberman, I have talked to Gregory about how sorry I am about some of the times I was mean before and I might cry a little. While he does not have much language, I think he understands what I am saying and I know that he accepts my apology.

The reason for the Keith Jarrett above is that we used to listen to music at dinner time to make the evening more pleasant and to help cover the fact that conversations were no longer possible unless they were one-sided coming from me. The music made for a mutually enjoyable experience. Keith Jarrett is one of our favorites.

After one particularly difficult blow up, Gregory and I sat quietly through the rest of dinner, tears running down my face, Gregory suffering quietly as well, while Jarrett's Köln Concerts was playing. That piece, if you are not familiar with it, is somewhat noisy, not really melodic, but beautifully strong and emotionally played by Jarrett with his moaning and breathing heavy showing up behind the music. He puts his entire self into the performance.

When the piece ended, Gregory said to me, "That was perfect for our situation. Wasn't it?" At that we were able to "make up" and hug and get on with our life. We were both always good at apologizing well and picking up our love again as we continued doing the best we could do with a horrible situation: Alzheimer's Disease!

In some ways, the more I listen to Köln, I think it would be great background music for the movie of Gregory and my life.

Dinner Time

As you know, residents with dementia have various levels of eating and swallowing difficulties. What is nice about the food at Lieberman is 1) it is Kosher, 2) it is tasty, 3) everyone gets the same although in different forms.

For example, one night we had Roast Beef, Carrots, and Potatoes. Pictured below is what is known as the "Puree" Meal. The middle of the road dinner is called "Mechanical" and consisted of "pulled beef," diced carrots, and mashed potatoes. The "Regular" meal consisted of slices of beef, circle cut carrots, and roasted potatoes.

I have tasted all levels of food several times and they are all delicious!

Martha and the Bay Leaf

Lunch today began with vegetable soup. Martha found a bay leaf in her soup and put it on the table. Either she knew that the bay leaf is for seasoning only or after having tried to eat it, she set it aside.

I told Martha the story about the bay leaf and my family. My mother would use two or three bay leaves in any one of a number of soups she would make. She would try to find the bay leaves and remove them before serving dinner but it wasn't always easy. And/or she didn't try too hard?

When one of the family members would find the bay leaf, mom would announce, "That means you have to wash the dishes. Who ever finds the bay leaf has to wash the dishes!"

"So," I said, "pointing to the bay leaf, Martha, you have to wash the dishes from today's lunch!"

Martha replied, laughing, "You are a card, aren't you!" We both got a good laugh.

Today Was One of Those Days

My phone ring at 9 o'clock this morning. It was Manny saying he had hurt his foot and was unable to walk. He would not be able to help Gregory today. So I got dressed, had a quick breakfast sandwich, and went to visit Greg knowing I would be helping him with lunch, spending time, and then also helping him with dinner.

In some ways it felt like my day been ruined, in other ways I was excited about spending the entire day with Greg. When I arrived it Lieberman, Greg was already at the table in the dining room with his the food sitting in front of him. I don't think he was confused that Manny wasn't there and he was patiently waiting. He was very happy to see me, we hugged, and I gave him a kiss.

Gregory ate his lunch uneventfully. Table conversation with Batia and Martha was fun and a bit of crazy as usual. We went back to his room where I shaved him and we visited until it was time for his nap. While he was napping I left to run a few errands.

I arrived back from my errands to find Gregory's wing's "living area" filled with people listening to Sharon play the piano. This activity was not taking place in the usual place because two residents were in the final hours/days of their stay at Lieberman so keeping their wing more quiet and peaceful was in order.

Friend Pat had also just arrived and was in with Gregory when she had to leave so the aides could get Gregory up from his nap and into his wheelchair. I saw the aides beginning their task so I stayed out in the hall. Pat and I had visited for a while when the door to Gregory's room opened and one of the aides poked out to say Gregory was having a difficult time.

Both Pat and I went into the room to find Gregory arguing, screaming, swearing, flailing, and kind of being physical with the female aide. He had gripped her by the arm and kept pushing his teddy bear at her saying take this, take this. (Meaning take the teddy bear.) She was struggling with him, saying "I don't want the teddy bear." and finally loosened his grip on  her arm.

I got involved by announcing that I was there, everything was OK now, calm down, calm down. I hugged him. Held him. And struggled physically with him but only a little bit. I told the aides that I could handle it now and they left.

Gregory was still being verbal, shaking all over, and upset. He had me by the arm and each time I carefully pulled myself loose, he would grab me again. Eventually, smothered with kisses, and hugs, and love he did calm down. He was still shaking but by massaging his neck and back he was able to calm down.

Pat and I stayed with him until dinner and by then all difficulties had passed. Pat said goodbye as I took Gregory into the dining room. Dinner was uneventful and by 6:30 I said my goodbyes leaving him parked in front of the main TV with the other residents.

What caused this melt down? Don't know for sure but can surmise. Manny was absent. Gregory's nap had been earlier than usual and/or too long. The aide had put his pants on only half way up in case he peed and his legs felt constrained. Pat's visit ended abruptly when the aides arrived which upset him. Gregory's assigned aide is newer to him and therefore unfamiliar. Maybe he had a bad dream. Maybe the noise from the music out in the hall was confusing. Maybe he was frightened. Maybe he was inadvertently hurt by the lift. Maybe he wasn't in charge of what was going on and it was just the Alzheimer's. Maybe it was just a bad day.

Haunting (Part 1 of 2)

First let me explain how residents of Lieberman's Fifth Floor spend their waking time.

After meals, and during the day, all residents are moved from wing to wing for the various on unit activities like exercise, music, movies, etc. Moving is in itself an activity which allows for a brief "ride" providing a different environment in which to spend the next few hours.

The moving is called "Transport." This example will describe moving to Wing A for a movie after lunch. All residents are in dining room at various stages of having finished their noon meal.

Some residents are able to walk, walker, or wheel chair kick themselves around the place safely. These residents are able to do so freely. They are encouraged to join the group at some activities, required to participate in others, but for the most part can be on their own if they choose.

Those who are a "fall risk" or are not mobil get their wheel chair pushed to the next destination. One RCA (Resident Care Aide) starts the transport by pushing a resident to Wing A and then stays there as "Guard." The other RCAs push the residents to Wing A and return to the dining room to get another resident.

Meanwhile yet another RCA has remained in the dining room until the last resident is finished eating and either is out on their own or pushed to Wing A. Should add here that often the nurses, social worker, activities director, and volunteers help as needed with the process of "Transport."

Once everyone is in Wing A watching the movie (or sleeping or staring or mumbling or whatever) another RCA becomes "Guard" for the next 30 minutes while the others are freed up either to change those residents who need it, attend to other needs like helping a resident shower, or they are able to get lunch for themselves and take care of other duties around the unit.

Sometimes, like during music or Oneg Shabbas, all of the RCAs join in and the activity is quite fun, active and reflects the "Community" that the unit is to residents, visitors, and workers as well.

Let me add one variation, if a resident has a private care helper or a visitor, that person can transport and/or decide where to go or what to do. Sometimes when I am there, instead of going to "music," Gregory and I will go to his room to visit or watch his TV. Often visitors take the resident out into the garden or to an all building activity like a concert.

With this picture of "Transport" in your mind, and with your wondering why the title of this post is "Haunting," I will keep you hanging until the next post.

Care Conference

Gregory has been at Lieberman a little over three months and I have attended six Care Conferences to discuss his progress and needs. That is a meeting twice a month! Every time I take a long list of questions, concerns, and quandaries. 

Every time I come away from the meetings feeling listened to and content with the results. The meetings are always attended by the Head Nurse, the Social Worker, and depending on what we need to discuss, others. 

This time we were joined by the Nutritionist and the Restorative Nurse Supervisor.

• • •

BOLDFACE WAS ON CHECK LIST WHICH I BROUGHT TO MEETING.
Italics is what was discussed at meeting.

• • •

CHECK and CHANGE: How going? Records/regularity? (Being kept by RCAs) Hover over chair or in bed? (Depends on need)  When changed how cleaned? (Warm cloth and special soap) Is special soap used so rinsing doesn't affect his skin? (Yes) Is “tushie cream” used every time? (Yes)

The Restorative Nurse reported that Check and Change is going well.

Use of Urinal Training has not been successful as physically it is difficult to accomplish in time before he "messes" and Gregory is not able to help.

I reported that I am NOT confident that the Check and Change every two hours is going as well as I would like. When Gregory is discovered to be wet there usually is not enough time and/or staff available to get him changed so he ends up "sitting in it" for 3 or 4 hours until they can get to him. Often he sits in his urine and/or feces during meals. Also, from my observations, human nature causes the “check” part to not take place as often as necessary. 

I know that Resident Care Assistants (RCAs) are doing their best, that there are times when changing him is not possible because it takes four people to do so; the nature of scheduling, moving patients, floor needs, etc are getting in the way of Gregory’s care.

I proposed that staff should check for "messes" every hour NOT every two hours. That would not take more time or cause Gregory to "mess" more often but rather might bring his being changed closer to a manageable time through out the day. 

It was agreed that this will be done.

I proposed a way to resume Urinal Training. I purchased specialty pants which zip down both sides to the knee? Sometimes G does give signals that he needs to go and if one can get into his "area" quickly perhaps we can "save the day." 

I also purchased a woman's urinal box which seems to be angled more appropriately thus allowing Gregory to urinate while sitting. Also, we can try  a "penis friendly" urinal which I created using a collapsible, flexible silicone funnel attached to a water bottle. 

Staff will be trained to use the new idea as will Manny, Gregory's private care help.

A change in Gregory’s permanent RCA's for Days and Afternoons was made. Previously I had insisted that the RCA be in Gregory's wing and therefore closer to his needs. "Floating" RCA's have fewer people to take care of. Now that Gregory is not in as much need as he was the first month at Lieberman, proximity of RCA is not as important.

I think the new people will be better suited to meet Gregory's needs.

What kind of Active Assisted Movement will be given now that Gregory is no longer in OT/PT? By whom? When? 

Stand now and then? Sit now and then? Walk now and then?

Active Assisted Movement takes place every morning. Each resident works with a RCA for 15 minutes doing exercises like tossing a ball or leg and arm movement. Also, Manny will be trained so he can provide more activity and exercise throughout the day besides the regularly scheduled times in the morning.

We went back and forth on "standing, sitting, walking" regarding safety for Gregory as well as the staff. I fought for not "giving up" on him yet even though PT/OT thinks he must always be in the wheel chair and moved with the Hoyer lift. We compromised in that there will be a new screening and review by PT/OT. Also a new kind of wheel chair without foot pedals will be tried which might allow Gregory to "walk" himself around the unit.

CONCERN: There are many things that the Private Care Aid I have hired provides for Gregory between 11:30 and 5:30 and which relieves the RCAs of some responsibilities and allows them more time to be with their other duties. Some examples: Need to be shaved, to be transported from place to place, to be fed, to "entertain," calm, or otherwise occupy Gregory's time, Need to be supervised.

I need to feel that some of that time is being given back to helping Gregory. Right now his most important need is with bath rooming and being kept clean since he mostly has to "mess his pants." My concerns were heard and recognized as valid. With the above changes I feel this will be accomplished.

Current doctor reports? podiatrist? eye doctor? 

Any changes are reported, if no change assume everything is OK.

Adhesive on neck has really helped keep Gregory's neck strong.

No need for that now but muscle power in neck will be under observation.

Has he been showered in shower chair? Belly Button is full!
Teeth brushed. When? How often? By whom? Doesn't seem to be happening.

While shower chair discussed previously, not yet acted on. Will begin now. Teeth should be brushed twice a day. With new RCAs should happen now. I made myself available to "help calm" by being available for first few shower times.

More sir! Lunch and dinner, please. Sometimes a "regular" portion is enough for residents but not enough for Gregory. At times Manny or I ask for seconds if there are any left. Also, can he have more fresh fruit and vegetables. When does he get evening snack?

Evening snack consists of apple sauce or ice cream. 

Even before my mention, it was noticed that Gregory has lost some weight and has been put on mealtime "double portion." If Gregory is ever still hungry, Manny should ask for seconds. If none at station on floor, worker will go down to the main kitchen. There is ALWAYS more food available!

We talked about adult life time usual 155lb weight, his recent developing a "little belly" 180lb weight, and his current 167lb weight. Will keep an eye on what his NEW optimum weight might be. 

Will add more fresh fruit and veggies. 

In touch with Psychiatrist who has been following Gregory? Psychiatrist who chatted with Hannah about what to expect in general with Young Onset Alzheimer's patients.

Done.

• • •

It continues to amaze me how wonderful the care and concern for Gregory is. Often the staff is "ahead" of me when a concern develops. They are open and willing to try my suggestions but also know when they need to "educate" me on the realities of Gregory's situation. I cannot say enough about how wonderful each individual person is.

Beet Soup

The Lieberman Center is run under the CJE, Council for Jewish Elderly. One of the important features of the center, besides their excellent care, is that they serve only Kosher meals to the residents.

Aides are not allowed to toast residents bread on the Sabbath according to a sign in the kitchenette. Following the "no work on the Sabbath" law.

Saturday lunch and dinner (still the sabbath until sundown) is prepared ahead of time to follow the "no work on the Sabbath" law, so tonights dinner was borscht, cold salmon salad, sliced tomatoes, and a lovely challah roll.

As I was lifting the cup of cold beet borscht to Gregory's lips, I announced in a loud voice, "Borscht!" Isaac, our God son who was visiting fell into the routine also announcing, "Borscht."

Gregory just gave us both a look, then announced very clearly, "Borscht" and began to laugh. Both Isaac and I laughed with Gregory and many of the other diners looked in our direction wondering what we were so happy about.

It was the Borscht! Also, for the most part Gregory is non-verbal so his loud, clear announcement, done in a humorous vain, cheered us all!

borscht |bôrSHt | (alsoborsch) nouna Russian or Polish soup made with beets and usually served with sour cream.ORIGIN Russian borshch .

Today

Earlier today at Lieberman, Barbara died. I do not remember what she looked like but I did notice her empty place at the table just behind Gregory's. She had stopped eating some three days earlier.

And I heard that Marie was probably on her way out as well. I do remember what she looked like. She sat at the other end of Gregory's table, or better said, was brought into the dining room and placed at the end of the table.

In stark contrast to the other active, somewhat responsive people at the table (Greg, Betty, Julie, and Fred,) she spent her time in the dining room asleep, waiting to be fed, crumpled into a fetal position in her tipped back wheel chair/bed. At times she would be staring off into the distance but never responded to a "Hello" or "How are you today?" Her world was mostly limited and internal.

On earlier days, I remember looking at her and even in her disheveled condition; imagining the loving, sophisticated woman she used to be. But no more.

After kissing Gregory goodnight and on my way towards the elevator, a nurse was headed to Marie's room where family had been sitting with her all day. I asked the other nurse who was just outside the room how Marie was doing and she told me that Marie had just passed.

No matter how "far gone" some of these residents may be, or how angry and non-communicative, I cannot walk by a fellow human being in the hall and not smile real big and nod my head or say, "Hello." In turn, over time, some of the residents regularly now smile at me and say hello.

When in the dining room and someone needs help, if I know how to help without getting in the way and for example only if I know what to do, like getting thickened juice for someone who needs it to be thickened so they will not choke when drinking, I have to help. When Freddy is upset and cursing, I hold his hand and he holds my hand back and settles down.

My love for Gregory continues to grow, my expectations for him now are in the present moment and mostly in line with his abilities and not my hopes and fears for the future, and my love of fellow humanity continues to be tested and stretched. There is such great love and beauty to be experienced at Lieberman.

I grief and am also grateful for Barbara's and Marie's deaths.

Indelible

indelible |inˈdeləbəl|adjective(of ink or a pen) making marks that cannot be removed.• not able to be forgotten or removed: his story made an indelible impression on me.DERIVATIVESindelibility |-ˌdeləˈbilitē|noun,indelibly |-blē|adverbORIGIN late 15th cent. (as indeleble): from French, or from Latin indelebilis, from in- ‘not’ + delebilis (from delere ‘efface, delete’). The ending was altered under the influence of -ible.
Recently, I experienced three indelible events.EVENT ONE: Gregory and I were at Northbrook Court to buy him a birthday gift and for lunch. My meal of pan fried, almond crusted chicken in a ginger and orange sauce was delicious. Gregory's lemon sautéed Sea Bass started out delicious.As usual, we each eat half, switch, and then enjoy another taste palate. It is fun to share meals. I was about half way through my half of Gregory's Bass when I took a bite that tasted like I had just sipped a shot of AMMONIA. I chewed a little more and had to spit it out quickly. It tasted so strongly of ammonia that I almost retched. Luckily we were at the end of the meal, paid the check, and left. Every time I thought of the taste I had experienced, my stomach did a summersault. In the car I ate a few cinnamon mints and that helped. For the rest of the evening, I felt a little off. I hadn't eaten enough to call it food poisoning but it left an indelible mark on my mind. I looked at the situation on google and this is what it said: It is also what their flesh produces in decay, so if they smell of ammonia it is either a sign of being unfresh, or in closed, unsanitary tanks (where they are so saturated with their own waste they smell of it) In either case, if you're in a restaurant, ammonia smelling fish is definitely a reason to send the dish back and take the chef de cuisine to task. Next time I will send it back even if it is at the end of the meal.EVENT TWO:Gregory and I had a massage last Friday. We drove to the location, arrived early, and parked for about 5 or 10 minutes. We were listening to the end of a classical piece on the radio when I noticed the air smelling a little rank. I accused Gregory of having farted but he denied it.When it was time for the massage we got out of the car, locked it up, and walked over to the massage appointment.As we returned to the car and I was about to open the door to let Gregory in on the passenger side, I noticed a dead rat at the curb right under the passenger door. It must have been 18-20 inches long counting the tail and 4 to 6 inches at belly wide. I told Gregory to wait on the sidewalk so I could back the car up and he could get in without having to step over the rat. Meanwhile the car had been sitting over this decomposing pile of dead rat for over two hours and in the time it took me to back the car up and open the windows I started to gag from the smell. Cinnamon mints to the rescue again. I felt a little "sick" for the rest of the afternoon. Not a nice way to spend a lovely afternoon of massage. Indelible. EVENT THREE:Gregory's Alzheimer's Disease. Enough said. Indelible!

Iron Lady Continued

Chatted with G after dinner about "The Iron Lady" but not really sure he realized until I mentioned it that Margaret Thatcher has Alzheimer's Disease. The movie, however, really affected him. (I think the movie and Ms. Streep did a really good job of portraying what it is like to live with the BIG A.)

In the past (B.A. = Before Alzheimer's) when he got really involved in a "heavy" movie he would be distracted and "lost in it" for a while after (hours at least.) This time his distraction via Alzheimer's showed up during dinner when he didn't know how to cut the peach in his peaches and cottage cheese, started to pull it apart with his fingers, so I cut up his food for him. He was quite confused between his knife and spoon, when he did figure out that the knife was to spread jam on his English muffin he did not really understand the principal of how a knife carries the jam and spreads it.

After his muffin was gone, he loaded up his knife with more jam, "Where am I supposed to put this?" he asked. "Back in the jar," I replied, "you have no more muffin to put it on."

He was aware of how confused he was and (in his few-ly worded way) recognized "How I am after a movie."

Meal Time

For a while I was worried about preparing dinner time meals for Gregory. Dinners usually consist of a fish/chicken/meat course, one or two vegetables, potato, salad, and sometimes bread. There are condiments and spices, butter, salad dressing, salt & pepper, etc to be added table side. 


I began to notice that Gregory was having trouble figuring out what to do with everything I placed in front of him and it was taking a long time before he could actually begin eating. I would hint and point and this helped sometimes but was aggravating for both of us.


I was afraid that I was going to have to simplify our meals and even had nightmares in which I served one course at a time and we didn't finish with dinner until breakfast time. Another possibility was one dish meals and I hated that idea.


Finally I came up with a solution and it seems to be working for now. I do all the dressing, seasoning, buttering, etc before we begin eating. This evening when I put the plate in front of him the beets were sliced, the green beans buttered and seasoned, the salad dressed, the bread sliced. That's all he had to do was eat the meatloaf.


He still has trouble deciding which utensil to use, fork-spoon-knife all seem to become one. Always having been neat at table, thanks to his mom Helen's training, I find that he uses his fingers more often but still appropriately.


For now, problem solved. This seems to be the way with us. Old solutions die causing new problem to arise which lead to improved ways of dealing with most situations. Hope this continues for a long time to come so I do not have to think about what the future might hold.