CADE Units
My life has fallen into a few stages.
As a child, I lived in Box Hill when it was a Village. I then became Pastor to the Slums of Inner Melbourne for eight years. I was then a Country Parson and a Teacher at a One Teacher Bush School out at Jackson Creek in Western Victoria and then for thirteen years, I was a Suburban Minister in one of Australia’s largest suburban ministries.
And now, for more than 20 years I’ve been Superintendent in Sydney of Wesley Mission, Australia’s largest church ministry.
I’ve told you stories of people in each of these places.
Tonight I want you to come with me into the heart of the city.
During 1964 and 1965 when I was a country parson I found that my earlier training at university in psychology as well as that in ministry meant I had the qualifications to be appointed as a psychiatric chaplain at Aradale, one of Victoria’s largest psychiatric hospitals. For two years along side my normal pastoral work in that rural community of Wimera in Western Victoria was my work of helping people who were inmates in the psychiatric hospital. Aradale was a remnant of Victorian England. It was an extremely large psychiatric hospital with 14-foot high solid stonewalls all round it topped by barbed wire. Huge gates swung open to admit new patients and to keep those already admitted securely inside and away from harming the community.
The truth of the matter was that most of the people in the psychiatric hospital were no danger at all to the community. Some had been heavy alcoholics earlier in life but deprived of alcohol within the walls of the institution had become normalised and lived an institutionalised but alcohol-free life. A number of them suffered from relatively minor mental illnesses including such things as Downs Syndrome, which is not really a mental illness, and those who suffered from Downs Syndrome should never have been locked in this environment at all. However many of them had been in the institution for thirty or forty or even fifty years of their lives and consequently knew no other life.
We did have another section called ‘J’ ward, which was the prison for the criminally insane. Here everyone was a murderer who had been judged by the courts to be insane when they committed their brutal crimes. These people would never be released. Our oldest inhabitant who when I was there had his 100th birthday and had been in that prison for 60 years.
Among the rest of the patients in the Psychiatric Hospital, most of the people were suffering from some form of dementia and were quite harmless to the rest of society.
Mind you the community didn’t think so. On top of the hospital administration block there was a huge war time siren, not to warn us about some approaching air attack from some enemy but to warn the entire community that some psychiatrically insane person had escaped from the high stone walls and people had to be on guard. I did hear on one occasion that siren go off, and as chaplain I immediately raced to the hospital to see what I could do perhaps in tracking down those who had escaped. It was a very simple case of some poor person wandering through an unlocked gate and somehow or other walking past those on duty.
I had an immense sense of pity for people who were demented. While there were some who were constantly babbling, attacking others, hurting themselves and whose behaviour was such that they were permanently in a locked ward, the vast majority of people in the psychiatric institution suffered from loss of memory and loss of social finesse.
They were not able to express who they were although I became convinced over a period of time that they knew who they were. They were not able to hold intelligent conversation and often went about repetitious tasks that would drive the rest of us to drink.
For example there was one man known as ‘Old Cedric’ who every morning left the ward early in work clothes and went out to where a wheelbarrow was standing besides a huge stack of old bricks. Cedric placed these old bricks in the wheelbarrow and wheeled it right across a main quadrangle where he unstacked the bricks into a neat pile. After a minute or so rest he then re-packed the wheelbarrow and wheeled it back to the original point where he unpacked them again. Then after a minute or so’s rest he would stack the bricks into the wheelbarrow and so on repeating this activity throughout the entire day. I used to say to him “Finished your work for the day Cedric?” and Cedric would reply, “It’s been a long job I’ve only got a couple more trips and then I will be finished.”
There were other people whose dementia took other forms. There was one lady who, in my simple church services that I conducted, always got out of her seat walked up the centre isle and gave me a big kiss on the lips while I was preaching. Without a word she would then turn and go back and be seated. This was a routine that occurred week after week. It was harmless, no one was upset, and provided I was willing to accept the affection, no harm was done.
Some people suffered from severe delusions about who they were and what they were doing there and I had more than one patient tell me long stories about their role within the mental health community of Victoria. They were smart enough to know all of the terminology and the functions of the hospital but they were still sick enough to be deluded about their role within it.
In one of the wards there were a group of elderly men who were in very bad shape. It was into this ward that I introduced the women members of our Ararat Church of Christ and we would hold a Saturday barn dance with the ladies bringing some afternoon tea and sitting down playing cards, monopoly, ludo and other board games with the men. For women who generally didn’t believe in dancing in those days, this was a huge sacrifice of personal standards in order to bring some companionship to those who were suffering from dementia. But the presence of those women in our midst was a remarkable impact for good.
I always determined that if I got the chance later in life I would do something to help those confused and disturbed dementia patients.
When I came to Wesley Mission in Sydney there were two things that pleased me more than anything. One was that I was now responsible for a large, well-established and respectable mental health hospital; Wesley Hospital at Ashfield, and two, we had a facility at the Lottie Stewart Hospital that provided some basic care for people suffering from senile dementia.
I was to put a lot of effort into those two centres. Wesley Hospital we doubled and doubled again with new buildings, the purchase of additional properties and the purchase of Wandene Private Hospital and then eventually the opening of our Eating Disorders Unit at Carlingford. That work is still a great personal pleasure. But it was in the field of caring for dementia sufferers that we were to do some extraordinarily good things.
In the early 1980’s I raised with the Lottie Stewart Hospital Board the possibility of developing a specialised wing to care for people with Senile Dementia.
During the early 90’s the Lottie Stewart Hospital in Stewart Road Dundas became a centre of specialised support for aged people. We had a rehabilitation unit specially designed to help people suffering from strokes, rheumatism and arthritis. We had developed the hospital kitchens to prepare thousands of “Meals on Wheels” which were delivered every day to the families in that region. We opened the Cumberland Day Care Centre. This was an existing large building in the hospital grounds, which was upgraded and refurbished. In 1986 I invited Mr. Barry Unsworth the then Premier of NSW to open the Community Care Centre in the presence of quite a large crowd. Many of these people came in for activities for two or three days a week. Many of them suffered from arthritis, Parkinson’s disease, and early onset of Alzheimer’s disease. We soon had more than 120 people working in this day centre which was equipped with craft areas, woodworking area’s for men who loved to make toys and handy wooden implements for the home in the well-equipped carpentry workshop, a scented garden with raised beds to make it possible for people in wheelchairs to access these beautiful gardens and so on. We added additional buses to pick people up from their homes and bring them into the day care centre.
But more was needed. We were going to later on establish a specialised Parkinson’s area, a spinal accidents ward, a geriatric rehabilitation centre and a Huntington’s disease centre. But the point that gave me probably the most pleasure was to develop the CADE Units. These units, spelt C A D E were the initials of Confused And Disturbed Elderly. This title was very much the subject of many jokes. For example I used to frequently say that the CADE Units were being built for Confused And Disturbed Elderly Staff. But every body knew that what we were doing was to meet a real need. After years of planning in 1991 we started building two large lodges with all the associated facilities. These were opened in April 1992. I named the two large residences Lynford Lodge after our chaplain Rev. Lynford Smith who had given us about 15 years of valued service at that time, and Herring Lodge named after the wonderful work Kathleen Herring had given to the Ladies Auxiliary and the hospital in general. She had given nearly 30 years of service to the hospital in a voluntary capacity.
These CADE Units were capable of caring for 32 residents in private rooms in a home like environment. I still have our original sketched plans that we did to bring together all of the good ideas that gradually had been moving in our minds for some time. Dr Tony Joseph, a local GP with a lot of specialist care in dementia became our CADE Medical Officer and he reported to the board that his work in the CADE Unit gave him ‘much professional satisfaction’.
Dr Joseph was able to report the significant improvement that had occurred in the health of some of the residents and I knew that we had a duty to let the community know that just because a person has advanced senile dementia or Alzheimer’s disease there was no reason to think there was no hope for the future. In fact, we had on our hands a very interesting experiment in socialisation that was going to prove benefit to the state of mind of many of our demented residents. Socialisation is incredibly important for anyone who is suffering from Alzheimer’s disease. In these two large units, each of which was home to 16 people, each had not only there own rooms and access to the gardens, the central living areas, the lounges, kitchens and laundries but we encouraged them to think of themselves as if staying in a first class motel as on a holiday.
We worked on the basis of 6 principles:
1.Residents feel more secure and at home with familiar possessions around them and with old photographs or other treasured items in their own rooms.
2.Self esteem and wellbeing are increased when residents are encouraged to do all they can for themselves and help each other and staff, even in minor ways, no matter how slowly it is done.
3.Self esteem and well-being are enhanced when staff take particular interest in each resident’s appearance, assisting them when necessary, to maintain a high standard.
4. Active rather than passive participation in simple household chores, everyday activities, outings and continued contact with family and friends helps them develop and make the best use of their remaining faculties, gaining maximum enjoyment from their lives.
5.One of the major tasks of the staff is to maintain the appropriateness of the residents’ behaviour. This involves modelling the required behaviour and working along side residents at their pace, with the aim of replacing confusion and disturbance with calm, appropriate behaviours which resemble the normal activities of the elderly, involving them in as many activities of daily living as they can manage.
6.Relatives appreciate the ‘homeliness’ of the unit, the choice of comfortable furniture which fits with the memories of the residents, the raised flower beds in the garden which allow easy watering, weeding and planting and the layout which allows wandering to take place in safety.
Into this centre the ladies of the auxiliary came and with the chaplain there were regular times of community singing, hymn singing, church services and social activities in which the auxiliary members and patients joined. Whenever the music was played, many of our patients loved to dance.
Sometimes people suffered more embarrassing habits such as the couple of ladies we had, Iris and Samantha who whenever the music started, would start to remove all of their clothes.
We designed a facility to help those suffering from advanced Alzheimer’s who liked to wander. It was against our thought that we should have walls or fences and yet somehow we had to keep our wanderers secure. There would be nothing worse than someone disappearing in the middle of the night. They would be a danger to themselves, perhaps wandering onto the busy Victoria Road nearby or simply getting lost. I then read a report from an overseas magazine that indicated that people suffering from advanced dementia and were wanderers would follow a path that was set before them but would not go off that path for example and walk up a steep hill. So instead of having fences and walls we ramped up the earth quite steeply right around the total area and on the top planted trees and garden beds with Australian natives and some planted annuals. These looked beautiful, especially in spring. We then built paths that wandered around the whole area but always coming back to the same central point. Over the years as I would call in to see our residents I would see many people setting off to walk. Some would walk for many hours and would not realise that by following that path that they would always come home. We didn’t need walls and fences; we simply needed paths that would always come back home.
Some of our severely demented people loved to do what they did in earlier life. For example there was a South American gentleman Miguel who loved to hammer and saw. Our handymen would always drop him off some more nails; some more off-cuts of timber and every now and then re-sharpen his saw. He enjoyed making simple things with his basic carpentry skills. Some of our staff were extremely good with women patients. Our women were encouraged to work in the kitchen along side our staff and every day they would not only help in preparing and serving meals but also in making scones which were provided for afternoon tea throughout the rest of the hospital. Some women had great cooking skills and although they could not remember their name or where they lived, or any other contemporary event, they had never forgotten the cooking skills they had acquired and used throughout a lifetime. In the same way, some of our women loved doing laundry, not for them was the washing machine and other labour saving devices. They would wash in the tub and ask someone had they seen the blue bag and after washing the garments would wring them by hand and hang them on the rotary clothes line. No sooner were they dry than they would re-wash them again.
The socialisation attempts worked, people became happy and contented even though they were severely mentally ill. Some women in particular seemed to have deep-seated grief about babies – perhaps babies who died before birth or in early childhood. To them the handling of dolls and the dressing and undressing of dolls became something very significant. Maisy was an 86-year-old lady who tended one particular floppy doll; she dressed and undressed her carefully, sang to her with lullabies and made sure she went to sleep. Maisy could talk to me for hours about her baby and about the way she cared for it. Maisy was happy living in the world of young motherhood.
With the closure of psychiatric institutions such as the Parramatta Psychiatric Hospital our CADE Units came into great demand. Most of our residents improved in their health and general well-being, related better with people and lost many of the antagonistic and aggressive habits they may have had when well-meaning family, friends or government institutions tried to restrain them. Unfortunately I hear that the present State Government of NSW wants CADE Units to close and their residents to move into high care nursing homes. That is bad news for the CADE unit residents; bad news for the residents of nursing homes but good news for the State Government because CADE Units are funded by the State Department of Health, but nursing homes are funded by the Commonwealth Government.
Jesus had a deep care for the sick and for the mentally ill and we in our turn were providing the support of doctors, chaplains, volunteers and a homely place with handmade scatter rugs and Ida Downs so that our residents felt that they were living in a home even though it wasn’t a home that they had spent most of their lives in. In the heart of the city where there is often hard concrete walls and asphalt roads there is a desperate need for compassion for those who are frail and mentally ill and in building the CADE units for confused and disturbed elderly I felt we were doing something for a very precious group of God’s special children.
The city of Sydney would grow to be one of the world’s great cities and Wesley Mission would grow to be one of the world’s great churches and I was privileged to spend each day in the heart of both.