In the Spotlight

News & Features
By Lynette Nyman
September 1, 1999
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Over the past 20 years, alternatives to nursing homes have sprung up across the nation including here in Minnesota. One is Rakhma Incorporated. Celebrating its 15th year this October, Rakhma has grown from one to three homes across the Twin Cities since 1984. Rakhma homes are places for people with dementia and Alzheimer's disease to live in a home setting, but not alone.

What Causes Alzheimer's?
The Alzheimer’s Association has developed a list of warning signs that include common symptoms of Alzheimer’s disease (some also apply to other dementing illnesses). Individuals who exhibit several of these symptoms should see a physician for a complete examination.

1. Memory loss that affects job skills. It’s normal to occasionally forget an assignment, deadline or colleague’s name, but frequent forgetfulness or unexplainable confusion at home or in the workplace may signal that something’s wrong.

2. Difficulty performing familiar tasks. Busy people get distracted from time to time. For example, you might leave something on the stove too long or not remember to serve part of a meal. People with Alzheimer’s might prepare a meal and not only forget to serve it, but also forget they made it.

3. Problems with language. Everyone has trouble finding the right word sometimes, but a person with Alzheimer's disease may forget simple words or substitute inappropriate words, making his or her sentences difficult to understand.

4. Disorientation to time and place. It's normal to momentarily forget the day of the week or what you need from the store. But people with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there or how to get back home.

5. Poor or decreased judgment. Choosing not to bring a sweater or coat along on a chilly night is a common mistake. A person with Alzheimer's, however, may dress inappropriately in more noticeable ways, wearing a bathrobe to the store or several blouses on a hot day.

6. Problems with abstract thinking. Balancing a checkbook can be challenging for many people, but for someone with Alzheimer's, recognizing numbers or performing basic calculation may be impossible.

7. Misplacing things. Everyone temporarily misplaces a wallet or keys from time to time. A person with Alzheimer's disease may put these and other items in inappropriate places – such as an iron in the freezer, or a wristwatch in the sugar bowl – then not recall how they got there.

8. Changes in mood or behavior. Everyone experiences a broad range of emotions – it’s part of being human. People with Alzheimer's tend to exhibit more rapid mood swings for no apparent reason.

9. Changes in personality. People's personalities may change somewhat as they age. But a person with Alzheimer's can change dramatically, either suddenly or over a period of time. Someone who is generally easy going may become angry, suspicious or fearful.

10. Loss of initiative. It's normal to tire of housework, business activities, or social obligations, but most people retain or eventually regain their interest. The person with Alzheimer's disease may remain disinterested and uninvolved in many or all of his usual pursuits.

EACH HOUSE HAS A NAME. There's Rakhma Peace in Minneapolis and Rakhma Joy in Saint Paul. Rakhma Grace is in Minnetonka. A white-picket fence marks the front yard area where its 11 residents are free to explore on their own. Inside the locked gate, two women in their 80s relax on the front porch while taking drags on their cigarettes. Louise, or "Weazy," doesn't know how long she's lived at Rakhma Grace.
Louise:Honey, I'd tell you if I knew. Does it tell on here?
Weazy fingers an identification bracelet around her wrist. Beside Weazy is her best friend Betty. She has freshly permed curls snug against her head.
MPR:Do you have memory loss? Do you say "Oh, I have Alzheimer's?"
Betty:: No, I don't have Alzheimer's. I don't have memory loss. No, I can remember everything.
MPR: But you are at a home for people who have memory loss.
Betty: I am? And the people who have memory loss?
Betty may not know it, but she has been diagnosed with Alzheimer's disease, a common cause of dementia in older people. An estimated four million Americans have it. Not until after Betty's death will doctor's know the damage the disease wrought on her brain.

Upstairs, Betty's small, private room is furnished with a twin bed, closet, sink, and her cat Lisa.
Betty: She's my baby. I've had her for a long time. She just loves me. And I love her.
Downstairs, Rakhma Grace is bustling with staff, residents, and volunteers.
Louise: A go, go, go, go...
There are daily activities and weekly outings to stimulate the residents, especially the Alzheimer's patients whose short-term memory declines over time making them child-like in attention span and response. Singing is big at Rakhma Grace; in the living room and around the dinner table.

This time it's Rakhma's founder and board president Shirley Joy Shaw along with a resident named Inelle singing "You Are My Sunshine."

The song brings Inelle to tears. Shaw wraps her arms around Inelle and tells her about a dream she had of Paris. It draws Inelle out of her sadness. Shaw says it's been her goal from the beginning 15 years ago to create a family with "rakhma," an Aramaic word meaning "unconditional love."
Shaw: So I started the model really sharing my vision with a lady, who was over 90 at the time, and said how would you like to live in a house with other people and when you wake up in the morning you smell coffee. And you'd have someone to have Bible study with. You could bake your cardamom bread in the oven.
At the time Shaw was a home health aid.
Shaw: And then I asked her, "Would you like to live in this home?" And then she looked me and said "I don't even dare think of it." So three years later I opened my first Rakhma home. And she was one of the first residents. I had to find her through her family and she was in a nursing home.
Rakhma's non-profit organization operates three homes serving 30 residents with memory loss, but who are otherwise physically healthy. The kind of independent, intimate living Rakhma offers isn't for everyone; not the super aggressive or obsessive-compulsive, and not for the poor. It's mostly private pay at around $3,000 a month.

Although some medical assistance is available, Medicare excludes dollars for home-style settings - like Rakhma's - where there's no live-in nurse. Instead, Rakhma homes provide a nurse on-call with certified nurse assistants around-the-clock. They prepare meals, dispense medications, and make sure the residents are clean and coiffed. Shaw says Rakhma's shared-home setting has comfort most other care settings can't offer.
Shaw: We are a family including our helpers, and you know nothing is perfect, but it's like the loving can't stop at residents. It has to be for your staff. It has to be for the families of the residents. It's like a little community.
Back in Betty's room, Judy Harkess visits her mother who knows her daughter less and less each day. She says it's been hard watching her mother's decline over the last five years. It's been, she says, like a parting of the ways.
Judy: This is all the time because mom will never be mom again. She's just not the same person that I knew when I was younger. I love her dearly, but it's just not the same and it never will be.