Frontotemporal Dementia Topics. Throughout her life, Lucy Pontrelli's mother, Anna, had always been the picture of health. 'She was invincible, constantly caring for the entire family,' said Ms. But five years ago Anna Pontrelli was diagnosed with frontotemporal dementia, a degenerative condition of the frontal and anterior temporal lobes, areas of the brain that control reasoning, personality, social graces, language, and some aspects of memory. 'She used to be very proper and refined, but she stopped paying attention to her appearance and became severely agitated when things were out of place,' Ms. Pontrelli said. 'She began overstuffing her mouth at meals, almost to the point of choking, and would often eat things off the floor.
Over a short period of time, this disease has stolen most of her basic functions. She is wheelchair bound, has a feeding tube, and cannot speak, yet some of her memory appears to still be there.' Pontrelli was speaking at the Frontotemporal Dementia Caregiver Conference, held earlier this winter at the New York Academy of Medicine. The conference is part of a new Frontotemporal Dementia Program at Columbia University Medical Center that is bringing together clinicians and researchers to improve the diagnosis and treatment of this still misunderstood and under-recognized disease, as well as help family members deal with the often unique stresses involved in caring for someone with FTD. Frontotemporal dementia (FTD) can present in different fashions. But it is often marked by changes in personality, behavior, and executive functions such as multi-tasking and reasoning.
FTD most commonly begins in a patient's 50s, but symptoms can begin as early as age 30, or as late as the 80s. Behavioral changes may include loss of impulse control or inhibition, hypersexual behavior, aggression, or apathy. Other features can include hoarding (e.g., buying 300 statues from a catalog), social withdrawal, making the same noise over and over again, and ritualistic compulsive behaviors.
'Jim. changed from being modest to being inappropriately boastful. He interrupts serious conversations with jokes. He threatens people on the bus who annoy him by exclaiming, 'I haven't killed anyone yet today,' said Mary.
of her husband. Mary was speaking at a recent meeting of the, created by Jill Goldman, MS, MPhil, CGC, a genetic counselor in Columbia's and the. FTD can also present as a language disorder known as primary progressive aphasia (PPA), which causes loss of expressive language that gradually progresses to being mute, or to semantic dementia, in which people lose the meaning of language.
People suffering from PPA or semantic dementia may not have behavioral symptoms and may be very frustrated due to their more preserved insight. 'He's aware of what's happening to him and he's crushed, totally devastated; but he's trying to keep his dignity intact,' said Anne Zweiman, whose husband David, diagnosed two years ago with PPA, can no longer speak, read, or write. 'And I'm very tired; my gas tank is on empty. I'm trying to keep a million balls in the air – working full-time, running our business, and trying to coordinate visits from his family.' David is treated by, associate professor of clinical neurology and a member of Columbia's FTD Program. Due to the personality changes it causes, FTD is sometimes mistakenly diagnosed as a psychological or emotional problem (such as depression, bipolar disorder, late-onset schizophrenia or anxiety).
Or downplayed as a 'mid-life crisis.' Because it affects executive function – the ability to reason or process information – FTD patients are easy targets for scam artists (responding to phishing emails for money, etc.). In the elderly, symptoms may be mistaken for withdrawal, eccentricity, or most commonly, Alzheimer's disease. FTD can progress to immobility and loss of speech and expression, causing isolation for patients and their family members. 'It took a long time for me to accept my husband's diagnosis and now I'm dealing with anger and overwhelming sadness,' said Diane. of her husband Charlie., who was diagnosed in 2007 with FTD.
'I'm now doing everything by myself or with friends – it can be very lonely. At a recent dinner party, I was the only unaccompanied person and all the couples were dancing. And weekends are horrible – I ask him questions and he just giggles and says 'I don't know.' There's just nothing there. I'm no longer comfortable taking him anywhere and I'm nervous leaving him alone in a room.
I even have to brush his teeth now. I'm taking on everything he used to do, including learning his business, which entails using a language I'd never worked in.' 'She's still alive, but clearly isn't there,' said Jason. of his wife, Miranda., who was diagnosed with FTD in 2009 and is currently treated by, the Sally Kerlin Professor of Neurology (in the, the, and in psychiatry) and, professor of neurology.
'She can't answer questions now – mostly she repeats things. I feel like I'm in a state of frozen grief.' FTD is the second-most common pre-senile dementia with an onset before age 65 (Alzheimer's disease is the most common). It is diagnosed following a thorough neurological examination by a dementia specialist. However, exact figures on the prevalence and incidence of FTD are still lacking, since definitive diagnosis is only possible upon brain autopsy.
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FTD is more of a mystery than Alzheimer's disease. Like Alzheimer's disease, some cases may involve genetic factors, and others not. Unlike Alzheimer's disease, FTD is not the result of a build-up of amyloid plaques in the memory part of the brain, and the disease tends to be memory-sparing for longer than Alzheimer's. Just as there is more than one clinical presentation of FTD, there also are at least two different molecular pathologies in FTD.
One involves tau protein, and the other a protein called TDP-43. These two different forms of the disease are being studied intensely at Columbia.
'Despite her behavior changes, my mother's memory appeared to remain intact for a long time. She would recall everyone's phone numbers, all of her medications, my dad's medications, and could always find the lost keys,' Ms. Pontrelli said. As the above testimonials illustrate, FTD can be extremely devastating for families, similar to the devastation caused by Alzheimer's and other forms of dementia. The economic and emotional impacts of FTD are often more pronounced because it strikes otherwise healthy individuals in their 40s, 50s, and early 60s at the peak of their careers and parenting responsibilities. 'The person that he was disappeared a long time ago – he became very apathetic and he used to be so dynamic,' said Carol. of her husband, who was diagnosed with FTD in 2004.
'I've had to take over his business, organize 24/7 home care, and I still have my own work. It's very wearing.' Since FTD presents in middle-aged people, it causes many different issues than with Alzheimer's or some other types of dementia. The patient's children may still live at home, many nursing homes and adult daycare centers do not accept patients who are still healthy physically, and families are reluctant to place their relative into a nursing home with much older residents. 'Now, in the end stage of his disease, he's totally mute and bed-ridden.
He's cared for at home, and it's a huge emotional and financial burden,' said Carol. 'I'm essentially a widow, but not quite.' Columbia University Medical Center.
FTD Clinical Evaluations Those who suspect they or their family member may have frontotemporal dementia (FTD) may schedule an appointment with a Columbia dementia specialist by contacting the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center by calling 212-305-6393 or sending an email to. Additional information can be found on the Taub Institute’s website:. The new FTD Program at Columbia University Medical Center brings together clinicians and researchers in order to improve the diagnosis, understanding, and treatment of this devastating illness. According to, professor of pathology (in psychiatry and in the ), 'FTD is actually a spectrum of diseases that overlap with each other and with other neurodegenerative diseases, allowing us to apply some of the knowledge obtained from decades of research into these other diseases to develop diagnostic and therapeutic approaches that would be suitable for FTD.' Patients with possible FTD are seen by Columbia neurologists at the. Patients are carefully screened for signs of FTD by highly experienced clinicians who use a range of techniques that can differentiate FTD from conditions with similar symptoms, such as psychiatric conditions and Alzheimer's disease. Extensive and relevant patient history, including family history, is recorded and tracked to establish whether any of the patients visiting the clinic may have familial forms of the disease.
If so, they are referred for genetic counseling. Initial research has demonstrated that 10 percent of familial FTD is autosomal dominant, meaning that the abnormal gene only needs to be passed down from one parent in order for the disease to be inherited. However, in other families without strict autosomal dominant inheritance, there may be several cases of FTD or related diseases, indicating still unknown genetic risk factors., the Gertrude H. Sergievsky Professor of Neurology, Psychiatry and Epidemiology, and co-director of the, together with, has initiated research at Columbia into the genetics of FTD. The FTD Program is also conducting research in cell models, and genetically-engineered mouse models of the disease created using known gene defects, in order to examine how the disease is initiated and how it kills brain cells. There is currently no cure for FTD, and in most cases, progression cannot be slowed.
The research team is focused on developing new treatment strategies, such as reducing abnormal forms of the protein tau, or preventing the damage done to the brain when toxic proteins accumulate. One of these therapeutic strategies, pioneered by Dr. Duff, is now in clinical trials in the U.S. And in the U.K.
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(visit for more information). Earlier this winter, 220 attendees gathered at an all-day Frontotemporal Dementia Caregiver Conference. Held at the New York Academy of Medicine, the conference was sponsored by the New York City Area Consortium on FTD, which was created by, co-director of the, in order to bring together researchers and other healthcare professionals in Alzheimer's and FTD to help increase the number of FTD patients involved in research studies, to share biological samples (such as brain tissue), develop new treatments, and to find other ways to address some of the challenges of studying the disease. There are very few treatments available for FTD – Alzheimer's therapies have been used with varying degrees of success, and SSRIs are often given to combat psychiatric symptoms. Mayeux brought together medical institutions in the New York area that have an expertise in neurological diseases.
Additional members of the NYC FTD Consortium include Weill Cornell Medical College, New York University, Albert Einstein College of Medicine, Mount Sinai Medical Center, Downstate Medical Center, North Shore Long Island Jewish Health System, and the Burke Rehabilitation Center. The conference was co-sponsored by the Association for FTD, the Alzheimer's Association, and the Alzheimer's Foundation of America. In addition, the National Institute on Aging and the National Institute for Neurological Disorders and Stroke are reviewing the possibility of creating FTD centers of excellence as part of their successful Alzheimer's Disease Centers.
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The event was open to the public and geared toward persons caring for those with FTD, including family caregivers and interested professionals – social workers, home health aides, and nursing home and day care staff. Topics included disease spectrum, diagnosis, genetics, medical management, and a full range of caregiver concerns, including placement and end-of-life issues, as well as guidance for navigating the complex legal-financial system. Jill Goldman, a Taub Institute genetics counselor, was instrumental in putting on the FTD Caregiver Conference, in which speakers from each of the NYC FTD Consortium institutions spoke about different aspects of FTD.
'The conference was an opportunity for caregivers to meet one another and realize that they're not all alone,' says Ms. 'Caregivers are forever looking for ways to keep their loved ones busy and engaged in a safe way, and it's extremely difficult, time-consuming, and exhausting.
They need to deal with family members who don't quite understand the disease; they're totally overwhelmed all the time. The stress level totally impacts the caregiver.' As Mary said of her husband, 'I'm very angry. All day long I don't quite know where he is – I've lost him several times. I know it's not his fault that he has FTD, but my whole life has turned upside down.' Frontotemporal Dementia Caregivers' Support Group.
FTD Caregivers' Support Group Held on the first and third Wednesday of every month 4:15-5:45 p.m. The Alzheimer’s Association, 4th Floor 360 Lexington Ave. (between 40th and 41st Sts.) New York, NY. If you are interested in participating, please contact Jill Goldman at (212) 305-7382. As a clinician, educator and researcher, Ms. Goldman has been driving efforts to create awareness and empathy of FTD and the struggles that family members and caregivers face. She leads a, which meets twice a month at the New York City chapter of The Alzheimer's Association.
'The issue of a changing relationship is very challenging, whether that person is a spouse or a parent,' says Ms. 'Because with FTD they're still present, but are not at all the same person.' Mary, mentioned above, is grateful to the FTD support group for encouraging her to share information about her husband's illness with others in their lives, 'Telling people about Jim's illness has brought tremendous understanding from those around us.
For example, we recently had an incident where Jim got upset at our doorman about a handyman not showing up for a scheduled appointment, even though the doorman had nothing to do with it. Because the doorman knew about his illness, he handled the situation with grace and kindness.' My Story: A Daughter’s Perspective on her Mother’s Diagnosis and Life With Frontotemporal Dementia By Lucy Pontrelli My story began six years ago when my then 63-year-old mother seemed to suddenly develop a speech problem. She was losing the ability to communicate, a quality which had perhaps been her greatest asset. During this time she would often state, 'The words don't come out.' The diagnosis appeared to be crystal clear to everyone she encountered.
Even perfect strangers in local stores would stare and whisper, 'Oh, she must have had a stroke.' I remember thinking, 'What else could it be?' After all, she was the picture of health. In fact, she was invincible, constantly doing everything for everyone and never taking a break. My family and I were convinced that this would pass and ultimately she would fine.
At the time she had no obvious signs of memory loss. Much to our surprise, two years, five neurologists, one psychiatrist and countless medical tests later, we discovered that she had Frontotemporal dementia, a rare disease unfamiliar to both the general public as well as the medical community. Now she’s seen by Columbia’s, the Sally Kerlin Professor of Neurology (in the, the, and in psychiatry), who was instrumental in making the diagnosis and helped my family understand the nuances of this peculiar disease at a time when it was overwhelming for us. Marder patiently explained this complex illness in terms everyone could comprehend.
Over a short period of time, this ruthless degenerative disease has stolen my mother’s basic functions, including speech, mobility, and most recently, her ability to eat and drink. My family and I cherish every moment we have with her – seeing her smile and hearing her laughter. Now the tables have turned and we have the privilege of caring for someone who has dedicated her life to taking caring of others. We are determined to find ways to improve her quality of life in addition to raising awareness and funding for this debilitating early-onset dementia that strikes during the prime of one’s life. Last name withheld for privacy. Names changed for privacy.
2003-2005 Projects 2003-2005 Dementia Grant Projects. Ozanam Hall of Queens Nursing Home, Queens, NY Advanced Illness Care Teams for Nursing Home Residents with Advanced Dementia. (PDF, 48KB, 1pg.). (PDF, 162KB, 23pg.). (PDF, 96KB, 18pg.). Hebrew Home for the Aged at Riverdale, NY An Evaluation of the VIGIL System. (PDF, 48KB, 1pg.).
(PDF, 109KB, 31pg.). Elant at Goshen Inc.
Electronic Dementia Guide for Excellence (EDGE) Project (PDF, 3.28MB, 11pg.) EDGE has evolved through many phases since its inception in 1995. EDGE is a web based resource program. Using the Internet as a mode of access and distribution, EDGE works by giving staff members in dementia care settings the tools they need to help them provide quality care. The program offers guidance to identify and implement interventions that specifically address care and communication challenges faced in dementia care. Why Use the EDGE Program?
The primary goal of the EDGE project is to develop and disseminate a computerized system of information to promote quality care of residents with dementia in nursing facilities. EDGE is designed to:.
have practical use in the long term care setting;. be extremely user-friendly;.
be a real help to improve quality of life for persons with dementia in nursing facilities;. reflect research based state of the art techniques and care practices;. delineate best living practices without being prescriptive;.
cover the most relevant subject areas within a reasonable scope of information; and,. provide interventions/approaches for residents throughout the functional phases in Alzheimer's Disease and related dementias.
It is essentially a quality improvement tool that:. Seeks to improve the process of caring for residents with dementia in long term care by teaching all persons who deal with the resident how to support the resident's attempts to obtain the highest quality of life possible. Includes receiving input for the care plan from all persons who have an impact on the resident's life:. staff in all departments. family.
volunteers. frequent visitors.
Provides a means to help all staff in the facility understand the needs of a resident trying to cope with the challenges of living with dementia. Looks at a resident with dementia as a person with a memory impairment who needs certain adaptive requirements to function at his/her highest level, just as any other person who is mentally or physically challenged does. Does not consider these adaptations 'special care', but necessary care; as wheelchairs, walkers, and hearing aids are for persons who need them to cope with certain physical challenges.
Is meant to be a starting point to help all facility staff to learn how to assess the ongoing needs of their residents with dementia in a comprehensive way in order to plan interventions and services that meet their needs. Is based on the in long term care which outlines the needs of a resident with dementia on every level, from most basic-biological (life-sustaining) to the highest level-creative and symbolic (life-defining), the same needs we all have.
Uses BASICS to look at a resident's problems and strengths to present a comprehensive picture of how well the resident's needs on every level are being met in the facility. BASICS gives staff a place to start in planning care for residents with multiple problems. Provides inservices and worksheets to teach staff to evaluate each resident with dementia in order to determine his/her place on the BASICS Hierarchy and then to plan interventions to satisfy needs on that level. In this way, the resident is supported to reach for the next level of need satisfaction.
Illuminate the fact that, conversely, when a level of need is not satisfied (such as the need for self-dependence, sometimes not fostered because of institutional rituals), a resident can remain stuck on one level and as a result behave in a distressed or distressing way. The resident may even regress to a lower level of function when strengths are not recognized and supported. Is based on the research indicating that problem behavior is often caused by unmet needs. The program uses to direct quality care by focusing staff on what they can do to meet resident needs on every level of BASICS proposing that 'problem behavior' is caused by unmet needs. Specific examples of how to meet each of the six Caregiver Goals during daily care are provided. EDGE looks at a person with dementia as a whole person with multiple needs and many personal resources instead of as a one-dimensional confused person with a particular memory-based problem that needs to be addressed.
Residents with dementia are often thought of, and care planned for, as 'persons with wandering problems' or 'persons with disruptive behaviors.' The Residents' other needs and strengths may not be considered when planning more comprehensive methods of helping them meet their needs and achieve successful adaptation to life within the facility. EDGE provides interventions composed of the following sections:.
What is it? (Purpose). Goals and Benefits. Program Structure (Duration, staff and equipment needed, participant selection). Inservice (For staff). Ritual (Program format).
Troubleshooting (Problems & solutions). Outcomes (Program results). References (For EDGE content).
Forms (Available in PDF) The interventions put current and credible resources in dementia care, complete with an implementation plan to use them, right into the facility, where they are accessible to all staff. The guidelines for each intervention in the EDGE program start with an evaluation of the resident's needs in reference to the particular problem it addresses. They also include definitions and criteria to use in assessing problems to clarify and standardize the meaning of terms used in the assessment. The EDGE format can be used to implement any intervention that might be beneficial to a resident.
Dementia Care Programs
It is a teaching tool that guides staff in every department to use it to become competent in meeting the needs of the residents with dementia they serve. While EDGE's primary focus is on long term care settings including nursing homes and adult care facilities, it can be used in other settings such as adult day programs.
SAN LUIS OBISPO, Calif. — Secel Montgomery Sr. Stabbed a woman in the stomach, chest and throat so fiercely that he lost count of the wounds he inflicted. In the nearly 25 years he has been serving a life sentence, he has gotten into fights, threatened a prison official and been caught with marijuana. Despite that, he has recently been entrusted with an extraordinary responsibility. He and other convicted killers at the help care for prisoners with Alzheimer’s disease and other types of dementia, assisting ailing inmates with the most intimate tasks: showering, shaving, applying deodorant, even changing adult diapers.
Their growing roster of patients includes Joaquin Cruz, a convicted killer who is now so addled that he thinks he sees his brother in the water of a toilet, and Walter Gregory, whose short-term memory is ebbing even as he vividly recalls his crime: stabbing and mutilating his girlfriend with a switchblade. “I cut her eyes out, too,” Mr. Gregory declared recently. Dementia in prison is an underreported but fast-growing phenomenon, one that many prisons are desperately unprepared to handle. It is an unforeseen consequence of get-tough-on-crime policies — long sentences that have created a large population of aging prisoners.
About 10 percent of the 1.6 million inmates in America’s prisons are serving life sentences; another 11 percent are serving over 20 years. While no one has counted cognitively impaired inmates, experts say that prisoners appear more prone to dementia than the general population because they often have more risk factors: limited education, hypertension, diabetes, smoking, depression, substance abuse, even head injuries from fights and other violence. Many states consider over-50 prisoners elderly, saying they.
With many prisons already overcrowded and understaffed, inmates with dementia present an especially difficult challenge. They are expensive — medical costs for older inmates range from three to nine times as much as those for younger inmates. They must be protected from predatory prisoners. And because dementia makes them paranoid or confused, feelings exacerbated by the confines of prison, some attack staff members or other inmates, or unwittingly provoke fights by wandering into someone else’s cell. “The dementia population is going to grow tremendously,” says Ronald H. Aday, a sociologist and the author of “Aging Prisoners: Crisis in American Corrections.” “How are we going to take care of them?” Some prison systems are confronting that now.
Many would like to transfer demented inmates to nursing homes, but their often-violent crimes make states reluctant to parole them and nursing homes reluctant to take them. New York has taken the top-dollar route, establishing a separate unit for cognitively impaired inmates and using professional caregivers, at a cost of about $93,000 per bed annually, compared with $41,000 in the general prison population. Pennsylvania and other states are giving mental health workers special dementia training.
But some struggling prison systems, including those in Louisiana and California, are taking a less expensive but potentially riskier approach. They are training prisoners to handle many of the demented inmates’ daily needs. “Yeah, they did something horrible to end up here,” said Cheryl Steed, a psychologist at the California Men’s Colony, where prisoners who help inmates with dementia are called Gold Coats because their yellow jackets contrast with the standard-issue blue. But without them, she said, “we wouldn’t be able to care for our dementia patients very well.”. Advertisement After escorting Joaquin Cruz to an appointment, James Evers, a Gold Coat, was returning him to their adobe-colored cellblock when they encountered corrections officers strip-searching inmates for missing tools. Cruz, 60, who barely recalls that he is in prison for killing someone who sold him fake cocaine, grew confused and resistant when guards tried searching him. “He has Alzheimer’s,” Mr.
Evers managed to explain. “It’s not that he’s refusing to do what you’re asking.” At the prison, shadowed by seacoast mountains, Gold Coats are paid $50 a month and have better knowledge of impaired prisoners’ conditions than many prison guards.
Gold Coats, trained by the and given thick manuals on dementia, were the first to notice when Mr. Cruz began putting his boots on the wrong feet and “started pulling down his pants and going to the bathroom wherever he was,” said Phillip Burdick, a Gold Coat who is serving a life sentence for beating a man to death with a hammer. Gold Coats report these changes, often at weekly support group meetings with Dr. They identify “different tricks and strategies to get guys to do what they need to do,” she said.
Before the program was started in 2009, demented inmates frequently caused fights, hitting those they considered threatening or disturbing other prisoners by encroaching on their turf. “The whole atmosphere was hostile,” said Bettina Hodel, a psychologist who started the program and once narrowly avoided being struck herself.
Now, Gold Coats absorb much of that behavior. Advertisement When a prisoner tried stealing a patient’s dessert, Mr. Montgomery, one of the Gold Coats, snarled, “You got to give him his cookie back.” “Who are you, the PO- lice?” the inmate barked. Montgomery retorted, “Yes, I’m the PO-lice!” More inmates have dementia than prison officials realize, experts say. Prison routines can mask symptoms like forgetfulness.
Corrections officers are used to punishing aggressive inmates, not evaluating them for Alzheimer’s. “Not responding to questions appropriately, being belligerent — it’s just considered bad behavior,” said Sharen Barboza, director of clinical operations for MHM Services, a prison mental health provider that trains prison officials.
New York’s Unit for the Cognitively Impaired, begun five years ago, has so far cared for 84 inmates, but “there’s a number of people in the system that we really haven’t tapped,” said Paul Kleinman, the program’s psychologist. “They’re not being identified properly.” Alzheimer’s currently, a number expected to double by 2040. Experts believe that Alzheimer’s disease in prisons could grow two or three times as fast, said John Wilson, senior clinical operations specialist for MHM, because “protective factors that might mitigate developing dementia are slim to none in prison — things like complex jobs, rich social environment, leisure activities.” Realizing that California, with nearly 13,000 inmates 55 and older, could not adequately care for demented prisoners, Dr. Hodel, when she was starting the Gold Coat program, asked the regional chapter of the Alzheimer’s Association to train inmates to help.
The chapter’s area director, Sara Bartlett, worried that she and Arlene Stepputat, then the program director, would not be safe as “women in a man’s prison.” She doubted whether violent felons could provide sensitive care. Advertisement The prison requires that Gold Coats have “a clean behavior record for about 5 to 10 years,” Dr. So far, only one Gold Coat has been removed, because “he had problems” with dementia patients’ messy eating and other behaviors, Dr. For inmates, the job has attractions. It pays better than other prison work and polishes a prisoner’s record.
Two Gold Coats have received parole. One of them, Shawn Henderson, who got 25 years to life for a 1985 double murder and was twice denied parole, was released last February. Doing a job where “you get spit on, feces thrown on you, urine on you, you get cursed out” helped teach him to cope outside prison, said Mr. Henderson, 46. “Now when I come into an encounter like that on the street, I can be a lot more compassionate,” he said. “And I don’t look at telling authorities as snitching anymore.” Gold Coats conduct exercise classes and run meetings designed to stimulate memory and lessen disorientation.
They escort inmates to doctors, acting as their intermediaries. And they often need to be deft. One 73-year-old inmate stands by a gate most mornings, waiting for his long-dead mother to pick him up. Sometimes he refuses to shower, afraid of missing her. Evers coaxes him inside, telling him that his mother “wants you to shower before she gets here.” More subtlety is required for Mr. Gregory, 71, who is serving a life sentence for brutalizing his girlfriend with a switchblade — throwing her body parts in the trash and getting caught, he said, when “I went right back to the room that I killed her in and had sex with another” woman.
Accelerated Nursing Programs New York
He does not believe he has dementia, but his gradually accumulating symptoms include breaking a mop over an inmate’s head and writing to outside agencies under the delusion that he will be granted parole. A LEARNING EXPERIENCE Two of the six Gold Coats, foreground, who care for 40 afflicted inmates at the California Men's Colony. Credit Todd Heisler/The New York Times To assist Mr. Gregory, Samuel Baxter, a Gold Coat who fatally shot a co-worker, firing six times, gently reminds him about bed making and schedules. “You have to allow Mr. Gregory to come to you,” Mr. There are limits to what Gold Coats can do.
They can file patients’ fingernails, for instance, but not clip them because that constitutes a professional caregiving responsibility that cannot legally be delegated to inmates. And there are indignities, like cleaning up after inmates who urinate on the floor.
Advertisement Still, he resists the Gold Coats’ help and believes that he would have to pay them. Oblique assistance, like Mr. Burdick bringing him a jacket, is all he accepts so far.
“I don’t need them, you know,” Mr. ‘I Was a Monster’ The compassion Secel Montgomery is required to show in his job as a Gold Coat was nowhere to be seen in the killing he committed in 1987. He wanted money for alcohol, and when his former sister-in-law refused, “I knocked her unconscious, tied her up and stabbed her.” Then he washed his hands and called his wife for a ride. He grabbed things that had his fingerprints on them, but left his infant nephew there alone.
“I figured that’s kidnapping,” he explained. Montgomery, sentenced to 26 years to life, spent 17 years in a high-security prison for “disobeying orders,” he said. He made contraband alcohol called “pruno.” Only in 2000, after Mr.
Montgomery, 47, was found with marijuana, accused of threatening a prison official and locked in the “hole,” did he decide to change. “I was a monster,” he said. Families of demented inmates seem unperturbed that prisoners like Mr. Montgomery now have so much responsibility. Laura Eklund, Mr.
Cruz’s niece, said prison officials have asked if his relatives wanted him paroled, but the family has declined. “To be honest, the care he’s receiving in prison, we could not match,” she said. Cruz spies his own reflection, he often believes it is his brother Sergio. To keep him from getting agitated, his cell mirror has been covered with tape. But now when he looks into a toilet, he calls: “Hey, my brother, he’s down there. I can’t get him out.” Mr.
Montgomery said he tries to reassure Mr. Cruz, but if Mr. Cruz is locked in his cell, Mr. Montgomery — still a prisoner, after all — cannot enter even if he is allowed out of his own cell. He will call to Mr. Cruz through a tiny window in the thick metal door.
“All I can do is say, ‘Cruz, come here, come here, come here,’ but he’ll stand there,” staring helplessly into the toilet and agonizing. “ ‘See, see, look, see.’ ”.
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