“You see, even here I don’t belong,” said the elderly woman, and she started crying. “Where do I belong? I don’t belong anywhere, I’m not useful any more.”
Said another, quite simply: “My dream is to eat what I want when I want.”
These, and other anecdotes, are told by members of a small profession that is almost guaranteed to grow quickly in the years ahead: Elder clowns. These are not clowns who are now elderly, but clowns who provide therapy and entertainment for the elderly, and especially for residents of nursing homes.
Their story is told in a fascinating new paper by researchers Ludivine Plez, Melissa Holland, Priyanka Kulasegarampillai, Thun-Carl Sieu and Stefanie Blain-Moraes from the school of physical and occupational therapy at McGill University in Montreal called “‘I made you a small room in my heart’; how therapeutic clowns meet the needs of older adults in nursing homes.”
“Therapeutic clowns are increasingly common in nursing homes,” they write, and interviewed 23 trained and experienced such clowns from eight countries.
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Elder clowns cheer up nursing-home residents through “singing and instrumental music, physical comedy, imaginative play and improvisation,” they report. “Elder-clowns elicit joy, offer opportunities for connection despite neurological disorders, and have the potential to reduce disruptive behaviors,” they add.
The researchers’ analysis concludes that elder clowns succeed by meeting five major needs of nursing-home residents that are not being otherwise met: “The need to escape routine; the need for reassurance of worth; the need for meaningful, personalized social interaction unrestricted by communication barriers; the need to have culturally meaningful opportunities for reminiscence; and the need to have a space where they could be unapologetically themselves.”
Or, perhaps: The need to be treated as a human being, not simply as bodies to be stored and problems to be managed. Elder clowns interact with residents on the residents’ terms, not on their own or the institution’s. They talk about listening, improvising, and avoiding having their own agenda. When a patient with Alzheimer’s was aggressive, one recounted, he and his partner created a routine where the patient and one clown pretended to punch the other, who fell down, over and over again, until the patient was exhausted.
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The results reveal both the incredible value of these jobs and the depressing, often shocking, way people in nursing homes are dehumanized.
The woman who burst into tears and said she didn’t belong anywhere? The clown said that she was in a wheelchair, and he had been sitting, talking to her, when a staff member just came along and abruptly whisked her away.
And the woman whose dream was simply to eat what she wanted when she wanted? As a clown explained, “They are obligated to get out of bed [but] if there’s not enough staff, they have to stay in bed. They eat, it’s not very good, it’s not what they feel like eating. They have no power. They get showered, even if they don’t feel like it, get their hair brushed…”
The way so many elderly people are treated in nursing homes can only be rationally explained by one simple fact: Few middle-aged people realize this may be them one day. There is surely no way they would tolerate so much underfunded, overstretched, dismissive and dehumanizing institutional treatment if they realized that there is somewhere between a one-in-three and one-in-two chance that they will end up in one of these institutions themselves before it’s all over.
And by the time they do end up there — well, it will be too late, and they will be subject to rules established by the next generation of middle-aged people, making the same myopic, self-centered and stupid mistake.
We saw this dismissive attitude during the pandemic, when governments spectacularly failed to protect nursing home residents, even though it was already known who was vulnerable and who wasn’t.
And we see it in the dismissive attitude to elder abuse. An attorney who specializes in cases of elder abuse and neglect in nursing homes told me that if his cases involved children “they would be on the front page of every newspaper.” But if it’s someone elderly, nobody seems to care.
We will have to see if that attitude changes over time. The Biden administration has taken several positive steps toward trying to improve conditions in homes, although as ever there is a battle over money.
Until then, at least we can send in the clowns.