Hogar de Ancianos, Costa Rica

Hogar de Ancianos

First Day at Hogar de Ancianos

On my third day as a Cross Cultural Solutions volunteer in Costa Rica, my assigned site is closed for a holiday. Margeth, the CCS program intern, suggests I accompany Rosa, another volunteer, to El Hogar de Ancianos since I expressed an interest in seniors. Hogar is the last home for about sixty men and women who are unable to care for themselves any longer. Many have been abandoned by their families or have no family in the area.

Rosa, Margeth and I jump out of the van at El Hogar. Low cement buildings surround us. Elders in wheelchairs are scattered around in covered patios and walkways. The aides bring more people from the dining room to their favorite spots. An aide pushes a wheelchair with one hand and with the other, he holds the hand of one of the men who can walk and gently pulls him along behind. One of the men is not satisfied with his location and is already on the move. His arthritic hands keep him at a snail’s pace but time is not an issue. Independence is. Some elders are nodding, sleeping off the morning medicines. A few are tied to their chairs with lengths of old sheets. I assume they are at risk of slipping out or of falling if they try to stand. At their age, a fall can be fatal.

After spending many hours at an assisted living facility where my mother lived the last of her ninety-three years I am familiar with the inconveniences of aging. I also love what shreds of life remain in failing bodies, and the secrets they hold.

Rosa has worked at El Hogar two days a week for several weeks and Margeth knows the residents since she visits often with new volunteers like me. We greet as many elders as we can find, shaking every hand with a relaxed “Buenos dias” and a brief exchange. We respect the privacy of the ones in their rooms and will talk to them later if they choose to emerge.

Rosa coaches me on names and personalities as we move from person to person. “This is Guillermo. He is such a sweet man. Always smiles and loves some attention but he never talks.” His bright eyes follow us as we all shake his hand and look into his eyes. He nods in appreciation.

“This is Julio. He always makes a joke when we come.” In this place where more than half the residents use wheelchairs, Julio is one of the few who are ambulatory. He is a small man. His favorite seat is inside a windowed reception area. He replies “Buenas Noches” to my buenas dias and looks up at me with an impish, toothless grin.

We move to another man with very dark hair and a short black beard. “Juan is one of the gropers I mentioned on the way over. He will take your hand and won’t let go and he is very strong. He grabbed at my chest the first time I greeted him so I avoid the handshake and just hold his shoulder. I never hug the men like I do the women because they just see it as an invitation.”

Rosa is just out of college, has long hair like all the local women and is dressed in jeans and a close fitting top. When she introduces me to Juan, he assumes I am a man. This is not an uncommon reaction. I am over sixty, have short hair and wear loose clothing. When I approach him, my low voice only confirms his assumption and he asks if I am her amigo, the male form of friend. She explains that I am her amiga, not her amigo, clarifying that I am a woman. I offer him my hand. He takes it but he does not pull me down for a kiss the way he did Rosa.

Walkway at Hogar

We move to a semi-circle of women outside the door of their building. “Patricia is one of my favorites,” Rosa says. “But we can’t show favoritism or the others get jealous.” Rosa takes the boney hand and Patricia’s leathery face creases into an enormous smile. Her lips slide inward over her toothless gums and she pulls Rosa down for a cheek buss.  She also takes me for man. When we explain the error, she laughs and claps her hands as if it is a huge joke. She closes one eye and skews her lips like Popeye. I love this woman. Who can’t help but fall for someone with so many years and such a lively demeanor.

We enter the women’s building. White figures move swiftly from one chore to another, stopping occasionally to respond to one of the resident’s request for help. In the hall a woman faces the wall, just putting her last leg through the back of a metal arm chair. Her facial features indicate she has Down’s syndrome. I guess that position feels safe to her and possibly minimizes stimuli. In any case, she remains quiet.

Eight women in wheelchairs are lined up against the far wall, every eye on us. The first one has a cloth around her neck like a sling. Both arms are out of sight. I reach for a hand but only find a knee for a light pat. She jerks it away and pulls her arms up in the sling and snarls. Rosa says, “She never wants to be touched,” and I rue my impertinence. I realize I have begun to make assumptions and greet them by rote. Every individual needs a fresh start, look for their humanity, find some way to make them feel special. And remember each person’s name!

We shake the last hand, return to the courtyard and gather near the colorfully painted cart where we had stashed our bags. From my bag, I pull out a three-ring binder prepared by a previous volunteer. It contains various items to stimulate senses and memories. Margeth gave it to me before we left our home base, an old home rebuilt as a hostel. The stimuli are prompts for conversation and memory recall. I was willing to try it after she assured me it was not an evaluation tool. I am a bit worried that she has overestimated my Spanish abilities so we all will work together on the first trial.

Hogar path

We decide to start with Patricia, Rosa’s favorite. I ask her if she would like a tour of the garden, a treat for most of the elders. It is only a short loop on a concrete path, but the vegetation is lush and varied. The natural shade with glints of light moving over the green leaves is soothing, a welcome change from the cement walls, floors and ceilings where the elders spend most of their time.

Patricia is delighted with the attention. We settle into the second cement bench, pulling her chair close. Margeth asks Patricia if she would like to see some interesting things in the binder. Without hesitation, she says yes, ready for anything. Her gnarled hands reach out but Margeth told me I should open to only one page at a time, not hand over the whole binder or they would turn the pages like a magazine. Questions swirl around in my head. How well can she see and hear? Is she able to process information? Can she recall memories and will they be happy ones?

I select a page with three pieces of shaggy material attached, maybe something to add detail to a little girl’s dress: shiny pastel pink, yellow and blue in various textures, thin thread, and heavier yarn to small ribbons. Patricia’s face lights up. “Que bonita,” she exclaims. She strokes the items gently, whispering the colors. She is in no hurry to turn the page. Patricia’s reaction seems like what the creator of the binder had anticipated. She certainly enjoys the experience.

When she seems ready to continue my Spanish falters. Rosa and Margeth come to my rescue. One page is yellow, with five pointed stars on a paler yellow background. Patricia can see them and knows exactly what she is seeing. To our questions, she tells us they are stars, and that they are in the sky with the moon. While she is quick to answer, I worry that the questions might be condescending for her. Refining that judgment will come in time.

At home I have been learning songs to be sung at the bedside of seriously ill people and those who are dying. I want to sing one to Patricia to see her reaction. I ask her permission to sing. She says, “Oh, si. Me gusta mucho.” I would like that.

I touch her hand lightly and look into her eyes. It is a short song, a Navajo prayer, and I sing it three times, slower and softer each time. She thanks me. Margeth asks if she would like to know what the words mean since I sang in English. She listens intently to the translation. She nods in appreciation saying it didn’t matter that it was sung in English. She understood.

We finish strolling around the garden loop with her and return to her spot. Most of the people have a favorite location for sitting somewhere on the grounds. It is a familiar place where they spend most of their day when they are not eating or sleeping or doing one of the activities that volunteers organize. Volunteers are vital to this place where the staff are caring, gentle and patient but can only do what must be done because they are so few in number. Crafts, exercises, games and just sitting with the elders are initiated and organized by volunteers. On many days there are no volunteers.

We choose another woman, Anna, and take her to the same bench in the garden. She is delighted with the materials in the binder. I don’t let her see everything, aware that this might not be the only day we use this material. She seems to enjoy the interaction. After I sing the song, she tells Margeth she would like to know what the English words mean. The first line is “When you were born, you cried and the world rejoiced.” In Spanish, the phrases “When you were born…” and “When were you born…” are the same and Anna jumps in to tell us when she was born. Margeth starts again, but the translation is lost.

“This is to stimulate memories and conversation. Let’s go with it,” I say and we do. Anna’s memory is still active. She is lively and animated as she shares her life with us though only Margeth understands fully what she says. Inside I am angry with myself that I cannot follow her stories. What Anna is saying means so much to her, I want to be able to respond with more than my limited Spanish skills allow. We are told that just being an active listener means a lot to the elders, but it is not enough for me.

CCS volunteer project

Margeth asks if we can carry on if she leaves. I ask her to stay a little longer. I prefer to work with women but feel we should try the binder material on a man since there are so many more men than women at Hogar. We might need her language skills. Rosa sees Silvio looking eager, or at least curious. He is a rascal and revels in having three women around him, though he is not so certain about me. For him, I choose a page with two postcards on it. One is of a man on horseback at the edge of thick, green vegetation. The other is of a blond, pony-tailed young woman in a bright red convertible.

I ask which he likes and expect him to choose the girl. To my surprise he chooses the man on horseback. Margeth asks if the picture brings a story to mind. Silvio has a lot to say since he once worked in a job that required him to ride a horse. I don’t know if this means he was a cowboy or just that horses were a convenient way to get around.

The noise from the street outside the fence makes it a difficult for me to hear his words but Margeth listens intently. At one point she turns to Rosa and me to tell us that he rode a lovely little filly and one day they had to jump into a river. He fell off and they both had to swim to shore and he laughs at the recollection. I’ve missed most of the story but for Silvio it lives in his mind, so I smile and nod.

While he is talking, I wonder if Silvio was abandoned by his family as Margeth said was the case for many at Hogar. Was he such a rascal that his children thought he was a bad father? Or was he unable to marry because of his work, has no children that he can claim. Is he only able to relate to women as a rogue?

Silvio continues talking. He is slumped in his chair and pulls himself up and forward until the sheet fragment restrains him. He relaxes back into the wheelchair to a position that looks uncomfortable. He probably wants to pull himself more upright, which would relieve whatever part is aching. If his legs are weak, he cannot do so without help. My heart goes out to him. Continuing his story without a break, he repeats this action several times. I want to hoist him up to relieve his discomfort, but we are not allowed to help in that way. There is so much we can’t know about these fragile people that would put them at risk. I understand, but it is hard to watch him.

Singing the song does not seem appropriate for this man. Maybe I can recall some more lively camp songs if the conversation drags with men like him. Best to go with that gut feeling and not sing, I thought. Silvio is wound up and rattling on, but I am aware of the “no favorites” rule and wonder if we should end this soon. It is my first day at El Hogar so I leave it to Margeth and Rosa to make the move.

We return Silvio to his spot in the courtyard and Margeth says goodbye to us. Rosa and I go to the laundry to help fold sheets. The pile is endless. I know that any interaction with the elders is welcomed by the staff but for me they are intense. I needed a little break. Folding sheets sounds just right.

Carmen and Jeffry, staff

A cart overflowing with warm, dried sheets almost blocks the entry to the laundry building. Rosa cautions me not to just dig in. There is a particular way to fold them and one of the laundry staff demonstrates by quickly rendering the mass of material into a tidy flat and manageable form. I miss the nuances. Folding a sheet. What can be the trick? Not only do we have to fold them just so, we have to place them on the pile all with the same orientation. When you are dealing with hundreds of sheets and blankets, you want those sheets folded so they come off the stack ready for the bed with the fewest of motions. I am gently corrected several times.

I want to ask how often they change the bedding. With so many incontinent people it could be daily or even more often. These women are like Sisyphus and his endless rock pushing. Fold the sheets, put them on the beds, take them off, wash them and begin again.

After half an hour, Rosa says it is time to help with lunch. The men in wheelchairs are taken first, then the other men and then the women. I push one man in and help distribute juices and meals. After the meals are all served, I spot an aide at a corner table feeding three men. One man sits by himself with his back to the wall. This is the man Rosa has told me moans at every meal though he is not making any noise right now. The other two sit at a table. The aide stands in the center of the three, feeding each in turn. I offer to feed one of them who appears to be blind. One eye is closed and runny, the other cloudy. However, the reason he needs help is that his arthritic hands are frozen and gnarly. He cannot close them to hold a utensil.

Even this job is a challenge for me. He is gumming his food but I realize he makes the same motion with or without something in his mouth so it is difficult to tell when he is ready for another bite. He knows when food is on its way and opens his mouth at the right moment. I find myself putting a light hand on his shoulder when the spoon approaches, but perhaps he can see light and shadow with his cloudy eye.

After a while, he gargles something to me and points with his lips. I understand that he is full although he did open his mouth for the last bite, gagging a little. A juice glass with a straw in it and a soup mug are in front of him on the table. A passing aide doesn’t slow down when I ask for help. Finally he gives up, takes the juice glass, sips some juice and swishes his mouth. He pops out a dental appliance and swishes again. Of course. He needs to clean the appliance. I am not sure he wanted water or what and am sorry I couldn’t help.

Aides scurry in and out, taking the elders to their next destination. I wonder if naps are a possibility. I feel ready for one. So many elders nap during the morning, is this only a matter of semantics?

An aide is sweeping in the far corner of the dining hall. There is lots of food to be put out of the reach of the tiny ants that search the floor in endless random patterns. I ask where I can find another broom and join the effort. Sure she has a system, I keep an eye on her.

Meanwhile, another staff person turns the corner into the almost empty room and makes a startled, high pitched “Oh, my goodness. I can’t believe my eyes,” sound.

Oh, yes, I think, I am sweeping and I am a gringa. We know how to sweep, too. In a way, I feel honored by her surprise. We finish up quickly and my co-sweeper doesn’t have to re-sweep too much of the ground that I covered.

Harriet and Patricia

I find Rosa. Time to begin our goodbyes. We approach as many of the elders as are readily accessible, shake hands and say “Hasta luego.” See you later. They tell us to travel safely.

Waiting for our ride back to our home base, I go over the day. The work is physically tiring, more than at my other site where more able seniors play card games, computer games and take classes. They love crafts projects and the exercise classes.

And the names to learn at Hogar de Ancianos, not fifteen but sixty! But I feel a personal attraction to the work and a challenge as well. At Hogar there are so many people with such a variety of abilities and disabilities. Each elder has a life and a story. Each one deserves respect and human interaction. The challenge is to recognize when I am not being understood because of my weak Spanish or their diminished hearing; when they are talking fast because they are wrapped up in a story or spouting gibberish like the man who has devils on his shoulder.

I change my schedule to work at the Hogar on Tuesdays and Thursdays. During the four days I work there before returning home, I learn that the Man Who Cries laughs gaily when we engage in making silly faces at each other; that the woman who shouted me down when I sang to the group in the hall has a delightfully inviting smile on some days; that the woman who sits between the phone booth and a table making it difficult to sit beside her, loves to color and does an excellent job; and that the man who gropes, longs for a quiet conversation. I also discover how hopeless I am when it comes to swiftly rendering a pile of fruit into chunks to make the fresh juice for lunch, but I see how surprised and delighted the two cooks are to have me in their kitchen for a while.

Patricia and her friend

On my last day at Hogar de Ancianos, I feel I am just getting to know these people. I am just learning who likes activities, who likes to go for a garden walk, who will talk forever if asked, and who prefers to remain in solitude. As I say goodbye, I chastise myself for not doing more, and yet, even the five days opened doors of possibilities for me. I know that what little I did was appreciated, and I know I can do much more next time.


See also: India and On Hair