'She likes to say she's a tough cookie'

A few months after my surgery, I went to visit Ruth Jacobi. My roommate from the hospital lives at Kensington Gardens, on College St. in downtown Toronto. It's a long-term care facility that evolved out of the old Doctor's Hospital.

John Jacobi, her son, led me upstairs to his mother's room. It was decorated with family photographs and furniture, including a beautiful old carved wooden cabinet. (When you visit a "home," it's easy to see who has family to help them and who doesn't. Some rooms are depressingly barren; the resident sits alone, usually with a TV blaring in the corner. The average length of stay in a long-term care facility is two years, followed by death. Ruth Jacobi has lived at Kensington Gardens for five years.)

John strode briskly into the room. "Hi sweetheart, how are you?" Ruth was lying on the bed. He leaned over and kissed her; she whispered something to him. He helped her up and into a wheelchair and wheeled her into the bathroom.

The physiotherapist, Sian Owen, arrived. "I rarely come across people like John," she said, watching him care for his mother. "He's consistent, he's really here for her."

Ruth Jacobi turned 82 in April. Thanks to intensive physiotherapy carried out by Owen, she can now walk, assisted, for short stretches. She feels triumphant when she takes a step.

"She wants to walk," John said. "She likes to say she's a tough cookie."

John visits a minimum of three times a week. When he's not with her, Owen comes on Monday and Friday; and Owen's assistant comes on Tuesday and Thursday. John pays. As I was to learn in my research, the private rehabilitation he is providing is more routine for most residents of Scandinavian nursing homes, where the focus is on enhancing what people can do.

John also pays for acupuncture two or three times a week, to reduce Ruth's pain. "She's had incredible pain since the stroke," he said. "When she was in Mount Sinai (hospital), she was screaming in pain for three weeks. They gave her Tylenol. I had to step in. Finally got a good doctor, finally got the right meds, which really helped."

The lack of geriatricians who understand the complex conditions of old people is a severe problem. For John, the harsh reality, apart from his mother's suffering, is the realization that "there is discrimination against old people. It's the worst kind. Ageism. So many times, I'm told, `Well, she is old. What you do expect?' It drives me crazy. It's pervasive.

"Our entire society ignores old people. We're afraid of death, yet we don't want to care for people who are aging – the place where we will be ourselves, someday."

He doesn't fault Kensington Gardens. "It's a not-for-profit, it runs on a shoestring, the people are good and caring. They do their best. But Mom asks for tea and it never comes. It's demoralizing for her."

Owen wheeled Ruth down the hall, to a sunny room where a man was seated at a computer. There was one piece of exercise equipment, called a Nustep, which John said was paid for by the family of a resident. "Can you believe there was no exercise equipment in this entire facility?"

Owen helped Ruth out of her wheelchair and onto the Nustep, which is a like an elliptical trainer with a seat. Ruth sat down; Owen strapped Ruth's feet into place.

"On three, Ruth, one – two – three," Owen said.

Ruth grinned and lifted her feet. She enjoyed the challenge, the exertion. "I'm a tough cookie," she said, delighted by her exertions.

Owen held Ruth's left hand, which was tightly curled into a fist, a result of the stroke. Owen massaged the hand, trying to gently open it. Ruth kept on stepping.

"If there was a pool here, Ruth could go swimming," Owen said. "We've taken her to the Variety Village pool a few times. It has the lifts and ramps and wheelchairs that can go into the water. Ruth loved it."

Ruth nodded and grinned. "I love the water," she said.

I would think of Ruth Jacobi later, when I was in Copenhagen, in a massive public swimming pool complex that had five or six pools, with access for disabled people.

Owen smiled. "That full body sensation, floating in the water, it's lovely. You don't get that easily."

John knows how different Ruth's life could be. "If I didn't hire Sian, and if this piece of equipment hadn't been donated, Mom wouldn't get to do any exercise at all. It's odd that we put people in these environments and don't give them the ability to do anything."

When I visited Ruth, I hadn't yet been to Sweden and Denmark, and I hadn't seen a dementia home where, if you could peel potatoes, you'd be in the kitchen peeling potatoes at dinner time, or picking tomatoes in the garden, or sweeping the floor. I didn't know there were nursing homes where you could participate in the life of the home; where the rehab nurse would say, "If you can do up three buttons on your shirt, or take three steps, we'll be working with you to get to four."

Owen helped Ruth off the machine. "Stand tall, Ruth. Get your balance."

"Head up, Mom," John said. "Look at me."

Ruth Jacobi smiled and took a few steps toward her wheelchair.

"That was a long walk," she said.

John applauded. "You're making great progress, Mom." His eyes were bright with encouragement. I imagined he was giving back to her what she'd given to him when he was a boy.

"I like exercise," Ruth said. "I'm happy to do it."

Back in her room, I could smell the fragrance of red roses on her bedside table.

"Where did you get the beautiful roses, Ruth?" I asked.

"That's my Valentine," she said, kissing John on the cheek.

John turned on the radio; classical music filled the room.

"Music is my first love," Ruth said. "My parents were poor and couldn't afford music lessons for me. John learned to play the piano. He plays very nicely." She took a few more steps and beamed.

John smiled. "She has things to look forward to. She has Sian coming, me, my wife, my son... a new baby on the way...She has hope."

At Kensington Gardens nursing home, rates are set by the Ontario Ministry of Health: $1,543.95 a month for a basic shared room, $2,091.45 for a private room. If you are poor, your rent is subsidized. Ruth Jacobi pays her own way.