Advocacy, Annie & Cricket, Antipsychotic drugs, NHBPS, Toward better care

29 normal behaviours you could be sedated for

dark hospital corridor cropped

The Nursing Home Behaviour Problem Scale (NHBPS) was designed by researchers in the early 1990s to measure the frequency of “bad” behaviours exhibited by people living with dementia in nursing homes; it lists twenty-nine problematic behaviours supposedly caused by dementia.

Misunderstanding picThis scale and others like it are used to rate the frequency of such behaviour, and often to justify using antipsychotic drugs to sedate people living with dementia. I was shocked the first time I read the NHBPS. Why? Because most of the items on the list describe ways any normal person would act if she or he found her or himself in similar circumstances. We blame behaviours on the disease when instead we should be asking different questions.

I have created a series of vignettes around the behaviours on the NHBPS to demonstrate what I mean. The stories in the vignettes are told in the voice of a fictional character called Annie, a woman in her mid-eighties who lives with dementia of the Alzheimer’s type. Like Judy Berry’s mother Evelyn Holly (a real person), my fictional Annie has also been sedated with antipsychotics and kicked out of several nursing homes for her “problematic behaviour.”

Click here for more vignettes.

nighttime nightmare

My eyes are closed. I must be asleep. What’s that noise? I open my eyes. It’s dark. But light is shining beside me. Is it night or day?

I’m lying down. My head is on a pillow. There’s a blanket on top of me. I must be in a bed. But where? And what’s that noise? It sounds like snoring. Listen. Listen. It IS snoring. Listen. Is it me? Am I snoring? Listen. Check. Listen some more. No. It’s someone else. Someone else is in this place wherever this place is, and that someone else is snoring.

I close my eyes. Try to sleep. What’s that noise? Someone is snoring. I pull the covers off. Sit up. Swing my legs around. Feet on the floor. Stand up. The snoring is coming from across the room. There’s a bed there. I think someone’s in it. Oh dear. Why am I in a bedroom at night with someone else? Why aren’t I at home? Mummy will be worried about me.

I walk toward the bed. My legs feel a little shaky. Something pulls me back, but I keep walking. My nightgown stretches tight across my chest. Something is holding me back. What is it? I lean forward. Suddenly the soft flannelette floats loose at the front again. I lurch a little from the unexpected release, but I don’t fall.

Whatever was holding me back isn’t anymore. A bell starts to ring somewhere. Ding. Ding. Ding. The snoring sound deepens as I get closer to the bed. I reach the bedside. Someone’s in the bed. An old lady.

“Excuse me,” I say. She doesn’t budge. “Excuse me!” Louder this time. Ding. Ding. Ding. A bell rings in the background. The bell is annoying. The snoring is annoying. The old lady in the bed doesn’t seem to notice any of it. Reach down. Put my hand on her shoulder. Shake her gently.

“Excuse me. Excuse me.”

“Mmmmmmmm, mmmmmmmm,” she mumbles. Her eyes stay closed.

“You’re snoring. Stop snoring. Wake up. Wake up.” Shake her a bit harder. She rocks back and forth. Doesn’t wake up. She’s dead to the world. Ding. Ding. Ding. There’s a bell ringing. What is that bell? This place is too noisy. It’s making me nervous.

“Annie! Someone says behind me. “Annie! What are you doing?” Who’s that!? Pull my hand back quick. Straighten up. Turn around. Slow motion. A young girl walks toward me. Or at least I think it’s a young girl. Who is she? Who is she? Her face is black because of the bright light shining behind her. Her voice is sharp: “What are you doing?”

“This lady is snoring. I want her to stop,” I say.

“Edna is trying to sleep, Annie,” the girl says. “You mustn’t disturb her, dear. You have to go back to bed. I’ll help you.”


The young girl with the black face doesn’t listen. “Come this way, dear,” she says. “It’s the middle of the night. It’s time to sleep now…”

#mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; }
/* Add your own MailChimp form style overrides in your site stylesheet or in this style block.
We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. */

Subscribe to MAS now & get 5 free PDFs & a page of welcome links:

Email Address

Take my short survey on behaviour here.

Image copyright: hxdbzxy / 123RF Stock Photo

Annie & Cricket, Fiction, Joy, Life & Living, Love, Our stories

better late than never

Holding hands painterly


“Hey Mom! There’s Stella,” Cricket said as she and Annie rounded the corner into The Home’s drawing room.

Stella sat in a big red armchair in the far corner. She looked up from the sock she was knitting.

“There you are,” Stella said smiling. “I was just about to leave because I don’t like to sit here all alone.”

“Well, you’re not alone anymore,” Cricket said. “Mom and I are here. Will you stay and chat with us for awhile?”

“Of course,” Stella’s reply was immediate. “I’ve missed you the last few days.”

Sometimes their timings didn’t match up, or one of Stella’s children took her on an outing.

Cricket rolled Annie as close as she could to Stella’s chair and stopped.

“Look Mom,” she said. “Here’s Stella.”

“Who’s Stella?” Annie stared into a space about three feet to Stella’s left and four feet behind her.

Stella, who was in her late nineties and still had all her faculties, set her knitting in her lap, reached out with her right hand and placed it gently on Annie’s knee.

“Hi Annie, it’s me Stella. I’m glad to see you. I’ve missed you.”

“Hello Stella,” Annie said. “Oh you’re a good girl.” She swivelled her head and eyes until they zeroed in on Stella, and then tapped the gnarled hand on her knee and smiled.

If Cricket had believed in God, she would have offered up a prayer of thanks. Instead, she just let gratitude flood through her for Stella, this place and the host of angels who staffed it.

Annie was recovering beautifully from a string of disasters in other facilities; after only six months in this new place she was like a different person. Cricket wished she had found The Home earlier. She would have spared her mom the suffering she’d been through the previous two years.

But better late than never.

Better late than never was her consolation.


This is the third instalment in a fictional series about Cricket & Annie; more here.

Like this post? Subscribe here.

Annie & Cricket, Fiction, Joy, Life & Living, Love, Our stories

it’s just not cricket

CRICKET-ICC-WORLD-T20-FINAL-WOMEN'S-ENG-AUS...England cricketer Charlotte Edwards (R) plays a shot as Australian wicketkeeper Jodie Fields looks on during the ICC Twenty20 Cricket World Cup's final match between Australia Women and England Women at the R. Premadasa International Cricket Stadium in Colombo on October 7, 2012. AFP PHOTO/Ishara S. KODIKARA (Photo credit should read Ishara S.KODIKARA/AFP/GettyImages)
Photo credit: Ishara S.KODIKARA/AFP/GettyImages

“May I ask you a question?” Stella said.

Stella was unfailingly polite.

“Of course,” Cricket replied.

Cricket was compulsively transparent.

Stella’s hands worked without pause. She didn’t look up.

Pearl one, knit one. Pearl one, knit one.

Cricket knew nothing about knitting, but she’d heard “Pearl one, knit one,” somewhere and imagined that’s what Stella might be silently saying to herself as the needles clicked.

“How did you get the name Cricket?”

Cricket laughed.

“What did she say?” Cricket’s mother Annie asked.

Laughter always sparked something in her, despite the dementia.

“Stella wants to know how I got the nickname Cricket, Mom.”

“Oh. She wants to know how you got the name Picket.”

Her hearing was fine. Her processing not so much.

“Cricket, Mom,” she enunciated more clearly.


“Yes, that’s right.”

“Oh dear.”

They sat side-by-side on a worn-out sofa. Multiple lacerations in the slip covers exposed the dull yellow foam underneath. Cricket had her arm around her mother’s shoulder; she pulled her a little closer.

“You know the expression ‘It’s just not cricket’?” Cricket directed her question at Stella.

“Yes,” Stella replied.

“It’s just not cricket,” her mother repeated.

“It means something is unfair. It means something unjust or just plain wrong is being done to someone or something. It comes from the game of cricket,” Cricket elaborated.

“Something just plain wrong is being done to someone,” her mother echoed.

“Yes, that’s right, Annie,” Stella agreed.

“Well, it’s not from that,” Cricket deadpanned. Stella chuckled. Annie looked blank.

“I was born in August, right Mom?”

“You were born in August.”

Repeating was a comfort, and Cricket helped Annie do it. It was a way for her mother to contribute to conversations, to feel connected, to express herself when other means failed.

“That’s right Mom. In August.”

Stella glanced up from her sock-in-progress, and nodded encouragingly.

“You used to tell me the crickets were in full song when I was a baby Mom, and I was really chirpy just like them–especially at night.”

“Especially at night,” Annie said.

“Yeah. So that’s how I got the name Cricket, Stella. From the mating sounds of insects on hot summer nights,” she laughed at the irony of telling the story on a blustery November afternoon fifty-five years after the fact.


This is the second instalment in a fictional series about Cricket & Annie; more here.

Like this post? Subscribe here.

Annie & Cricket, Fiction, Hope, Joy, Life & Living, Love, Our stories

jingle bells and chocolate truffles

Cricket hadn’t expected any gifts that Christmas, but her mom surprised her.

“Would you like tea Mom?” She asked as the two of them rolled into to The Home’s drawing room.

“No, I I I I I I I don’t like the tea,” her mother replied. Continue reading “jingle bells and chocolate truffles”