By LUCETTE LAGNADO
BRONX, N.Y. — Here at the Providence Rest nursing home, which caters mostly to retired nuns and devout Roman Catholics, Harold Packman has developed an important expertise: Giving massages to women who may have spent a lifetime shying away from this kind of physical contact.
Women like Sister Mary Austin Cantwell. Recently, Sister Cantwell, 67 years old and wearing some traditional vestments, rolled in on her motorized scooter for an appointment. Mr. Packman gingerly lifted the hem of the nun’s black skirt and started rubbing her arthritic knee.
“Oh, this is heaven,” Sister Cantwell exclaimed as he applied cream to her afflicted joint. “I am in heaven.”
Sister Cantwell is a bit of an exception: She lets Mr. Packman make contact directly with her knee without any intervening garment Many other patients are more vigilant, arriving in long dresses, support hose, and bulky long-sleeved sweaters that are not to be disturbed.
Providence Rest hired Mr. Packman, a licensed massage therapist, as part of an unusual experiment to cut its use of antipsychotic drugs. These controversial drugs — which are often used as “chemical restraints” to sedate agitated patients — have set off a national debate over whether nursing homes are misusing them. Newer versions, known as “atypical” antipsychotics, can increase the risk of death in elderly people with Alzheimer’s disease, the Food and Drug Administration has warned.
Providence Rest’s alternative treatments sound like something from a pricey spa, not a nursing home in the Bronx. Instead of antipsychotics, it has developed regimens involving aromatherapy, long, soothing bubble baths, use of medicines thought to have fewer, less severe side-effects — and Mr. Packman’s rubdowns.
The results are startling. Nationwide, some 30% of nursing-home patients are put on antipsychotics, according to federal data, but Providence Rest has cut its own use down to 2% or 3%. That’s the lowest rate of any nursing home in New York, and among the lowest in the country, according to the New York Association of Homes & Services for the Aging.
“Harold is a very big factor” in that success, says Jocelyn Ronquillo, Providence Rest’s medical director and leader of its anti-antipsychotics drive. When she arrived at the home, usage of antipsychotic drugs was at about 21%, Dr. Ronquillo says.
Mr. Packman’s strongest weapon in persuading clients to acquiesce to his touch may be the fact that he’s as old as — or older than — most of the women he treats. “There are advantages to looking like I do,” says Mr. Packman, who is 85, although with his sprightly gait and shock of white hair doesn’t look a day over 80.
“Patients say, ‘You have no idea how much pain I have,’ and I say, ‘Oh yes I do.’ ”
Providence Rest, which is run by an order of nuns, mainly cares for lay Italian Catholic women and some retired sisters, though there are a few males and non-Christians. All residents have crucifixes in their rooms. Many hail from the old country.
Patients arrive for their massages in wheelchairs and never disrobe or even lie down. At the most, some might merely let him lift up a trouser leg.
No matter. Mr. Packman, who has been a massage therapist for nearly a half-century, insists he can get the job done while respecting the boundaries. To put patients at ease, he banters like a borscht-belt tummler, delivering a stream of corny old jokes.
“What is such a rotten joint doing in a nice kid like you?” he says to Sister Cantwell’s knee. She chuckles, even though she’s heard that one before — at her last massage.
Back when Providence Rest went looking for a massage therapist with a specialty in geriatrics, Mr. Packman was the only one it could find. He joined in 2002 as the home began testing its alternative approach to managing patient pain and agitation. Among other things, Providence Rest substitutes antidepressants and Alzheimer’s drugs for antipsychotics, believing them to have fewer, less-drastic side-effects.
On a typical day Mr. Packman, who works part time, might see as many as 12 to 15 patients.
“Rosa, buon giorno,” he calls out as Rosa Rizzo, 93, arrives bundled up in a flowing dress and a woolen sweater that she won’t remove. In fact, she won’t let him so much as roll up her sleeves, despite severe pain in her arm and shoulder.
The Italian-born widow is more typical of the women Mr. Packman works with. “She had a very formal upbringing, as an Italian girl in an Italian family,” he explains.
“Rosa, are you going to let me take off your sweater so I can work on your arm?” he asks.
“No,” she replies curtly, waving him away.
Undaunted, Mr. Packman takes her arm — woolen sleeve and all — and proceeds to loosen the muscles. Then, he massages her fully clothed shoulders. “You don’t want to take off your clothes? Fine. I go with it,” he says.
Anyway, he says, young people today are too quick to bare all. In his private practice, “a lot of them don’t hesitate, they take their whole nightie off,” he says. “I tell them, ‘I don’t need all that.’ ”
The Last Frontier
But at Providence Rest, he says, modesty is the last frontier. The elderly, even patients with dementia, finds ways to make it clear they don’t want to be touched in certain areas. And some patients simply refuse to have a massage by a man, so he has trained female assistants to handle those cases.
Still, there are a few patients who are willing to let their inhibitions, and perhaps an article of clothing, slip away. Among them is Helen Filardo, 89, who has been receiving regular treatment for soreness in her back, arms, legs, and even, lately, her hands.
As she arrives, she cheerfully announces: “I have to strip.” So with some gentle assistance from Mr. Packman, she peels off her sweater and lets him massage her bare shoulder and back.
Write to Lucette Lagnado at firstname.lastname@example.org