From the outside, Steere House looks normal enough. The spacious three-story facility houses a nursing home and rehabilitation center in downtown Providence, R.I., right off Interstate 95. On the third floor, the Safe Haven Advanced Care unit has 41 rooms reserved for patients who have dementia. Nothing appears odd about the wing, until you get to know one of the house pets: a sweet-faced gray and white tabby named Oscar.
Oscar was adopted by the nursing home when he was a kitten and passed his first year rather uneventfully, playing with fellow feline adoptee, Maya, or entertaining himself out of the public eye. But shortly before his first birthday, he began visiting patients during their final hours. He’d take up a vigil on the beds, waiting quietly until the patient had passed away.
The nursing home employees soon began to realize he was the first “staffer” to know a patient was about to die. They took Oscar’s visits as a cue to notify the family and make final preparations. David Dosa, M.D., a Steere House geriatrician who treats the dementia patients and researches the illness at Brown University, wrote an essay about Oscar for the New England Journal of Medicine. The piece made international headlines—and propelled Oscar into unusual stardom.
Dosa then launched his own personal investigation to learn about the effect Oscar had on the people around him—namely the patient’s families. He relays what he found out in his new book, Making Rounds With Oscar. He spoke with the AARP Bulletin about it.
Q. Before you met Oscar, were you a cat person?
A. Absolutely not. I had had some bad experiences with cats growing up and that colored my perception of them and their importance.
Q. So what motivated you to investigate the Oscar effect?
A. I wanted to get a sense of what the families thought about having this cat sit at the bedside while their loved ones passed on. When I wrote the essay on Oscar, there was a fair amount of publicity. It was geared toward “if Oscar’s on your bed, you’re dead.” He was depicted as the grim reaper of cats.
Q. But you saw Oscar’s services in a different light?
A. We were seeing a cat that was providing families with a great deal of distraction—and comfort.
Q. In his five years living at Steere House, has he missed a death?
A. He’s been right most of the time. We’ve estimated that it’s over 60 at this point.
Q. You’re a scientist. Have you heard of a satisfactory explanation why Oscar does this?
A. What makes the most sense to me is he’s perceiving a smell or a pheromone. We know that when cells are in starvation states or in their final stages, they release ketones, which are sweet-smelling chemicals. Doctors are actually taught to smell them on the breaths of diabetics to determine if their sugars are really high. We also know ketones are released during hunger strikes or when people are at the end of one.
Q. But even if he does tune in to a smell, and “knows” when death is near, what makes him stay by the patient’s side?
A. I’ve interviewed a lot of people for this book, but Oscar wasn’t talking, so ultimately your guess is as good as mine.
Q. But what’s your guess?
A. I do think animals have an empathic relationship with people and Oscar is the resident pet for 41 patients on this unit. He seems to know when he’s needed. If he’s responding to a smell, that might be, but there’s something more to it because he doesn’t leave until the undertakers come.
Q. Have you heard of any other animal like him?
A. He’s not alone. That’s been one of the most rewarding things about writing this book. I heard from lots of people around the world that they have animal experiences that rival Oscar’s story. You need only listen to hospice workers who go into homes to care for people at the end of life and ask them how they know when someone is close to passing. Lots of times they’ll point to the pets. When the cat or dog starts to mill around, that’s often when hospice workers know someone might be near death.
Q. You made a huge effort to visit with the families who had lost their loved one with Oscar by their side.
A. It was a journey for me. My wife’s mother has been diagnosed with dementia herself, so we’re going through the caregiver-sandwich generation situation ourselves. We entered this process thinking I knew everything there was to know about this disease. I’ve been taking care of patients with dementia and cognitive impairments for many years now. But listening to patients’ families talk about caregiving, it’s opened my eyes to what it all means.
Q. Maybe that was part of Oscar’s plan.
A. That’s very possible.
Q. What kind of impact does Oscar have on family members at the end of their loved one’s life?
A. He’s a great source of companionship to most, whether they were cat people or not. He was a distraction for them. It’s a very lonely journey that family members take with their loved ones in the cases of end-stage dementia. Having Oscar there was a great comfort. They were able to leave at night knowing that their loved one wouldn’t die alone if that happened to be the night.
Q. Do all families welcome Oscar?
A. Some have asked us not to have Oscar on the floor. Initially, we thought we’d just close the door to that room and they’d be fine. But Oscar gets pretty upset if he’s not allowed into a room.
Q. What does he do?
A. He’s been known to pace backward and forward in front of a room and even gone into the room next door and try to scratch his way through the walls. These days, if a family asks to have him not there, we have to take him off the unit.
Q. What has he taught you?
A. What he has to teach all of us is that just being present, being there and validating a life, is so important, even if it’s at the end.
Q. You also write about dementia’s “middle stages” and how hard they are for families.
A. These stages are all about making the difficult decisions and letting go. There’s the difficulty of seeing a loved one who has lost what constituted themselves, their very essence. Family members try to maintain the status quo as much as possible, but that’s not how you cope with someone who has memory impairment and is constantly changing.
Q. What else is so tough?
A. There’s also often guilt for having to move a family member into a nursing home, or guilt of not spending enough time with a loved one going through these stages. There’s even guilt of not wanting to spend time with that particular person because you don’t want to see what this disease is doing.
You can learn to love the person as the disease takes hold, but he or she is different from the person who took you fishing as a child or taught you how to read or listened to your problems while you grew up.
Q. What’s the hardest part of your job?
A. Other than the paperwork?
Q. Paperwork aside.
A. I get so much out of working with older patients. It’s like working with completed canvases, appreciating what someone did with their life. That to me is so much more important than taking care of a child that is a blank slate. Working with families can sometimes be challenging in the current care environment. There’s a lot of things I’d like to do as a provider that I’m not able to do because our health care system isn’t set up to allow me to care for patients in the various stages of dementia.
Q. What would you like to be able to do?
A. If I know someone is going to fall and get hurt, I can’t order physical therapy because you can’t order treatment until the patient breaks a hip. Our health care system doesn’t provide reimbursement for the family discussions that they need to hold with patients during those stages. That’s difficult.
Q. Is our health care system supportive of people with dementia?
A. Our health care system is designed around acute care. If you have a problem, go to the hospital, they’ll fix you. But we’re a nation of people suffering from chronic diseases. We’re not a nation that dies anymore from infectious diseases or heart attacks. We die from congestive heart failure, from dementia, from chronic obstructive pulmonary diseases. But our health care system isn’t set up for that. Unless we reformulate our health care system to be one that can cope with chronic medical conditions, we’re doomed to fail.
Q. Are animals helpful to older people?
A. Animals in nursing homes are critically important, and good research shows that the presence of animals reduces depression or agitation among patients, even ones who aren’t communicative or have dementia. There’s good data to suggest that among healthier older adults, pets reduce heart disease and hypertension and depression, so there’s every reason for older adults to have animals. They’re very healthy.
Q. Are you a cat person now?
A. I’ve become much more of a cat person. I’ve learned to appreciate what they do. When I do rounds on the unit, Oscar will come seek me out. We’ve become buddies.
Carol Kaufmann is a contributing editor at the AARP Bulletin.