Complementary comfort on request.

Family gathers around Mrs. P's bedside. Her disease is running its course, and she is dying. But in this room, the sound of ocean waves gently caressing the beach gives Mrs. P comfort as she and her family recall their first vacation at the shore. The scent of a sea breeze permeates the room, and tire soft lighting accents the serenity of their visit. Their time together is meaningful, gentle, and removed from the specter of death.

At the Isabella Geriatric Center, a not-for-profit non-sectarian facility in northern Manhattan, many of our residents need to control medical conditions such as high blood pressure or diabetes. However, many other residents have severe or advanced conditions, such as Alzheimer's disease, some heart diseases, or advanced cancer for which a cure is no longer a realistic or achievable goal. In such cases, the primary goal is to control the pain and emotional distress caused by the disease and its eventual outcome, and to prevent suffering.

Although chronic and acute physical pain can be effectively controlled with today's extensive array of pharmaceutical interventions, there ate other methods to help residents cope. Should not the pain that family members experience also be relieved, so that their visits with their loved one affirms his or her dignity and adds to the quality of life that remains?

As an adjunct to the palliative care program and under the auspices of the Department of Therapeutic Recreation and Pastoral Services, the C.A.R.E. Cabinet (Comforting Alternatives for a Relaxing Environment) was designed to enhance the resident's personal environment and provide spiritual comfort for the resident, visiting family, and friends. What exactly is a C.A.R.E. Cabinet? The C.A.R.E. Cabinet is a mobile sensory unit that carries various accessories that help a resident relax, reflect, and reminisce in a calming atmosphere to reduce anxiety, pain, and discomfort.

To determine what would be emotionally therapeutic/of a resident on palliative care, we conducted a survey of residents, family members, and staff. Incorporating their suggestions, the C.A.R.E. Cabinet was stocked with a nature sound machine, a CD/cassette player, an aroma diffuser, a radio, disposable scented fingertip cloths, Bibles (in various languages), inspirational pamphlets, individually wrapped candies and mints, and poetry and picture books (many of which are accompanied by audiotapes). When in use, the cabinet is customized to the resident's preference of music CDs and cassettes. Meal vouchers that visitors can redeem in the staff cafeteria and the location of coffee stations are also included.

Before stocking the cabinet, we needed to locate a safe, protected unit. It had to be well constructed, durable, user-friendly, and large enough to hold a variety of items. The proper dimensions were essential--it had to fit comfortably at the resident's bedside, and it had to be a safe, manageable height to avoid toppling when a resident was reaching for a book or a staff member was moving it to another location. After much research, we acquired a compact, high-quality mahogany cabinet that had the appropriate storage features: open shelves, shelves behind doors, and drawers. Wheels were installed for easy portability and maneuverability.

To make optimum use of the C.A.R.E. Cabinet, we established a referral process. During the weekly Palliative Care Committee meeting, the list of residents in the program is reviewed. Then, through assessment and discussion, committee members ascertain which residents would benefit most from the C.A.R.E. Cabinet. Factors discussed include the resident's cognitive and functional ability to manipulate the items; family visitation habits; availability of assigned doulas, professionally trained women who care for the terminally ill or women in labor (translated from the Greek as "women who serve"), and/or "Bedside Buddies" (Isabella's volunteer corps of trained visitors); and, most importantly, the resident's acceptance of the cabinet. Once it is determined who would benefit from its usage, the cabinet is wheeled into the resident's room and set up at the bedside for easy access. Periodic review determines whether the cabinet is still wanted, needed, or useful to that particular resident. If the resident's health status has declined and the cabinet is no longer beneficial, it is removed and taken to another resident's room.

The C.A.R.E. Cabinet continues to be a work in progress. Periodically, residents and family members ate asked to complete a simple questionnaire. In it they ate asked how often they use the cabinet, which items are preferred, and if they have any further suggestions for enhancing the cabinet. Residents, though often in a weakened state, welcome the cabinet. One resident especially enjoyed a Time/Life book of photographs from the 1940s.

Families agree that the C.A.R.E. Cabinet creates a harmonious, relaxing atmosphere during their visits with the residents and provides topics of conversation and moments of recalling. One resident's elderly husband commented how he and his wife listened to 1930s music and "visualize the two of them dancing at the Roseland Ballroom in Manhattan." As he spoke, a smile appeared on his face. Visitors and family also appreciate how the cabinet meets their needs--complimentary meal tickets, the availability of freshly brewed coffee, and for those needing spiritual sustenance, the Bible.

The Bedside Buddies often use the cabinet during their visits, as do the doulas. To provide comfort and serenity to residents, they read the Bible, let residents experience nature sounds--ocean waves, babbling brooks, a summer shower, rustling leaves, the music of songbirds--and spend a quiet visit shielded from the noise of a long-term care environment. One doula reported "The C.A.R.E. Cabinet has been a lifesaver! It's been wonderful! When we listen to the big band music, the resident, who can barely speak, grins and very softly sings along."

The C.A.R.E. Cabinet was a pilot program, with only one cabinet servicing the 18 units at Isabella Geriatric Center. Because of its overwhelming success, the program is being expanded. Through product donations and fundraising efforts, additional C.A.R.E. Cabinets will be available to help residents who benefit from our specialized care. As a result of the continuing recommendations and suggestions, the C.A.R.E. Cabinets will continue to evolve, reflecting the ever changing needs of residents on palliative care and their families.

Janet Listokin, CTRS, is assistant director of recreation at the Isabella Geriatric Center, New York, New York. Listokin also teaches and supervises therapeutic recreation interns at City University of New York/Lehman College. For further information, phone (212) 342-g452 or visit www.Isabella.org. To comment on this article, please send e-mail to [e-mail].