French Cantou Offers Model Elder Care

Residents and staff are chattering in French and playing cards in small groups as director Elizabeth Rank leads me through the cantou, an Alzheimer’s care unit unique to the French culture. Rank leans over, embraces a very confused resident, and laughingly whispers into the resident’s ear. The resident beams.

Alzheimer’s disease is cross-cultural: It strikes people over 65 anywhere in the world. Afflicting some 4 million people in the United States and 400,000 in France, Alzheimer’s is the progressive deterioration of thinking, speaking, personality and self-care.

Terror of this disease is universal.

“One of the biggest problems facing quality Alzheimer’s care in France is the embarrassment which surrounds it,” says Arnaud Fraisse, director of Association France Alzheimer. “Doctors do not want to diagnose it, and families ignore symptioms. It tends to be a hidden disease.”

Fraisse works tirelessly to educate the public about the importance of bringing Alzheimer’s out of the closet, and the benefits of France’s excellent treatment modalities.

With the help of volunteers, Association France Alzheimer organizes vacations to the sea or mountains for Alzheimer patients and their caregivers. Fraisse explains, “The positive effects of these vacations are astounding.” Often, patients’ skills are improved. For example, patients dependent on spouses to feed them will notice others in the group eating with forks and knives and suddenly resume this task. Additionally, volunteers supervise the Alzheimer’s patients while caregivers take the day off.

“Caregivers report an enormous boost in morale and an alleviation of the depression which so often afflicts caregiving spouses of Alzheimer’s patients,” Fraisse says.

The French concept of Alzheimer’s care in a cantou is unique. The word itself comes from Old French and pertains to sitting on a bench near the central family cooking hearth, with its large chimney and overhanging mantle. This “little corner” was a welcome haven to frail elderly who spent their final days in the family home.

A modern cantou is a small home or separate unit in a larger facility. It typically hoouses six to 12 residents who are supervised and cared for by one specially trained “Maitress” and her assistants. Residents have their own bedrooms and bathrooms. (Typically in the United States, bedrooms and bathrooms in similar facilities are shared.) Autonomy, the normalizing of daily life in a homelike atmosphere and family participation are stressed.

Rather than filling residents’ days with the entertainment activities so common in our country’s programs – completing rhymes, kindergarten-level art or repeatedly folding towels – residents of a cantou continue to participate in daily domestic tasks. Rising independently in the morning, they breakfast, dress and help clean their rooms. With assistance, they plan and prepare all meals, set the dining-room table, wash the dishes and do laundry. It is believed that these familiar activities are interesting, stimulate faltering memories and maintain independence. In addition, leisure activities are similar to those at home: playing cards, listening to music, gardening, attending a lecture or taking a walk in the park.

Our country’s approach to Alzheimer’s residential care tends to be very different. Warm rapport between a director such as Rank and residents is rare. And I have watched Alzheimer’s patients literally herded in one big group from one busy-work activity to the next, then to a huge dining room to eat meals prepared by someone else, on to bathrooms where they bathe and brush teeth together, finally to shared bedrooms and institutional furniture stripped of all personal items.

Our country has a handful of facilities like the cantou. I would like to see more.