Author Archives: Bob Goddard

The Rhythm of it all

   

 

Corey

     It’s not fair of me to expect you to open your eyes. Your world’s not filled with people trying to get by through a haze that age has placed upon their minds as they struggle to remember; as they struggle to survive.

     And maybe it’s because I was once broken, a million sharp pieces cutting through the shade of a haze, the cage in which I locked myself just to hide from the truth and put my life on the shelf that I hear so clearly the words that they can’t say as they tell me their stories in their different kinds of ways. There’s a price to pay for wasting your days. Don’t wait to learn this lesson, don’t let time steal it away. 

    I get that you don’t get it. It’s not all around you, walking the halls of your mind, tattooing your soul with a truth you can’t shake, can’t dispel, can’t ignore, can’t forsake, can’t erase, can’t un-tell. I’m stuck with it, burning inside my heart. Inflaming me, claiming me; picking me apart until I shout it out and keep pushing forward. I can’t beg to climb the mountain and then bitch about the boulders.

     And damn, those boulders can be so heavy, weighing me down, crushing out all the light as the bleakest of shadows creep out from the night. Powerless over death and dementia, addiction, other people’s choices and mental afflictions. At three in the morning, alone with my thoughts I rage against machines. It’s a hell of a cost; all this anger and all this blame, hating one another because we don’t all think the same. 

      A tale told by an idiot full of sound and fury yet signifying nothing and empty of the glory. But it doesn’t have to be and has little to do with me. I don’t have the luxury to get caught up in the sea, in the riptides of the fury and insanity. So I take my second chance and all moments they have lost, and vow to make them count regardless of the cost. There is a fire that has always burned inside. I can let it consume me or I can hide or I can use it to light my way through the night. I can use it to continue to set things right. 

     Don’t bother with the stats. Don’t waste my time with spite. Don’t try to buy my mind. Don’t try to squash my fight. I’ve learned these lessons from those within my care. I’ve learned from their experience. I’ve learned from my own to atone, make amends, do my best, hold my own. 

     I have no power over anyone else. If I’m whining about others, I’m not focused on myself and what I can do with this mind   and this drive, and this fire that continues to burn inside. I owe a debt to this world that gave me a chance. I made a promise to myself not to sit out this dance called life. I won’t cower because of the strife. I will let my actions do my talking instead of doing a bunch of squawking, yelling to the void, adding to the noise that drowns out the best of humanity, robs us all of empathy, and attempts to sell us who we should be in order to be happy. It’s all smoke and mirrors, noise and thunder to complicate, agitate, aggravate, humiliate those with whom you don’t agree behind the safety of a keyboard, so viciously. There are none so blind as those as those who will not see. 

       And I know I’ve wasted my share of moments but time is something I can’t unwind. To regret the past is to waste today and that’s not a price I’m willing to pay. I choose to live and love, grow and thrive; to hope and think and not be defined by the surge of anger and smugness and misplaced pride and keep plugging along without breaking my stride. 

     You don’t owe me your approval. I don’t owe you mine. We don’t have to agree, but we do have to see that we should treat each other with integrity. Be your own leader and bet on yourself, think on your feet, find your own beat, defy the odds, don’t live for the applause. And yes to thine own self be true but remember that this world doesn’t exist to serve just you. These are the lessons from those in my care who’s declining mental status in no way impairs their ability to teach those who are willing see beyond the surface and find a life that’s fulfilling.

Long Term Care’s “Trans” Issue

 

 

Minstrel

When the issue of CNA wages is raised, the response is never “Sorry, we don’t think you deserve better wages. We’re not going to pay you enough to live on if we can get you to work for peanuts.” No: administrators will say, “Yes, we know aides are worth more and we would love to pay higher wages. We just can’t afford to. The money isn’t there.”

Are you sure about that? Show me the money. Let us see your budget. Every organization has a budget, detailing what comes in and what goes out and where it goes. Long-term-care administrators tell us they can’t find the money to increase wages or benefits of aides. Maybe so, but we aides would like to be included in the search.

This is about transparency in money matters. If you attend conferences and webinars and read articles on how to achieve quality care in long-term-care homes, you will often hear the word ‘empowerment.’ Residents need to be empowered. Persons living with dementia need to be empowered. And direct-care workers need to be empowered—that’s what the experts say. What could be more empowering than having a say in how money is spent? Including aides in a transparent discussion of resource allotment would demonstrate trust in us, respect for us, and appreciation for the creativity we might bring to problem-solving. There may not be a wealth of money being wasted or misspent. But aides are in a unique position to see opportunities for cost savings that others might overlook. As a CNA I saw the amount of food that, at the end of every meals wasn’t in the stomachs of residents but in black plastic waste bags. I saw the wastefulness in our use of disposable items like plastic cups, paper plates and napkins. Without impacting the welfare of residents, aides might find multiple ways of cutting costs so that money might be re-directed. We might bring fresh vision to decision-making about saving and spending. Give us a chance!

Perhaps administrators protect budget secrecy out of embarrassment over the wide gap between the salaries of aides and the salaries of the executive and managers. Or out of worry that this knowledge might lead to poor morale and workplace unrest. Maybe the organization worries about privacy rights; why should anyone’s salary be public knowledge? First of all, budget transparency doesn’t mean that individuals’ salaries have to be known. (However, if it did, would this be so bad? Americans are more open about their sexual practices than about their finances! We know the salaries of the President and members of Congress and of the CEO’s of publicly-traded corporations. It is a tool of accountability.) There are ways to protect information about individual salaries (as the federal government does for federal civil servants) while making information available about salary ranges, the percentage of the budget spent on various classes of jobs, etc. This privacy issue is an excuse, a ploy to halt discussion before it starts. It’s not a justification for saying no to transparency.

Aides aren’t children. We’re capable of understanding issues, of being reasonable. We can understand that some positions merit higher wages than others and that some employees will deserve to earn more than others. We can be patient about wage increases. But we shouldn’t be shunted off to the side when budgets are discussed, as if we were just another piece of mechanical equipment in the workplace. We need to breach this wall that seems to create a ‘them’ and an ‘us,’ the intelligent responsible people on one side and lower class workers on the other. We are all part of the care community; we all want to improve it. One way to do this is to make budgets more transparent. If we want to retain employees and attract new job seekers, salaries and working conditions must become more appealing. I suspect that money might be found to do this, if budgets were transparent to all stakeholders.

We hear a lot about the need for culture change in long-term care. Budget transparency is a culture change issue that we don’t hear about yet. Let’s hear a call for transparency from the leaders of the culture change movement. Let’s hear it now!

Deal or No Deal: Choosing a Long-Term Care Home

 

Minstrel

They’ll want to show you their renovated patient rooms and their glitzy calendars. They will want you to see the art room and hear about the visiting music therapist. They’ll make sure you notice the flower-bedecked reception area and see the nicely-appointed dining room. They might even cite the training their aides receive. And these are all positives. But administrators of long-term care homes may not encourage you to examine the nuts and bolts. To spend the time it takes to make a true assessment of the standard of care and the residents’ ‘joy’ levels. (Yes, that’s what I said, JOY.) You need a more evidence-based way of assessing the quality of care your loved one will get in the long-term care home that may cost $4000 to $12,000 a month. What do you look for to judge the quality of the home?

When you visit a long-term-care home your tour guide might want to direct your attention to superficialities or to things no longer relevant for your family member, especially one declining physically or cognitively. (Smart TVs, anyone?) Here are some features that are essential for your family member’s well-being. Look for them. These are the minimum No-Frills tests your prospective long-term care home should be able to pass.

1. The Wheelchair Test, suggested by ‘May,’ a former CNA Edge contributor. When you visit a home take a good look at wheelchair footrests and frames. Are they clean? If not, other unseen areas may be neglected. Are footrests attached to the wheelchair? Sometimes a resident benefits from ‘paddling’ along with her own feet; this can strengthen ankle or leg muscles. But if you see residents being wheeled uncomfortably without footrests, this may signal minimal attention from aides and inadequate monitoring by nursing supervisors.

2. The Bathroom Linen Test: Are there clean facecloths and towels in bathrooms? Shortage of towels is a perennial problem in care homes. If management is asked they will tell you that the residents hide towels, and this is sometimes the problem. But sometimes the problem is that there simply aren’t enough towels, or not enough laundry workers to ensure that clean towels are always available. How can we maintain hygiene standards if there aren’t clean bathroom linens? Ask to visit a few resident rooms. If the tour guide discourages you from seeing occupied rooms (“Privacy Rights.”), befriend a resident and ask if you can see his/her room. This will nearly always gain you access.

3. The Warm Water Test. All medical authorities tell us that hand-washing with warm water is the best way to prevent the spread of infection. CNAs are expected to wash their hands with soap and warm water frequently. When you visit a room, check out the sink. Do warm-water faucets in residents’ bathrooms and hall toilets actually run warm? How long does it take to get hot water? If you aren’t able to enter a resident’s room, try sinks in the visitor’s toilets, in the kitchen area, wherever you can find a sink that should have hot running water. The water may warm up after two or three minutes. But when an aide might have only five or ten minutes to get a resident washed and dressed in the morning, she might not have that two minutes to wait. Your family member might get a cold face cloth first thing in the morning. Is this what you want? Do you want the most basic infection-control measure, warm water, to be MIA?

4. The Bath Room Temperature Test. Visit the bath or shower room. Is it warm enough? Older residents usually want warmer rooms for bathing. When they leave the bath or shower, they shouldn’t shiver and shudder.

5. The Call-Bell Test. Do you hear annoying call bells that go unanswered? How long does it take an aide to attend to the person calling for assistance? If these annoy you, imagine how they affect a resident who feels anxious and confused.

6. The Chair-Alarm Test. Notice the residents’ bed and seats (both wheelchairs and other seating) to see if there is a chair alarm on the seat. Virtually every group with an interest in improving the lives of residents in long-term care homes, including CMS, recommend eliminating the use of chair alarms. “But these keep residents safe,” supervisors will say. Evidence suggests that they don’t keep people safe and indeed lead to more falls. (Google it!)
7. The Noise Level Test. It’s not only alarms that can distress residents. If aides routinely shout down the hall to each other, this can be upsetting.

8. The Dining Room Test. How is the noise level? Is hot food served deliciously warm? Are residents offered condiments (salt, pepper, sugar, mustard, ketchup) they would have used at home? Are the aides attentive to residents or do they converse mostly with each other during mealtime, as if this were an extra break time? For those who can no longer use a knife, is the food served in bite-sized portions that the person can comfortably chew? Are residents offered refills of drinks?

9. The Calendar Test. Every long-term care home has its monthly calendar of activities posted prominently. Pay attention to the type of activities offered, how often the calendar matches what is happening in real time, and whether residents seem engaged when they are at the activity session.

10. The Family Council Test. In elder care homes a Family Council is one of the strongest ways we have of monitoring care and advocating for high-quality care for residents. Many homes do have resident councils, but frail elderly residents, especially those with dementia, either don’t know their rights or just can’t express their needs and preferences and criticisms. They rely on us, their family and friends, to be their eyes and ears and their mouths. Once they needed you as a caregiver, and you did that lovingly. Now they need you to be their advocates. So ask whether the home has a Family Council.

11. The Staff-to-Resident Ratio Test. You want your family member to get the attention and care she/he needs. You ask the supervisor about staffing levels and are told, “We meet all the state’s requirement for the number of staff.” And they probably do. The problem isn’t that the home isn’t staffed according to standards. It’s that the standards don’t meet today’s needs. Our expectations for care are higher today. Residents’ needs are also greater; many have cognitive as well as physical disabilities. In some homes there is one aide assigned for eight or ten (sometimes more) residents. And if an aide calls out sick or has a family emergency at the last minute, the ratio is worse. Care quality is worse. Though you may not find an ideal staff-to-resident ratio anywhere, at least ask about this. Ask whether census or resident acuity determines the staffing level. Ask how the home assesses resident acuity, and whether dementia symptoms are factored into acuity.

12. The Supervisor Test. Who is responsible for monitoring care standards of the unit your family member will live in? Where is that person’s office located: within the unit or in some distant section of the home? Ask to see that person’s job description. (After all, you’re paying the salary!)

13. Last but not least: The Aide-Engagement Test. Do aides smile and make eye contact when they engage with residents? Do they seem to know and respect the residents’ needs and preferences? When a resident calls out for something—a snack, an answer to a question, a response of some kind, how do the aides respond? This may be the most important thing to look for on a visit: how aides interact with residents. To get a truer picture of aide engagement you’ll need to visit several times, including weekends and at different times of day or evening. Midmorning. Mealtimes. After supper. Try to visit during a change of shift. Are aides still available to pay attention to residents during shift changes?

When you’re evaluating long-term care homes, don’t be overly swayed by the charm initiatives of the marketing staff. Instead, use this checklist to observe those conditions your family member will live with day in and day out. There is more involved in achieving excellence of care. But these concrete items can be clues to less visible elements of quality care. If those in charge aren’t getting even these basics right, are they really committed to the loftier goals they claim to have?

A Numbers Game: Resident Acuity and Staffing – Part Three

 

 

Minstrel

We cannot provide person-centered care without the personnel.  My previous comment, Part Two, presented a list of symptoms that arise from dementia.  These symptoms are the constant companions of those living with more advanced dementia, and their care partners.  The symptoms create behavioral challenges we CNAs must and want to respond effectively, so our residents can feel secure, content, at home.  

We have our list of dementia symptoms.  But wait—there’s more.  Let’s look concretely at the workday of a LTC direct-care worker.  Aides work an 8-hour shift, with one-half hour mandatory meal break.  (In some places they are also entitled to or permitted to have a second 15-minute break.)  The first and last ten or so minutes of a shift are spent getting and giving shift updates to the previous or next shift of aides.  Aides will also need one or two bathroom breaks during a shift.  Thus an aide has about 7 hours (420 minutes) left for care tasks.  This scenario doesn’t take into account the moments an aide might need for a calming ‘time-out,’ for a few minutes of helpful conversation with another aide or a supervisor, for an important phone call from home, for time spent walking from one task to another or one resident to another.   And it doesn’t allow for other encounters we expect aides to have with residents, creating ‘moments of joy.’ 

Aides will customarily be responsible for the care of six to ten residents on a shift that has plus or minus 420 minutes of usable work time.  (And would you believe the number of residents might be higher?)  If you do the math, you see that aides may have 42 to 70 minutes for each resident.  Seventy minutes to help a person exhibiting symptoms of dementia with toileting, washing (on certain days showering), grooming, dressing or undressing, moving to the dining room, eating, returning to the day room, using the toilet during the day.  And these are just the essential ADLs.   

Other tasks aides are responsible for during a shift: 

  • for safety purposes, keep alert to where each resident is;
  • distribute drinks to prevent hydration;
  • serve snacks;
  • check toileting needs and assist residents with this as needed;
  • help with transfers (from bed to wheelchair, wheelchair to lounge chair, lounge chair to wheelchair, wheelchair to toilet and back several times in a day, wheelchair to bed) for those residents who cannot transfer themselves;
  • help other aides with two-person-assist transfers;
  • answer resident questions throughout the shift (“When can I eat?” “Where is my mother?” “When will my son be here?”  “I’m cold, where is my jacket?” “Don’t I have a doctor’s appointment today?”) ; 
  • in between ADLs engage with residents through conversation, music, activities;
  • accompany residents to other areas of the building as needed for medical care, hairdressing appointments, other events.

In some LTC communities aides are also responsible for making beds, doing laundry and putting it away, or other housekeeping duties.  Throughout the day there are spills to clean up, phones to answer, paperwork to be done, questions from visitors.  If an aide is tired from working a second job, or a double shift, this will slow the aide down.  If an aide has a bad back that day, or sore knees, or is pregnant, these things will also mean the aide has a lower energy level or slower response time.  All these factors take a toll.  If some aide should call out at the last minute and the shift is short-staffed, this further impacts care.   Even if forty or fifty or seventy minutes of care per resident were sufficient—and really, it’s not—at the current staffing levels in most LTC homes, residents don’t get even this.  I challenge administrators to refute this with data.  

Is it really acceptable to pare staff levels so thin that we impair not only the quality of care but the safety of residents and aides alike?  Is it acceptable that the owners of long-term care homes are sustaining their organizations by controlling their costs with sub-par staffing levels?  Those responsible for setting care and staffing standards should feel responsible for doing something about the unacceptably low staffing requirements they’ve established and tolerated, thanks to lobbying efforts of the long-term care industry.  (Shame on you, CMS.)  The rest of us should hold them accountable.  Families and direct-care workers and anyone who is an advocate for those living in long-term care communities:  Unite!  Lobby!  Write, email, text, twitter.  Demand that your care home managers and your state legislators see what is before their eyes.  For added clout, partner with organizations that advocate for better long-term care.  To any CNAs up for a little non-violent guerrilla warfare: sneak a copy of these comments to a few trusted family members of residents.  Ask them to bring the staffing issue up at a Family Council meeting.  Send a copy anonymously to your Administrator.  

Owners, operators, executives and regulators of LTC homes will say that we don’t need more staff, we need more or better training.  Our CNAs need to work ‘smarter.’  And there is something to this, we do need to look at work assignments and patterns and at aides’ understanding of how to interact with persons with symptoms of dementia, etc.  But tell me how all this will change the fact that an aide may, on a good day under ideal conditions, have 70 minutes to give a resident.  (A resident who may be paying $5000 to $8000 a month for memory care.)  

This isn’t a game.  Would we let a dog lie in a kennel and give that animal only seventy minutes of direct attention a day?  Long-term care homes don’t care for dogs, they care for human beings.  Tell me please, how can we sit still and stay quiet about this appalling reality, one minute longer? 

The Facts About CNA Wages

 

Bob Goddard

There is a great deal of confusion within the CNA community regarding the issue of wages and how it fits into the larger long term care picture. While there is general agreement that caregivers are underpaid, that perception is primarily based on personal experience, that of our own and of others. This anecdotal evidence is useful in its own right, if for no other reason than it is overwhelming. However, discussions regarding the wage issue are characterized by emotional responses and typically lack references to data that back up the arguments.  Solid facts are sometimes offered within the CNA online forums, but usually not in any kind of comprehensive or purposeful way.

In order to help us get a more accurate picture of the state of direct care work in this country, below is a list of just a few of the more significant statistics. The primary source for these is a PHI fact sheet published in August of 2017.

I think this kind of short list might be useful for those who argue for better wages for caregivers. In future posts, I’ll give my take on what I think these statistics mean.

First, just to get a sense of the scope:

15,400 long term care facilities in the United States

1.4 million residents live in these facilities

600,000 CNAs work in them

But those 600,000 are only 13 percent of the total of direct care workers employed in the United States, because…

4.5 million direct care workers are employed in all types of situations, including home care, Continuing Care Retirement Communities, Assisted Living Facilities, Hospitals, Centers for Developmentally Disabled, Mental Health, Substance Abuse, Employment & Rehab.

Second, the demographics of caregivers:

91 percent are female

Half are under age 35

Half are people of color

Half have some college, (about 1 in 7 have associates degree or higher)

20 percent were born outside of the United States

Third, the money issue:

$12.34/hr is the median wage of CNAs (half make more, half make less)

$20,000 is the average annual income

Half work part time at least part of the year

17 percent live below the poverty line (compared to 7 percent of all American workers)

40 percent receive some form of public assistance

72 percent of long term care is finance through public programs (mostly Medicaid and Medicare)

Finally, the demand for caregivers is growing:

60,000 more caregivers will be needed by 2024. It is one of the fastest growing occupations in the United States workforce.

1 in 2 caregivers leave the job within 12 months. And more LTC workers are leaving this sector than entering it.

I would encourage anyone who is interested to visit the PHI site where more information like this can be found. Of current interest is the ongoing 60 Caregivers Issues series where they tackle a whole range of issues regarding our work, such as caregiver wages, training, recruitment and retention, and advocacy.

Next week, I’ll share what I think some of these numbers mean for the larger long term care picture.

A Number’s Game: Resident Acuity and Staffing – Part Two

 

 

 

Minstrel 

This is about person-centered care. To repeat: We cannot provide person-centered care without the personnel! CNAs, do the administrators of the LTC homes you work get this? Do they really comprehend what your work day is like? Do they appreciate how much time it takes for you just to assist with ADLs, when a person is showing symptoms of dementia? Do the state regulators? Or are they ‘cognitively impaired’ when it comes to understanding life on a memory care unit. As my uncle used to say when his dementia advanced: “Donna, I hear you but I don’t understand what you’re saying.” Administrators may see things, but do they really understand? A Resident Acuity Assessment tool might help them understand.

A Resident Acuity Assessment tool is a descriptive list of the symptoms of dementia. This list isn’t comprehensive; it can’t be. We’ve all heard this: “If you’ve seen one case of dementia, you’ve seen…one case of dementia.” Everyone is different; each care partner may observe a new symptom. This list isn’t meant to be discouraging for those who, thanks to the support they have, may not show severe symptoms. The better care a person has, the more a person diagnosed with dementia can retain functionality, with fewer and less severe behavioral symptoms. But insofar as residents of LTC homes do experience serious consequences of dementia, those who regulate care homes need to appreciate their needs and regulate accordingly with regard to staffing.

Here is what I think a Resident Acuity Assessment tool might look like.* If you are a CNA working in a memory-care community, or a home care aide, or someone caring for a family member at home, these symptoms of dementia are familiar to you. I’m not sure they’re as familiar as they need to be to those who set long-term care standards. If they were, we would have better staffing.

Part Three, the next chapter in my mission to lobby for better aide-to-resident staffing ratios, will mention other factors that need to be taken into account by administrators and regulators.

RESIDENT ACUITY ASSESSMENT

Key: N = Never = 0      S = Sometimes = 1        F = Frequently = 2        A = Always = 3

** under 60: low to moderate acuity;   61 to 100: moderate to high acuity; over 100: very high acuity.

RESIDENT _________________________ Date Assessed _______ by ________________

*There may already be such a tool, a better one, that I haven’t found. (The tests used to diagnose dementia serve a different purpose.)

 

 

 

 

 

 

 

 

A Numbers Game: Resident Acuity and Staffing – Part One

 

 

Minstrel

This is a story of staffing, substandard staffing in memory care homes. It’s an attempt to offer evidence of what life is like in a memory care home and to document why staffing guidelines are missing the mark, are ignoring the ramifications of residents’ symptoms and CNAs’ workloads. In memory care, the gold standard of care is ‘person-centered care.’ But we cannot provide person-centered care without the personnel! In a hospital setting, administrators use something called a Patient Classification System to plan care. This is a method for determining how serious the medical condition of a patient is, what level of care the patient needs, and how many nurses they must have on duty to ensure that patients get the care they need. The severity of a patient’s medical condition and needs is known as acuity. In long-term care homes this notion of patient or resident acuity doesn’t seem to have the same imperative that it does in hospitals. It should.

We hardly use the term ‘nursing home’ nowadays, it’s almost politically incorrect. We speak of long-term care ‘homes.’ It’s to the credit of the nursing home industry and consumers of that industry that if our loved elders become too frail to remain at home, people want to make their final residence more homelike. Not an institutional, hospital-like environment—with all the sterility and standardization and disregard for individuality that the word ’hospital’ ironically implies. And so we move our family members to long-term care homes: skilled nursing facilities, assisted living communities, or personal care homes. Still, residents of these homes, whatever we call them, are there because of declining health. They need care. Maybe not the kind of care that calls for physicians, medical specialists, hi-tech equipment and RNs to be on hand on a daily basis. But they do need attention paid to their declining physical and/or cognitive health.

The area of long-term care I’m involved in is dementia care. I challenge everyone reading this page to name one memory-care home that has the staffing it needs to ensure a high level of person-centered care for every resident on every shift, every day. Not perfect care; just consistent high-quality care. (And if you know of such a place, please let us all know about it. I’m signing up for their waiting list!) Long term care homes simply don’t have the staff they need. CMS and state regulators don’t set specific standards that could ensure better care. The sad standards they do establish don’t come with penalties that encourage compliance.

I first became interested in this kind of tool while working in a memory support home. When we CNAs asked for more staff, the Administrator would respond, “Document that you need more help.” I began putting charts together to demonstrate the time CNAs actually had to do ADLs. One reason legislators don’t pay more attention to staffing levels is that they just don’t understand what the symptoms of more serious dementia are and how these symptoms impact aides’ workload throughout the day. A Resident Acuity Assessment tool could, I believe, help us educate administrators, families and legislators about the staffing we need. In Part Two I’ll present one suggestion for a Resident Acuity tool, hoping that other CNAs will find ways to improve it. Use your own tool to persuade your employers and regulators to require improved staffing of memory care homes.

Can I Afford to be a CNA?

 

 

Bob Goddard

A prospective caregiver asked this question in one of the CNA Facebook groups: “What do CNAs start at?”

The first person to reply said this: “If that’s the first thing you want to know about being a caregiver, you don’t belong in this field.”

That reply got several positive responses. After all, CNA work isn’t about making money, right?  It’s all about taking care of people, not your bank account. Right? So take your question elsewhere, you money grubbing sociopath.

Of course, they didn’t actually say those words, but the condescension was certainly there.

This attitude is shared by a small, but vocal minority within the direct care workforce. It’s an attitude that arises from a small-minded, but persistent misconception: expecting reasonable compensation for the work is incompatible with the compassion necessary to do the work. This notion is erroneous and harmful.

Really, take a moment and consider what the young lady was actually asking. I think it was this: “Can I afford to be a CNA?” “Will it pay my bills? Will I be able to support myself and my family? What sacrifices will I have to make? What sacrifices will the people who depend me have to make? Or do I have to go elsewhere in order to better meet my obligations?”

My guess is that she went elsewhere.

“Can I afford to be a CNA?”  This is grown-up talk. It’s about the hard realities and difficult choices people have to make. Asking it has nothing to do with a person’s capacity for caring and compassion. Anywhere else this would be regarded as reasonable and responsible question. But for some in the CNA community, it’s a red flag and those who ask it should be dismissed as morally unfit for caregiving.

I have a question for the caregiver who gave the “you don’t belong in the field” reply – or for anyone who thought that it was a good way to respond: Where is your compassion for that young lady?  Where is your compassion for people who might very well become great caregivers and love the work just as much as you, but are denied the opportunity because they simply wouldn’t be able to make ends meet?

Where is your compassion for caregivers who are single mothers and have to work two jobs or unreasonable amounts of overtime just to feed and clothe their kids? Do you have any compassion for the young children who don’t see enough of their mothers?

We know that wages have a direct impact on attracting and retaining workers. The high turnover rate of caregivers has an appalling effect on the continuity and quality of care in LTC, and makes it almost impossible to keep many of these homes adequately staffed. Where is your compassion for the workers who struggle day after day in these chaotic conditions and unmanageable work situations?

Also, let’s not forget the managers that are forced to hire people they might not necessarily want to hire, because poor wages artificially limits the pool of candidates. And then they – and everyone else in the place – has to tolerate inadequate work performance or absenteeism or tardiness or outright disrespect from these workers because the managers know how difficult it is to replace these caregivers.

Where is your compassion for the families of residents who live in poorly staffed homes?

Finally, where is your compassion for the residents who have to live in these homes? And really, isn’t that the bottom line here?

There are those in positions of authority who are influenced by and even exploit the notion that “good caregivers don’t care about money.”  Make no mistake, when that idea comes from our ranks, they will use it.

Lost in Translation

 

Corey

Where is my mother? Father? Brother? Husband? When these questions come from my residents at three in the morning, I have to do an on the spot assessment. If not handled correctly, these conversations can quickly spiral into an emotional meltdown that unnecessarily traumatize those living with memory disorders.

Too many people, from the doctors to new caregivers, make the rookie mistake of attempting to pull those living with dementia into their level of awareness rather than meeting them where they are. Instead of trying to convince those living with Alzheimer’s or dementia of our reality, it is better to actively listen through the words they say to assess the resident’s needs.

When I hear “where’s my mother,” I think about what my resident’s mother might have provided her that she may be missing in that particular moment and attempt to fill that need as best I can. It is not 100% effective but it has worked better than any other method I’ve utilized so far in this field. Where’s my mother at three in the morning could mean any number of things. Did she have a nightmare and need reassurance? Did she wake up hungry? Does she need to use the bathroom? Is she in discomfort? All of these basic needs were once taken care of by her mother and in recognizing that, I am usually able to put her at ease and through the process of elimination, discover and solve the problem my resident could not articulate.

Have you ever been anxious or frustrated or simply in a funk for no specific reason? Maybe you didn’t even realize you were feeling down until someone said or did something that pulled you from it? It’s happened to me plenty of times and it’s a strange feeling when my emotions don’t match with my reality. Imagine walking through that with severe cognitive impairment, when your reality is just as fluid as your emotions. It would terrify me if someone attempted to convince me that what I know in my mind to be true isn’t real. I would be too scared and frustrated to comply with even the simplest of suggestions. Part of caregiving is learning how to translate. There is a language and understanding that can only be developed by active listening, keen observation skills and empathy. It up to us to first understand that language and then translate it for those who don’t know those in our care as well as we do. It is how we make certain our residents do not get lost in translation.

Problem Solver

 

 

Bob Goddard

Okay, so back to the Claire Chronicles. It’s been two months since I reported anything on her progress. So this will serve as an update. Actually, more like a battle report.

At 18 months, Claire is still not crawling. But that doesn’t mean she isn’t developing. She is more mobile than ever, her primary method is rolling. And she’s fast. Turn around for five seconds and she’s across the room attacking the cat or reaching for some forbidden object such as the TV remote. Or something ridiculous, like the Christmas tree. It’s as if she has no real plan.

While Claire is very visual, exploring the world around her by looking at things, this is often supplemented by the sense of taste, everything she grabs goes in her mouth. Including the cat’s tail and the TV remote. And thus I’ve become more mobile than ever too. I often find myself bounding across the living room over the field of scattered toys she’s left behind for greater adventure elsewhere: “NOOOO…. NOT THE DOG’S WATER DISH…”

This impulse to move is powerful in humans. If we can’t do it one way, we’ll find another. It’s just a matter of figuring out how. This brings up another of Claire’s developmental advances: problem solving. She’s become quite the solver of problems. And this creates problems for me to solve.

In our effort to get Claire to crawl, we’re trying different ways to trigger the reciprocal, across the body coordination (left arm working with right leg and vice-versa) necessary for that form of mobility. Because of her ACC, this does not come naturally for Claire. So, we place her on her belly on the floor and then put things that she wants in front of her, just out of reach hoping that’ll entice her to move the necessary body parts to retrieve the item. I use what I consider the ideal bait: Cheerios.

Claire loves Cheerios. And for good reason, they’re wonderful in so many ways. They’re particularly good for use as reinforcement or just straight-up incentive. I tried using toys for reinforcement of desired behavior, but there is a built-in cruelty to that: you have to take the toy away in order to move on to the next step. A Cheerio is immediately and happily consumed, leaving the consumer looking for more.

I start by handing Claire a single Cheerio in the “first one’s free, kid” tradition. This primes the pump. Taking tiny bits or sips of anything that tastes good stimulates the taste buds in a way stuffing your mouth can’t. Thus we go into the exercise in a heightened state of expectation and motivation.

I have to be careful. She’s been known to lunge herself over the hand offering the first free Cheerio to the mother lode in my other hand just beyond it. I’ve learned to keep all additional Cheerio reinforcements in the big yellow box until I’m ready to deploy them.

Anyway, this is what happened in my first attempt with the Cheerio Just Out of Reach technique to get Claire to crawl:

 

If you listen carefully, you’ll hear me say “Oh, my goodness…” What I was actually thinking was “Oh, you little shit…” In endearment and admiration, of course. I try not to use bad language around the children, even though it’s sometimes difficult to refrain.

So, I said “damn the bacteria” and I placed the Cheerio directly on the carpeted floor, 18 inches or so out of reach. Fool-proof plan, I thought. Until, in one seamless motion, the little shit rolls in a 180 degree semi-circle and snatches the Cheerio with her little hand like a frog flicking a fly from mid-air. It was over and the Cheerio was in her mouth before I knew what was happening.

Of course, she wanted more. I just reached in the big yellow box and tossed her a bunch all at once.

There, problem solved.