Category Archives: Administrators

A Wide Movement


As I talk about CNA Edge more, there’s a question that keeps coming up: for whom am I writing? What is my target audience?

Whenever I’m asked, my initial reaction is always: “My audience is whoever reads it”.
But that’s a vague answer at best, and no answer at worst. There are some who tell me I should focus more on reaching policy-makers and people in positions of power. And I can follow their line of thinking and I agree with their points: there is a divide between direct care workers and those at the top. That divide hurts our residents, often badly. So yes, I would love to reach more policy-makers.
But not at the expense of also my reaching my fellow CNAs. To put it another way, I do not want to be the sole spokesperson for CNAs to policy-makers and administrators. 

Policies can change. Rules and regulations can be changed with administrations, and then swept away with the next changing wind of politics. I am not dismissing the importance of good policies and those who work so hard to affect change for long-term care. We need people fighting for good policies, and for responsible leadership. We also need people fighting to change the way CNAs think about themselves, to throw off the label of “nothing but an ass-wiper”. If I can do that, then I am not alone. One or even three CNAs speaking up can be ignored. We could even be silenced. How about one hundred CNAs? Or three hundred? How about a thousand, or a million?
That starts by letting CNAs everywhere know that they are not alone. Sometimes I think the worst affect of this broken system is that it makes people who work so closely with others feel utterly alone. We, who have the power to deeply impact the lives of our resident, are often made to feel helpless by all that we cannot change. We feel alone, helpless and burnt out. Silence and sullenness can and do follow.
But together and aloud…what can’t we achieve?
I do not ever want to talk over the heads of my fellow caregivers. I refuse to fall into the trap of thinking that I am somehow more than they are, or that they are something less than me. If I am intelligent, compassionate and eloquent, that does not make me unique among caregivers. Actually, I’d argue that makes me about average. If I stand out, it’s only because I speak out.

What we need now is change, both on a personal level and on a larger cultural one. Compassion, common sense, communication and critical thinking have got to be infused into this broken system. We have to have people dedicated to change on every rung of the ladder…including the one belonging to CNAs.
Just like a democracy cannot function without the active participation of ordinary citizens, neither can our long-term care system function without a principled and vocal base of direct care workers. CNAs who are willing and able to speak up for themselves and their residents.

Bad Boss Part 2: Consistent or Crazy



I tip my chair back, enjoying this. I had to take my lunch late due to craziness on the hall and it appears as though I wasn’t the only one. The break room is packed; everyone is eating and enjoying this chance to relax. Conversation is flowing smoothly–we’ve hit on a great topic, one with legs that could run around the world.
“Oh, I’ve got one and it’ll top May’s story!” T says between bites of her casserole. “So I had this supervisor once, who decided she was going to ‘whip us into shape’. She started disciplining people up over rules that hadn’t been enforced in so long that we’d forgotten what they were. So here she is, a holy terror over everything…until one day she asked why we were so short every shift. Then we had to remind her she’d fired half the staff.”
I choke on my baked potato. “Yeah, I’d say that tops mine.”
“You’d think she would have noticed,” mutters A.
“At least she was trying,” says P, a new aide. I haven’t known her long enough to decide if she’s optimistic or naive.
“The problem,” I sigh, “is consistency. At some point, even a crazy boss is tolerable…as long as they are consistent. If I’m allowed to do something on Monday, I’d at least like to know that I’m not going to get in trouble over it on Wednesday.”
“Only for the boss to decide that the next aide can get away with it on Friday,” T finishes.
“Hard to toe the line when it keeps shifting under your feet,” A agrees. “So which do you all think is better: the boss who never comes out of the office and lets the staff get away with anything or a micromanager?”
“I don’t know about better,” P says, “but based off your stories, I’d rather deal with an absent boss than one who is all up in my business.”
“Yeah, second that,” I say. “I’ve had enough bad bosses to learn it’s best if I just take personal responsibility for my own work ethic.”
T shakes her head slowly, like she’s thinking really hard. “That works for you–and everyone in this room–but what about the bad aides? The ones who don’t care about the quality of their care?”
Three voices rise in unison: “Then they shouldn’t be CNAs!”
“Which,” I add drily, “means that either we step into the gaps they leave or the residents go without.”
“Those kind of aides should just go flip burgers,” A spits out. “They’d make about the same and our folks wouldn’t suffer from their apathy,” P agrees.
There’s silence for a few minutes. Everyone goes back to chewing their food. Thoughts are churning ceaselessly around in my head and, from the expressions on their faces, the others are thinking just as hard. Eventually P breaks the quiet, an almost desperate look etched on her face. “Please tell me you’ve all at least had one good experience with a supervisor.”
I smile at her. “Of course. Matter of fact, we’ve got a pretty good one now.”
“Yeah,” T agrees. “He’s doesn’t do the drama, doesn’t play games and he helps.”
“He’s looking pretty stressed out lately,” A sighs. “I hope he’s not on his way out.”
All four of us look at each other in horror. Truth is, as much as we boast about our ability to self-direct and self-discipline…it’s nice to have a supervisor who can take up the slack. It’s nice to have someone who will listen when we speak, pull us aside when something needs to be addressed. It’s nice to have rules that don’t change with the wind, nice to have someone who doesn’t play favorites and isn’t afraid to be stern when he needs to be. Who isn’t afraid to joke with us when he doesn’t need to be stern. Who we can trust to be fair.
“Oh, God I hope not,” I say fervently. “Let’s go write him Employee of the Month recommendations before we get back to the floor!”


What makes a bad boss? If only I knew. As it is, I have only guesses…thoughts inspired from seeing events from below, glimpses into Management through cracks in the floor. I can only assume it’s the same stresses that make a bad aide. There’s too much to do, not enough time to do and precious recognition or thanks. It’s an impossible job. Only instead of taking care of far too many people for far too many hours, they are juggling the constantly changing demands of Medicare, Medicaid and the Health Department–and keeping the floor in some semblance of function.

There’s also disconnect between the care plans and the living people they represent. It’s a disconnect that in some ways can’t be helped in the current system. Charts can’t convey the reality of long term care, not alone. Accurate documentation of my shift as a CNA would mean writing a novel each day before I go home–there’s just no way to communicate the reality on a glorified spreadsheet.

And in some ways, it’s a disconnect that can very much be helped.

There’s a culture of enforced silence among direct care workers, learned in the dark hours of neglect when speaking up meant losing your job. It’s a habit we’re still trying to break, to speak our truths and tell our stories. There’s a culture of enforced deafness among managers, learned in the dark hours of greed when listening meant being mocked by your peers. It’s a habit we’re still trying to break, to listen with wisdom and compassion.

If all you look at are care plans, then you haven’t seen the person. If all you look at are numbers on page, then you haven’t experienced the toll those ratios take on your employees and residents. The best of bosses know the people they are responsible for, both residents and caregivers. They are the ones who can read on my face when I’m about to break down, who care about me enough to step in and say: “What can I do to help?” But that takes time. That takes energy.

That takes a real dedication and devotion to the art of caregiving. To all good managers and bosses–thank you from the bottom of my heart for all you do and risk for me. It does not go unnoticed and, I hope, does not go un-thanked.

A Failed Attempt




    I had planned to write a piece from the point of view of the administrators; what it must be like to walk in their shoes. Such pieces help me connect on a deeper level with others. I sat down at my keyboard and closed my eyes for a moment, trying to imagine the chaos and stress that my bosses must feel in order for it to translate into such dysfunction on the floor. But nothing came. All that kept popping in my head was that the call bell system didn’t work. How does that slip through the cracks? HOW DOES THAT SLIP THROUGH THE CRACKS? What’s worst is that I told the owner of the facility that it was on the fritz a year ago.

       Ok, Alice. Try again. Deep breath. Think about all the paperwork and pressure to keep up the census. Think about all the complaints they must hear from both residents and staff. Think about how they have to fix specific situations in order to meet state regulations…but…census IS up and staff is poorly paid and badly scheduled. Honestly, every month they put out three to five schedules! And most of the situations they have to fix could have easily been prevented had they listened to those of us on the floor in the first place. Had they not placated the residents with empty promises and then dismissed their concerns.

       Ok. This is going nowhere. Think of this as a business. It’s not a nonprofit. People have a right to earn a living…except I know how much my folks pay each month to live in this place. And I know how much Medicaid and Medicare cover. And I know that the combination of disorders is not healthy. And I know my residents living with severe mental illness are not getting the kind of care they need. And I know the “house” doctor pops up every two weeks supposedly visiting eight-twelve residents in under thirty minutes; and after several YEARS, still can’t remember their names. I know that they shuffle around my folks with no warning and no thought to the impact such changes have on the people…

       That’s when I realized that this was an exercise in futility. I was too angry. I AM too angry. They deserve better. The sheer courage it takes to live with such debilitating challenges should give them a pass at a decent quality of life. They deserve better than the best I can give in these circumstances, better than the system provides and certainly better than the passing acknowledgment that they happen to live where the administrators work. As if my residents are in the way in their own home.

         It’s not MALICE that drives administrators. It’s apathy. Greed. Maybe fear of losing their own jobs. Its ignorance and they lack both the willingness and the interest in learning from anyone other than their peers. The trouble is that their peers are also in the office, far away from the reality on the floor.

       THEY aren’t the ones in the in-services learning more about mental health. They aren’t the ones being taught about the importance of consistency and how to successfully redirect certain behaviors without robbing a person’s dignity. They aren’t out there every day learning folks through trial and error. They are not solution oriented problem solvers. At least not in my facility. They are surface level friendly, but the times I’ve tried to discuss the real, underlying issues, they completely closed ranks and shut down.

       They are not interested in open communication. They are not interested in supply shortages or unreasonable workloads. They don’t bother themselves with how things truly are, only with how they appear to be. They dismiss us and in doing so they dismiss the people for whom we care.

         I admit that it isn’t my incredible boundary setting skills that make me good at my job. I am unable to detach enough from my residents and my own experiences to objectively see through the eyes of my administrators. What I do see clearly is the end result of bad decisions and poor leadership. Could I do it better? Who can say. I do know that the one thing I wouldn’t be is apathetic. Because I started out as a caregiver; because I am by nature a caregiver, I believe I would have a very different bottom line.

         I mentioned earlier that I’m angry. That is true enough but anger is a surface feeling. It masks deeper emotions that are more difficult for us to face. Feelings like disgust and heartbreak over the idea that we, as a society, take little issue with “warehousing” our sick and elderly. Our ability to simply embrace this “out of sight, out of mind” mentality with fellow human beings, dismissing people who have lived and experienced more in their lifetime than most could imagine rather than embracing and learning from them. I also fear that reality, because like it or not, we are all on the road to that same destination. The day will come when the line between “them” and “us” will no longer exist.

       I don’t need to walk in the administrator’s shoes. I would rather use them as an example of how I do not want to be, regardless of where I may land. I know and feel all of these truths. They feed my commitment. No matter what path my life may take, I will not stop advocating for those living in these facilities. I will not stop shining a light of their truths and on ours. I will tell our stories. If we give our all every single day in an attempt to change their lives for the better, maybe nothing will come of it. But if we DON’T try; if we just accept the status quo, then DEFINITELY nothing will come of it. These people are more than worth the effort. They are more than just residents. They are my friends.

Two Open Letters






To Potential new hires,

I want you to be responsible for the care, protection and quality of life for a hall full of people with a wide variety of physical and mental illnesses. Make sure they are clean and dry, supervise their gait, and make certain that their oxygen tanks are full and on the appropriate setting. If they have a doctor’s order for TED hose, please make sure they are on in a timely manner.

Because these folks are unwell, they are occasionally combative. We will offer no help to you in these matters, other than suggesting that you get another aid to help, if you can find one. Often, you won’t be able to because we have a bare staff. We are also desperate for help, so many of the people we DO hire are unable to lift and are squeamish about body fluids, so they will not be much help to you. We hope that you are not like that, but if you are, eh. You get what you pay for. Someone will pick up the slack. Someone always does.

We can’t promise that we’ll remember to tell you if your hall partner called out or your shift relief will be late. We are very important and busy people. You can’t expect us to value your time and effort enough to interrupt our own.

You will be covered in any number of body fluids, we will often run short of supplies and expect you to figure it out. As a matter of fact, we pretty much expect you to handle any situation with little or no input from us. Oh! We will make rules and change them without telling you and we will apply them with inconsistency, as we see fit. This applies to both you and the residents. There will be no raises. No benefits and no rewards for doing an excellent job. But there will also be very few consequences for doing terrible job. Life’s a balance. We’ll pay you 9.00 an hour. What do you say?




To Potential new hires,

This job is tough. It is not for everyone. It will break you into a million pieces and teach you how to put yourself back together in ways you never thought possible, if you allow it.

There are facilities with kind, involved supportive management who offer substantial training and ample rewards for good work ethic. There are facilities with relatively calm residents who are not living with severe mental illness. This is not one of them, a fact that over time I have grown to appreciate, oddly enough. When there is no one willing to solve problems, it motivates you to first understand the problem and then figure out how to solve it yourself.

I have learned more about life, love, courage, vulnerability and perseverance than I could have in any other facility. I have explored, hand in hand with my residents, the subculture in which they live. I’ve learned to trust and be trusted. I’ve learned how to speak my truth, and more importantly, to speak theirs.

None of this will pay my bills, and there are times that I am resentful at the lack of pay, and basic lack of respect for what we do; a job that matters deeply to me is dismissed by those who should know better. I don’t wallow in that though, because I believe that WE can change that. If enough of us refuse to allow our pay rate to dictate our level of care, if we use the systems flaws and mismanagement to teach us how to problem solve and lead ourselves rather than embitter us enough to lose our empathy, then we really can make a difference. I believe this in my heart of hearts and truly hope that you will be a part of the solution. It’s easy to be a light in the day. My facility needs lights in the dark.


Your fellow Caregiver

A Start


It sits in front of me, wrapped in gray paper with the words “Happy CNA week!” scrawled across it. It was given to me by my supervisor, along with the words “thank you”.
I don’t know what’s inside…I haven’t had a chance to open it until just now, hours after it was given to me. Too many call lights going off, too much to do. Some would say that this is the prettily-packaged perception that the facility wants to present going smash against the reality of what a nursing home is really like.
It’s just a small gesture, after all, doesn’t change anything…right?
It’s just a gesture, offered once a year, doesn’t balance the scales…right?

Except…the last place I worked never celebrated CNA week. There were no gifts, no cookouts, no free candy. Nothing. No gestures.

I start ripping the paper off like a little kid at Christmas. Gestures can’t be measure by how large they are, but by how genuine they are…and this one feels pretty damn genuine. The “thank you” was sincere. It’s not my supervisor’s fault I’ve had a lousy day on the floor; it’s not my facility’s fault that the rules are stacked the way they are. We’ll never win the fight if we fixate on the wrong bad guys. We’ll never get anything more than small gestures if we don’t say “thank you” too.
My place is trying. That’s enough–or rather, that’s a start.

The Unspoken Rant



“I thought this would be a productive conversation. I really did.”, I said to myself as I sat across the desk from the fifth administrator that I’ve worked for in seven years. Rookie mistake. I should have known better.
I asked to speak to her because  there is a distinct lack of communication between the office and the floor. What little interaction we have comes in the form of snappy demands, as if we are incapable of comprehending sentences containing words with more than two syllables. It is seriously affecting morale and when morale goes down, so does quality of care.
I wanted to tell her that when a person in authority such as a resident care coordinator speaks negatively of staff members in front of their peers, it breeds dissent. I had hoped to explain that there has never been “light duty” in our facility because there IS no light duty. We don’t have enough staff to allow for such luxuries. The rule has always been that you can come back when a doctor signs off on it. Otherwise, you have one caregiver doing the work of two, while the other is getting paid to sit down and watch. It’s different than in the bigger facilities, where perhaps they have areas that don’t involve lifting, running and transfers. I wanted to point out that this naturally causes resentment for those of us who end up carrying the load when it happens every other week.
I had hoped to discuss the incredible frustration I feel when the powers that be freak out over someone forgetting to put away a package of briefs but don’t blink an eye when every single month, a resident runs out of his colostomy supplies, leaving the staff on the floor scrambling for solutions with no help from the office, or only having small or extra large gloves, or not being informed that we would need to work over until after our shift ends.
I wanted to tell her that the woman who does our inservices is passionate and full of fantastic information and ideas that we aren’t being given the opportunity to utilize.  I had hoped to explain that the uneven application of consequences suck the motivation out of caregivers who feel like the end results are the same regardless of whether or not they give their best.
I thought she should know that it was a bad idea to put a resident who has maintained sobriety after a number of years of being drunk and violent in the same room as an active alcoholic who sneaks in bottles of Canadian Mist any chance he gets, or a resident living with severe mental illness in a room with a resident who doesn’t speak a word of English.
I though she should know that it’s both dismissive and unfair to paint all the caregivers in the facility with one brush; as if we aren’t individuals, each with our own work ethic and points of view.
We choose to stay there, whatever our reasons, knowing that there will be no raises, no bonuses, very little leadership, hell, the shower room doesn’t even have a dip in the floor. The water just pools around so we have to work in wet sneakers. Still, we STAY. Despite the fact that it’s the lowest paying facility in this town, our folks deserve the best possible care and we deserve open and two-sided communication that would benefit everyone; to be talked WITH rather than talked AT.
I WANTED to tell her all of that, but after about two minutes of discussing the need for better communication, I realized I would be wasting my breath.
“I would LOVE to just have to give someone a shower. You have NO idea what it’s like for us in the office!”, she snapped. I sighed, as I left the office, strangling on all that was left unsaid. She’s right. I don’t know what it’s like in the office, but if she thinks that showering people is the basis of what we do, she has no idea what it is to be caregiver and very little interest in learning anything that would make life run more smoothly for all involved. I will never understand why people in authority continually fail to grasp the simple notion that an ounce of prevention is worth a pound of cure.

Excuses and reasons



Every time I’ve got gloves and…other stuff…on my hands, my face starts itching.

I’ve no idea whether it’s simply that I notice the itching more when I’m unable to do anything about it, or whether it’s fate playing a cruel joke on a poor CNA. Most days, I’m inclined to suspect the latter.

I suppose that it doesn’t matter, either way. Even the persistent, annoying itch in my eyebrow is small potatoes compared to the fact that I have five minutes before I am “officially late” to the meeting (I’m “actually late” already). I try to hurry as best I can, though I’m rather thinking that a cork, rather a wipe, would be appropriate for this situation.

Eventually, there comes a time when you stop wiping and call it enough. I fasten the new brief, turn her on her side and pull the covers over her.
“I’ll be back soon, okay?” I tell her as I snap off my gloves and turn on the water to wash my hands. This resident hasn’t spoken in weeks, but I swear she doesn’t need to power of speech to express her doubts about the “soon” part. Her eyes continue to bore into my back until I leave the room.
Two minutes later, I’m quick-marching down the hall in that not technically running that I’ve perfected in my time as an aide. It’s one of the ways I got over my green-aide days, by cutting down the time it took me to get from one resident to the next without invoking my administrator’s distaste for “running around in an unprofessional manner”.

Despite my not-running, I’m one of the last to enter the meeting room. I hope for a minute that this at least means I’ll get a seat in the back of the room, but no. Seating is first come, first serve and apparently, we started in the back today. Lucky (late) May gets to sit in the first row, right in front of our special guest. And the DON and administrator, who both raise their eyebrows over my late appearance. I shrug in a half-meek, half-cheeky manner and slide into my seat.

Our guest today is a middle-aged man, dressed in an impeccable fashion. Well, impeccable if he were attending a board meeting; here, he rather sticks out. His suit fits him perfectly and nothing about him is out-of-place. Under his blazer sleeve, I see the glint of a gold watch and his brown shoes are so shiny that I can see my reflection in them. I wince.
In the sleek, expensive leather, my reflection is not flattering. My scrubs are old and faded; my shoes cheap and scuffed. I’d actually done my hair and makeup this morning, but you can’t tell now. Sweat has washed off the makeup and revealed what I was trying to hide: the pale skin and large bags under my eyes, courtesy of two doubles this week. I don’t look professional; I just look tired.
I can’t help the thought: I’d have to work a lot more doubles before I could afford a similar outfit. I try to stop the thought: I know better than to judge someone based only on appearance…but I also know that you dress for who you are trying to impress. Everything about him screams that this man is not really here for the CNAs. In this setting, his clothes do not so much impress and set him apart from us.
I glance around me and I know I’m not the only one who’s noticed. Grumbles sweep the room: there are a lot of us who hover on the poverty line, lots of single mothers working themselves ragged to provide a good life for their children, a lot of us trying to scrape enough to save for school and pay the bills.

Resentment is an ugly thing, but hard to shake…prejudice, even more so.

He clears his throat and begins to talk. I try to stop thinking. He’s here to discuss “time management and job efficiency”. Apparently, ours suck. He doesn’t say it quite like that, of course. He starts with a story about how his office is cluttered and how this ‘negatively affects’ his job performance. Somewhere along the way, he makes the connection between offices and time: how a cluttered office is like misused time. Just like we need a well-organized office to properly do our jobs, we need to manage our time.

Office? I work on the floor–closest thing I have to an office is a bathroom. I shift in my seat, stifle a yawn and think his examples are a bit odd, considering his audience. I’ve never had an office in my whole career. I’ve never had a desk, or a filing cabinet or even a chair. I do have scrub pockets, though.
He goes on at length, citing studies and tying them back to time management policies. He tells us how much room for improvement he sees for us “on the books”.
But that’s all he does: cite studies and tell us what we are doing wrong. He doesn’t give any relevant examples or any insights on how to apply these principles to the world of the floor–where residents crap a ton, tumble out of wheelchairs, slap us in the face, get confused as to we are and where they are. All he does is stand there in his fancy suit and offer us generic slogans and cookie-cutter criticisms.

Oh, crap. I forgot to lay down Mrs. T. I can see her in my mind’s eye, leaning over the right side of her wheelchair, leaning towards a tumble. How did I forget her? Oh, yes, I was dealing with the never-ending squirts. Now there’s a time management conundrum: if you only have ten minutes, do you change the soiled resident or do you lay down the fall-risk? Suddenly, I am all impatience for this meeting to be over, so I can lay down poor Mrs. T.

My attention is jerked back to the meeting by an aide behind me speaking up.
“All that is well and good,” she says drily, “but it ain’t practical. How’s it my fault that I got six people to get up and only an hour to do it in? And you want me to be doing all this other stuff in that same time? Ain’t gonna happen. If that’s mismanagement, it ain’t mine.”
“Well, you will just have to try harder,” he says. “You just need to stop thinking it can’t be done. All this can be done…I’ve been to hundreds of facilities and you’re telling me that this one is so different from all the others I’ve been to?”
Resentment flares up from all corners of the room. Come again? She made a valid point, I thought. At least valid enough to be discussed instead of being dismissed out of hand.
I’m speaking before I’ve half-made up my mind to say.
“Some days, you’re right and we do have time. But she’s also right: good quality care takes time. You can’t tell us to only provide the highest quality care–but be snappy about it. It just doesn’t work that way; especially on the days when we are short-staffed–“
“So you’re telling me that there’s nothing you can do to improve your time management?” he interrupts. “Nothing at all? You are perfect? Because this isn’t going to reflect on me; it’s your job performance that is going to be judged. And being short-staffed is just an excuse, young lady. Just an excuse to not do your best.”

I’ve got so much I want to say that they all get wedged in my throat. Of course there’s stuff I can to ‘improve my time management’. I could not sit with Mrs. W. while she cries–that’d save me ten minutes at least. I could just randomly check boxes when charting instead of accurately recording my shift–that’d be huge time saver! I could cut out the part of my day when I wash everyone’s face…I could not pee for eight, twelve, sixteen hours, whichever one I’m told to work on any given day.
A higher-up clears her throat. “I think what May means is that we do have really crazy shifts and it’s hard to focus on how else we can be doing things when we’re already so far behind. And May, he’s not trying to be mean or harsh. You’re just…tired.”
Behind my back, I can feel the heat of resentment washing up from my coworkers. Tired? We’re all tired! And yes, exhaustion does affect our job performance. Sorry about that.
Maybe we shouldn’t be talking about time management. Maybe we should be attending a seminar on how aide fatigue affects the residents’ quality of care and what we can do about it. How we can resolve the problem, in this facility and elsewhere. But according to this expert, these are just excuses, not reasons. Complaining, not cause-and-effect.

I glance at the clock and I don’t say any of the things that are boiling inside. I need to get back to the floor and I’d be wasting my time trying to argue my point. This man is not open to listening to me and honestly, I’m not open to listening to him right now, either. Anything I say is going to get tossed in a box with the label “tired”. Funny things, labels and boxes. “Tired”, “disgruntled”, “angry”, “uneducated”: easy ways to categorize statements without sifting through the bath water to find the baby. I guess it’s easier to treat the symptoms than to cure the disease. Truth is almost always messy and multifaceted: it never fits into a neat little box.
Though, that cuts both ways. I wish this meeting had happened at some other time than during my hectic shift, some time where I had the mental energy and actual time to listen and weigh his words. I still don’t appreciate his attitude.

The last thing I hear as I leave the meeting is another higher-up talking to the special guest.
“I think a softer approach might have been appropriate. I mean, didn’t you see how tired they all are?” Her voice is quiet but hard. Displeased.
Well, they’ve noticed. No, not “they”, I remind myself as I slowly walk back to the floor…sitting still for so long in the middle of my shift has sapped my energy. The people in the offices aren’t one collective being, no more than aides are a faceless mass of cheap scrubs. At least two of the office-workers have noticed how exhausted I am, how exhausted we all are.
It’s a start.




Edison Terrell

It is our pleasure to welcome Edison Terrell as a guest contributor on CNA Edge. We think his stream of consciousness style is both entertaining and thought provoking. Terrell is currently writing a book based on his experiences as a caregiver in a long-term care facility. The working title of the book is I Take My Pills with Ice Cream.

It’s maddening that so many executive directors are seat-of-the-pants drivers in a business that inherently only runs when it’s running perfectly. You can talk all you want about aides not doing “enough”; about there being a dissonance between aides and nurses that shouldn’t exist; about how the financials don’t add up for us to have another aide on a floor, but our nonprofit made $50 million last year and you should be proud of yourselves! At the end of the day we’re the invisibles keeping the machine greased and powered, noticed when things go wrong, when there’s a buck to be passed.

I don’t feel unappreciated, that’s not what I’m saying. I don’t expect the CEO to stop calling me “Matt” when I’m clearly Will. I don’t even look like a Matt. I’m one of a sea of faces, recognizable maybe because of my lazy eye or the fact my black scrubs, hefty imposing frame, big beard, and curled in, defensive, timid shoulders make strike a schizophrenic figure. And for all his comradely bullshitting, reminding me we’re both from Massachusetts, putting on our annoying accents, talking about “‘cahs’ and ‘pahks’ and how we like to drive ‘thehe’ to eat ‘frankfahtas'” I know he’s just a bullshitter. I can see it in his eyes. They shine in an over-bright sort of way, backlit from within like he’s got a lightbulb for a brain, painted green for money. That’s all he sees in me. Not a large pair of scrubs, just a means to an end.

It doesn’t bother me so much that my CEO smiles too big, too toothy, too tight around the corners like a mask, to be real. I’m not bothered by the way he fusses a strand of silk on his lapel and worries every wrinkle and crease in his suit. Nor does his silver crew cut bother me too bad. He likes to tell us he was raised in Southie and Dorchester (“Dohchestuh”), tough towns in their time, and I think the cut is to remind himself, and us, that even though his nails are professionally manicured and his face is soft-looking, he’s as tough as ever. I’m not a fighter, but this guy is 5’4, tops. Looks like the last time he could be in the ring with anyone was ten years in his rearview mirror. I’m not even all that bothered by the fact that he subtly guides you into the elevator when the doors open, putting his light, cream-color tanned hairy hand on my broad shoulder, as if without him to lead I might stand there like a dumb animal until the door closed.

Piecemeal my CEO doesn’t bother me, but taken as a whole entity, he and his cliquey little crew piss me right the hell off. Like the activity director with her tinkling, condescending little laugh. There’s nothing I can do about it, and on the whole things run semi-decently because of these towering titans at the top of the food chain. But for the most part it’s because of the people in middle management and below, sweating the tasks and responsibilities they’re given against the reality that we’re forcibly crushing two, three people jobs into one eight-hour shift some days. When we have a full allotment of aides we’re still short, somehow. A combination of our reckless executive’s practice of keeping wanderers in a unit without locks, putting the crazies in with the general population, basically.

I worry about what will happen here when I go back on full duty. While I’m on light I can be called upstairs to keep an eye on Gretta, whose husband is in skilled and who has crumbled mentally to a puppy-like state, following the aides, the dietary people, other residents, going into rooms looking for her spouse. It’s actually somewhat beneficial my back went out right around the time her husband Greg declined, but as soon as I go back Gretta will be unchained, free. Residents who don’t lock their doors will find her in their rooms when we’re not looking, and we’ll have to go running to turn her around, dropping whatever important thing we’re doing that can’t just be dropped to hump it back out into the hall and listen for wherever the sound of cursing is coming from. Stuff like that happens in memory care, too, where I’d argue she belongs, but there at least everyone is stealing everyone else’s stuff, or they’re not with it enough to care. We’re drilled to respect these people like they’re family, like we’re working in a microcosm, a small slice of Americana and this unit is their neighborhood. A sentiment I wholeheartedly, one hundred and ten percent agree with. Then the guys upstairs turf someone like this over here. Or hell, have a few.

When someone declines mentally, we write notes in the care plan, write notes to the administrator, talk to the nurses. If it’s not bad enough for state to put us in their sights nothing gets done. A person might bring it up at town hall to the director himself and he’ll give us the run around. There’s no place on the premises for them to go. We have to keep making money on them, we don’t have a memory care unit, so do your best until we break ground at the end of 2015.

It bothers me how hands-off these guys are. You never see them in your unit. I catch him canoodling with the independent people in the cafe, but they represent only a part of our community, and let’s be honest, the one needing the least of your attention. He tries to be like a father-figure, but if that’s his thing, he’s a father that dotes on the smartest, ablest sons and daughters, and leaves the others to the nanny. I know I’ve said this before, in different ways, online and off. I’m sure it’s everybody’s complaint. This isn’t anything new or incredible. It’s practically a requirement that getting to the top means becoming a cajoling sleaze bag. But it still bugs me…

Really, if he didn’t call me Matt I don’t think I’d have even written this.