Category Archives: demanding residents

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





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.


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.)









Selling lemons and changing briefs

Sunflower May


This is crazy.

It’s one of those times when nothing I do works. This woman is not going to let me change her brief.
I’ve already left the room and come back three times: the re-approach technique isn’t working. She may not remember who she is or where she is, but when it comes to how many times I’ve been in her room…good Lord, but this woman has a fantastic memory!
I place her hand on the opposite bed-rail and try to roll her over again.
“No! No! No!” she screams, letting go of the bed-rail and pushing against me with all of her frail but frightened might. “Oh, stop, please stop! Mother!”
And now she’s crying again.
My feet hurt. My head hurts. It’s been a long day: this shift just will not end and this woman just will not be changed.
“Please, Mrs. E,” I beg her again, “just roll to the right–just a little bit! One roll. One roll, that’s all I need! I can get this brief out from underneath of you and put the new one in just one roll. And, um, maybe the sheets too. Possibly. Please?”
Mrs. E just buries her face in her hands and cries harder. There’s a certain smell when a brief has been left on too long, when it is soaked beyond capacity to absorb anymore: I catch that scent now, wafting up at me every time she moves. There’s a brown ring on the pad too, further evidence of her refusal to let anybody change her all shift.
I’ve stood here for fifteen minutes, alternately pleading, begging, reasoning, ordering and bribing: nothing is working. She’s not my resident. I could just walk away, tell my newbie coworker that “Yep, she’s refusing care all right, can’t do anything with her”.
Or I could go get help and we could change her in spite of her refusals. This is one of the blurry lines between right to refuse and being mentally incompetent.
I groan and lean against the bed rail. I’m too tired for ethical quandaries right now. I’ve been working for fifteen hours now and I’m dead tired. I swear I can feel my patience wearing thin, like the belt in a car about to snap and bring the whole engine to a crashing halt. In this case, my ability to be a caregiver is what’s in danger…I want to scream, cry, run away and make this woman let me take care of her.
Instead of doing any of those wonderfully tempting things, I move the bed-rail closest to me and, taking care to land on the clean sheets, collapse beside her on the bed.
It feels good to sit down, to not be on my feet. I feel like all my bones have turned to liquid within me and all my muscles have turned to jello.
Mrs. E jumps slightly and hiccups, my sudden movement startling her out of her tears. I stare back at her, blinking away my own tears. The silence holds for a long, long moment.
“You see this thing,” she says suddenly, catching ahold of the call-light and swing it around in a lazy little arc that brings it close to my face. “I told my father, I said, I don’t know what you want me to do with this…thing. It’s just stupid, is all and I said, well, I said I’m not doing it. And he said, well, what am I supposed to do with it? What am I supposed to do with thing, huh? What’s it for?” She holds it out for me.
On a sudden inspiration, I lean forward. “Hello?” I say into it, pitching my voice as though it were being filtered through a microphone.
For the space of three heartbeats, Mrs. E just stares at me. Then she throws her back and laughs, great big chuckles that shake the whole bed. “You’re a nut!” she gasps out, shaking her head.
“That’s me,” I agree, “the biggest nut you’ve ever seen. A cracked nut, too.”
“A cracked nut,” she repeats. “You’re silly.” But she’s smiling now and not crying.
“I am so silly that I want to get this pad out from underneath you,” I continue. “Do you think you could roll for me so I can get it out?”
“No,” she says firmly. “I’m not doing that.”
“Because I’m not. My father said, now he said, we’ve got to sell these lemons and I said, now who wants to buy lemons? That’s just stupid. But he, he wanted to sell them and I thought, he’s nuts. He’s crazy.”
“He sounds crazy,” I say, wondering how the hell we got to selling lemons. “Hey, how many lemons do we have to sell?”
“Lots and lots.”
“Tell you what, I think I can sell your lemons for you–there’s a baker who wants to trade me lemons for cookies…she’s, um, making lemon meringue pie or something. But I need your help with something, ok? My wallet fell under your sheets and I need to get it out or my father is going to be very upset with me.”
“We can’t have that,” Mrs. E says, shaking her head in solidarity with me over unreasonable fathers who expect us to sell lemons and not lose wallets in other people’s sheets. Then, without warning, she grips the bed-rail tightly in her left hand, braces her right hand on my thigh and lifts her bottom off the bed.
There are times to provide meticulous peri-care and times to hurry it the hell up. This most certainly falls into the latter category. Her bottom is hardly in the air for twenty seconds, but I somehow manage to whisk out the old brief and pad and replace them with a clean set. It’s hardly the best brief placement I’ve ever done, but at least it’s not saturated with six hours of urine.
“Did you say cookies?” Mrs. E asks as her bottom thumps back on the bed.
“Sure did,” I smile at her, “but first, can you give me a hug?”
“Oh, honey,” she laughs, but she rolls towards me and crushes me against her. “You’re so silly,” she tells me.
“Guilty as charged,” I gasp, using my free hand to wiggle the brief into a better position.

It’s serious work we do, as CNAs, but sometimes serious just doesn’t get the job done.
We cannot always bring our confused residents back into what we call the “real world” so must be willing to lay aside our pride and look silly for a good cause. I have often found that a person’s sense of humor is the very last thing to go.

Small Gestures Go A Long Way

Sunflower  May

This would so much easier if there were tears, screaming or something. Hell, at this point I’d take a nightmare and violent confusion. I know how to soothe nightmares. I’m good at chasing the monsters away.
I’m not good at this.
I don’t know how to make this better, this lingering listlessness, the utter lack of energy and interest. It’s not like I’ve never seen this before: depression is wide-spread in the nursing homes. Depression is a hard thing to treat, harder still to manage in the time-crunch of Long-Term Care…the CNAs quite literally do not have the time or emotional energy to coax every one of our residents out of the deadened state of despair every time they fall into it. The sad truth is, when a resident refuses to get out of bed, that’s one less person you have to try to get back into bed later. It’s easy to let slide. It is, after all, the resident’s right to refuse. You can’t make them get up and coaxing takes time. Sometimes a lot of time. You say “I’ll get them next time,” and the next time things are so hectic that you don’t even remember your whispered promise. Eventually, you realize that you’ve let your depressed resident stay in bed for the tenth shift running…but by now it’s a habit, both for you and the resident.
I’ve seen it a hundred times, and I’ve had to turn away, had to prioritize my other residents who really wanted to get up and interact with the world over the one who continually refuses to leave their room…the one who just wants to sleep.
Not this time. I can’t make Mrs. N get up, but I can’t just leave her to wallow in her own regrets and despair.

“I’m not leaving you like this,” I say suddenly. “I’m not giving up on you, okay? I really don’t care if you appreciate it or not. I’m not giving up on you. Ok, then think, May. What helps alleviate depression?”
I rush to the window and twitch the curtains open. Light floods the room, chasing away the shadows and warming the air. A thousand dust-motes swirl in the golden beams. Well, I feel better, at least…strange how quickly the sunshine can work on human physiology. Mrs. N stirs and mutters. One eye opens, just a tiny sliver and then it’s squeezed shut with a force that only a person can only manage when they’re awake.
Well, that’s sunlight. I can’t think of anything else to do and as much as I like to shut the door and say “I’m not leaving her alone,” I can’t abandon my other residents. Also, if I push too hard, I could unravel any progress I’ve made.
I lean over her and squeeze her limp hand. “I’ll be back,” I tell her.
It’s a busy day (as per normal), so it isn’t until a couple of hours later that I’m able to slip back into Mrs. N’s room to check on her. She’s still laying motionless in her bed, but she’s oriented to the window and her eyes are open. She’s staring out at the green grass, the trees and the flowers. As I watch, a tear slips down her face.
What’s it like for her? She knows that even if she musters the energy to get up, even if she goes outside, she can’t do anything help. She can’t run across the grass, she can’t reach up and touch the trees. She can’t pick the flowers.
I rush from the room, down the hall and out the front door. Thank God for landscaping, because I don’t have to search very long to find what I was looking for.
I head back inside, back to the room that remains gloomy, in spite of the warm sunlight still pouring through the window.
“Here,” I say loudly, ignoring the way she slams her eyes closed and pretends to sleep. I set the handful of flowers I picked down on her bedside. “These are for you.”
She’s so startled that she drops the act mid-snore. I hear a call-light go off down the hall and I reluctantly turn to leave.
“Hey, little girl.”
I turn back. Mrs. N is clutching all of my flowers in her hands.
“Bring me some more tomorrow?”
“Oh, you bet,” I agree softly.

Those of us with whole bodies and sound minds, I think we often forget to appreciate the simple things. Things like opening the curtains to let in light, going outside for a walk when we feel blue. The natural world is bound up tightly in our psyche…replaced by the sterile environment of a hospital-like nursing home, is it any wonder that depression abounds in nursing homes? We can’t give our residents back everything they’ve lost: their mobility, their independence, their careers and loved ones.
By contrast, it’s a simple thing to bring a bit of nature to those who cannot go out to nature…to open a curtain, hang up pictures of landscapes, take them outside for five minutes turn on the Nature Channel, or bring a handful of flowers to a depressed resident who won’t leave her room. But simple doesn’t mean insignificant and small gestures often mean the world to someone who has learned the hard way not to take anything for granted.

There is something about nature that speaks to our primal nature, that has the ability to soothe us even after we lose our words or our will. There’s something about natural light that makes us feel at home, something about flowers that delights us. These primal instincts are a caregiver’s best friend, if you learn how to harness them.




It’s a conversation I have had many times in my years as a CNA. This time it happens while I’m struggle to dress a very picky resident in the ten minutes I have until lunch is announced.
“Are you married?”
“Nope,” I mutter, still working to get her shirt straightened. She’s so particular about her appearance–at times like these, when I’m pressed for time, it’s hard to be patient.
“Well, don’t worry, you’ll get a husband soon: you’re pretty. Though,” she says, reaching out to touch my hair (once neat enough, but now throughly destroyed by hours of non-stop movement and sweat), “you could put just a bit more effort into your looks. You have to look your best to get a man’s attention, Momma always said.”
As far as labels go, I guess “feminist” can be applied to me; in the time it takes me to raise my head to look her in the eye, I’ve got several retorts lined up. They range from “Sweetheart, I’m not getting up any earlier than I already do to get gussied up” to “I have a fundamental problem with being anybody’s eye candy”.
She quickly adds, “Just make sure he’s a good one who will take care of you.”

It’s just one of those times when I have to swallow my initial reaction and put myself in my resident’s shoes. What does this mean to her?
Empathy is easier with knowledge, knowledge is shared more freely with trust and trust must be earned. It’s a getting-to-know-you process that’s never over, only refined. I’ve earned her trust with good care and a willingness to listen; in turn, she’s told me stories of her life…stories I now use to reframe my way of thinking into something closer to how she views the world.
What does her surprise at my single state and her concern over my less-than-perfectly put together appearance mean to her? Well, she grew up in a poor, rural area during the Great Depression, in a time when women had far less freedom and options. When she was my age, a lot of women still depended on their husbands to provide for them. Moreover, she married “up”–due in no small part, she says, through her attention to appearance catching her future husband’s eye. One time she went as far as to call herself “Cinderella”.
She just wants me to be taken care of and happy. She just wants good things for me…it’s just that her methods are a) outdated and b) not my style.
I smile briefly. Not everyone is or was a pioneer of social change and not everybody I care about is going to agree with me on my every opinion. It’s not my job to argue with her about feminism, the purpose of marriage or anything else, really. Take the compliment and the concern and move on.
“Thanks,” I tell her. “I’m not in any hurry to get married, but when I do, I’ll make sure it’s to a good man. Now, is this okay? Because you’re going to make a fashionably late appearance at lunch, Cinderella.”

Call lights and promises



“Hey! Hey! Little girl!”
I’d mutter ‘what have I done now’…except I already know in this case. I seem to have perfect recall today: perfect recall and terrible timing.
Instead of going into the room, I turn and sprint the opposite way. Maybe I should turn off the call light first, but I don’t want to take another chance. No way.

Mr. C has taken to repeatedly pushing the button by the time I get back. I’m sure it makes him feel better, but it doesn’t do anything to the light. “Call light” is a bit of a misnomer, I’ve always felt. Sure, there’s a bulb lit up above his door…but the real attention getter is that incessant, irritating noise. Beep-beep-beep. I hear that sound in my dreams–not exactly as a nightmare, but rather my subconscious echoing with the sound I hear way too much. Beep-beep-beep. It’s the sound of promises I need to make, or reminders of the promises I’ve broken.
Like now.

Mr. C glares at the steaming cup in my hand.
“What the hell is that?” he demands as I switch off the call light. There’s peace for one blissful second…then, another call light goes off. Beep-beep-beep. How many more hours until shift change? One hour and four minutes.
“This? This is the cup of coffee I promised you,” I reply.
“Oh, the cup of coffee you promised to get me after breakfast?”
“After breakfast is such a wonderfully vague time-”
“-no, it’s not-”
“-as, technically, it is still ‘after breakfast’ and will be…until they bring up the trays tomorrow morning.”
I smile brightly at him; Mr. C glowers back. Okay, so this isn’t a laughing matter yet.
“Look, I’m really sorry I forgot. For what it’s worth, at least I remembered what I forgot. It’s been cr…it’s not been my day today.” It takes everything I have to pull the rest of that sentence in, but an apology isn’t really an apology with an excuse riding shotgun.
Another call light adds to the madness outside this room. One hour and one minute.
Mr. C sucks down his first sip. “Ah, that’s good stuff,” he sighs.
“I thought you weren’t fond of our coffee.”
“Anticipation equals appreciation…today. Well, go get your call lights, little girl. Those people out there aren’t as patient as I am, you know. Oh, could you get me a cookie? And specific, non-vague deadline for completing the task?”
“Yes, I’ll get you a cookie. Two cookies…before I go home.”
“Before you go home today?” he asks suspiciously.
I wave my hand at him, then rush to answer the nearest call light. I make a lot of promises during my shift; it’s like riding herd on a whole zoo. Some promises inevitably slither, fly or bound away…after all, there’s only one of me and a lot of them and their call lights.
That’s why I’m so passionate about adequate staff ratios: the fewer residents I have and the more help we have, the fewer promises I break.

Wonder Woman





Taken for granted. THAT’S what I’ve been feeling. I’d been trying to put my finger on what exactly has been causing this nagging malaise for a few days now.

It’s nice to be able to finally put a name to it, though it’s not a feeling that I like admitting. It feels so very self-serving. Poor me. I work so hard for so little. People don’t understand the nature of our work. Blah blah blah blah. That is not who I am. That’s not who I WANT to be.

How can I feel SORRY for myself when I’m surrounded by people living with sometimes unimaginable hardships? Who LIVE in the environment that I can leave at the end of my shifts? How can I feel such exasperation, frustration and occasionally even anger towards my residents who I really do love very much? How can I hate and love what I do in such equal measures? Is such a juxtaposition of emotions normal? Is it the facility? Is it me? What’s going ON here?

It took some time for me to work it out, but I did find my answer. My facility is toxic. It is all excuses and no accountability. It is impossible situations piled on top of undertrained staff. It is equal parts challenging, which I love, and frustrating, which I don’t love. This is not new. This is how it’s always been. I’ve learned to compartmentalize very effectively, but every so often the doors will open and all of a sudden, I’m feeling everything at once. So far, thanks to the hectic pace of first shift, those fall apart moments happen off the clock; they happen in the quiet of my own apartment (or on break in a linen closet) when I’m alone with no one depending on me.

I’ve been in the same facility for seven years. The bonds I’ve formed with my residents have been an incredible gift in my life. It is through working with them that I’ve learned to trust, not only others, but also myself. They have taught me how to value the moment, to not take life for granted, to look beyond the obvious. They have greatly enriched my life, and I will always be grateful for that.

They are WONDERFUL people; that doesn’t mean that they are EASY people.

“alice. Alice. ALICE. ALLLICCEEEE!!!!”…all day every day. The down side to having been in the same facility for so long is that they are used to me. In a world where faces change as fast as underwear, mine is the familiar one. Twenty-eight residents, a brand new trainee and a call out. Alice can handle it. Before I even hit the clock, Ms.___throws up a massive lake of stewed beef and peaches. I got it! Nobody panic! Mr.___ doesn’t like his feet to touch the floor. Ms.___ is claustrophobic. Ms.___ isolates when she’s feeling depressed. Mr.__ lashes out in anger when he’s scared…hundreds of pieces of knowledge that are now like muscle memory for me. What residents need boundaries and what residents need coddling. So I run. All day every day, from resident to resident, task to task determined to do whatever needs doing…but that’s not fair. It’s not fair to my residents, my co-workers or to myself.

I learned all I know by working consistently with my folks. What I NEED to do, instead of running whenever a co-worker says they are calling for me, is to encourage her to try for herself and encourage the residents to allow her to do her work. Otherwise I am enabling all of us, myself included. Make no mistake, there is a part of me that has become as dependent on filling the role of “Wonder Woman” as they are at putting me in it.

The inner need to “fix” impossible situations is an old song and dance for me, as if somehow solving a problem guarantees that I wasn’t the cause of it. It is an issue of mine that I am working through, but MAN does it fit in well within the world of Long Term Care.

The truth of it is this: it is not my job to be the solution to every problem, inside of work or out. It is setting myself up for failure and OF COURSE it leads to feelings of being taken for granted. I have choices. I could leave and find another job. I CHOOSE to stay, at least for now. That means I have to gain a measure of acceptance about the facility as a whole while doing my best to improve my corner of it. I don’t want to be Wonder Woman. Take away the magic lasso and invisible plane and she is just a regular person dealing with issues of co-dependency.

Meet Them Where They Are





Unreasonable, misplaced anger, unrelenting fear, heartbreak from deeply felt emotional wounds, a lack of trust both of others and of their own capabilities, powerlessness, despair, frustration, feelings of abandonment, and utter lack of control over their own surroundings are only some of the negative emotions that those living in Long Term Care facilities face on a daily basis.  My residents who struggle the most with the above mentioned feelings are usually the ones who are the least capable of clearly articulating it.
So what happens? They act out. They become verbally and on occasion, physically abusive. They often yell or become obstinate over seemingly innocent little tasks. They manipulate situations in a way that they feel best benefits their needs. They are the residents labeled “difficult”, “trouble makers”, “problems”, not just by those of us on the floor but also by those in the office.
God knows, I’m guilty of it; inwardly sighing, as I make my way to a resident who is furious at me for something over which I have no control. Or a resident who is vengeful because I’ve had to set a boundary that she doesn’t like. Some days, I wonder if all of my uphill battle folks had a meeting and decided that they would join forces in order to make a shift impossible just for their own entertainment. Those are the days that I leave work questioning both my sanity and my capabilities; the days when I think I suck at this gig and wonder why I am so determined to stick with it.
The thing is, though, when I step away for a minute, I realize that I have a level of awareness that is desperately needed in this field. I really do know that these “difficult” residents are not behaving in such a manner simply because they’re “mean”. The powers that be may know that, but in all honesty they don’t care. They can’t possibly care because their only solution appears to be medication, a problem that I will be discussing in a future post. A facilities treatment of their caregivers directly corresponds to their level of interest in their residents’ quality of care. They are not invested in us, then they are not invested in them.
SOMEONE has to be, though. Someone HAS to see beyond the behavior, which is nothing more than a symptom to the greater underlying illness. That responsibility lies on the floor. We are the witnesses and the carriers of their emotional wounds. While we are unlikely to heal them, we can step outside of ourselves and use their behaviors to learn how to better care for them, much like the pain from touching a hot stove teaches us to not touch it again.

Unreasonable, misplaced anger, unrelenting fear, heartbreak from deeply felt emotional wounds, a lack of trust both of others and of their own capabilities, powerlessness, despair, frustration, feelings of abandonment, and utter lack of control over their own surroundings…that’s a lot for any human being to have to live with. Sometimes adding “fit into my concept of acceptable behavior” on top of all that is just too much to ask of them and they can’t meet US where WE are. That’s when our empathy and understanding needs to stretch in order to better meet THEM where THEY are.

Mistaken for Mother


Mrs. Q grimaces. “Can’t you shut her up?” she asks me, exasperation written all over her face. And I get it…oh, how I get it. Just across the hall, Mrs. W has been screaming variations of “Mother!” and “Help!”–in what seem to be increasing decibels–for a long time. Both my patience and my nerves are shot to hell. It doesn’t help that everyone else, including the other residents, are in the same state as me. Everyone is riled up, frustrated and exasperated. I just want to march in that room and…
Instead I unload my own exasperation on Mrs. Q.
“No, I can’t ‘shut her up,'” I say frostily. “She won’t calm down and you know I can’t make her.”
“Go get her mother–that’s who she’s yelling for.”
“Mrs. W is older than you are,” I tell her. “For obvious reasons, I can’t fetch her mother.”
“Oh. Well, do something,” she snaps in reply. “Why should I have to sit here and listen to that?”
Ordinarily, Mrs. Q is a wonderfully sympathetic neighbor. Ordinarily, I am an empathic caregiver. Deep down, under the frayed nerves, I wonder if this is some kind of test we’ve both failed. I sigh, then turn on my heel and march into Mrs. W’s room. They say third time’s the charm, right?

Mrs. W’s eyes are wide-open, darting all over the room. Her breath is shallow, panting; she’s clearly frightened and, if I had to guess, doesn’t know where she is, when she is…maybe even who she is. Her terrified gaze catches me and locks on. “Mother!” she cries again, her hands grasping at mine. “Oh, mother I’m so scared.”
I don’t disabuse her of my mistaken identity. I just sit down on the edge of the bed and let her cradle my hands to her sweating face.
“Oh, mother I’m so glad you’re here,” she sobs.
It’s hard to stay hard-hearted around such naked fear; it’s hard to feel frustrated with someone when your presence brings them such profound relief. Even though I’m not who she thinks I am…
“Don’t leave me, mother,” she begs, squeezing my hands.
“Hey, it’s okay,” I tell her. “I’m here, I’ve got you. You’re okay. I’m gonna stay right here until you calm down, okay?” It’s a fine line I’m not crossing, neither confirming nor denying that I’m her mother. Truthfully, I honestly don’t care: let her see whatever face brings her the most comfort. I’m in the wrong field for giving credit where it’s due anyway.
“You won’t leave me?” she sniffles, finally–it seems–beginning to calm down.”
“Not for a bit. And when I do have to leave this room, I’ll be just out in the hall. Not far away.”
“Okay,” she says. “But can’t you sit here with me for a minute?”
I smile at her and nod my head…mothers aren’t the only ones in charge of keeping the monsters away. As she grows steadily calmer and quieter, I glance across the hall to Mrs. Q’s room. She’s smiling and, when she catches my eye, she waves cheerfully at me.

Peace restored…to this section of the hall.

It’s How You Say It




I would like to expand on something Alice wrote in her post earlier this week. In making a distinction between “kindness” and “niceness,” Alice told us, “Sometimes, the kindest answer is no. Sometimes, setting boundaries that will upset a resident or a co-worker in the short-term but will benefit us all in the long-term is an act of kindness.”

I think part of what Alice is saying is that the tendency of LTC staff to appease a demanding resident can set a pattern of unrealistic expectations. There is nothing wrong with appeasement in and of itself, we do it all the time in both our professional and personal relationships. The problem is when we use appeasement as a quick and easy solution rather than address the underlying issue. By doing so we treat the symptom rather than the cause.

In this sense kindness is the willingness to take the time and effort to determine not only what a resident wants but also why he or she is asking. This requires a measure of patience and self-control. In the heat of the moment, it can be difficult not to react to the tone or unreasonableness of a demand. We’ve all said or heard said some version of this: “You’re not the only one that lives here.”

However, the negative tone of a resident can actually help us understand the root of the problem. Anger, impatience and frustration can indicate an underlying anxiety. Instead of reacting to surface emotions, we can focus on allaying that anxiety.

Anxiety comes from not knowing. We can better endure all kinds of mental and physical discomfort as long as we know that it’s not indefinite and that we have some control over it. For example, I can tolerate hours of being outside on a frigid winter day as long as I know I can go inside and get warm anytime I want. Take away that assurance and in ten minutes I won’t be able to stand the cold.

It’s the same with our residents. When it’s time to say “no” and set boundaries we need to engage with them in a way that reassures rather than reproaches. When we actively listen, negotiate and compromise we are communicating to the other party that they bring something to the table and that it matters. In the process, they gain a degree of control over what happens to them. And it doesn’t always have to take a lot of time. Just that opening can be enough to defuse the anxiety.

In some LTC circles, it’s fashionable to speak of this as “resident empowerment.” We should be careful not to think of this as something we bestow on them, because in reality, it rightfully belongs to them already. Our job is to facilitate it and not deny it through haste or a lack of awareness.



Human too



“Oh, never mind about her, she’s not important; she’s just the aide.”

It’s surprising at times, how context defines how much a certain set of words can hurt us. I’ve heard those words from so many people: a stranger, a nurse, a visiting doctor, a State inspector, myself…and yet it hurts the most coming from this person, in this context. Coming from another, these words would sting, but coming from my resident, it’s a slap in the face. I feel like I have been physically abused by this sentence…as though it’s constituent syllables were fists pounding in the message.

“She’s not important; she’s just the aide.”

The resident continues on her conversation with her visitors and I’m still standing here, moving quickly from shock to anger. I have half a mind to throw down the glass of water I’m carrying and just walk away. I can’t, I know. For one, it would be unprofessional; for another I literally can’t. There’s not enough space in this room to properly storm out, especially not with all these visitors milling about. That’s what started this particular episode–this resident’s room mate asked me to fetch her insulated cup (and other assorted items) from her room, as she hadn’t been able to get in her room with the people crowding the door. To reach it, I had to squeeze around too many people crammed in too small a space–of course the resident unable to enter the room would have the second bed, farther from the door. Some of the visitors had recognized my predicament and had suggested they move this visit from the room to somewhere with a little more space so they wouldn’t be in my way so much. That’s when my resident, who I have known and sweated buckets for a long time now, declared that I and my inconvenience were not important.

She’s not important; she’s just an aide.”

How long until I stop hearing these words reverberate inside my skull? The visitors have the grace to look uncomfortable…but they don’t say anything. I am alone here. I stalk to the bathroom to fill up the cup and when the door swings shut behind me, I allow myself my anger. I’m human too, after all. Not a robot or even a one-dimensional “aide”, whatever Mrs. ___ in there imagines that to be. It just hurts to be valued so little by the resident I fight for everyday. I come in to work when I don’t really want, work a crap-ton of over-time–all so she can have the highest quality care. I struggle to hang on to the qualities of compassion and empathy on this battlefield of exhaustion and stressors–all for her and my other residents. Doesn’t she care? I know she sees. How can she not?

Mrs. S is still waiting for her ice water, I realize, and I’m hiding out in a bathroom with people I’m struggling not to see as the enemy right outside the door. I take a deep breath and push my way out of the room. I’ll have to come back in here later, I know. I’ll have to continue to provide her with the highest quality care despite the hurt she’s just inflicted. That’s my job and I do my job. Doesn’t mean I won’t report this incident to my supervisor. She might not be able to do anything about the treating the staff like crap, but she’ll certainly have a conversation with Mrs. ___ about her disregard for her room mate’s right to enter her own room. Mrs. S is still where I left her in the hall and almost ridiculously happy to see her insulated cup–a Christmas gift from her son, I remember. “Oh, thank you, thank you!” she cries, before taking a very long drink. “Don’t know what I’d do without you,” she says when she comes up for air.

“Don’t know what I’d do without you.”

I think I’ll hang on to these words instead. I like the way they make me feel needed and valued. Hey, I’m human too.