Category Archives: family members

Nursing-home-made

Sunflower May

In compliance with HIPAA, all resident names and identifying details have been altered or removed. 

It’s funny, how a person’s possessions can tell us so much about them. Most new residents come in with very little: just the clothes they wore in the hospital and maybe a small bag. Then, their families either start bringing in loads of stuff…or they don’t. I have seen rooms so crammed full of personal mementoes that it’s hard to care for the resident; so many clothes in the closet that the door won’t shut and every surface covered with knick-knacks.
I have also seen rooms bare weeks after the resident moved in, the only proof of occupation being the person in the bed. Only a few clothes, no knick-knacks…no decorations or pictures.

Mrs. L seems to be one of the latter category. After a week, she still only has the one bag that she had clutched so tightly on the first day, plus a couple outfits. They’re nice, but the kind of nice that has been worn for years and years. Her family comes often, but they seem more stressed each time and their visits get progressively shorter.
There’s always a learning curve, some time required to start feeling comfortable in the new environment…but Mrs. L doesn’t appear to be adjusting at all. She won’t leave the room, she hardly eats and from what I can tell, she seems to spend most of her days screaming into her phone and crying. I decide I can’t kept walking past such agony. We don’t know each other very well, but that’s about to change.
“Hey, can I sit down?” I ask, walking into her room and gesturing to the empty chair (provided by the facility) that sits by her bedside. She shrugs and I take that as permission. Good Lord, but it feels wonderful to get off my feet.
“I’m May, if I haven’t introduced myself before,” I add…although I’ve introduced every day this week. “Do you need anything?”
She shakes her head. I’m trying to decide between asking another question and telling a story about myself when she suddenly starts talking.
“You can’t help, nobody can help. Can you make me better? Can you tell the insurance company not to be assholes? Can you give my family a fortune so they won’t have to sell my house to afford ‘getting me the help I need’? Can you buy back everything of mine they had to sell, so I don’t have to look at bare walls while I wait to die?”

I can’t. I can’t wave a magic wand and sort out the economy, endow her with the money she needs to have a good life even though she is now elderly and disabled.
The only magic I have at my disposal are my imagination and my hands. I stay for a few minutes, now holding her hand as she cries yet again, then I slide off the chair and leave the room.
It only takes a few words in the right ears. When I come back, I’m not alone and we aren’t empty-handed.
We disperse over the room, laying out our various offerings. The Laundry department brought up clothes that have been donated to the nursing (usually by families of resident who have passed away in our care); Activities gave several left-over decorations from the various Arts-and-Crafts over the years. Nursing gathered personal care items from the supply room and arranged them in her drawers. Staff from every department drew pictures and scribbled down nursing-home-made Get Well cards…but the best bit came from a fellow resident. She heard of my cheering-up campaign and told me to pick out the prettiest flowers from the bouquet she got for her birthday and give them to that “poor lady”.

Small acts of kindness in Long-Term Care are not whistling in the dark. With each act of compassion, we light a candle. True, it will take a lot more candles than I can personally light to lift the shadow of greed from our broken system…but that’s the funny thing about kindness. Even when it’s not enough to turn the tide, change the culture or right the wrongs of this world––it is still appreciated and it can still mean the world to that one person.

My hope is that, one day, we will have more to give than what we can scrape up. I hope that one day, compassion will be considered along with costs, that questions of ethics will be given equal standing with questions of economics. 

Respect Your Elders

Sunflower May

At times, it’s really hard to be professional. No, strike that––sometimes it’s really hard to be nice. This is one of those times I really wish I could just open my mouth and…well.
Breathe. Breathe and move on. Do not respond. Do not reply. This is neither the place nor the time for such a discussion. You aren’t calm enough not to scream, so don’t say anything. Prove him wrong with your actions. I keep thinking these words until I wonder if they’ve been seared onto the inside of my eyelids from the sheer force of repetition. It’s hard because I have to be professional and they can be whatever they want to, even if that’s unkind.

All this started because Mrs. L’s husband had come over for a visit. And he is a man with Opinions. He’s not one to keep them to himself either…and I could perhaps forgive him his outspokenness if I wasn’t the target of his outrage. Or I should say, one of the targets. Today, Mr. L has Opinions about Millennials.
“Man, kid these days,” he rants to his wife, ignoring me as I labor to make her bed behind him. “What idiots. When we were kids, man, I tell you, nobody was so selfish. They just want everything handed to them. Afraid of hard work, that’s what they are.”
I’m putting the pillowcase on as he says these words and I am so tempted to…no. Absolutely not, May, that is utterly unacceptable behavior. You are not allowed to even think that. Never mind that I’ve been hard at work for five hours already today, with seven more to go. Never mind that I’m in overtime for the umpteenth week in a row. Never mind that I haven’t had a break or a breather since I clocked in. Never mind…
“What is this world coming to?” he muses. “These kids are crazy and they don’t know nothing. Everything wrong in this world is because of them, I think. When we were young, we were taught to respect our elders, but I wouldn’t trust a dog with these so-called Millennials. What a disgrace––”
I can’t take this anymore. I dart around Mr. and Mrs. L, leaving the bed half-made and escape into the hallway.
No, he didn’t trust a dog to a Millennial. It was his wife he entrusted to my care. Many of the CNAs and nurses I work with are among the Millennial generation and we are the front-line of Long-Term Care. We make up a large percentage direct care workers.
I lean back against the wall, fighting tears. They’re tears of rage, but I really can’t afford to shed them right now. I am the caregiver and this isn’t the time to be emotional.

One day, I might have Mr. L or someone like him as my resident. His dignity will be left in my care, to either affirm and defend, or ignore and abuse. I wonder if he realizes that, as he rants and raves about the sins of my generation.
When you are weak and helpless, crippled and confused, I will be there, I think. And when you are my resident, then maybe you will see. Maybe you won’t…but either way,
I will take damn good care of you, whether you want me to or not. I will be your advocate and I will be your caregiver. I will fight as hard for your dignity as I fight for the gentleman down the hall, who I absolutely adore. You cannot change my compassion and you cannot change my professionalism.

I am a caregiver. I am a Millennial. And I think I am calm enough to go back into that room to finish making the bed.
When I do, it’s to see the strangest scene. Mr and Mrs L are glaring at each other; he looks surprised and she looks angry. They break it off when they realize I’m back.
“Oh, hello, sweetie,” Mrs. L says to me. “Do you know, you are my favorite aide. I don’t know how you do all the work you do. Especially,” she adds with a pointed look at her husband, “since you’re so young.”

The Savvy Resident’s Guide

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Yang

Empathy is at the heart of caregiving. While the ability to understand and share the feelings of others has an intuitive element, a natural byproduct of genuine compassion, this awareness can be developed and enhanced through thought and imagination. Simply put, we can use what we know about another person to put ourselves in their shoes.

As I read through Dr. Eleanor Feldman Barbera’s nursing home primer, The Savvy Resident’s Guide, I found myself doing exactly that: imagining what it would be like to be an elder about to enter a nursing home. The book, subtitled Everything You Want to Know About Your Nursing Home Stay, But Were Afraid to Ask touches on all the basic topics, including what to expect when you first arrive, working with staff, managing medications, your relationship with medical and social work staff, dietary issues, rehab, activities, money issues and lodging complaints.

Throughout the book, “Dr. El” offers practical advice on everything from the best way to request assistance from care staff to techniques that help you stay motivated during rehab sessions to the best way to talk to your doctor. Dr. El keeps the tone light, often illustrating her points with personal interactions from her own experience. A common theme running through each chapter is that as a resident you are not powerless and that, in fact, there is a great deal that you can do to improve the quality of your experience in a nursing home. The book is an easy read, literally an easy read, with its large print format.

There is very little in The Savvy Resident’s Guide that could be considered new information for experienced caregivers. But in a way, for us at least, that’s the point. These issues are so woven into the fabric of our work experience that they become second nature to us and sometimes we lose sight of the fact that what might be obvious to us might not be as clear to someone else. A guide such as this, geared for new residents and their families, can help us become more aware of the basic kinds of information new residents need to help them cope with what can often be an overwhelming psychological adjustment.

In another way, as Dr. El invites us to in the foreword, the book helps us step into the new resident’s shoes because it reminds us of when we as caregivers were new to the system. The whirl of faces and personalities, the jargon, the strange cultural norms and customs of the facility and care unit, were all things we had to adjust to. Now, with a little imagination, we can put ourselves in the place someone who might not be feeling well to start, who perhaps has gone through a sustain period of loss and now has to adjust to this strange new world. Our empathy can begin even before the resident enters the front door.

Dr. Eleanor Feldman Barbera is an accomplished speaker and consultant with 20 years’ experience as psychologist in long-term care. Her blog, My Better Nursing Home can be read here. Dr. El is also a regular contributor to McKnight’s LTC News. The Savvy Resident’s Guide is available on Amazon as a paperback or as Kindle book here.

The Things They Never Tell You

Sunflower  May

Here’s something that’s not quite––or not at all––a newsflash: human beings are sexual creatures.
Here’s something that’s (an often quite hilarious) newsflash: old people are still sexual creatures.
They still notice and remark on certain aspects of life that maybe we young folk would prefer they do not. Occasionally, we young folk are the ones they are noticing and remarking about.

At times this attention is sweet, like the nine marriage proposals I’ve received in the course of my career–only three of which were delivered in a location other than the shower room.
Or the time I went to wake up a resident and was subjected to a long, loud verbal tirade about how I was thoroughly unpleasant person and he was his own boss. This tirade derailed the instant he opened his eyes…prompting him to interrupt himself with “My God, you’re beautiful!” From that moment on, he treated every word out of my mouth like Gospel truth, to be obeyed immediately. I admit it: I quite enjoyed being treated like the Queen of the Universe. Being told that I was beautiful enough to derail a full-fledged, would-make-a-toddler-jealous temper tantrum didn’t hurt my confidence any either.
Then there was the time that I noticed a resident’s pant leg needed adjusting. When I bent over in front of her to fix it, I ended up getting a reminder that not everybody born before the 1960’s necessarily conforms to the Norman Rockwell image of heterosexuality. I will say that of all the passes ever made at me, hers was tasteful–far more in the nature of a compliment on my, er, physique than objectifying my body for her viewing pleasure. That woman had game.

∞oOo∞

And then, of course, there’s the far less enjoyable kind of attention. This comes in many forms, from overhearing a group of male residents ranking the female employees by sexiness, to outright asking me to climb into bed with them. You’ve got the “handsy” old men, the incessant dirty jokes, the lewd comments, the creepy stares…and the list goes on. I’m sure every aide out there has had an experience of some kind or another of this nature.
There was a time when I cleaning up an extra large BM that was, in spite of my best efforts, just getting anywhere. I became distracted from the mess when I felt the resident’s hand on my leg, slowly creeping further up. When I told him to remove his hand, he just looked at me, smiled and said: “What, don’t you like it?”
“Are you going to take your hands off me?” I asked him calmly. “Or do I have to use my hands to get yours  off me?” To illustrate my point, I held up my gloved hand…which just happened to be dripping BM. To anyone who says that there’s nothing like cold water to curb a libido, I can only guess that you’ve tried using BM. I’ve never seen anyone back off quite so fast as he did, or stay backed off for quite as long. I hardly needed to report the incident to my supervisor, whose first comment was that I “had managed the situation rather handily“.

Of course, it’s not just the residents who put on such displays of sexism and lechery. I learned very quickly to wary of certain visitors. I’ve had a visitor try to get me in trouble with my boss because I told him to keep his hands to himself. He was always trying to touch the female aides, especially trying to put his hand on a shoulder or upper arm and “steer” us around by squeezing. I objected to being touched so frequently and familiarly without my consent, especially after I politely asked him to stop. Unfortunately for me, he was one of those men who have trouble to concept of “No Means No” and began complaining to my supervisors that I was “rude”, “mean” and “hateful”.
Unfortunately for him, I’m fairly eloquent with written words and not afraid to defend myself.

Nor should you come to the conclusion that it’s only the men who make unwanted sexual advances upon staff. While I have noticed that some of the female residents do as well, they are far fewer…in no small part, I think, to the cultural conditioning that encouraged men to be aggressive and women to be passive. Also, there’s the same mentality at work that leads some of our residents to treat their caregivers as “the help”, instead of a skilled worker. When you’re perceived as standing a rung below them on the social ladder, many people feel as though they’ve been given a pass to act as they want to, without regard to your feelings.
But it exists still, with or without the spotlight. All the crap women have deal with in our still amazingly sexist culture, with a side of proximity. There is, shall we say, an intimacy of the caregiver-resident relationship that often exasperates the “normal” harassment. Personal space boundaries are in a constant state of flux in Long-Term Care. You’re often operating in what Edward T. Hall, the cultural anthropologist who pioneered the field of proxemics, called “intimate distance” (6-18 inches between you and the other person). This close proximity influences the dynamics between you and the resident, especially if that resident has dementia. They either react with hostility, “What is this stranger doing in my personal space?” or an assumption of familiarity, “She’s right next to me, so we must be close.” Or “She’s leaning over me, so she must be open to my attentions”. Inhibitions are lowered or forgotten, causing many people with dementia to act without the social filter. Is it any wonder then, when they make a move and react with confusion when they are shut down?
Of course, empathy in this situation is a tricky thing. No matter how well you’ve managed to put yourself in the resident’s shoes, how much you understand the factors that lead them to act as they do––you cannot deny the validity of your emotions. Sexual harassment is a demeaning experience, even if the perpetrator is your resident. We can’t just shrug it off and say, “Oh, well, it’s not worth the fuss,”. If we aren’t taught–or don’t learn–how to shut down such advances with compassion and firmness, we only encourage more of the same behavior, making life harder for ourselves and all our residents.

Either way, it’s one of the things they never tell you about. It’s one of the areas that we are, for the most part, told to report to our supervisors and then left to figure out on our own. How do you deal with the handsy residents, the lewd comments and other objectifying behaviors without demeaning the resident who is exhibiting the behavior? It’s one of those ethical obstacle-courses we deal with every day.

The Magic of the Cinema

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Alice

I glanced at my client out of the corner of my eye. The lights danced across her face in a myriad of shapes and colors as her eyes widened with delight at non-stop action and shattering explosions that filled the movie screen. I sat back in my chair feeling a very deep sense of satisfaction.

      For two weeks, she had been talking about taking her granddaughter to the movies. Specifically, Independence Day Resurgence. I knew that her granddaughter would be there all day because the three of us had worked it out so they would spend at least one day a week together in the summer. To watch them both eagerly plan and anticipate our weekly “Girl’s Day” has reignited a love for what I do and opened my mind to the joys of private care. It has given me a new angle from which to view it and it has been amazing to see them bond and laugh and grow together over the weeks

       Still, the idea of packing the necessities, preparing for the excursion, transferring my client into her car, loading her wheelchair, leg pegs, seat cushion, back pillow and granddaughter into her Buick driving there and unloading it all again was…well, daunting. Not to mention making sure we find seats and it’s wheelchair accessible and that she would be warm and comfortable as possible…and…and…and.  But this was something she had her heart set on and I was going to give it my best shot.

       The movie started at 3:50. By 2:30, we were done with lunch and meds and I had the car packed and ready. Her husband told me many times over the past two weeks not to get my hopes up. Or hers, for that matter. He didn’t think we would be able to pull off such an adventure. He called it her “flights of fancy.” That only made us more determined.

        Just as we were getting ready to leave, the sky lit up with lightening as a sudden summer storm decided that it was the perfect moment to unleash the fury of the gods. WE WERE NOT TO BE DETERRED! Her granddaughter ran back into the house and grabbed a hat and umbrella, I transferred my client into the car and we were off!

     We made it in time, found our seats and even had time to get snacks. My client hadn’t been to a movie in over ten years. It was loud. The lights were bright and we agreed that the movie was somewhat of a let down and you know what? She loved every single second of it. So did her granddaughter…so did I. The whole day reminded me of a very simple truth: you never know if something is possible if you’re not willing to give it a shot.  She later told me that she felt truly normal for the first time in years because of that trip to an overrated movie. I thought about that for a second and then I replied,

     “But you AREN’T normal. You are extraordinary.” 

Just a Perfect Day

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Alice

Ah, the Family Guy. I love that show. I can put it on after a long shift and all is right with the world. It’s not everyone’s cup of tea, though, so you can imagine my surprise when I heard the opening tune through the door in the bathroom as I was getting my client dressed. Well, this should be interesting. My client’s fourteen year old granddaughter was over for the day. I couldn’t be happier about that. It’s something that I had been pushing for behind the scenes for a while now. I thought it would be good for them both. 

    One of the benefits of being an independent caregiver in a family’s home is that I have much more influence than I did in a facility. This comes with a lot of stressors and frustrations that I will save for another post, but it also puts me in a unique position to do some good. So it was GIRL’S DAY! And the kid was watching old episodes of the family guy. How this would gel with my client’s ultra-conservative views, I could not say, but hey, at least we were all together. 

     I pushed my client to the living room and positioned her in her lounge chair. We had plans to go to the movies, but her level of pain and the weather did not cooperate so we had to come up with a new game plan. In the meantime, Stewie was beating up Brian. 

      “Why is that baby beating up a dog?” she asked.

       “He owes him money!” her granddaughter replied. I knew this episode well. Time to redirect a little. My client’s social morays may not be able to handle the family guy for very long. 

    A self-described “emo kid”, the granddaughter was absolutely beautiful, though she didn’t realize it. Her hair was so rock and roll, that if I could pull it off at forty, I totally would. She’s a creative, sensitive, interesting kid trapped in that unforgiving age of fourteen. I hated fourteen and after knowing her for ten minutes, I felt a real kinship.

     As the day went on, I realized that this was not only about my client. Her granddaughter was enjoying it every bit as much as she was. So was I, for that matter! All of our plans fell through, so we rented a movie on TV and ordered a pizza. Because it was just the three of us, both granddaughter and grandma opened up to each other in ways that they may not have been able to otherwise. I reached into my bag of things that I don’t know about and listened enthusiastically as they both eagerly shared make-up tips that I would most likely never use. We had fun. In this field, it was as close to a perfect day as we can get. 

     I grew up with that bond with my Grandma. It is one of the richest and most meaningful connections in my life. So much of who I am is because of her so to see that bond begin in others…I can’t put into words how incredibly important to me that moment was. It was beautiful.

     By the end of the day, we all made a plan for her to come over every Tuesday she has free this summer. We brainstormed ideas for outings and the joy was contagious. This. THIS is why I do what I do. As caregivers, we get to be a part of these moments and we know that they are far from inconsequential. There is a lot of shit, both literally and metaphorically, that comes with this gig. Ah but the moments when I get to know that I had a hand in directly impacting another’s day for the better? So worth it! We get to lift people up. We get to fight for something bigger than ourselves. We get to have our lives impacted by others…what’s BETTER than that? It really is a hell of a job perk.

The Best and Worst

Sunflower

May

I swear, some days I feel like a ball in a ping-pong game. Back and forth, slamming into things and rebounding, helpless. No control.
The game rages around me and I’m sailing in midair, waiting for the next collision.

I walk into a room and it’s like I can taste the hostility in the air. I never know what to dread: for this family to speak or ignore me. If they speak, it’s going to be another list of complaints. But if they don’t, it’s almost worse. Being so completely ignored is…unnerving. Disturbing. But either way, it’s a good bet that I won’t hear my name spoken in this room. Actually, they treat me rather like how the aides I’ve learned to despise treat their residents. Like I’m a thing, an obstacle causing inconvience and not a person with feelings and faults.
I think my heart broke a little the day I realized that being a CNA has given me a good grasp of all the ways we humans use to strip the humanity from others.

In a few minutes, I’ll cross the hall and appreciation will slam into me. A different family will be clustered around a different bed. They’re here almost as much as I am; they know my name without glancing at my badge and, even better, they use it. They say hello and they ask how my day was. They’ve learned to read all the things I can’t say from my face–same as I know how to spot the minute expression of agony that are all they allow themselves to show.
I think my heart mended just a bit when I realized not everyone becomes an expert in dehumanization.

Thing is, I’m not rebounding between good and evil here; I’m walking down a hall between the best and worst responses to stress and pain. One family got caught up in the inconvience, got into the habit of casual unkindness. The other learned to hang on to their smiles and even to direct a few my way.
And I can walk away, go home and get away from them. My residents don’t have that option. When it’s their turn to play the ping-pong ball, they can’t remove themselves from the game. I only feel helpless; they are.

Sometimes I miss the days when I sat in a classroom, studying procedures and wondering what it feels like to pray “Not that aide today, please”. If nightmare families are bad, nightmare aides must be a thousand times worse from the other side. I’m not helpless. I can’t really do anything about the nightmare families, but I can do something about the aides. Well, one aide.

I leave the room, muttering a solemn vow under my breath: I will never treat a resident the way that family treated me. Ever.

More Than Meets the Eye

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Alice

  People are amazing. I forget that sometimes. It’s easy to do, especially during an election year. I’m so often tempted to retreat into cynicism when I read the paper or hear the news or go on social media. If they were to be believed, we all hate each other. Democrats, Republicans, black, gay, straight, rich, poor, young, old; we just can’t coexist peacefully anymore…except I have a largely diverse group of friends who somehow manage to not kill,  berate, lament, or hate each other over differences of opinions. They are bigger than whatever overly-simplified label is slapped on them. So I know that outside of the 24 hour news cycle, most of us are living our lives and co-existing just fine. All of that rage and animosity toward one another is a mirage, but if we aren’t careful and vigilant that mirage can easily become reality.

     My client is the sweetest woman.  Growing up on a farm taught her to put a high value on work ethic and she worked right up to the day her body failed her and her life changed dramatically in an instant. And she was so young! Barely in her fifties. Her husband also has worked his fingers to the bone his entire life. They started with very little more than wishes and the willingness to work hard and save more than they spend and that hard work coupled with some luck paid off. They have a beautiful beach front house, complete with a dock and boat.

     He could have sent her to a nursing home. He could have and it would have been understandable. Suddenly, their entire life was changed. But he didn’t. For eight years, he cared for her on his own. He had the bottom level of his house redesigned so that she could maneuver. When he could no longer care for her by herself, he hired in home caregivers. 

       Before every shift, I have to take a deep breath and leave my political opinions at the door. I know that I’m in for twelve to fourteen hours straight of conservative talk radio and quite frankly, those people scare me. They make their money by terrifying people and I have found that it is especially effective on the elderly, who tend to view the past through the lens of nostalgia. I want to tell my client that these people who you think bleed red white and blue are the very ones who want to cut funding to the programs designed to help you and others living with similar challenges. But I don’t. I smile and nod and don’t mention how I think fear and insanity are the conductors on this crazy train campaign season.

      It occurred to me recently that there was a time not too long ago, that I would pass a house like that with a Trump sign on the lawn and immediately assign a label and disdain to whomever may be living within the dwelling. It’s instinctual. I would recoil from meeting such people without giving a second thought about it. Backwards thinking, greedy, selfish bible thumping bigots live in such places…except didn’t that make me every bit as guilty as them? Am I an elitist, lazy, ne’er do well who just wants money from the Government and weed? Of course not, but I am a Democrat and that’s how we are painted by the talk radio hosts I have to hear all day. That’s how they paint us and that’s how we paint them and the world crumbles around us as we yell at each other.

       My client is a mother, grandmother, survivor, loves music, Little House on the Prairie and coffee and chocolate. She is delightfully funny and kind. She also happens to be a Republican. Why should her political opinion override everything else about her?  The truth is it shouldn’t. We are ALL bigger than the labels slapped upon us.

       Differences of opinions should not tear apart the very fabric of our humanity. Indeed, this nation was founded in order to allow such freedom. We are free to disagree and it’s ok to be passionate. God knows I am, but the moment we forget that we all have a story is the moment that the tail starts wagging the dog in our society. We start to think that the only way we can be right is if everyone else is wrong. Not only wrong, but dumb, mean, and evil. We lose our empathy and start treating those with differing ideas as if they aren’t even human. It’s a dangerous path to tread. So I refuse to drink the Kool-Aid. I would rather believe my own experience and insight than what other people, from both sides of the political aisle tell me to think. We do not all hate each other, no matter what they would have us believe. There’s a market for panic and anger, fear and vengeance because scared, angry people are much easier to manipulate. This campaign season is the proof in the pudding.  I’m not buying any of it.

A Teachable Moment

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Alice

        Private Care is kind of like a weird Tim Burton version of Mary Poppins, except instead of love starved, dysfunctional children, I’ve got an elderly couple who have been married for nearly fifty years.
Technically, only one of them is my client but the fact is it’s a dance. As I am working independently, any work boundaries that need to be set have to come from me and setting and accepting my own limits in a work environment is an area in which I sorely lack.
I don’t like to rush my client. It is quite simply my favorite part of home care. If she wants to take an hour to brush her teeth, she can! The shifts are long and we have the time. I fail miserably at curling and teasing her hair and helping her with her make up, but the end result isn’t nearly as important to her as the fact that I’m willing to try. The trouble comes when her husband feels the need to rush. If I don’t act quickly, he’s a bundle of nerves and then she’s a bundle of nerves and then HELLLLOOOO ANXIETY, as I try desperately to keep everyone happy while maintaining an air of serenity.

I find myself tip toeing on that line of co-dependency far too often. Staying late and coming early, letting those little bits of time go without mentioning pay, cooking for their children and grandchildren on occasion, it does add up. I’m learning though, and not just how to be a better cook either. For one thing, I’m negotiating with myself. I like it when my client’s family comes to visit. It fills her with pure joy, like turning on an inner light switch. I am willing to cook for ten and clean up after for my client to have those moments. It gives me joy too. But then I have to put on my big girl pants and have that oh so scary conversation about being compensated for the hours that I stay late or come early. That’s the deal. Some things, I am learning to bend on and others I have to stand firm.

I’m learning how to teach someone who doesn’t even realize he’s a student. I love that!
“You have to speed her up. Sometimes she needs reminding that she’s handicap.” Her husband said to me one day. I explained to him that my job is to do all that I can to make it so she feels LESS powerless over her condition and owned by her limitations, not to remind her of them. He was quiet and for minute I thought I was in for it.

“You know, I never thought of it like that before.”  It was a teachable moment for both of us. I forget sometimes that not everyone can see what is obvious to me after working in this field for a few years.

Often I miss facility work. I felt more at home with the pace and home health can be very lonely. It’s long days with only the client and her husband to interact with. So much is dependent on moods. If her husband is in a bad mood, it throws my client off too and then I’m in for a long and uncomfortable fourteen hours. But it definitely isn’t boring, as I thought it would be. There is plenty to do and learn. I feel like I’m still exploring the parameters of my job in this area of the field.

Do I want to be in private care in a year? No. But for now that doesn’t matter. This is where I landed and this is where I’m needed. At least I’m not in Long Island!

The question of tips

May
Sunflower
“Here.”
Without further word, a green wad is shoved into my hand; I can just barely make out the “20” written on it before I’m shoving it back.
“I can’t take this,” I say…and it feels like the millionth time. (Just last week I had to shake out my pockets after a suspiciously handsy-hug a resident gave me. Sure enough, one-dollar bills had tumbled out.)
“Well, I want you to have it,” the man in front of me says, as he shoves the money back into my hand and attempts to curl my fingers over it.
“I’m not allowed to accept tips,” I reply, uncurling my fingers and, for good measure, clasping my hands behind my back.
He sighs. His mother is a resident here and…how shall I put this…she thinks the world of me. This is the third attempt her son has made to give me a tip; the third time I’ve had to refuse.
“Just don’t tell your boss,” he suggests.
“First, I’m a terrible liar. Second, I can’t accept the money on principle. Look, it’s very nice of you to offer, but you’ve already paid for her care.”
“Yes, but I want you to thank you for the great care that you, personally, have given Mom and I want you to keep it up. I do that with tips, like I would tip a great waiter.”
“Yes, but it’s a slightly different relationship here,” I say. “Besides, it won’t make a difference in the level of care; I can’t give the resident down the hall less care than your mom because her family can’t or won’t tip me. That would be unethical. I don’t know how to put this, but you’ve got to trust me to provide my own motivation for your mom’s care. If you just want to thank us…we can’t accept cash, but nobody’s got a problem with families bringing food for the staff.”
He nods, not looking very convinced and I hustle out of the room. No matter how many times I have that conversation, no matter what shape it takes, it’s still as awkward as all get-out. I know where he’s coming from: in America, we’re used to giving tips for good service–especially for what we consider high-end or exceptional service. And I’m not going to deny that it would be nice to receive tips.
But I also know that long term care is already a crushing burden on so many of these families. I know that the family of the resident in the next room would love to offer me a tip but they really can’t afford it. I know that if the long term care industry were to add the expectation of tips, that it would push a lot of these families over the financial edge.

The next day, there’s a big bowl of candy sitting in that room. There’s a note attached: “Staff, please help yourselves.”
I grin and grab a big handful. It is nice to be appreciated.