Category Archives: priorities

Broken System vs Personal Responsiblity

Sunflower  May

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

If there’s a story of my career in health care, it’s probably: Nothing happens the easy way, or when I have time to deal with it. Take right now, for instance.
Mr. K has a reputation for being a jokester; he loves to laugh and he loves to make others laugh. The aides are his best audience as we always appreciate a bit of levity. Unfortunately, Mr. K doesn’t so much speak as he does mumble. It’s hard to understand him…especially when he’s cracked up laughing at his own joke. I know from experience that if I keep just repeating that I can’t understand him, his joy will vanish like his independence. So, I lean down and put my face right next to his mouth, in order to catch the words of what I am assuming is a killer joke. When he repeats himself yet again, I don’t take in his words. I can’t; I’m a bit distracted.
His breath is so foul, it smells like something died in it.

I didn’t brush his teeth this morning. I haven’t brushed his teeth all week. As I gag, I ask myself “How did this happen?”

Oral care is often the last part of personal care to be done, and by the time I get to it, I’ve been in the room for fifteen minutes already and ten other call lights are going off. It seems like a quick task, so it’s easy to say “I’ll get to it in a moment,”…and then never actually find time for that moment. When you’re scrambling just to change your people, making the time to do oral care is hard. Adding another five minutes to each resident’s personal care time, when you have ten residents and you’re already running behind…yeah, that adds up quick. Sometimes it is literally a choice between brushing Mr. K’s teeth or changing Mrs. L’s brief before she soaks through her pants. In other words: when you only have ten minutes, what is the most effective way to use them? Most often, we choose the big problems to tackle, the things that have an immediate impact on our residents’ quality of life.
The other problem is that we get so used to dealing with emergencies, crunch-times and hard decisions. We get so used to cutting corners just to survive the day that we form habits around the emergencies. The little things that we had to drop during the crisis? We forget to pick them back up. We get used to not brushing teeth.

The problem of oral care is the problem of this broken system of long-term care, narrowed to razor-thin focus: too few aides taking care of too many residents. We have a system that punishes the aides who take the time to provide good care, and then punishes them again for providing mediocre care. And yet, for all that is true, Mr. K’s mouth still smells like something died in it. I am still his aide…do the flaws of the system really absolve me of my personal responsibility? Being a CNA is, in so many ways, to be forever caught in the moment of drowning: my best isn’t good enough and yet my best is always required.

I laugh, like I got the joke. “Good one, Mr. K! Tell you what, while you think of another one, I’m going to brush your teeth, ok?”

One Voice, One Vote: Why Bother?

Sunflower May

I hate election time. I’ve come to absolutely despise all the political ads, all the fear-based rhetoric and emotional responses that seem to wash away all traces of common sense from both sides of the political spectrum. Working in a nursing home, it’s hard to get away from the political reality: TVs blare from every room and, supported as the Long-Term Care system is by the political one, it’s hard to forget that election season and its results could/will have a direct impact on my work environment.
I just can’t get away from this election, not even while I am passing out lunch trays to my folks. As I enter Mr. U’s room, the first thing I see is his TV on, set on a news channel where they are, once again, talking about the election. And in the room itself, fat stacks of political ads litter the bedside table, leaving nowhere to set his tray. As I sift through faces and promises, trying to make enough room for his lunch, I have to wonder: how did my residents get on all these mailing lists?
I’m so sick of this election and I can hear that frustration seeping into my voice as I announce the presence of food to Mr. U.
“Thanks,” he replies, never moving his gaze from the TV. “Hey, little girl, are you voting on Election Day?”
I nod. Politics is always a dangerous subject, but this isn’t exactly politics, I guess.
He frowns and shifts around slightly in his wheelchair. “Are you going to vote?” he repeats, a bit louder this time, every word slow and distinct…for all the wold as I am the one with hearing loss. Apparently, he wants a real answer: the kind spoken out loud. Suddenly I am reminded of all our previous conversations, conversations that reveal his still-fierce passion for social justice. His face is lined, his skin wrinkled and his body weak…but his eyes still shine brightly, all the more intense for the rest that has been forced upon him.
“Yes,” I say. “As much as I grumble, I’m not sure it would be…appropriate for me to pass. I mean, there have been too many people who have fought, died and sacrificed for my freedom for me to just sit on my ass at home.”
“That’s right,” he says approvingly. “Ignore the noise, forget all these negative ads and remember: what is your right will always be your responsibility. I’m gonna kick your butt if I find out you didn’t vote, little girl!”

∞oOo∞

As a CNA, I often feel powerless. I am at the bottom of the food chain: in a position to see many wrongs, but not in a position that makes it easy to correct those wrongs. There’s only so much I can do, and what is within my power often seems so small: nothing more than a trickle of water seeping between the stones of a dam. Why bother? Why keep speaking out, why keep writing and trying, breaking my heart as often as not? I am only one CNA, one American with one voice and one vote. What difference can I possibly make? How can my voice and my vote make any difference whatsoever?

The worst part about the systems and mindsets that make us feel powerless: they make us forget what little power we have. When we listen to the voices that whisper “Why bother?”, when we throw up our hands and walk away with our words all left unspoken, it is not one voice and one vote that has been silenced. It is nothing less than a victory for the systems and persons who would indeed make us powerless. Feeling powerless is the first step to actually becoming powerless. Perhaps it is not so much, this freedom of speech and this freedom to vote. Perhaps I am not so very important, but I am one of many.

Silence spreads like wildfire…but so does liberty. I am an American…I have the freedom to vote, to have my voice heard in the election of my leaders. No matter who is elected, I am not powerless. I will not be silenced or shackled, either because I am a woman or because I am “just” a CNA. My voice has weight and my opinion has value no matter my socioeconomic standing. I urge you, my fellow CNAs…do not be silent. Do not forget the power that has been bought for us by the sacrifices of those who have come before, and the sacrifices we ourselves have made. Always remember: what is our right is also our responsibility. We are not powerless and we will not be made to feel so anymore.
Go out and vote. Make your voice heard. Do not be swayed by fear or fancy rhetoric. Do your research and make up your own mind about which candidates you wish to be your leaders. And never, ever forget: no matter who wins this election, it does not absolve us of our responsibility to keep speaking out for those who cannot. What is our right will always be our responsibility…what wrongs we see, we must work to right. Vote for peace and prosperity, for compassion and communication, for empathy and intelligence. Vote for the whichever candidate you feel will be more willing to embrace the qualities we have learned to value most as caregivers of the elderly and disabled.

Do not surrender your ability to think for yourself to the politicians. Our freedom to vote is our birthright, so let it be your reason and not your fear that cast the ballot. Freedom…it’s far too precious to waste on an opinion that someone told you was the right thing.

Enabling Exploitation

Sunflower May

Times like this, I can really see the connection between nursing homes and haunted houses. Both have claims of being the abode of ghosts and, more relevantly, both seem to have innumerable nooks for people to hide in. Well, maybe not hide in, but it does seem like every time I need help, there’s no one there to help me.
I peak around another door, finally finding the person I’ve been looking for.
“Hey, do you have a second?” I say, panting just a bit. It’s been nonstop all day and I’m exhausted. Perhaps if I was only working one shift today, it wouldn’t be so bad, but it’s another double I’m working today. I swear, even my bones ache tonight.
My hall partner looks up from bagging up a brief. “What do you want now?” she grumbles. She’s been a bit…less than friendly with me and looks like she’s running out of patience.
“I need your help to get Mrs. H to bed,” I tell her, glancing at the clock hanging on the wall and immediately wishing I hadn’t. It’s much later than I thought and we still haven’t started our lunches. At this rate, I’ll be clocking back in from lunch just in time to clock out for the shift.
“Mrs. H is a tiny woman,” she says crossly.
“Yeah, but she’s not standing right now. I’m going to have to use the lift to get her in bed and I need a spotter.” Seeing the hesitation on her face, I hasten to add: “I just need help putting her to bed, I can handle the rest from there.”
My partner does not look happy, but she agrees to come help me…although she takes me at my literal word, standing in the doorway while I hook up Mrs. H to the standing lift and maneuver her into the bed. Before I even have the chance to unhook Mrs. H, my partner turns to leave.
“Go to lunch when you’re done,” she calls over her shoulder.
It takes me a few minutes, but I get Mrs. H finished up and head off to the break room. I haven’t had a chance to sit down since my first shift lunch break…many, many hours ago.

Oh, but sweet mercy, it feels good to sit down! I’m too tired to eat, so I just sit back and attempt to become one with the chair. I feel like all my bones have turned to jelly; like I’m going to have to be poured out of this beautiful, gorgeous, wonderful seat.
It’s entirely possible that my brain has checked out for the night, long before my body can. I fish my phone out of my pocket and open Facebook. Even if I can’t eat, I need to do something or I’m going to fall asleep.
It’s sitting there at the top of my newsfeed, only twelve minutes old.
Worst night ever. Partner is so damn by-the-book and can’t do anything by herself. Seriously, if you’re so lazy or weak, you’re not cut out for this job.”

Twelve minutes old. She must have posted this right after she left Mrs. H’s room. It isn’t until the phone starts to jump in my hand that I realize I’m shaking with anger. What the…I mean, come on! Facebook! By-the-book? Not cut out for this job? Weak because I asked for help with a resident who, while normally one-assist, needed lifting tonight? Would she have rather I took the chance of injuring myself or Mrs. H?

<oOo>

CNAs have one of the highest rates of back injuries among any other profession. Why in the world would we continue to solo-lift residents who are either require two-assist transfers or a mechanical lift?
Minstrel hit the nail on the head with her latest post. There is a “Macho” culture that has sprung up among CNAs—borne, no doubt, from the chronic short-staffed circumstances. Asking for help (and waiting for help) eats up time…time we quite honestly do not have. Every aide is therefore left with a choice: lift and take a chance on hurting yourself or go get help and fall even more behind.
You can start this job with good intentions, decide you’ll never lift a two-assist. That decision wavers the first time you see another aide lift a resident and walk away—apparently unharmed. It crumbles some more when you hear other aides rank each other by their toughness: so-and-so can lift the heaviest resident on her own. Now that’s a good aide!
That decision is left by the way side when you realize that you do not have time to things the “right way” and you take a short-cut. You lift a resident who is explicitly a two-assist. You don’t raise the bed up to change someone. You change the bariatric resident by yourself.
Now you are a good aide, a tough aide. Now you’ve earned the respect of your fellow CNAs.
And when your body succumbs to the strain, when you feel something pop or pull, when you can’t straighten your back without gasping in pain…you pick yourself back up and continue on. You grumble about the conditions that led to this injury, but you are still a good aide, a tough aide and no injury is keeping you down. You don’t have time to be hurt. You’ve seen other CNAs work injured and sick and you applauded them for their toughness. Time to prove your own.

There is, shall we say, an expectation of injury and an attitude of invulnerability at play among CNAs, two ideas that should be contradictory but are held together nonetheless. There is this mentality among Long-Term Care aides, a mentality that says by allowing ourselves to be injured, we have shown ourselves to be weak. Perhaps this is not the right phrasing. Maybe a better way to say this is by allowing ourselves to be affected by our injuries, we have shown ourselves to be sub-par CNAs, weak and “not cut out for this work”.
It’s a tough job, but we’re tougher. Those CNAs who refuse to lift, or who ask for help…these CNAs are mocked and, dare I say, bullied for their caution.

Very little of this, I’m sure, is intended to be malicious. Solo-lifting, after all, ensures that our residents are toileted when they need to be and put to bed when they ask. It ensures that they do not suffer from this broken system. Refusing to solo-lift can be construed as placing your wellbeing above that of a resident…and that’s just selfish.
Isn’t it?
Whatever the reasons and justifications of any party, the fact remains: the health of CNAs is not treated as a priority…not by management, not by the policy makers and not by the CNAs themselves.
This is a problem. True: the conditions of Long-Term Care are stacked so that injuries among CNAs are high. Yes, the resident to aide ratios are so high that doing things the right way slows you down, very often to the point that you are the last of your shift to leave every single day.

I am a CNA and I do not find it acceptable that I live in expectation of injury. I do not find it acceptable that I have to make a choice between harm done to a resident and harm done to myself. Being “by the book” is my quiet protest of the over-worked conditions of Long-Term Care. If we cut corners and finish on time, but document that we did things ” the right way”, then our complaints of being overwhelmed can be shuffled to the side. “What do you mean, you can’t care for 12 residents? You do it just fine according to my spreadsheet and your charting!”
By solo-lifting two assists, we are not proving our toughness as CNAs: we are enabling the system to exploit us.
Take care of your health. No one else is going to do it for you. This system is not set up to treat the health of CNAs as a precious resource, anymore than it is set up to treat the CNA as a valuable member of the team.
I do not solo-lift and I try to cut as few corners as I can. It is not because I am lazy or weak or not cut out for this job. It is not because I like seeing my residents wait for care. It is because this gesture is one of the few resources at my disposal to show why culture change in Long-Term Care is needed. It is my defiance of a system that exploits me and will throw me away if I break beyond repair.
As an individual, I am easy to ignore and my gesture of defiance easy to overlook. Strength comes in numbers. If every aide refused to cut corners and committed themselves to being “by the book” when it comes to lifting…well, now that would be hard to overlook.
I’d go so far as to say that would be impossible to ignore.

Bad Boss Part 2: Consistent or Crazy

Sunflower

May

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!”

<oOo>

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.

Back to the Floor

May.                          Sunflower

It would appear as though my residents missed me.
To show how much they missed me (or perhaps to convince me never to go away again), they’ve apparently decided to throw a call-light party, complete with a few alarms…you know, just to complete the experience. The party entertainment seems to be in the form of the guest of honor, aka me, running around like a chicken with its head cut off. I’m running from room to room, sweat dripping off me and breathing hard; it’s been non-stop all day long–and the day is still young. This shift ain’t over yet and I already feel as though I need another vacation. No sooner do I answer one light than five more go off.
This is getting ridiculous.
I swing into the next room, turn off the call light and ask (in a slightly breathless voice): “Whatcha need? Are you ready to get up now?”
“No,” says Mrs. H. “Not ready to get up yet.”
“Okay then, ring again when you’re ready, good to see you and bye!”
“Stop!!” she shrieks. “Come back here!”
I stop as ordered, skidding forward just a bit from excessive momentum. Thankfully the door frame is there to help me redirect back into the room. “Yes?” I ask.
“Sit down,” she says, or rather, orders. “Sit down and tell me about your vacation. I haven’t seen you in a week!”
“That’s why you put on the call light?”
“Well, duh! I heard your voice out there and figured you were back. So sit down little girl and tell me all about your trip.”
I glance out in the hall. There’s only one other call light going off and I catch a glimpse of my hall partner heading towards it…so I close the door and sit down as requested/ordered. “It’ll have to be quick,” I tell Mrs. H. She nods and settles back against her pillows, eagerly awaiting my story.
I grin. Ah, yes. The best and worst of my job were waiting for me today: everything I can’t stand and everything I love both wrapped up in this one shift, my first back from vacation. Still, it’s good to be back.

If I had to pick one word to describe the Pioneer Network Conference, I would have to go with “thought-provoking”. (Then I’d have to argue that yes, that is one word thanks to the hyphen, thank you very much, Grammar hounds.)
Over the course of four days, I had so much information thrown at me, engaged in so many conversations, asked and answered so many questions…it was a lot.
I learned new things.
I received confirmation for ideas I’ve long held without any proof.
I heard things that made me change my mind on certain issues.
I listened to arguments for certain things that did not change my mind, but showed me how other people were convinced.
I walked away with a thousand ideas for change, and 30 or so blog post ideas.

It was rather odd, sitting shoulder-to-shoulder with administrators, DONs, ombudsmen, policy makers, and other people whose spheres of influence are much larger than my own. It was odd, noticing that we took notes at the same time during a session. I guess I had rather expected to feel small, sitting with the movers and shakers, but I didn’t. Different, maybe, but not smaller. Perhaps that was the best part of the conference: hearing other people’s perspectives and actually listening. Having other people listen to my perspective.
My sphere of influence might be comparatively small, but it does have the advantage of being personal. I can’t change whole long term care facilities, or alter policies or build new facilities based on new models of care…but I can adjust my own personal style of caregiving to better suit the needs of my folks. I can take the big picture things I’ve learned and use them to make the day-to-day lives of my residents better. I can use what I’ve learned to stretch my own assumptions and perspective, use them to formulate and articulate new blog posts.
It might only make a difference to a few people, but it will make a world of difference to those few…and that’s totally worth it for me.

In the end, it’s the people who are important. The system should serve the people, not steam-roll them into molds with labels slapped on top. For me, the system will only be fixed when it empowers people to do and be their best whatever their role, whether it be resident, CNA, DON, RN, administrator or policy makers. For me, the best system is the one that encourages connections between people, no matter their social status or job title.
Systems break down, technology becomes outdated, but those personal connections?
That’s always been the thing at the heart of caregiving. It’s certainly why I do what I do.

If you don’t get it

Sunflower

May

The strangest things about training new people is watching them react and then adjust to the work. It’s more than learning the ropes of a new job…more than finding your feet in new place.
Health care is a different world and long term care is a strange corner of that world.
It’s interesting to watch as people who had no previous experience in caregiving learn what it means to be a CNA, the emotional shift that has to happen, the mental hurdles that have to be overcome. It is somewhat like facing your own mortality, or your own fragility, to see human being made frail and helpless by disease and injures. You see in the residents all the horrifying ways your own body might betray you. It’s awkward and uncomfortable and the natural reaction is to distance yourself from all of that. It’s easy to let the diagnosis swallow the person…but if you want to be a good caregiver, you can’t do that. You have to fight to see the face of the person in front of you.
I like to watch for that moment when the green aides realize that, the moment when they break through the strangeness and the discomfort and connect with my residents. The moment when my residents become theirs too. Sometimes, despite my best efforts, there are people who just don’t get it, who can’t make that shift. For those people, the moment never comes and I’m left wondering what, if anything, I could have done differently.

These training experiences leave a bitter taste in my mouth after…during, I often feel like I’m in a plane that’s falling out of the sky. One instance stands out clearly in my memory. It’s near the end of training, after almost a week of trying and failing to teach this young man the job. I’ve been walking him through everything step-by-step for the past few days and in that time he has displayed absolutely zero initiative. If I don’t tell him what to do, he just stands back with his hands in his pockets and looks at me. Only me. Never the residents.
It’s gotten to the point where I’m sick of the sound of my own voice. Maybe I should just record myself and put that on continuous playback…it’s not like I’m saying anything new, just repeating the same instructions over and over. The same basic instructions, one in particular.
“Talk to your residents,” I say again and, if I’m honest, exasperation is creeping into my tone. “Talk to her, tell her what you’re doing.”
He nods…and doesn’t say a word. I’m about ready to scream.
“Look, I’m not just saying this to say it. I mean it: talk to the person you’re taking care of. This is important for two reasons. A, it lets them know what you’re doing and more important, B, it reminds you that you are working on a person. Not a plastic dummy, a human being just like you. You’re not here to wipe an ass, you are here to take care of the person that ass is attached to; so talk to her!”
He nods again. And still doesn’t speak to her, just like he hasn’t spoken to any of the residents during care all week. All of a sudden I have this vivid mental image of reaching across my resident, grabbing his jaw with my gloved hand and forcing it open and closed like a marionette. Instead, I squeeze my eyes shut and sigh.
“I’m not trying to be bossy or mean, but I just don’t understand why this is so hard for you,” I finally say.
“It’s just weird,” he replies stiffly. “I feel uncomfortable with…talking to a person who doesn’t even understand what I am saying. It’s not even on my skills check-off. I don’t get why you’re so stuck on this.”
“Treating your residents like the people they are shouldn’t have to be a list of things to learn,” I grind out between my teeth. “And who are you to say what she does and doesn’t understand? I’m stuck on this because it is the most important part of the work we do. Would you want someone to push and pull you around without ever once making eye contact or saying hello? I sure as hell wouldn’t. So talk to her.”

If you can’t understand the bond that grows between caregiver and resident, if you ‘don’t get’ the importance of interacting with your residents…I humbly submit that you do not need to be caregiver. Compassion, empathy: these aren’t skills that I can teach. At most they are an attitude I can encourage in the new aides I train; an attitude I can nurture in myself.

The Great Yoga Pants Debate

photo

 

Alice

    Yoga pants. YOGA pants? Poor staffing, supply shortages, low wages, a world full of people who see a disability instead of a person, a world full of people who treat the elderly as if they were disposable, a broken system and a national elder abuse average of one in four but no. She’d rather put an embargo on Yoga pants. Stop muttering to yourself, Alice. You’re alone in your apartment ranting like a lunatic at something you read online. Take a breath.

      It was nothing, really; an innocuous comment on one of the support sites that got me going. The poster commented about a facility that contracts out to her agency that allows their employees to wear yoga pants. She thought it was inappropriate. That was it. So why did slowly work me into a tizzy? Why did it nag at me like a hole in my sock? 

      There is a smug superiority in some of the comments I read that concerns me. If you don’t like yoga pants, work at a facility that doesn’t allow them. Why pull others down in order to boost yourself up? And it happens often. First shift blames second. Hospitals are better than facilities. Home care has higher standards. This caregiver has tattoos and is unprofessional. We pull each other apart over nonsense when in reality, we are ALL running around and sticking our thumbs into the leaky dam as the water comes crashing around us!

      Don’t misunderstand me. I think the fact that we have online groups is great. Many of the questions are insightful and uplifting and funny and it’s wonderful to have sites full of people you’ve never met who all speak the same language. Long term care is a bizarre world and as caregivers we see it through different eyes and relate on a different level. Maybe it’s because I believe in the best of us. Maybe it’s because I know we are better than the powers that be treat us. Maybe it’s because I expect more from us, but for whatever reason, I was really bothered by that comment and could not shake it…but then Yang pointed something out to me. Maybe people resort to that sort of destructive behavior because they feel so powerless over everything else. That stopped me in my tracks.

       Let me assure all of you that we are not powerless unless we allow ourselves to be. We have choices! We can advocate in so many ways, big and small. We can be kind to the new co-worker. We can speak our truth to our employers. We can volunteer or start a support group, or write for a blog, or join the Alzheimer’s association. Most importantly, with our united actions, we can start a much needed conversation about changes that need to be made in the system from our own perspective as well as those for whom we care. 

    It’s not that we are “entitled” to a living wage. It’s that we’ve EARNED it. We have earned the right to safe work places and proper supplies. We have earned the right to be treated with respect and we have earned the right to be heard. We will never get to the real issues if we allow ourselves to stay stuck in a mindset where another person’s pants choice is of grave concern. Margaret Mead said never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. Isn’t it time to get started

That it is the question, part two

Sunflower

May

Being an aide, I’ve decided, is a bit like throwing yourself at a brick wall, thinking that either the wall is going to come down or you are going to splatter yourself all over it.
Unfortunately or not, what actually happens is you come away bloody and for all your pain, all you’ve done to the wall is put a couple hairline cracks in it.

“If I don’t do it, who will?” This question might feel like it is being asked out of a lack of faith in our fellow aides…like nobody but myself is capable of doing it.
Unfortunately, it is a honest question. Anyone who has been around Long Term Care for any length of time, for any reason, can attest the chronic short-handedness that plagues so many facilities.

“If I don’t pick up that shift, who will?”
The answer might be nobody. Everybody is exhausted and everybody has lives outside the nursing home. They’ll go short that day and frustration will increase.
“If I’m not here in a year, who is going to be there for these people?”
Very possibly, a stranger who will put in her two-weeks notice the next day. The staffing coordinator didn’t tell her she was signing up for a tour in hell, after all. There’s got an easier way to make a living.

The system, as it is set up today, depends on sacrifice. It relies on dependable aides who pick up shift after shift, who will stick it out for little money and little hope of relief. And that’s a problem…and CNAs are not the only victims. The residents suffer too, often feeling like it is their fault. The elderly often feel themselves to be a burden and it is horrible that the current system only enforces that feeling, as they watch the parade of faces come and go.

Perhaps the answer lies in the middle. Set your own boundaries because your supervisors certainly won’t. There’s no ceiling on overtime and if you’re willing to do it, they aren’t going to stop you.
Know how much you are willing and able to give. Stick to your story: if you’ve got plans, you’ve got plans you can’t reschedule. The pathos is palpable in the nursing home and it is so very, very easy to give more than you have when surrounded by desperation. Remember your own needs while you take care of others. There is something in the make-up of a caregiver that wants to make things better. Watch that instinct and don’t be the hero all the time. You can’t give from emptiness.

Give what you can, but know when you can’t. Our only responsibility is to provide high-quality care and compassion while we are there…however long that is. Picking up is (or should be) optional. Pace yourself.
That wall isn’t going to come down all at once and I’ve seen aides break their hearts and shatter their compassion trying.
Hairline cracks are progress, no matter how insignificant they feel.
Don’t burn yourself out.

That is the question, part one

Sunflower

May

It’s the oddest conversation I am not part of.
I mean, I’m just sitting here quietly, chewing my food and watching two other aides fight it out. Neither one of them is backing down and I honestly agree with both of them…which is odd because they cannot agree with one another.
Like so much of the world of long term care, this argument arose over being short staffed.
“We have a responsibility,” A says with conviction. “You see how many open shifts there are this month! I have a responsibility to my residents not to let them suffer and that means picking up shifts when I can. Working over, to make sure they get the quality of care they deserve. If I don’t do it, who will?”
“I have a responsibility,” B says firmly. “I have a responsibility to my residents not to burn myself out. You see how often people quit! I have a responsibility to my residents to make sure I’m here for a long time. That means pacing myself and not working insane hours. If I’m not here for these people down the road, who will be?”

Ah, that is the question. Questions, I should say…although, at their root, both seem to be of a similar flavor to me. But my lunch break is over and I need to get back to the floor.
The questions linger in my head, possible answers swirling around.

The definition of “unhelpful”

Sunflower

May

I wish I could turn invisible. I wish I could turn back time and shove a washcloth in the nurse’s mouth. I wish she could read minds so she would have caught my frantic thought of “oh, God, please don’t say it”. I wish all these other people weren’t clustered all around. I wish they’d go back to glaring at her and leave me out of it. I wish she’d leave me out of it.
Perhaps she thinks it was a nice thing to say. Perhaps she thinks it was helpful.

It was not. The dictionary definition of “unhelpful” ought to include a picture of this moment, I think savagely. Perhaps it’s true, perhaps it’s not; I have a razor-sharp feeling this is question I would do well to avoid answering. Or thinking about much.
I certainly hope it’s not true. If I am the best aide ever as this nurse suggested…out loud and in front of several other CNAs…well, that’s not a very good sign, is it? I know my flaws as an aide better than anybody except the residents who suffer from my shortcomings. I do try, but I would hate to think that my efforts are the pinnacle of CNAdom.

It’s not that I object to being appreciated and valued for the quality of care I provide. I work hard to overcome my shortcomings and the flaws of the system to provide compassionate and competent care. Appreciation is nice, and I do better work with a pinch of it. But I prefer my praise like I prefer my criticism: done in private. No audience. Most particularly, no audience of slighted fellow aides. Please don’t praise me in front of my coworkers without having something good to say about them too. Even if they aren’t quite as…how shall I say this without sounding arrogant…doing as well.
The absolute only thing this singling out does is surround me with unhappy coworkers. Actually, let me restate: the only things this singling out does is surround me with unhappy coworkers and give them an outlet for their misery. Trust me, if the difference between work ethics is apparent to a supervisor, it’s obvious to the workers as well. Pointing it out is not necessary.
And the resulting, um, situation is not conductive to a good work morale. At least, my morale tends to bottom out after a shift of cold shoulders and whispered remarks behind my back (often while I’m still in the room). It’s very hard to work with people who think you’re either a suck-up or a spy.
Being forced to work on your own because a badly timed bit of praise has given your coworkers the impression you think you’re too good for them…that is not going to result in high quality of care for the residents. And the residents are supposedly why we are all here. Well, I’m certainly not here for an ego-trip (there have got to be more socially acceptable and higher paying jobs for that).

Unfortunately or otherwise, the current system is best worked as a team. On my own, it’s hard to push past all the obstacles erected in my way by bottom-line obsessed bureaucrats. With hard-working and stubbornly compassionate CNAs beside me…well, I can conquer this world, defy the system.
Care for my residents. Figure out how to fix long term care.
That’s a more important question than “Who is the best aide of them all?”