Category Archives: The Art of Caregiving

Looking back and forward

May

Life is funny, sometimes. And it’s strange, always it is strange.
For almost three years, I have been writing for CNA Edge. Three years…it hardly seems possible. I must be getting older, because it feels like just yesterday that I was writing my very first post for this blog (Perception, now found in CNA Edge: Reflections from Year One).

But three years have passed, three wild and crazy years. Life marches on, bringing new responsibilities and opportunities. Just to be clear, I’m not leaving CNA Edge for good. I’m just stepping down to part-time contributor. Instead of once a week, I’ll be writing once a month. I’ve learned so much about the world and myself here on this blog; become a better writer and caregiver because of CNA Edge. Now it is time for me to take the lessons I’ve learned and apply them to new challenges.

Long-term care is a crazy corner of a strange world. We form deep bonds quickly with our residents and with our fellow caregivers. We have to: there’s too much work to do and too much stress to bear on our own. The relationships we form lighten the load, making it possible to bear. Not easy…but possible. Something we can struggle through, together.

The human cost of our long-term care system is something that is not counted enough. When it’s easy to justify making a profit off broken backs and burned-out hearts, you know there’s something screwy in the system. Something broken.
If I am proud of one thing I’ve accomplished in these last three years, I’m proud that I helped to empower other CNAs. My words and my stories touched people, helping them remember that they are not alone. Maybe I’ve helped to alter the perception of CNAs…that we aren’t poor, uneducated ass-wipers who can’t do any better than a crappy job. That many of us are intelligent, compassionate and hard-working people, just trying to do our best in a system that is set up against good care. We caregivers fight the clock every shift, just trying to give good care that we can be proud of…and trying to do it in five-minute windows. Drive by care, that’s what we’re forced to give. And it hurts us, to have to offer scraps and band-aids.
For so long, CNAs had no recourse but to swallow the hurt. Not anymore.
We’ve always had thoughts and feelings, voices and stories. Now, we have platforms to speak them from, safe spaces to tell our stories.
And CNA Edge has been so good to me, giving me that platform to write down and share my stories. Carving out time for good care is hard, but it’s easier now, knowing that change is possible. Knowing that there are those among management and policy-makers who do care, and try to implement lessons they’ve taken from my stories. Knowing that there are other CNAs who, like me, process feelings through writing stories.
I’m so grateful to CNA Edge, to Yang and Alice and the friendship we’ve forged here on the Internet.
Guys, you are the best and even though I’m stepping back, just know that I’m not leaving. I’ll still be here for you, even as I embrace new roles and opportunities.

To all my readers, thank you so much for all the likes, shares, comments and support. Your loyalty and support mean so much to me.

Who’s the One with Dementia?

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Minstrel

For those who might not have seen the ‘goddess’ of dementia care (imho) Teepa Snow in action yet:  Teepa has a wonderful skit she performs in her training programs.  At these programs the audience members are generally caregivers.  Teepa will play the role of the caregiver while an audience member takes the role of the person with dementia.  (Every caregiver becomes an expert in this role!)

Caregiver, smiling:  “OK, Jeannie, time for bed.  Let’s go to your room.”

Person with Dementia: “No.”

Caregiver: “C’mon, time for bed.”

PwD: “No.”

Caregiver, now frowning:  “Now Jeannie, it’s time for bed.  You know you’re tired.”

PwD: “No, I’m not.”

Caregiver, in a louder voice: “Jeannie, it’s time for bed.  Come with me.  You need to go to bed.”

PwD:  “No!  I’m not going.”

Caregiver, louder still:  “Yes, you are!  It’s bedtime and I have to get you ready for bed!!”

PwD, now pushing and screaming:  “There’s a stranger after me!  He wants to rip my clothes off!  Stop it!  Somebody HELP me!!  I want my Mother, where’s my Mother!!  I want to go home!!”

Caregiver, louder than ever and totally exasperated: “You come with me right this minute!  You are COMING WITH ME NOW!!

As Teepa asks at the end of her role-play: Which person seems to be the one with the cognitive problem?  The one who seems to know what she wants (not to be put to bed yet), or the one who is hell-bent on getting the dementia-impaired resident to change her mind.  The resident probably can’t change her mind at this point, especially not in response to a caregiver who repeatedly sends, in an ever louder and more frustrated voice, the same message: DESPITE YOUR WISHES, I’M GOING TO PUT YOU TO BED NOW.  If anything, the caregiver’s rising frustration triggers the resident’s fight-or-flight instincts.

For CNAs, this is the question of the hour: What do I do when a resident won’t cooperate?  Do I become more and more insistent, and in the process arouse further defiance in the resident?  Maybe I worry “I need to rush.  If I don’t get everyone ready for bed by the end of the shift, the unit manager will be furious with me.”  (PS: Remind her of that person-centered care she’s trying to sell to families—and which the brand new CMS regulations confirm.)  Do I gripe to my co-workers?  Or do I try something new.  We CNAs develop great ‘tricks of the trade.’  My secret weapon is music.  Others try chocolate.   Sometimes a short walk will help.  Or we might initiate discussion of a favorite family photo.  Trial-and-error is the name of the game.  Creative redirection.  The point, as Teepa Snow and Naomi Feil teach us, is to connect with the person.  To empathize with the underlying emotion being expressed and validate that emotion.  To engage the person in an experience they might enjoy before moving back to the ADL.

All this takes time.  But taking time to engage a resident isn’t a frill.  It’s an essential part — the best part, of being a CNA.

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.

Cueing for Caring

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Minstrel

I volunteer in a long-term care home which serves, among others, those with dementia.  The aides in this home have had dementia training and the care level is already exceptional.  I think this is because management expects the aides to…well, to care — not just to ‘provide care,’ and because management models this value.  Still, the nursing supervisor wanted a performance boost.  Training.  

Aides benefit from understanding dementia and from exposure to the best ideas on dementia care.  But what’s most important about staff education is that their new knowledge lead to new workplace habits.  Training that doesn’t result in improved care is about ‘CYA’ compliance for CMS, not about caring.  How do we ensure that training actually improves how we do our jobs?  How do we transfer the training lessons from the training site to the workplace?  As a reinforcement tool, cueing is used very effectively in memory support homes which adopt Montessori methods.  Are there some short-and-sweet (and fun) cueing tools we might use to reinforce training? 

If there were just a few practices that would transform care, I believe it’s those illustrated in the poster below.  These are tried-and-true best-care practices from experts like Teepa Snow and Naomi Feil.  Let’s try turning these ideas into cues to use where we work: nurses’ stations, employee lounges, food prep areas, in the laundry, at the time clock.  Hanging icons separately in the halls—for example, the little cheerleader—may remind us all to encourage and praise residents’ efforts.  We’d be surrounded by encouraging reminders.  Cues keep us mindful of the kind of environment that is most beneficial for all residents, especially those with dementia.  

Along with cueing, another way to reinforce training lessons is the use of rewards of some kind.   The next step is to develop a rewards program for aides who go the extra mile to use these ‘care commandments.’  This is trickier but surely warranted for aides working to create an environment that says, “We Love Our Residents.”

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What it’s all about

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Yang

 

I’m going to post my thoughts regarding our time at the 2016 Pioneer Network Conference in more depth next week. Today, I would like to address an incident that occurred during the conference orientation on Sunday. It was a little unsettling and it affected me in a personal way.

It happened as Barry Barkan of the Live Oak Institute and one of the founders of the Pioneer Network, was closing the orientation with what he described as a “solemn ritual” that went back to the early days of the Network. In a gentle and reverent tone, he instructed the group of a hundred or so orientees to form a circle around the auditorium. As we linked hands in anticipation of a prayer or a pledge or some version of Kumbaya, Barry bowed his head for a moment, then looked up and did this:

Put your right hand in,

Put your right hand out…

Oh, that.

Let’s get something straight:

I don’t do the Hokey Pokey.

I don’t put my whole self in

I don’t put my whole self out

And I certainly do not “turn myself about.”

But I did on Sunday.

Barry Barkan, Miracle Worker, got me, a life-long anti Hokey Pokier, to perform this absurd children’s dance. And I liked it.

It wasn’t the social pressure. A good portion of the group chose not to participate and I could have easily joined the ranks of my brother and sister Hokey Pokey objectors and not have suffered any of the awkwardness of being the lone dissenter.

I did it not just because Barry is an instantly likable person …

I mean look:

Solidarity through Hokey Pokey

Solidarity through Hokey Pokey

I did it, and I liked doing it, because his approach, the buildup and the subsequent surprise (Humor 101), was utterly disarming. It allowed us to drop our social armor and just have a bit of fun.

The moment was made possible by an understanding of how we were perceiving the situation, the use of humor to lighten the mood, and the reliance on an indirect approach. Had Barry taken a direct approach and told us to get in a circle for the Hokey Pokey because it was the designated time for the Relax and Have Fun portion of the orientation, I would have indeed “put my whole self out”… of the room. As soon as I navigated the one-way traffic jam at the door.

This really is “what it’s all about.” A person centered environment means that as we approach and respond to our elders, we pick up on the cues that provide us with an awareness of how they as individuals are perceiving the situation and use this as the context for our interaction with them. An unhurried and indirect approach with a light touch creates an atmosphere of cooperation and reassures our elders that they are in control.

I didn’t have to do the Hokey Pokey. I wanted to. And I would do it again, reserving of course, my right to refuse.

Ghosts in the Room

Sunflower

May

So this is different. I’m become used to being a picture of a sunflower on the Internet, the unseen hands typing away on a computer…or more often than not, my iPhone between shifts and errands. Being here, at Pioneer Networks Conference is…way, way different. It’s awesome, and pretty scary. My hands are shaking so badly I’m beginning to rock the music stand holding my script. It’s part nerves…and part something else. I take my hands off the music stand and clasp them behind my back.

Smile was hard. In rehearsal, I burst into tears because that resident…that woman who sat on the commode and broke through her own aphasia to remind me to smile…she’s gone now. She died a few months ago, and that moment, that memory is so precious to me. It’s been the moment and the memory that I relive each time I think about quitting this job or this field. (Yes, even I have those moments.) And now she’s gone. She won’t ever speak again to me, won’t ever tell me to smile. And experience has taught me that in a year or so, I’m not going to remember her face. It will blur and while I will hopefully never forget her, her face will fade until one day it won’t be her face I see. I hate it, but that’s the truth.

I’m so sorry, I tell her in my mind. I’m sorry that I made you feel bad that day and I’m sorry I won’t be able to perfectly preserve your memory. I sorry HIPAA didn’t let me capture your image so I could always remember your smile, your eyes. But while the details will blur, you will always be part of me…and you’re here in this room now. I carry your ghost with me everywhere. All of us caregivers have ghosts.

I look up from my script and look out over this crowded room and I wonder…how many ghosts are here today? How many silent residents stand behind the people sitting at these table, how many lost loved ones are watching them, watching me? I’ve got well over one hundred myself. How many do they have, these people watching me?

Ok, ya’ll, I think, turning my script to how do you say goodbye? This one’s for you guys, all you ghosts filling the spaces and the hearts in this room.

Oh, boy. And I only thought the room was crowded before I remembered you were here!

Top Ten Things To Remember While Training

Sunflower

May

I started training other aides by default–by that I mean, I was trainer by default of being the aide with the most experience that day. Six months after I started my first aide job.
To say I was a little startled would be an understatement. I was not at all certain that I knew enough to be training other aides, and I probably was right. However, I fudged my way through, with missteps and mistakes but apparently doing enough right to asked to do it again. I guess my constant mental refrain of “Be like A, not V!” was indeed helpful. I’ve been training ever since. It has been a good experience for me, and I sometimes think of it as the first step towards writing on CNA Edge, because the thing about training is you have talk somebody else through the job.
I learned slowly, one trainee at a time, what works and what doesn’t. Here’s my Top Ten Things To Remember While Training:

  1. Slow down.
    This one is hard for me, even to this day. I talk fast; I’ve got a long stride and move like Speedy Gonzales…or so I’ve been told. One day I was explaining the fire policy to my trainee and all of a sudden I became aware of this wheezing behind me. Naturally I thought a resident was having difficulty breathing–but when I spun around, there was no one around except my trainee. Her hands were on her knees and her face was bright red. “Do you think you could slow down just a bit?” she gasped. “I can’t make out anything you’re trying to show me beyond the human-shaped blur.”
  2. Show and tell.
    “How about you take this one?” my trainee laughs, nodding at the next resident in our rounds. “I’ve done almost all the changing today!”
    “Correction,” I say, “you’ve done almost all the work today. I believe in hands-on learning: think of me as your training wheels, there if you need me, but meant to be phased out. If all you did was watch me do the work, all you’d learn is how I do it. I want you to learn how you do it.”
    Normally, I show once or twice, then I talk my trainee through it step-by-step. As the training progresses, my verbal instructions become verbal cues and then, on the last day, simply confirmation or critique.
  3. Encourage initiative.
    To survive in long term care, you’ve got to think on your feet. The earlier you learn creative problem solving, the easier it will be to take the pressure without breaking. I try to give my trainees first go at a problem, encourage them to think how bend so you don’t break.
  4. Take the time to explain “why”.
    I noticed pretty early on that people would respond better if I could tell them why they needed to do something a certain way, instead of just telling them that I knew best and they needed to do as I said.
  5. Don’t swoop in and finish a job you set them unless it’s an emergency.
    This one was hard for me: I like things done right. Also, there’s always a clock ticking instead my head, reminding me of much time is slipping away, how many more residents I have to do. However, I had to learn not to swoop in and snatch the job away from my trainees…especially if they were struggling. All that did was reinforce the feeling of “I can’t do this”.
  6. Don’t sugar-coat the reality.
    I was terrified the first few times I trained–not of training, but terrified they would think it too hard and leave. We were extremely short-staffed at the time and I was terrified of losing these new aides before they even finished training. I tried to make everything run smoothly, busted my behind to create a good day around them. The first time they worked without me, they were shocked and horrified to learn that things didn’t run so well outside my little umbrella of forced calm. I learned the hard way not to sugar-coat things; let the newbies see the reality of what they were getting into before we were dependent on them to pull their own weight.
  7. Set realistic expectations and be patient.
    “Faster, faster, faster,” was V’s constant refrain while I was with her. “Come on girl, you’ll never make it if you don’t speed up. 15 minutes per shower, come on, let’s go.” Sadly, V was not the only aide from whom I have heard this. Many newbies, like myself once upon a time, find this extremely frustrating: to be brand new at a job and expected to keep up with the most experienced aide in the building. It feels like you’ve been set up to fail and nobody likes that. “Slow down, learn it the right way,” I say. “Speed will come with experience. It’s a lot of information being thrown at you all at once, but don’t worry. Give it a few weeks and you’ll get it. I don’t expect you to be Superaide right out of the gate.”
  8. Set a good example.
    I hope that I’m a fairly pleasant and polite person to begin with, but I’ve learned to keep a cheerful demeanor while training no matter what my personal emotions are that day. Like it or not, I am the face of my nursing home while I’m training…the face of long term care even, when I’m training brand new aides. Constantly griping or focusing on the negatives is setting a bad example of what is acceptable from a caregiver. Constantly freaking out about all the work we’ve got left…doesn’t quite inspire confidence, either in you or their own ability to do the job. Grace under pressure is the goal, I tell myself. Grace under pressure and show these new initiates how to handle a bad day.
  9. Follow the rules.
    This one hurt a bit to learn. Look, any aide who has survived for any length of time in this business has probably bend (if not broken) a few rules. Unfortunately, that’s the way the system is set up: doing it the “right” way is always difficult, if not impossible. At first, I cut corners in front of my newbies. That stopped the first time one ratted me out to my supervisor–over a minor infractions, but whatever. Lesson learned. Follow the rules, be friendly but don’t assume this is your new best buddy at work.
  10. Draw your line in the sand and stick to your guns.
    There’s a few important things you cannot budge on. For me as a caregiver, these are body mechanics and how you treat my residents. My trainees learn quickly that I’m strict when it comes to good body mechanics and treating my residents with respect and empathy.
    I warn them about the statistics on CNA back injuries; I tell them not to be a number on that graph. I remind them constantly to talk to resident during care, to remember that it’s not the dirty brief that is important: it’s the person who wears the brief.
    Protect your back.
    Remember: residents are people too.
    Simple to say, not so simple to practice. As a trainer, I try not to let newbies start any bad habits. There’s no “just this once” for bad body mechanics and being mean to residents.

The perfect world

Sunflower

May

It’s almost funny, how what people assume are the worst parts about my job actually aren’t. In some cases, such as this, it’s close to my favorite. I finish getting Mrs. L settled. She’s in so much pain that it takes me a long time to find a position she can relax in. Her body is so stiff, it’s almost a minor miracle when her arm straightens enough for her hand to grip mine.
“Thank you. I love you…but…”

The world is full of “I love you”s, and they are recorded, celebrated, memorialized. “I love you”: three of the most powerful words in any language. It’s a complete, perfect sentence: subject, verb, object. It’s a sentence that we are taught to say and react to…what we aren’t taught as often is how to react when that complete, perfect sentence continues with a qualifier.
“I love you but”.
I love you but I wish we had never met. I love you but I would never have chosen to be your friend. I’m glad you’re here but I wish I wasn’t.

I squeeze her hand carefully: not so hard that it causes her pain, not so lightly that she can’t feel it.
“It’s okay. I wish you weren’t here either…but, since you are, I’m glad I’m here as well.”
I’ve become used to this role, being the friend that nobody wants to have. Or rather, being the friend that nobody wants to have to need. After all, in the perfect world, there would be need for me. No one would lose their minds to disease, bodies would remain hale and trustworthy until death came to them peacefully. That’s not the world I live and work in. Bodies break, minds shatter; people lose themselves to disease and injury. Death walks hand-in-hand with pain.
And I’m here, in this imperfect world, just trying to make their hard way a little easier, trying to gather up as much peace for them as I can. When death comes for them, I’m there too: there to hold their hand while they struggle, there to fold their hands after they’ve gone.
I wouldn’t wish me on my worst enemy. Or rather, I wouldn’t wish the need for me on my worst enemy. And yet, I’ve become comfortable with this role: the friend you never wanted and the friend you cling to the hardest. When the need is great, so is the love.

It’s funny, how people assume the hardest parts of my job are also my least favorite. They aren’t. They are the reason I do it.

Footnotes in history

Sunflower

May

Lots of people get Memorial Day and Veteran’s Day confused.
I confess, I’m one of them.
“Morning, Mr. V!” I say in a bright, cheery and sleepy voice. “It’s your day! Happy Memorial Day!”
“No,” says Mr. V, his voice quiet, sad. “It’s not my day–that would be Veteran’s Day later in the year. Today is my buddy ____’s day. He’s the one who never came home from Germany.”
“Oh,” I say.
“He’d have liked you,” Mr. V continues thoughtfully.
“Really?”
“Yeah, you’re pretty. He never met a pretty woman he didn’t flirt with.”
“Sounds like you two had a lot in common,” I grumble.
“Oh,” Mr. V laughs in response, “he was better at it than me. I only think I’m smooth…he actually was. Used to hate going out with him, he’d charm all the girls and none of them would even look at the rest us!”
As I get him ready for the day, Mr. V continues to regal me with stories of his friend and the war. I linger in his room longer than maybe I should, listening to him, letting his words paint a vivid picture of a time that is quickly becoming ancient history.

It occurs to me, quite suddenly, that after my generation, there very well might be no more caregivers for those who fought in World War 2. There are fewer and fewer of those veterans left; more and more pass away every year. I know that time period has been documented extensively and there is no shortage of movies, books and other stories based around the events of the Second World War. The war will likely never be forgotten.
My residents, with their personal stories and their personal losses might be.
That’s just the way history works: not every name will be remembered, not every story will be passed on. Not every soldier gets a movie made about his life; most become footnotes in the history books. In twenty more years, Mr. V’s friend might only be a name on a wall, a faded clipping of an old newspaper. And if his story is recorded in some format, it won’t be the same. It won’t be the same experience as sitting on the bed next to his buddy, hearing him stumble his way through memories gone fuzzy with time, but still raw with the pain.

I know that there will be other caregivers sitting next to other soldiers of other wars, listening to their stories. But they won’t be from World War 2, such a massive turning point in the history of our world. They won’t be about my friend’s friend.
That can’t be helped. You can’t stop time or slow it down. But while the stories and faces will change, I hope this tradition won’t; this simple, powerful act of sitting down and listening with all your focus. Honoring those lost in war by taking the time to listen to their friends who lived.

Happy Memorial Day, a bittersweet holiday if ever there was one.

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.