Category Archives: The CNA Voice

Looking back and forward


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.

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!”


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.

All about the money…except it’s not


The world of long-term care is changing. CNAs are no longer a silent workforce, an easily replaced part of the machine inside healthcare, and labeled “ass-wipers” outside. Earlier this month, CNAs around the country raised their voices together for better pay. For the most part, the response to this was positive.
And yet, there were still seemed to be some who were blindsided.
“Where’s this coming from? You said you weren’t in this field for the money!” “So I guess money is what you care about after all.”
“If you want real money, get a real job.”
Even worse, I think, are the unspoken accusations: a good, selfless CNA shouldn’t be concerned by how much money they make an hour. A good and selfless CNA isn’t in this for the money.

You see, it’s not really about the money. It’s about what the money represents: respect. Call us angels or ass-wipers, but still we are shoved under the rug, forgotten in the corner. But we do not stand alone. Behind every stressed out CNA there are 10-20 residents. People who are soiling themselves because there are not enough aides on the floor to meet their needs in a timely fashion. People are often quite aware that their needs have been placed very low on society’s priorities.

“But with the current pay and workloads, the job is still getting done!”
I hear this one a lot. It’s true, I suppose: CNAs work jobs that have pathetically low pay and where they have to care for over a dozen residents by themselves.
The workloads go hand in hand with low pay: we’re often paid a less than living wage to do the work of two or more people. But fewer people are willing to do this anymore. There’s a CNA shortage, and a turnover rate that is mind boggling…well over 50%.

So many of us work multiple extra shifts a week or struggle just to keep our families fed. It might seem an “acceptable budget measure” to keep the pay and staffing low,but I assure you, it is not “acceptable” on the reality of the floor. You cannot give from emptiness and there is little as draining as exhaustion and stress. And yet we are still expected to provided the best care or else…here come the ambulance chasers. Here come the lawsuits and state complaints.

Policy makers, I’m speaking to you personally. If you truly believe that excellent, personal care can be provided to 12+ people by an exhausted, stressed out and fiscally struggling caregiver…come be my resident. Come live in the world you have created. Come be my resident, dependent on me for everything and having to share me with 12+ other people. Tell me then that below average pay for caregivers is an “acceptable measure”. Tell me then that my residents are not worthy of enough respect to give their caregivers a living wage and good working conditions.
Tell me then that pushing for higher wages is a sign of greed; that pushing for better resident-to-aide ratios is a sign of laziness.

It’s not about the money. It’s about what the money represents: respect. Respect for me, for my chosen field…respect for the elderly and disabled that I care for. They are worthy of having a caregiver who isn’t scrapping by. They are worthy of having a caregiver who isn’t a few double shifts away from having a nervous breakdown. They are worthy of my time and they should be worthy of the money it will take to give them proper and personal care.

The River and the Dam



It’s interesting, how conversations start and change. I have no idea how, but somehow my brother and I have drifted to the topic of art therapy and its uses. He tells me how it is being used to great effect with soldiers returning home with PTSD. Apparently there’s a recurring motif seems to be a mouth sewn shut; the feeling of voicelessness given speech through art therapy.

That got me thinking: how would I depict my job in that kind of art? I’m not much of a visual artist (that’s Alice), and while I might have a slight aptitude for photography, I can’t draw worth a darn. I tend to process my thoughts and emotions through words, not images. But if I was asked to draw my feelings about my job, to find an image to convey my emotions…
Almost as soon as I think it, I see it. A wild river, a gray concrete dam rising up out of it, controlling the flow of the water. It’s solid, sturdy–or so the people on top of the dam tell me. But that solidity is an illusion. From where I stand, waist-deep in the water on the other side of the dam, I can see the small cracks etched in that wall of concrete. The cracks are growing in size, joining up with each other; water seeps and trickles through.
And here I am, one arm jammed into the nearest crack, the other desperately scrabbling, trying to widen the river on my side. The water’s getting higher on the other side, the river swollen and rough: there’s a flood coming and this dam isn’t going to hold. I’m trying to hold up the dam while I prepare the river to handle the floodwaters. There’s no doubt in my mind: this dam is going to crack, crumble. I don’t want to get swept away when all that pressure finds its release…but I can’t leave. Those people on the top, they can run for it: straight off the dam and across the cliffs. I can’t. I can see all too clearly and too personally what will be destroyed if I pull my arm from the dam and make a run for it. I can also see places where I can adapt the river, so we can ride out the inevitable wave. I wish those people up top would come down here and help me, or get off so I don’t have to hold up their added weight too. It seems like more and more are gathering to stare down at me.

Well, not “me”. There’s a thousand cracks–that’s true. There’s also hundreds of arms reaching out. Is it enough? I don’t know. I can’t step back long enough to count them; all I know is that I’m grateful for each person who stands with me.

The Public Image of Direct Care Workers





I wince every time I see the words “nursing home aide” appear in a news headline. More often than not, it involves stories of elder abuse, neglect and exploitation. In fact, the second most common CNA related Google media alert showing up in my email inbox every week involve negative stories about caregivers. The most common are help wanted ads for CNAs. The correlation there is a subject for another post.

Such media reports reinforce negative stereotypes and distort the public’s perception of who we are and what we do. But I’m not suggesting that the media is in any way obligated to balance these negative reports with positive stories about caregivers. It’s naïve to expect it. Unfortunately, the news media in this country has essentially become a subset of the entertainment industry and outrage is a perverse form of entertainment. A negative story gets our attention better than a positive one and it’s not uncommon for reporters to downplay or ignore details that would make the story more accurate, but less interesting. Besides, the headline for a feel good story about what direct care workers actually do would read more like a headline from The Onion: “Caregiver Treats Nursing Home Resident with Dignity and Respect.”

It’s just not news.

As part of its never ending struggle to improve public opinion of Long Term Care, the industry goes to great lengths to counter these negative impressions of direct care workers and present caregivers in the most positive light possible. In this effort, we are represented by the Brochure Caregiver: the lovely stock photography model with a warm smile and immaculate scrubs. Our model is almost always a few years younger (thus indicating a lesser status) than the stock photography models – also with warm smiles – representing the licensed nurses, assorted LTC professionals and administrators. For the LTC industry, image is king.

Caregivers themselves play a more direct, if limited, role in helping to fashion the public image of CNAs. Every time we interact with visitors from the outside, we represent not only ourselves and our facility, but our profession as well. Like it or not, how we conduct ourselves as individuals and the impression we give visitors is a reflection on all of us.

With the advent of a CNA community on social media, direct care workers now have a platform to address public misconceptions of caregivers that takes us beyond the walls of the work place. And we can do this quite independently from the efforts of our LTC bosses. We have the opportunity to directly address both the health care community and the general public and present something much more real and powerful than either the negative media stereotypes or the LTC industry’s glossy image of caregivers.  How we do this is a matter of articulating how we actually see ourselves and our work. We can – if we choose – define ourselves and create our own identity.

In my next two posts I would like to address how we move from image to identity, and ultimately to advocacy and an independent voice.

Ring in the new year



Another day, another dollar. Another year over and a new one just began.
Sometimes it’s hard to hold on to optimism when you work in healthcare.
It’s 2016 and we’re still short of staff.
It’s 2016 and we’re still light on pay.
I’ve been in the business for years now and it’s still the same old story.
I’m the one who has changed. I’m a little bit tougher, a little bit gentler. I’m a touch wiser, a shade sadder.
I’ve been around the block and this ain’t my first rodeo. Sometimes it’s hard to remember what it was like on my first week as a CNA. It’s like all that happened to another person. CNA…it isn’t just a job, you see. It bleeds into every aspect of life, coloring the way you see the world.

So yes, it’s a new year and no, the industry hasn’t changed much. It’s hard to keep from falling into cynicism. Maybe things will never change.
But I’ll keep changing. I’ll keep choosing. I’ll take a lesson from my residents and I’ll keep smiling. Happiness is something they snatch from the jaws of despair and boredom. An old person holding on, with grim determination, to an attitude of youthful delight is quite simply the most badass thing I’ve ever seen in my life. It’s also awesome in the oldest sense of the word.
There really is nothing more beautiful than the eyes of a child looking out at you from the wrinkled face of an elder.

The Moral Authority of Caregivers




Even in the worst work environments caregivers have the opportunity to make an immediate and positive impact on how residents experience life in long-term care. So much of what our elders experience depends upon the quality of the interactions we have with them. Whatever our difficulties, we are ultimately responsible for the manner in which we approach and respond to our residents. At the same time, how we conduct ourselves as caregivers has significance that can go beyond our ability to impact the immediate environment.

Caregiving is a practical art. Our role involves us in the details of the daily routines of our residents, but not necessarily in the larger issues of Long Term Care. While we are profoundly affected by things like poor staffing ratios, direct care staff turnover and disconnected management, the conventional wisdom among caregivers is that we simply don’t have the authority to do much about those things and the only option we really have is accept things as they are or find a different place – or field – to work.

Meanwhile, we leave the larger problems to those who we believe have the real power: the administrators, regulators, legislators and assorted LTC professionals. However, no one has greater awareness than direct care workers of how chronic understaffing and turnover rates actually impact the care and well-being of individual residents on a day to day basis. We know what it looks like and we know what it feels like to our residents in a very real way. We can give these problems texture and a real sense of the human cost. Our experience in the trenches of Long Term Care provides us with a unique perspective, a perspective that is very much needed if Long Term Care is ever to truly come to grips with its problems.

While caregivers lack formal authority, we can still influence those who do have formal authority. Our real world experience gives us something valuable to say. Our capacity to convince others that what we have to say is valid depends on our moral authority. But if we are not doing everything we can as caregivers to improve the immediate environment of our residents, then why should anyone listen to us about the bigger problems? By taking responsibility for our own behavior and conducting ourselves according to what we know by reason is right – in spite of difficult circumstances – we provide the basis for our moral authority.

And with that, we cannot be ignored.

The Value of the CNA Voice




There is a school of thought among some professional advocates for CNAs that says caregivers will never fully appreciate the true value of their own work until they have a better understanding of how the business of long-term care works. That, until they recognize their role in the bigger picture, caregivers will never fully grasp how they influence the larger goals of the industry and are thus left to doubt the significance of their work – and their self-worth.

While I’m not prepared to dispute any of that, I will say that in terms of utilizing resources to deliver the best care possible, the converse is far more significant: the business of long-term care can never fully come to grips with its own problems until those who establish policy and enforce standards develop a deeper awareness of what we are all about.

And it’s up to us to tell them.

Before social media, the “CNA Voice” did not have an adequate platform for independent expression. With few exceptions, CNAs were heard only through the filter of the health care hierarchy. The result was a sanitized voice, good for parroting industry buzzwords and contributing to interdisciplinary window dressing, but giving only a glimpse of how we really experience our work.

With social media, direct care workers have been given the opportunity to express themselves more openly, albeit with the caveat that you never know who is watching. The majority of these forums are administrated by caregivers and they accept a far wider range of public expression than is possible within the formal work environment.

While social media gives us a better sense of the CNA Voice, all too often it presents that voice in a fractured and superficial way. That’s just the nature of social media, which promotes interaction and response. What social media doesn’t encourage is the kind of reflection necessary to properly sort out and express that complex and often contradictory blend of thoughts and emotions that make up the inner experience of the caregiver. That is the true source of our voice – and our self-worth.

We can help long-term care understand itself by offering something precious: a dose of reality. And if there is anything that this system obsessed with image needs, it’s a steady dose of reality. Yes, there is much about the “bigger picture” that most of us don’t know. But we are aware of certain truths about long-term care in a way no one else can be. Because outside of the residents themselves, no one knows better than we do how they experience their time in long-term care. In fact, we can’t talk about our experience in a meaningful way without talking about theirs. And that is the real value of our voice.

An Obligation to Testify




A quick review of CNA related Facebook pages will show that no group of people get more upset over media reports of court cases involving caregiver abuse of nursing home residents than other caregivers. After expressing their shock and disgust, caregivers will often add that they have no problem reporting other staff members who mistreat residents.  There is nothing in these comments to suggest that both the strong emotion and the claim are anything but genuine.

Not all forms of abuse are equally severe.  When determining charges and sentencing, the legal system itself takes into consideration such things as the intent of the accused, the severity of a crime and – important for our purposes here – how the victim experienced it. Obviously, some acts are particularly heinous and deserve harsher sentences.

Caregivers are obligated both morally and legally not only to report incidents of abuse that they’ve witness, but to intervene on behalf of the victim.  Silence and inaction are forms of collusion and zero tolerance is the standard policy. Zero tolerance means that the relative severity of mistreatment cannot be used to relieve long-term care staff of the responsibility to intervene and report.

How a resident experiences our interactions with them is a primary consideration. As caregivers we may not intend to mistreat, but if we fail to give reasonable and adequate attention to how a resident perceives any given interaction, we could be guilty of a form neglect or abuse.  Perhaps not a severe or overt form, but under zero tolerance it is a violation and we are required to intervene and report.

The quality of life for residents in a long-term care setting depends on much more than how they experience their interactions with their direct caregivers. While the factors that determine their quality of life are diverse and complex, there is at least one universal standard that should be applied in all situations: how does the resident experience it?

No one is more aware of how residents experience life in a nursing home than their caregivers. Direct care workers accompany residents through that experience on a daily basis.  They see and feel the impact of when the system is working  – and when it fails. They are familiar with the flaws of long-term care in a way no one else can be: in intimate detail and within the context of the lives of the people in their care.  No quality assessment tool or inspection protocol can adequately replace that unique perspective.

This is a perspective that informs the worker of how things such as inadequate staffing levels, an unstable work force and insufficient or inappropriate regulation negatively affect residents. Because of the way residents experience that impact, it is nothing less than a systemic form of abuse and neglect.

While systemic forms of mistreatment are not intentional or overt, under zero tolerance do we not as witnesses have a moral obligation to report them like any other form of abuse?

If so, the question then becomes how do we respond to this obligation? How and to whom do we report?