Category Archives: The state of long-term care

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.

60 Caregiver Issues: PHI and the Caregiver Shortage

 

Yang

Last week, the Paraprofessional Healthcare Institute (PHI), the leading expert on the nation’s direct care force, launched a two-year online public education effort called “60 Caregiver Issues.” Over the next two years, the campaign will identify 60 policy and practice ideas that can begin to address a problem that we, as CNAs, are all too familiar with: the growing shortage in direct care workers.

The first installment, “8 Signs the Shortage in Paid Caregivers is Getting Worse” can be found here.

The purpose of the campaign is to focus public attention on the problem and offer some real solutions. CNAs have a vital role to play in this effort. No one has greater awareness than we do 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. By sharing our real-life work experiences we can offer a perspective that gives these problems texture and a real sense of the human cost.

As advocates for our residents – and for ourselves – CNAs can become part of the solution by joining and supporting PHI in this effort. In the coming months, CNA Edge will share posts from the PHI campaign and, of course, we will offer our own take on the issues surrounding the nation’s caregiver shortage.

To kick off the campaign, PHI offers this 60 second video which highlights the problem:  Caregiving Crisis: 5 Million Workers Needed

 

The Caregiver Shortage and Immigration

In reaction to the Trump administration’s recent immigration ban, Lori Porter, founder and CEO of the National Association of Health Care Assistants, pointed out a connection between the immigration issue and LTC staffing levels. In a recent Facebook post, she stated:

“A large percentage of CNAs are from the banned countries. Long Term Care is always testifying before congress for immigration to solve their staffing issue… I know nursing homes in this country who are largely staffed by those affected. Did anyone stop to think about who would care for the residents? Especially in a country who will not come out in sufficient numbers to take care of their own OLD citizens! … I have heard from nursing homes all day who will not have enough CNAs to staff their building because so many CNAs have left out of fear.”

In support of Lori Porter’s assessment, we do know two facts:  that over 50 percent of CNAs leave their jobs every year (PHI Factsheet) and over 20 percent of caregivers in the U.S. were not born in this country (Market Watch).

My concerned is about the vulnerability of caregivers coming into this country on work visas, especially if their legal status is tied to their employment. Since advocating for our elders is such a big part of what we do as caregivers, we need workers who feel secure enough to speak out within the facility and, when appropriate, in the public forum. Sometimes, we are the last line of defense for our residents and if we do not speak, no one will. Too often, incidents and issues that should be dealt with in the open are swept under the rug, mainly out of fear of some form of retaliation.

If Long Term Care is to rely on immigration to solve the caregiver shortage in this country, what kind of protections can we provide these workers so that they feel secure enough to speak out and advocate for our elders when necessary?

 

A Wide Movement

May

As I talk about CNA Edge more, there’s a question that keeps coming up: for whom am I writing? What is my target audience?

Whenever I’m asked, my initial reaction is always: “My audience is whoever reads it”.
But that’s a vague answer at best, and no answer at worst. There are some who tell me I should focus more on reaching policy-makers and people in positions of power. And I can follow their line of thinking and I agree with their points: there is a divide between direct care workers and those at the top. That divide hurts our residents, often badly. So yes, I would love to reach more policy-makers.
But not at the expense of also my reaching my fellow CNAs. To put it another way, I do not want to be the sole spokesperson for CNAs to policy-makers and administrators. 

Policies can change. Rules and regulations can be changed with administrations, and then swept away with the next changing wind of politics. I am not dismissing the importance of good policies and those who work so hard to affect change for long-term care. We need people fighting for good policies, and for responsible leadership. We also need people fighting to change the way CNAs think about themselves, to throw off the label of “nothing but an ass-wiper”. If I can do that, then I am not alone. One or even three CNAs speaking up can be ignored. We could even be silenced. How about one hundred CNAs? Or three hundred? How about a thousand, or a million?
That starts by letting CNAs everywhere know that they are not alone. Sometimes I think the worst affect of this broken system is that it makes people who work so closely with others feel utterly alone. We, who have the power to deeply impact the lives of our resident, are often made to feel helpless by all that we cannot change. We feel alone, helpless and burnt out. Silence and sullenness can and do follow.
But together and aloud…what can’t we achieve?
I do not ever want to talk over the heads of my fellow caregivers. I refuse to fall into the trap of thinking that I am somehow more than they are, or that they are something less than me. If I am intelligent, compassionate and eloquent, that does not make me unique among caregivers. Actually, I’d argue that makes me about average. If I stand out, it’s only because I speak out.

What we need now is change, both on a personal level and on a larger cultural one. Compassion, common sense, communication and critical thinking have got to be infused into this broken system. We have to have people dedicated to change on every rung of the ladder…including the one belonging to CNAs.
Just like a democracy cannot function without the active participation of ordinary citizens, neither can our long-term care system function without a principled and vocal base of direct care workers. CNAs who are willing and able to speak up for themselves and their residents.

Nursing-home-made

Sunflower May

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

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

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

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

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

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

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?”

Empathy vs Apathy

Sunflower  May

In compliance with HIPAA, all names and identifying details have been altered or removed to protect patient privacy.

Can I ask you something?” a newbie CNA asks me…in that tone of voice that usually means “Trouble this way”. We’re assisting Mrs. A to eat her lunch, although “assist” doesn’t quite seem like the right word when all she can do on her own is open her mouth. 

“Um,” I say, “sure.”

“That one aide. Why is she like this? How do you get to point where you just don’t care? Why does she act like giving these people your very best is a waste of time?”

“Well,” I sigh. “There’s a lot of stress that goes with being a CNA, and a lot of the time you don’t seem to be making a difference…”

He picks up the spoon, loads it up with mashed potatoes and gently gives it to Mrs. A. “There,” he says, “I just made a hell of a lot of difference for her.”

I almost come out of my seat. “Promise me you’ll stick with this,” I say fervently. “You’re right. Every little bit we do makes the world of difference…but sometimes it’s hard to remember that when you’re frustrated, over-worked and, well, when nobody else sees the good you do. And for that one aide, well, sometimes it’s easier to shut off the part of you that can feel, to spare you from feeling despair. Some aides learn how not to care to survive this broken system ”

“You didn’t,” he says indignantly. “I won’t.”

“Remember that promise,” I say gently, “but also remember this: deciding to be a good aide is not a battle you will ever leave behind you. It’s a choice you will have to keep making every single shift, to do your best even when it seems pointless, to keep being kind even when your efforts seem as terminal as your resident.”

“Is that what makes a bad aide then?” He asks. “Deciding that your best isn’t required? Choosing apathy over empathy?”

∞oOo∞

What is the good of small acts of kindness done for a person who will shortly be dead? Isn’t it a waste of time and talent? Isn’t your struggle to be kind as terminal as the disease killing your resident? One day soon, your resident will lie cold in a bed and there will be nobody left to remember how you put off your break so you could fluff her pillow. Nobody saw you give a good bed bath to Mr. T instead of just running a wet wash cloth over him. So what’s the point of trying? Why put yourself through the agony of giving good care in a system that is not set up for small acts of compassion?

Nobody wants to admit to having these feelings. Who wants to stand up and proclaim to the world that you wonder if somebody’s grandparent was worth the effort?
So instead of acknowledging these doubts, you repress them. You decide that you’re going to be a good caregiver, not like those bad ones who seem to act only on your worst thoughts. So you take your doubts and you shove them down, bury them deep, you say that you’ll never be like those CNAs…but idealism and good intentions will only carry you so far. Eventually, you will reach the place where everything exists in extremes and to feel at all is to be in pain. In that place, it easier to just shut it off, to distance yourself from that which causes you pain.
In this case, what causes you pain is the same thing that causes you doubts.
How do you handle the stress of constantly never being good enough? When you are constantly given more work than you can do and when you see your residents suffering because of it…what can you do?
Becoming a jaded CNA is not a single decision you make; there’s no switch you flip between “good CNA” and “bad CNA”. It is instead a series of small compromises. It’s slowly learning how to shut off the connection between you and the resident, until that resident seems more like work than a person. It’s getting to the place where your worst thoughts are the only ones you can hear. That’s when you become the thing you swore to never be.
This is how you surrender your compassion…because it hurt too much to care. Empathy hurts and apathy is appealing.
So, to all new CNAs, don’t go in blind. Being a CNA is like holding your heart to a cheese-grater. To feel is to feel pain. You will doubt whether you’re actually doing any good, and any difference you make will seem to die with your resident.
When these doubts came, face them. Look them straight in the eye and do not despair.
Doubts do not define you; a feeling that came over you during the struggle does not make you a bad person. But a feeling you buried deep in the bedrock of your soul, left to fester until it poisoned all the feelings that came after it…that one might, in ways you never expected. Sometimes, they chain you in such a way that you will never get free. The only way to break the chains is to acknowledge that they are there.
Remember that empathy hurts, but apathy doesn’t…because apathy means you don’t feel anything. Not pain and not joy. You can’t have one without the other, not in life and especially not in Long-Term Care.

And most of all, do not forget the other person in the room. Never forget the silent observer to the tiny acts of compassion, to all the sacrifices and struggles to carve out room for good care.
Do not forget yourself. 

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.

Bad Boss Part 1: “Work Harder”

Sunflower

May

Note: This, like most of my posts, does not tell the story of recent events. I try to chose stories that are a few months (or years) old, although I am usually inspired by recent events or conversations which remind me of the story in question. 

All I get is a whispered warning in the hall: “Watch out for so-and-so [a person of unspecified authority in the nursing home who shall henceforth be called VIP]. She’s on a bit of a power-trip today.”
“Great,” I sigh back. This bit of information has two possible meanings:

  1. The other aide is having a Bad Day, very possibly got talked to about some deficit of care and now thinks everyone’s out to get her or
  2. VIP is actually on a power-trip and I’m going to have to try to be invisible as in addition to being everywhere at once.

We’re already working short today, and seeing as how the next shift is also short, there’s a good possibility I’m going to either be asked or ordered to work a double shift. Again. I really don’t have the energy for any more drama, I really, really don’t.
“May!”
I swing around, startled and resist the impulse to shout: “Speak of the devil!” However applicable the phrase, I fear the wording would not go down well.
“I need to see you,” VIP says. She’s dressed to the nines today, I notice and mentally calculate the cost of her outfit and accessories to be roughly a month’s worth of my wages. With, you know, the usual amount of overtime thrown in.
“Okay,” I say, bracing myself for anything.
“May, I don’t want to hear anyone saying that we are ‘short-staffed’ today or any iteration of it,” she says. “We are not. We are still within acceptable and legal ratios.” Well, technically, in our state there’s no safe staffing requirements for direct care workers/CNAs…that might very well be legal, but it’s no help on the floor…no requirements that I can find, any way. She might as well say “It’s after breakfast” when asked for the time; it’s perfectly true and very little help in figuring out if you’ve missed your favorite show. “If I hear anyone saying ‘we are short today’, or any iteration thereof, or even a mention of how difficult it is today, I will be writing up that person. Understood?”
“What am I supposed to tell my residents when they ask why I’m taking so long to get to them?”
“You’re just going to have to do your best and not let them even notice,” she says. “We do not need to be adding to their burdens because you have a few extra people today. They shouldn’t even notice a difference, it’s only four people more per group. Understood?”
I nod. Well, I’ve only been forbidden to say a few phrases: how rough can it be?

As it turns out, the only thing worse than working short of staff is being forbidden to mention this factoid.
“May, I put on my call light half an hour ago, where have you been?”
“May, this person is soaked. Why haven’t you changed him?”
“May, why isn’t this person up for the meal? What do you mean, there’s nobody available to help you with the hoyer?”
“May, why can’t you help me right now?”
“Where the hell have you been, you lazy bitch? I’ve been waiting for my shower for an hour!”
It’s chaos. I rush through my shift, begging for understanding from my folks and unable to explain why it is taking me so long to get to them. Words have always been my best weapon and I suddenly feel shackled, having been forbidden to use my words to coax or cajole patience and empathy from my folks. And I really don’t think just coming out and saying “we’re short today” would be a great shock to the increasingly frustrated and soiled residents. They’re not stupid and (for the most part) they can still count. They can see how quickly I’m running between rooms, that I haven’t stopped for a break yet, that nobody has shown up to help me. Oh, trust me, they know and my refusal to admit the truth is making some of them angry.
They aren’t the only ones. I’ve always been emotional and today has strained my control. I’m running myself ragged, haven’t had a chance to stop and breathe and for my efforts I’ve been screamed at, insulted, cussed out all day. I can’t even blame them, sitting in soiled clothes for almost an hour while I try to take care of everyone who has put on their light first. In a rather disturbing turn of events, I’m apparently having the walking-talking kind of melt-down…perhaps because I don’t have time for the actual sit-down variety. That is to say, tears are leaking from my eyes, but I haven’t stopped working and, rather bewilderingly, I’m still speaking in a semi-normal voice. I’m rushing around, doing my work in fast-forward and all the while, my sweat and tears are mixing on my cheeks. This day can’t get much worse.
I really should know better by now.

I round the corner and VIP is waiting for me. “May,” she says without preamble, “what’s going on? Why is it such chaos today?”
“…” I stammer. What can I possibly say in explanation that won’t get me written up? “I can’t keep up when it’s just me on the hall, okay? There’s just too many of them and I can’t do everything at once. Which is when they want it.”
Her eyes flash…but I never actually used the words “We’re short-staffed today.” This feels so unfair. How can I explain myself after she tied up my words and laid threats against my job?
“May, these residents deserve to have a good day without having to deal with all of our troubles. They’ve earned your best, even under challenging circumstances, so calm down, put on your big girl boots, dig a little deeper and work harder.”
Work harder? What the freaking hell does she think I’ve been doing all this time, sitting on the bathroom floor and crying my heart out? I wish! Oh, how I wish. I’m about to say something that will get me written up for sure, when a call light goes off in the room behind me. Seizing upon this gift from the heavens, I blurt out “Excuse me,” and dart in the room before VIP can say anything else. The resident in the bed looks extremely grumpy.
“May, I asked to get up an hour ago.”
“I’m sorry,” I start to say, but she doesn’t let me finish.
“May,” she says in a very different tone, “are you okay? What’s wrong? Are there not enough of you girls to take care of us today?”
“I’m running behind, but I’ll be okay,” I reply, conscious of VIP on the other side of the door. It’d be just my luck today if she had her ear pressed against the door! My resident doesn’t look like she believes me. I can’t say I blame her: faced with the evidence in the mirror over her sink, I don’t believe myself.
“You’re not okay,” she says firmly, but kindly. “You need to take a break.”
“Don’t have time.”
“Did I ask for your opinion? Did I call for a vote? Now sit down and take a minute to pull yourself together. If anyone asks, we’ll say I had to shit really bad.” That sliver of concern, of human compassion breaks the last of my control and I start to sob in earnest, out loud and quite noisily. I sink down to the floor, half-hidden by her bed, bury my face in my arms and proceed to rage and storm at the injustice of it all.
Who the hell does she think…no, that’s not it. VIP isn’t wrong in what she said. She’s actually got a good point about what my folks deserve…but under these “challenging circumstances” I don’t know how to give them what they deserve. Does she think I want my folks to soil themselves? Does she think I like having my residents sit in their own urine for hours? Does she think I’m not trying my damnedest to push through these challenging circumstances?
She isn’t wrong. She’s got a good point…and yet, it’s hard to hear the words “Work harder” from someone who is calm and collected while I’m weeping silently and uncontrollably. It’s hard to accept criticism from someone who is wearing roughly a month’s worth of my wages on her person, when I’m decidedly not looking my best. I looked at her, then I looked at myself and all I saw were the differences that divided. And I hate that. I hate thinking in binary terms, us and them, the powerful and the powerless. I hate looking at her and seeing only the wealth she’s wearing, the power she holds over me. It shouldn’t be like this. We’re both persons. Everything I believe in says we are equals…but I’m so stressed I can’t even hear my own beliefs in my own head. I hate that the only words reverberating in my mind are those that scream: “She’s on a power-trip and I’m the pavement she’s pounding.” It comes down to trust and right now, I don’t trust VIP to have my back.
Okay, calm down. Breathe in, breathe out. I’m not thinking straight and it’s likely I’m misconstruing her motives or projecting my turmoil onto her. I can’t do that. She’s got a good point, the residents shouldn’t have to bear our burdens…it’s just her approach to the problem was a bit half-baked and she didn’t consider how an overwrought CNA might take her words or choice of expensive accessories.
Calm down. Pull yourself together, if not for her than for your residents.
Because if there’s one thing in this whole mess that I have reason to be upset over, it’s that between a staff member with [unspecified] authority and a resident, it shouldn’t have been the resident who made the sacrifice to give me the time I needed to pull myself together.
When my ten minutes of rage and tears are over, I rise and splash cold water on my face. My resident still looks concerned, but she allows me to get her up and together we leave the room. Back into the chaos, but this time, I am master of myself.

<oOo>

I have been blessed: while I have had experiences with bad bosses (as detailed above), I’ve also had good bosses and, more frequently, decent bosses who were neither great nor terrible. It’s not all horror stories. It’s even mostly horror stories.

But what makes a bad boss? What combination of stresses and personal flaws combine to make a nightmare experience for those who work under these people? Sometimes it’s hard to remember, especially in the moment, that a bad boss is still just a person and not evil incarnate…a flawed human being, same as yourself. It just so happens that their flaws have the power to make your life a living hell while you labor under their authority.

CNA Edge at the Pioneer Network Conference

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Next week, July 31st through August 3rd, the CNA Edge contributors will be in New Orleans attending the 2016 Pioneer Network Conference “Revolutionizing the Culture of Aging.” Alice, May, and Yang will be speaking during the Tuesday morning opening plenary session from 8 to 9:30. We will be sharing excerpts from our new book CNA Edge: Reflections from Year One. Following the presentation, there will be a book signing.

The Pioneer Network was formed in 1997 and is at the forefront of the Long Term Care culture change movement. The organization advocates and facilitates deep system change and calls for a move away from the existing institutional model toward a more humane consumer-driven model that embraces flexibility and self-determination.

The contributors of CNA Edge share the vision and values of the Pioneer Network. While we recognize that elder care in America has come a long way in the last three decades, our experience in the trenches of Long Term Care makes it impossible for us not be in favor of a radically new approach. Too many elders fall through the cracks and are left to wither away due to the current system’s many faults. Too many caregivers fall victim to poor work environments as they are marginalized by an industry that pays lip service to the value of their work, but treats direct care workers as an expendable resource. We are convinced that as a society, we can – and will – do so much better than this.

It is an honor for us to participate in this conference and we are excited about the opportunity to share our work and continue our advocacy for real change in Long Term care.

For more information on the Pioneer Network visit http://www.pioneernetwork.net/