I felt all my energy drain quickly as I punched out at the end of my shift. I was thoroughly enjoying my transfer back into facilities and I relished the challenge of working third shift as I do all new experiences in this field. Even so, there is a marked difference between my ability to push through my new hours on the clock and my hours off.
I’m on work mode when I clock in for the night. Everything falls away except my enthusiasm for this new opportunity and my desire to do the best job I possibly can. I’m not bothered by sleepiness and I have never been bored on the floor. Even at three in the morning, there is always something to do. I spend the periods of downtime getting to know the layout of the gigantic facility, acquainting myself to the residents who are night owls and occasionally getting some writing in. Clocking out is an entirely different story. Exhaustion that I didn’t feel on the clock falls upon me as I walk out after my shift, squinting my eyes against the harsh sunlight that slices sharply through the mental fog in which I am suddenly enveloped.
Why won’t my car start?! Oh. Because I’m trying to put the key fob into an ignition switch that doesn’t exist. What day is it?! Come on Alice, you can do this. Two days ago, you were volunteering at the behavioral health center. You do that Saturday’s. That makes today Monday. Monday…what am I supposed to do Monday’s? Should I sleep now or push through until this afternoon and sleep then? Or maybe I’ll sleep a few hours now and a few hours later?…I have never thought so much about sleep in my life. It’s not rocket science. I should be able to figure this out!
And difficulty with sleep and keeping track of the days was just the start. My emotions off the clock have been haywire. Like the worst case of PMS ever. One minute I’m fine and the next I am completely convinced that I am ill suited to handle even the most basic life events. When should I eat? Brush my teeth? Shower?…it’s topsy turvy world! And then there’s the anxiety and disorientation that comes from waking up at four in the afternoon to start your day. While I wouldn’t go so far as to call it a panic attack, those first few moments of wakefulness haven’t been so pleasant.
After I finished my first week, it
occurred to me that those living with dementia or Alzheimer’s exist in a much more severe and progressive version of this state of vagueness. That awareness stopped me in my tracks and I was filled once again with admiration at the strength and courage it takes for them to walk through each day. I know it even if they don’t. So I decided to employ what I like to call the three “C”‘s on myself much the same way I do when I work on the memory care unit. Consistency- decide on a sleep schedule and stick with it. Schedule outside events and social interactions around it. I’m still working on that one but I feel good just having that plan in place. Calm- recognize that my change in sleep patterns is going to have an emotional and physiological impact on me. Realize that feelings are not facts and this will improve with time. Compassion- go easy on myself. Practice self care and if occasionally I have to have an off the clock melt down, allow it to happen rather than repress it.
It is getting better. I am actually adjusting faster than I expected. My head feels less muddy day by day and there is something special about working when the world is asleep. Third shift has challenges that I didn’t expect and it isn’t the cakewalk I believed it to be when I was working first shift for all those years. But I really like it. In time, I think I will love it. And I am already learning from it.
One of the things I like about working in Long Term Care (LTC) is the relationships we develop with residents over time. We get to know our residents almost as well as we know our own families, sometimes even better than we know our own families. This is also one of the things I don’t like about working in LTC. After Death takes a resident and an empty space is all that is left. The resident’s bed is empty, where they used to sit in the dining room is empty; there is a sense of emptiness throughout the building and that emptiness can be deafening.
The worst part of a death is the silence that accompanies the emptiness. Their names aren’t mentioned in the daily reports and are removed from the care lists. Their special dietary slips aren’t printed anymore. The name on the door is gone. Their old pictures and cards are missing from the walls of their room. Their chart is put into storage. The existence of that person is wiped away from the white board of LTC life.
There is a poem called “Funeral Blues” written by W.H. Auden. The first line of the first stanza comes to mind when that special person leaves with Death: “Stop all the clocks, cut off the telephone.” I desperately want the clocks to stop and the phone to stop ringing. I want time to stand still for 10 minutes, 30 minutes, an hour. I want to stop moving, to stop marching forward with time and grieve over the awful silent void left by my special resident’s departure. But clocks don’t stop. Phones keep ringing because the living can’t wait and time marches on.
W. H. Auden
Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.
Let aeroplanes circle moaning overhead
Scribbling on the sky the message He Is Dead.
Put crepe bows round the white necks of public doves,
Let the traffic policemen wear black cotton gloves.
He was my North, my South, my East and West.
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last forever; I was wrong.
The stars are not wanted now: put out every one;
Pack up the moon and dismantle the sun;
Pour away the ocean and sweep up the wood;
For nothing now can ever come to any good.
Everyone knows each other here.
It’s been so long since I’ve been the new kid that I’d forgotten how uncomfortable it can be, instantly thrusting me back into that awkward, lonely state of mind that I had whenever I had to start a new school.
Just focus on the work, Alice. Take in the new experience and be yourself. Such thoughts have become muscle memory when facing major changes and lately my life has seemed nothing BUT major changes. Still, I found myself aching for the close friendships I had at my old facility. Years of shared experience had forged bonds between my co-workers and I that time could never erase from my heart. I hoped they knew this. Now at this beautiful new facility full of strangers in the hours when the world sleeps, I half wish I was back there with them in the light of day.
To be fair, most of my new co-workers have been nice and friendly, if somewhat skeptical at first of my ability. I get that. They don’t know my work ethic. They don’t know that the odds of me quitting suddenly are about as good as getting struck by lightening inside on a sunny day. My enthusiasm is oddly off putting to those who work this shift and the fact that after a week, I still have to wander around until I stumble upon the time clock probably doesn’t look promising. Mainly, though, it’s just that I’m new. I’m new to them and they’re new to me. Third shift is new to me. The facility is new to me. It’s all…new.
Life is change and I tend to grow on people. Eventually this will feel like home. I adapt quickly. Still, to all my past co-workers, to my friends who happen to read this, thank you. Thank you for always making me feel at home. Thank you
for teaching me. Thank you pushing me to continually move forward. Thank you for your support and friendship. Having worked with you has made it easier to be the new kid here.
I took a deep breath as I entered the human resource building for orientation. That was new. I’ve never worked at a facility with a human resource department. It was a small building nestled in the back of the sprawling campus.
“Facility” seemed to be a misnomer. The property of my new employer stretched easily for a mile. There were several houses, each with a separate living environment complete with their own restaurant style dining area, an onsite rehabilitation center, a gym and indoor pool with access for both clients and employees when off the clock, and the assisted living building in which I would be working, complete with a memory care unit. It looked like a town more than a long term care facility. There was even a map included in our new hire packet.
Focus, Alice. Just breath. I listened as the HR representative discussed the medical benefits and company policies. I tried to ignore the tiny voice inside that whispered all the “firsts” that I was about to face. This place had technology that I have never used before. This place was bigger than my entire apartment complex. I have never worked third shift. For two years now, it’s just been me and the families in my care.
I tried to quell the fear and embrace the excitement of another new opportunity. I reminded myself that I’m a quick study and a dedicated worker, that it’s always uncomfortable to be somewhere new and that in my experience all growth, professional and personal, has started by walking through those emotions.
This new job opportunity is in a facility that is beautiful and clean and peaceful. There is art on the walls of the hall and windows so the sunlight just pours in from all angles. There are pet birds in the main lobby and it could not look less like a “nursing home”. It’s the sort of environment I would like to see made available to all our elders and those living with disabilities, regardless of income. I’ve never been a part of a company that seems so invested in the happiness and well being of their employees. The turnover is much lower than average and the results show. For the first time since I’ve started my journey in caregiving, I don’t feel the need to fix, elevate, educate, or problem solve on a large scale. Maybe this time, in this place, my role is simply to learn. What they have accomplished appears to be working for workers and residents in a way I have not yet experienced. So, tonight, I will walk into my first ever night shift at 11:00 PM with an open mind, grateful heart and use what nerves I experience to fuel my desire to do well.
The other day I was in a resident’s room getting ready to administer a nebulizer treatment. Her TV was turned to the Game Show Channel with “Family Feud” going on. My fellow care givers can attest “Family Feud” is a staple in the LTC environment with Turner Classic Movies a close second. You can’t walk down a hall without hearing at least 3 different versions of “Family Feud” blaring out of multiple residents’ rooms.
It was the beginning of the show where the host, Steve Harvey, has each of the family members introduce themselves before they provide an answer to the question he is asking. I wasn’t paying much attention to the show as I am busy getting the treatment ready and assessing my resident’s shortness of breath. I am vaguely aware of Steve Harvey talking to the first three family members. I didn’t hear their names, what they did or the answers to the question. The fourth family member made me stop and look at the TV screen. I half heard Steve Harvey ask her, “What do you do for a living?” It is difficult to explain the fullness of what happened next.
She said, “I am a CNA at a long term care facility.” It wasn’t the words she spoke as much as her tone of voice that made me whip my head around to look at her. I see and hear so many CNAs when asked what their occupation is a sort of apology tends to follow. “I’m a CNA but I plan on (insert a perceived better career choice here)…” or “I work as a CNA while I figure out what I want to do.” The body language that accompanies those statements relays uncertainty, self-consciousness, and/or humility.
This woman on that game show was different. Those brief seconds she was on the TV screen showed a confident woman who was proud of her career choice, proud to be a CNA. Everything about her body language supported the self-assured tone of voice in which she spoke those words. “I am a CNA at a long term care facility.” End of sentence. The words “courageous”, “bold”, “empowering”, and “confident” all ran through my brain in those few precious seconds. She offered no apologies or explanations. She stood tall, looked Mr. Harvey in the eye and declared her right to be proud of herself, of her career and those in her care. I am proud of her, too.
CNAs, be proud of your career choice. Do not ever, not even once, apologize in any way for working as a CNA. Stop feeling like you have to rationalize being a CNA with sentences like “I’m a CNA but…” You don’t have to do that. Part of changing the LTC environment and other health care settings involves how we speak about ourselves and each other. Talk about your job with pride, with confidence. What CNAs do is challenging, emotionally rewarding and taxing, sometimes all in the same day. Not everyone can do the work. It takes a special kind of talent and perseverance to be a CNA for 2 years, 5 years, 15 years. The more each of you declare with confidence and pride in your voice, “I am a CNA” the more empowered you will become. The more empowered you are, the more others will want to hear what you have to say. Be bold; declare with confidence your career choice just like that wonderful woman on a popular game show did. Be confident in yourself. Be proud to be a CNA. I am proud of you, too.
Last week, PHI posted the third installment of their 60 Caregiver Issues Campaign. This issue brief highlighted how the Affordable Care Act brought coverage to many caregivers who previously had no healthcare insurance and discussed how proposed changes now before congress could impact the nation’s direct care workforce. The link to PHI’s report is at the bottom of this post.
It boils down to this: among its many provisions, the ACA included an expansion of Medicaid that benefited the working poor and thus provided healthcare coverage to caregivers who did not previously qualify because they “earned too much.”
Here are the numbers directly from the PHI brief:
- From 2010 to 2014, approximately 500,000 direct care workers nationwide gained health insurance following implementation of the Affordable Care Act.
- The uninsured rate decreased 26 percent during the same time frame, from 28 percent to 21 percent.
- These coverage gains are primarily attributable to a 30 percent increase in the number of workers insured through Medicaid programs.
The repeal of the ACA threatens this coverage and many caregivers may again find themselves without the means for adequate health care. In a field where workers are at high risk for injuries resulting in musculoskeletal disorders and face the risk of serious infection every day, this lack of healthcare coverage is devastating. It not only leads to higher turnover rates that negatively impact the care of our elderly and disabled, it also reinforces the tendency to view caregivers as short-term workers, an expendable resource that can be used up, disposed of, and replaced.
We cannot properly care for the most vulnerable of our citizenry if we overlook the health and well-being of those who care for them. The two cannot be separated. In a time when the demand for caregivers has reached a crisis, reducing direct workers’ access to adequate health care is an unwise – and unhealthy – step backward.
The PHI report can be found here.
I had to have the big hard conversation. It is handsdown the most difficult part of being a caregiver for me. Long hours, short staffing, poor management, bodily fluids…even dealing with death itself is easier than telling someone that I am leaving them in order to embrace a better opportunity. I’ve done it before. You would think that having previous experience with such conversations would make it easier. You would think.
All of my reasons for making the change are valid ones. I gave notice. I’m even doing my best to find someone to fill my position, knowing full well that is not my responsibility. I have all the emotional support in the world from loved ones who know
how hard it is for me to change jobs. I know this is about taking the next step forward and not abandoning a client…but it still hurts. I still feel guilt and I don’t get to minimize the hurt my client is feeling in order to make myself feel better. As always, the woman who was once a client is now a friend and it is never easy to disapoint a friend.
Work boundaries have never been my strong suit. In caregiving, this is a double edge sword. On the one hand,it keeps me flexible and this is a field that demands flexibility. On the other hand, it takes a good kick in the ass and a shitstorm of chaotic emotions for me to move forward. And it’s not just my overblown sense of responsibility or protectiveness; it’s not just the underlying feeling that I am abandoning someone in need. It’s not just about them missing me…I will miss them. I always do. Letting go is also not my strong suit.
Tomorrow, I will go in for my usual twleve hour shift. I will not wallow in my fear or sadness. I will not be morose. I will let them be wherever they need to be emotionally. This may feel like walking on knives but no one can love every aspect of what they do. I will allow this to teach me. Maybe I will set better work boundaries in the future. Maybe I’ll learn how to let go of outcomes outside of my control. The one thing that I refuse to learn is how to not be so close to those in my care. This is hard. This SHOULD be hard. Just because this move is the right one for me does not mean it doesn’t negatively affect others. Just because it’s the right choice does not mean it should be easy. I take care of people for a living. Taking proactive steps forward does not mean minimizing the emotions that are derived from those actions. It means walking through them and using the experience to grow.
In his recent post Yang brought our attention to PHI’s campaign to educate the public about caregiver issues, and gave us a link to their introductory video. In that video PHI posed these questions:
1. How can we ensure caregivers get the training they need?
2. How can we keep care affordable to families?
3. What data is needed to help policyholders take action?
While these are important questions, if you ask caregivers themselves why some are leaving the field and others wouldn’t think of entering it, they’ll no doubt raise a different set of issues. At nearly every conference or webinar I attend I ask about staff-to-resident ratios and caregiver wages. Usually there is no reply, as if I were speaking from some parallel universe and couldn’t be heard. If there is a reply it’s on the lines of “Yes, we know. But it’s complicated. These things take time. You can’t expect things to change overnight.”
Yes, there is a shortage of caregivers. And yes, good care isn’t affordable. In fact good care can’t be bought. By that I mean whatever you might be paying, either for in-home care ($20/ hour? $40?) or for care in a long-term care home of some sort ($6,000-10,000/ month), the more care the person needs as health declines, the wider the gap between the person’s needs and the quality of care the person actually receives.
Everyone is selling solutions like workshops and videos and toolkits and new business models to long-term care administrators or home healthcare systems’ owners. Some groups are advocating on a state or even national level and some gains have been won. But from the outcomes I’d say that a lot of the effort is wheel-spinning. (An increase in the NYC minimum wage for home care workers to $15/hour by 2021??) Today’s aides have rare luck if they earn $15 an hour and have a regular 40-hour work week. An aide may have six to ten residents/patients to care for, and many of those will suffer from dementia and/or be unable to walk alone safely or even support themselves standing. (Yes, I know I’m a broken record…) Do you know what it’s like to try to wash, toilet, transfer these residents several times a shift, and keep them from falling the rest of the time? (If not, go back and read CNA Edge.) This is before we even begin to provide enrichment a la ‘person-centered care.’
I want the whole healthcare industry – including those championing reform — to acknowledge what the biggest issues are for caregivers: our obscenely low wages and our outrageously onerous, even unsafe, working conditions. These organizations don’t yet tackle caregivers’ most urgent needs: a living wage, safe work conditions, and a work environment that supports person entered care. We need to ask them, What are you doing about these issues and what can we CNAs do to support you in this?
When Malcolm X called for a change in Americans’ attitudes on race and was told that such changes (culture change, if you will) take generations, he reminded us of this: At the beginning of World War II Germany became our enemy and Russia became our ally. But when the war ended we, America, saw Germany as our ally and Russia as our enemy. That attitude-change didn’t take even one generation. The healthcare industry needs an attitude adjustment. It is not okay for long-term care operators or owners of home healthcare agencies to charge exorbitant fees to clients and return a too-small fraction of these fees as wages to their direct-care workers, while management and professional staff and consultants are handsomely compensated. It is not okay to hire employees unless you train them in the skills they need to work with the elderly frail, starting with English language skills. It’s not okay for the industry to tolerate poor work ethics: last-minute callouts; texting while on duty; and most of all, failure to interact with residents in a way that says to them “I love being with you. Thank you for letting me be part of your life.”
There are thousands of followers of CNA Edge. As Yang exhorted us, we need to support PHI in their effort to educate the public about caregiver issues. Let’s ensure that when they frames their 60 Issues, they don’t airbrush our issues out of the picture they’re drawing.
The alarm clock cut through my dreams, it’s deceptively cheery jingle jarring my consciousness awake. I groaned, fighting the urge to hit the snooze button just once more. I had to go in early. No more time to snooze.
As I ran about the apartment in my pre-work routine of craziness, grabbing coffee, hunting my keys and making sure that I was wearing the same shoes on my feet, I mentally reviewed the day ahead. It was going to be an uphill battle.
Uphill battles are nothing new to me in this field. Both my experience in facilities and in private care have come with their fair share of obstacles. Not being one to shy away from adversity, more often than not I relish the challenges. It’s when I begin to view life as NOTHING but uphill battles that the trouble begins.
As a caregiver, I deal with a lot of loss. We all do. Death is inevitably part of our job. I’ve learned to view it not as a tragic necessity but as an inevitable conclusion. There is joy and peace in knowing that I have a part in making the last chapter of someone’s life as pleasant as possible, making certain that those in my care never feel alone. It is why I do what I do and that part of the gig I consider sacred.
As a woman in recovery who volunteers at a behavioral health center, I deal with a lot of loss as well. That kind of loss is different somehow. That kind of loss comes with a sort of survivors guilt that makes me choke on my own powerlessness. Why do I get this when others don’t? What could I have said or done differently that may have prevented another’s death or insanity or consequences? The answer is nothing. I can’t force a moment of clarity on another person. I can only share my experience.
I tell you guys this because I know we all have our baggage and we work in a field that can skew our perspective. Because I have to be vigilant, I recognize that change as it’s happening. When I start obsessing over the two people I was unable to help rather than the ten that I was, I know I need to check myself.
I cashed in all my “give up” chips years ago. Now as long as there is a breath in me, I will…I MUST keep moving forward. There is so much I want to do in life; so many people I want to reach and help. My fellow caregivers, my residents, anyone and everyone who feels lost and alone…we all have those shared experiences. I was given a second chance. I do not have the luxury of wasting it.
As a caregiver, I have the privilege of seeing the face of courage every shift. People who have survived cataclysmic and life changing events. People living with dementia, addiction, AIDS, strokes, PTSD, cerebral palsy; people of all ages and I SEE them…the very essence of who they are as individuals shine through their disorders. Their personalities, sometimes difficult personalities, may have been informed by their challenges but they are not defined by them. They laugh and cry and occasionally rage but they face their uphill battles every single day. They have no choice. Neither do I.
My keys were in hand, the same shoes were on my feet, my lid was tightly on my coffee cup and I was ready to face the day. I took a deep breath as I opened the door into the bright sunshine and reminded myself that it was uphill battles that made me who I am today. For that I am incredibly grateful.
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.