I’m sure in the light of day, this facility is charming. I can’t quite remember the impression I had of the building in which I work during my two day orientation, which took place in the bright sunshiney hours. The relief and excitement I felt about the new job opportunity dimmed my keen powers of observation; the same Sherlock Holmes level of visual acuity that prevents me from getting into the wrong car and trying to start it more than twice a week. So I can’t say for certain that in daylight it’s a charming, lovely place. I can only assume. At night, however, there is no more fitting a descriptor than “creeptastic”.
Let’s start with the huge portrait of an incredibly stern looking man above the fireplace. His eyes seem to follow you everywhere and then there are the clown pictures and blood red carpets and creaks in the floor and the overabundance of wind chimes…all of which may add whimsy and class to the joint in the day, but at night? No. It feels like the environment of a stereotypical horror movie that would be panned for being too predictable.
I say this with great affection. It’s exactly the sort of strange and surreal experience that I’ve come to appreciate in my life. It’s anything but ordinary but after this weeks stretch on memory care, I realized that buildings are not the only things haunted at night and there is only so much I can do to chase away another person’s inner demons.
It makes sense, really. When does my mind spin the most, picking apart the day and chasing my own imaginary fears? When is my own anxiety at its peak if I had a rough day? Right before bed. And if I can’t sleep? Forget about it. My mind runs wild. Why would I expect any different from those in my care?
At night in the quiet, dimly lit halls of the memory care unit, my night owls pace. Sometimes they are just confused about the time. That is easy to redirect usually. I explain to them my days get topsy turvey too, we share a chuckle, I tuck them in and off to sleep they go. I can do that all night without losing patience. No, it’s the other situations that get to me.
I call them the “night dreads”. When one of my folks has a rough night, it’s very different than what I experienced when I worked the day shifts. Sure, there was any number of challenging behaviors and there was less time to redirect in the day but it was different. Maybe because there were more people around and the extra stimulation kept them more alert. They seemed less…haunted. Nightmares can be hard to shake off. A vivid enough one can muddy my perspective for awhile but when I’m awake, I’m awake. This is not how it is for my residents. A nightmare will shake them to their core. They don’t always understand the difference between their dreams and waking life. Often they will wander up and down the halls, looking for lost loved ones. Where is my mother? Where is my love?…letting them know they aren’t alone and are safe seems to help. I put them back to bed and sit with them for awhile. Sometimes I sing quietly. I make certain that the bathroom light is on.
More often than not, I will be repeating that throughout the night but each episode seems to be just a little easier. Each time the resident seems a little less scared. Usually, right as the sun is coming up, they are able to rest more deeply. Those nights are the hardest; the ones when I can’t chase away the ghosts for them, I can only put them at bay. They leave me exhausted, sad and a little scared at the idea of anyone having to live through the night dreads and little frustrated that the best I can do is walk with them through it.
Thankfully, tonight was free of that. Tonight there was mostly laughter. I have a resident who without fail leaves his room wearing the oddest combinations of clothing: long johns with a back brace and a red ladies hat with a purple flower (no telling where he picked that one up) was today’s fashion choice.
“Is is time for coffee?” I managed to keep a straight face for five seconds when I saw his get up.
“No, buddy. It’s 3:00 in the morning.”
“Ok. I’m going back to bed then. Don’t forget me in the morning!”, he called over his shoulder.
“Never, my friend.”, I assured him. You know what? Today, I’m going to make a conscious effort to see how this place looks in the sun. Most things are clearer in the light of day.
“Well, I can’t FORCE him to get up to eat. IT’S HIS RIGHT!”, the second shifter indignantly whined. I took a deep breath and bit back the snarky response that was desperate to escape my mouth.
“It’s his right” is the most often repeated phrase in this biz and for the most part, it is used inappropriately.
I never hear “IT’S HIS RIGHT!” when a particularly persnickety resident wants a ride to the office to discuss his finances for the fifth time during a shift. No caregiver self-righteously exclaims it when a resident requests a unscheduled shower. No. It’s seems that their “rights” only becomes a concern when it means having to work outside of the routine in order to effectively get the job done.
The problem, as I see it, is that for too many caregivers the only two options they are willing to consider are force or neglect. As if the concepts of persuasion, redirection, different approaches, assistance from their partner on the floor or simply revisiting the situation later in the shift never crossed their minds.
When I look in the paper work and see that a resident hasn’t been bathed in two months because he refused, what I am really seeing is a caregiver who is either unwilling to do his/her job or in need of more training. That is neglect. Period.
When a resident who can be challenging but will work with you if you gain his trust and take the time to explain to him what you are doing, suddenly drop in weight and his paperwork states he is refusing to eat dinner for weeks on end, what I am really seeing is a caregiver too tired to be bothered with taking the time to persuade him, comfort him or advocate for him in order to get a doctor to check him out.
I know we don’t have an easy job. Not everyone is suited for the floor. It is not a world of black and white. It’s takes a certain talent to be able to create and implement a consistent routine without being so married to it that it won’t bend when needed. It takes creative thinking to do this job well! It takes patience and empathy. We have to persevere.
We work with sick people whose first instinct is often to give up. It is OUR job to use every tool in our arsenal to prevent them from doing so.
If you know your residents well, you can usually talk them down from a refusal. You get to the root of the problem. Sometimes, all they need is to be heard. Sometimes, they just want to feel they have control over SOMETHING in their lives. Sometimes, they only need five extra minutes of our time. Five minutes. On a hectic day, it’s a small inconvenience for us, but can make all the difference for them. It’s not too much to ask of us. After all, don’t our residents have the RIGHT to a decent quality of life?