Working the graveyard shift on a memory care unit…there really are no adequate words to describe the experience. In many ways, it’s the most challenging experience I’ve ever had in this field. I have twelve residents on my hall and on any given shift there are four to six that won’t sleep. It’s a crapshoot whether it will be an all night dance party full of fun or a nightmarish landscape over which I have little control. Mostly, it’s some combination of the two.
“I think I’m dead.”
“You’re not dead.”
“I might be.”
“ You’re not.”
“Ok. If you say so.”….I have that exchange at least once a week. This particular resident is very matter of fact about the whole idea that she might be a ghost, as if she finally figured out why her life has become so strange and unrecognizable. Death, however final, at least made some sense to her. The disease that has ravaged her mind and slowly robs her of who she once was makes no sense at all. She is still in there, though. Her caustic wit cuts through her mental fog; a beam that lights brief paths to moments of clarity in which who she is underneath the Alzheimer’s disease shines through. She loves music. All kinds of music and she loves to dance. She hates tuna fish. If she doesn’t trust you, she lets you know it. She doesn’t respond well to formality, preferring warmth to surface level pleasantries and when she laughs, it is full throated and from the soul rather than polite titters hidden modestly behind a handkerchief. This is a woman who does not bother with giggles. She laughs like she means it and I love that about her.
Those are the moments that I hold onto when the bad nights come; when my people wander in the darkest hours of the night, confused and afraid. When she is having a difficult night, she doesn’t sleep.
“I’m frightened!”, she tells me. Eight hours straight of I’m frightened. And when I’m on a round and out of her sight that fright turns to panic until I am finished helping another resident and she can lay eyes on me again. The best I can do to help her through those nights is to continuously remind her of who she is; that she hates tuna fish and loves music and loves to dance. That helps some, for a little while…but I have eleven other residents who also need me and when three or four of them are having a difficult night at the same time I feel like I’m drowning in my own powerlessness. I can’t cure dementia. I can’t bring back dead mothers or lost dogs from their childhood. In the light of day, with the activity and structure of the daily routines, redirecting is much easier. At three in the morning, it is much more difficult to escape the ghosts of the mind. That’s true for me, so I can’t imagine how hard it is for them.
When I first started on this hall, those shifts were so emotionally exhausting that by the time I punched out, I was feeling something very close to despair. I do not do despair very well. I haven’t for a very long time. Despair leads to giving up and that is quite simply not an option. Besides, those were only the shifts when it seemed that everyone was having a bad night at once and as painful as they were for me, it was exponentially worse for those in my care who were actually living through it.
So much of this field is trial and error. I decided to go back to my basics; ideas and tools I learned years ago when I worked in memory care on first shift. The hours are different and as are the mental state of those in my care but certain truths transcend from day to night. Consistency is always vital in memory care. If I say I’m going to do something, I follow through. I learned my residents, their patterns and preferences and the best night time bathroom times for each one individually and developed my routine. I keep it consistent but flexible. I work around them. If a lot of my folks are restless, I have a midnight snack party and play calming music. My night owls like Law and Order. It’s funny…the can’t follow the show but they seem to remember enjoying it and that’s enough. All of this has helped a great deal.
Of course there are still really tough shifts when events seem to snowball, but they are less frequent and I am better able to deal with them. One of my favorite aspects of my work is that in order to be most effective, I have to learn continuously. Anyone who says differently isn’t doing it right. I have been blessed with the support of those who love me most, both in and out of the field. It is impossible to give up when surrounded by people who believe in you. I walk in the footsteps of those caregivers who trudged the path before me and passed on what they know. At the end of the day, good or bad shift, daylight or in the still of the night, I love what we do. I love writing about what we do. I love that I see the value in what we do and I love those in our care for whom we do it.
Old People’s Home
– W.H. Aulden
All are limitory, but each has her own
nuance of damage. The elite can dress and decent themselves,
are ambulant with a single stick, adroit
to read a book all through, or play the slow movements of
easy sonatas. (Yet, perhaps their very
carnal freedom is their spirit’s bane: intelligent
of what has happened and why, they are obnoxious
to a glum beyond tears.) Then come those on wheels, the average
majority, who endure T.V. and, led by
lenient therapists, do community-singing, then
the loners, muttering in Limbo, and last
the terminally incompetent, as improvident,
unspeakable, impeccable as the plants
they parody. (Plants may sweat profusely but never
sully themselves.) One tie, though, unites them: all
appeared when the world, though much was awry there, was more
spacious, more comely to look at, it’s Old Ones
with an audience and secular station. Then a child,
in dismay with Mamma, could refuge with Gran
to be revalued and told a story. As of now,
we all know what to expect, but their generation
is the first to fade like this, not at home but assigned
to a numbered frequent ward, stowed out of conscience
as unpopular luggage.
As I ride the subway
to spend half-an-hour with one, I revisage
who she was in the pomp and sumpture of her hey-day,
when week-end visits were a presumptive joy,
not a good work. Am I cold to wish for a speedy
painless dormition, pray, as I know she prays,
that God or Nature will abrupt her earthly function?
The poem that Lynn shared in her post a couple of weeks ago inspired me to start looking at poetry again. This one in particular really spoke to me today. The lines of this poem match up with the faces in my head. I think that’s why I like it so much. It puts into words something that I’ve never been sure how to verbalize- how do I help people who’ve lost so much? Each line brings to mind a resident to match it.
Mrs. E- a stroke took her sight, and old age took her strength. Every time I help her with a shower, she apologizes for taking up so much of my time. Mrs. A doesn’t like my help- her mind is going, but while she still has her body she wants me to know it. Whenever I forget, she’s quick to remind me, “I can do it.”
A resident whose name I can’t remember anymore. “Would you like to go to Happy Hour?” A blank stare at the wall- no. “Would you like to watch some TV then?” An eye roll and a shrug- yes. I turn the TV on, and change it to the channel she asks for. I’d like to stay and cheer her up. But I have two call lights going off, and a shower to give before dinner. The stare has been transferred from the wall to the TV.
Mrs. F. I like to think that she and I have a bond- she might be losing most of her function, but her sense of humor is still intact. After dinner she leaves to round the building in her wheelchair, and I let her go. It’s better than keeping her cooped up on the hall with nothing to do.
The geri-chair group on the Skilled unit. After dinner, we group them around the TV until we can put them to bed. Mrs. W sits and watches the TV, and next to her Mrs. K mutters nonsense, the same phrases repeated over and over.
Sometimes I find myself forgetting that they used to be different. I’ve only known them like this, and in a way, I guess that makes it easier? I don’t have to remember, to look at their faces and see what used to be. But if I pay attention, I can see glimpses that still shine through.
Mr. J used to be a farmer and every once in a while he’ll tell me he can’t go to bed because he needs to check on the cows. Mrs. F isn’t the person she used to be, but she absolutely lights up every Thursday evening when her grandson visits. It’s the longest I’ve ever seen her sit in one place without getting bored.
Mrs. V used to let me practice my Spanish with her, before she stopped walking down to the dining room. Mrs. M likes to chat about crime shows. Mr. B likes to discuss logic and human nature.
They’re still there. Behind the eyes of each of my residents sits a person trying to hold onto what’s left of their life. I find it hard to deal with, and I get to go home at the end of the shift. They don’t. If I’m burnt out, I can’t imagine how they must feel.
My favorite quote comes from the book Unwind by Neal Shusterman. The book itself has nothing to do with long term care, but this one quote has always stuck with me- “Love the ones you can. Pray for the rest.” I’m trying to make this my work philosophy. Each day, I am given a group of people to care for, and for that day, they are mine to love. I can’t do everything. I can’t make legs work or memories come back or pain go away. But I can smile. I can listen. I can look and actually SEE. I might not be able to do everything, I can do SOMETHING. And then I can go home and pray about the rest of it.
For those who might not have seen the ‘goddess’ of dementia care (imho) Teepa Snow in action yet: Teepa has a wonderful skit she performs in her training programs. At these programs the audience members are generally caregivers. Teepa will play the role of the caregiver while an audience member takes the role of the person with dementia. (Every caregiver becomes an expert in this role!)
Caregiver, smiling: “OK, Jeannie, time for bed. Let’s go to your room.”
Person with Dementia: “No.”
Caregiver: “C’mon, time for bed.”
Caregiver, now frowning: “Now Jeannie, it’s time for bed. You know you’re tired.”
PwD: “No, I’m not.”
Caregiver, in a louder voice: “Jeannie, it’s time for bed. Come with me. You need to go to bed.”
PwD: “No! I’m not going.”
Caregiver, louder still: “Yes, you are! It’s bedtime and I have to get you ready for bed!!”
PwD, now pushing and screaming: “There’s a stranger after me! He wants to rip my clothes off! Stop it! Somebody HELP me!! I want my Mother, where’s my Mother!! I want to go home!!”
Caregiver, louder than ever and totally exasperated: “You come with me right this minute! You are COMING WITH ME NOW!!
As Teepa asks at the end of her role-play: Which person seems to be the one with the cognitive problem? The one who seems to know what she wants (not to be put to bed yet), or the one who is hell-bent on getting the dementia-impaired resident to change her mind. The resident probably can’t change her mind at this point, especially not in response to a caregiver who repeatedly sends, in an ever louder and more frustrated voice, the same message: DESPITE YOUR WISHES, I’M GOING TO PUT YOU TO BED NOW. If anything, the caregiver’s rising frustration triggers the resident’s fight-or-flight instincts.
For CNAs, this is the question of the hour: What do I do when a resident won’t cooperate? Do I become more and more insistent, and in the process arouse further defiance in the resident? Maybe I worry “I need to rush. If I don’t get everyone ready for bed by the end of the shift, the unit manager will be furious with me.” (PS: Remind her of that person-centered care she’s trying to sell to families—and which the brand new CMS regulations confirm.) Do I gripe to my co-workers? Or do I try something new. We CNAs develop great ‘tricks of the trade.’ My secret weapon is music. Others try chocolate. Sometimes a short walk will help. Or we might initiate discussion of a favorite family photo. Trial-and-error is the name of the game. Creative redirection. The point, as Teepa Snow and Naomi Feil teach us, is to connect with the person. To empathize with the underlying emotion being expressed and validate that emotion. To engage the person in an experience they might enjoy before moving back to the ADL.
All this takes time. But taking time to engage a resident isn’t a frill. It’s an essential part — the best part, of being a CNA.
As I begin the HS care routine, my thoughts wander to home, to Jenny and the girls. I always get a little tug of homesickness around this time in the shift. The girls are picking out their bedtime stories right now, each gets to choose one book and they pick one together. They’ll gather around the bed of our youngest – along with our little Australian Shepard, Kip – and Jenny will read to them. Then, she’ll tuck them in, kiss them good night, and they’ll drift away with Wynken, Blynken and Nod. Not being there is the hardest part of being here.
Tonight, it’s worse than usual because I’ve been pulled to a unit that I’m not familiar with and I’m the outsider. I don’t know the staff well and I know nothing about the residents in my group, save for the information on my “cheat sheet” and what the other caregivers have time to tell me. For the rest I have to depend on what I can glean from the residents themselves.
Ziggy can’t help me much in that regard. He has a pleasant demeanor and he follows simple cues, but he doesn’t respond to all of my questions and when he does respond it’s with a nod or one word answer. And he seems reluctant to maintain eye contact.
In the dietary column, the cheat sheet states that Ziggy is a “feeder,” an uncomfortably crude way of saying that he can’t eat without total assistance. But the information is accurate, as I discovered at supper time. He loves to eat – that isn’t on the cheat sheet – I couldn’t get his dinner on the spoon fast enough for him. He polished off his tray in ten minutes and accepted a second dessert when one of the regular caregivers offered. For caregivers, there is something satisfying about a resident who likes to eat. And I could tell from the regular caregivers’ interaction with him that he is just about everybody’s favorite. That isn’t on the cheat sheet either.
There is a lot about Ziggy that isn’t on the cheat sheet. You can’t tell a story in box.
He nods as I explain that I’m going to help him on to his bed, but he says nothing. Under the “transfer” column of the cheat sheet, he is listed as 1HH, meaning one human help. He is as tall as I am and not thin, but if the sheet is up to date, he should be able to bear weight and I should be able to get him into his bed without having to ask the other caregivers for help.
I position his Geri chair parallel to his bed, about midway between the head and foot. This leaves room for me to help him stand and pivot 90 degrees, then ease him into a sitting position on the edge of the bed. The next step is to use the edge of the bed as a fulcrum and help him swing his legs into the bed, effectively creating another 90 degree pivot. If all goes to plan, his head will end up straight on the pillow.
I pause after getting him on the bed. I always like to take a moment when a resident is sitting on the edge of bed, whether it’s in the process of getting out or going in. Just to let him get his bearings after the change of position. Sometimes I’ll sit on the bed with him – for just a moment or two – steadying him if necessary.
As I’m sitting next to Ziggy, my attention is drawn to two photos tacked to his personal poster board hanging on the wall over his night stand. Other than the Activity Department’s weekly newsletter, the photos are the only items on the board. In most of the residents’ rooms these poster boards are covered with various personal items such as photos, greeting cards, notes, and assorted decorations. For our residents, these items sometimes serve as tangible, but slender connections to the lives they had before they came here. For us, they provide tiny shreds of evidence of who they are as people.
One of the pictures is an 8×10 of a gorgeous pure bred German Shepard standing in someone’s front yard. A smaller photo shows a much younger Ziggy kneeling next to the Shepard with his him arm draped across the dog’s back. Both photos are faded, dog-eared, and peppered with a dozen thumb-tack holes along the top edges.
From my spot on the bed, the larger photo is within arm’s reach. I lean over, remove it from the board, and hold it up in front of Ziggy.
“He’s beautiful, Ziggy.”
Ziggy reaches for the photo and I hand it to him. He studies it and nods. “Chummy is a good dog.”
Okay, present tense then. I’ll follow his lead and we’ll stay there. “Yes, he looks like a great dog.”
He nods again. “Chummy is a good, good dog.”
“Are you best buddies?”
“Yeah. He’s my dog.”
He still hasn’t taken his eyes off the photo.
“Do you play with him?”
“Yes… he plays.”
“There’s nothing like a good dog. I have one too.”
He looks at me, eyebrows slightly raised.
“Here, I’ll show you a picture of her.” I lean back and retrieve my wallet from my front pants pocket. I slip a small photo of Kip from its protective plastic sleeve. The picture shows Kip with all four legs off the ground, snatching a tennis ball in mid-air.
Ziggy is impressed. “He’s a good dog!”
“Yes, she is,” I agree, but I stand firm on the gender. “She loves to play fetch. We play until I get too tired to throw the ball. I always get tired way before she does.”
Ziggy chuckles, he’s familiar with that story. I hand the photo to Ziggy. He’s still holding the picture of Chummy in his other hand and looks from one photo to the other, apparently comparing the two dogs.
“Ziggy, do you suppose Chummy is more expensive to feed than Kip?”
He grins, “Oh yes, Chummy eats a lot.”
“Kip loves to hunt. One time she ran away and came home with the leg of a deer. And rabbits don’t dare to come in our yard anymore. Does Chummy hunt too?”
“Oh, no, no. Chummy doesn’t hunt.” He hands me Kip’s picture and returns his gaze to his Shepard. “Chummy is a good dog.”
“Do want to hear a secret about Kip, Ziggy?”
He looks back at me. “Yes… what is it?”
“My wife let’s her sleep in our bed.”
Ziggy shakes his head. “Chummy sleeps in his own bed.”
“I know, we’re not supposed to let her on our bed. But we do anyway.” I put my hand on his shoulder and say, “At least there is one thing that we both know…”
He looks at me again, “What?”
“… There’s nothing like a good dog.”
He smiles and nods. “Yes, Chummy is a good, good dog.”
I proceed with his HS care and wonder if Ziggy will dream about Chummy tonight. I hope so.
I also wonder what other connections we could make if I had more time and knew more about who Ziggy is.
I became a CNA at an age at which most people are retired. By this time most CNAs have backs, knees, shoulders that are broken down or on their way to that. On my first day on the job, the CNA I was shadowing asked, “HOW old are you? You’re never going to be able to do this job.” Biologically speaking, I could have been a grandmother to some aides. But I was in better shape than many, in terms of weight and flexibility. Some aides arrived at work groaning, “My back is killing me!” “My knees are soooo bad today.”
In reality I could do everything a CNA needed to do. But there was one thing I couldn’t / wouldn’t do: move a two-person assist alone. At first the experienced aides helped me. But soon they expected me to care for these residents without help, as they did. There seems to be a machismo culture among aides: “I can do this on my own.” I was saved by the fact that our unit supervisor had posted a list of all residents who needed the assistance of two aides to be moved. When I needed help I asked for it and was given it. But other aides wouldn’t ask me or each other for help, except in the toughest cases.
Who is a two-person assist? A person doesn’t have to weigh much to be a dangerous dead weight when she needs to be moved. Even frail, thin persons become dead weight when they don’t have the bodily strength to stand or the cognitive capacity to follow instructions. The CDC, OSHA and other organizations have developed algorithmic guidelines which state in effect that unless a person is both fully weight-bearing and able to cooperate in the action (that is, able to understand what is needed and able and willing to do what is needed), then the resident needs two persons, sometimes more, and sometimes also requires mechanical equipment, to be lifted, repositioned, transferred. Fellow aides: How often is this the rule of thumb where you work? Given staffing levels, how many of you have time to stop to help others with residents who should, under the guidelines, have the assistance of at least two persons when they are moved? How many of your co-workers have time to help you?
Unfortunately, as far as I’ve been able to learn, failure to provide adequate staffing to ensure two-person assists for all non-weight-bearing residents isn’t an OSHA violation that has any penalty attached to it. This is a guideline and not a mandate. Thus LTC homes might not be as worried about compliance with these guidelines as they are about Medicare rules. But some states might have tighter rules. And guidelines do have some weight in policy-making in LTC homes.
Despite my facility’s two-person assist list and despite all the guidelines, many aides chugged right along, lifting residents without help. Both the resident and the aide are at risk of injury (or at least distress), but aides insist on flying solo. Sometimes we’re our own worst enemies. CNAs: Let’s call a truce with our aching bodies! It’s worth a try to work with our unit supervisors to develop a two-person-assist list, using it to transfer residents more safely and comfortably.
If life has taught me anything, it is that there is far more beneath the surface than meets the eye. Most of us wear our damages and wounds on the inside where they are safely tucked away from the view of others. This allows the illusion of normality for some as they walk through their 9-5 lives, thinking and engaging on a surface level with all whom they come in contact.
Some people cling to that normalcy as if it were a lifeboat that will save them from the crashing waves of genuine uncertainty that threaten us all from time to time. But is it real? I mean, what IS normal, other than a setting on a drier?
These very normal people are the ones who walk past my client and I in a store and look at her with a mixture of pity and fear, as if they very sight of a woman with obvious physical challenges reminds them that their illusion of normal can smashed in an instant. They are the same people who would pay an obligatory visit to a relative once or twice a year at the facility for which I worked and try unsuccessfully to hide their distaste for the residents that weren’t their family members. As if my people were nothing more than their diagnosis or age.
For a long time, I felt actual rage at the short-sightedness of these normal people who are more likely to grumble about people looking for handouts when they see a homeless vet than actually consider the fact that he is a human being with a story just like the rest of us. It would ruin my peace of mind. The CALLOUSNESS of it. But then it hit me. They don’t even realize that’s what they are doing. It’s a subconscious reaction to distance themselves from such potential outcomes. They HAVE to see the sick or poor or ill or elderly as somehow lacking or broken in order to protect the mental image they have of themselves. After all, any other insight would force them to accept the fact that we are all one cataclysmic event from becoming what they most fear.
Ah, but I know what they don’t, both through my own life experiences and those for whom I have been blessed enough to have in my care. I know that when you are forced to accept life as it is, you learn how to create a new normal. You learn how to adapt. What my residents and clients have shown me time and time again is that life is a balance. When one ability is lost, another is gained. My client lost mobility, but she gained perspective, perseverance, a higher tolerance for pain. She has a level of empathy for others that she said was a bit lacking before her health failed her and never once have I heard her say that life is not fair. Think about that. It is truly humbling.
I have seen people in perfect health have a complete meltdown over a coupon in a grocery store. I have heard countless versions of “why me’s” from those who have all they could possibly need to be happy. If “normal” means taking life for granted until catastrophe teaches you otherwise, I’d just as soon learn from the outcasts.
Ah, the Family Guy. I love that show. I can put it on after a long shift and all is right with the world. It’s not everyone’s cup of tea, though, so you can imagine my surprise when I heard the opening tune through the door in the bathroom as I was getting my client dressed. Well, this should be interesting. My client’s fourteen year old granddaughter was over for the day. I couldn’t be happier about that. It’s something that I had been pushing for behind the scenes for a while now. I thought it would be good for them both.
One of the benefits of being an independent caregiver in a family’s home is that I have much more influence than I did in a facility. This comes with a lot of stressors and frustrations that I will save for another post, but it also puts me in a unique position to do some good. So it was GIRL’S DAY! And the kid was watching old episodes of the family guy. How this would gel with my client’s ultra-conservative views, I could not say, but hey, at least we were all together.
I pushed my client to the living room and positioned her in her lounge chair. We had plans to go to the movies, but her level of pain and the weather did not cooperate so we had to come up with a new game plan. In the meantime, Stewie was beating up Brian.
“Why is that baby beating up a dog?” she asked.
“He owes him money!” her granddaughter replied. I knew this episode well. Time to redirect a little. My client’s social morays may not be able to handle the family guy for very long.
A self-described “emo kid”, the granddaughter was absolutely beautiful, though she didn’t realize it. Her hair was so rock and roll, that if I could pull it off at forty, I totally would. She’s a creative, sensitive, interesting kid trapped in that unforgiving age of fourteen. I hated fourteen and after knowing her for ten minutes, I felt a real kinship.
As the day went on, I realized that this was not only about my client. Her granddaughter was enjoying it every bit as much as she was. So was I, for that matter! All of our plans fell through, so we rented a movie on TV and ordered a pizza. Because it was just the three of us, both granddaughter and grandma opened up to each other in ways that they may not have been able to otherwise. I reached into my bag of things that I don’t know about and listened enthusiastically as they both eagerly shared make-up tips that I would most likely never use. We had fun. In this field, it was as close to a perfect day as we can get.
I grew up with that bond with my Grandma. It is one of the richest and most meaningful connections in my life. So much of who I am is because of her so to see that bond begin in others…I can’t put into words how incredibly important to me that moment was. It was beautiful.
By the end of the day, we all made a plan for her to come over every Tuesday she has free this summer. We brainstormed ideas for outings and the joy was contagious. This. THIS is why I do what I do. As caregivers, we get to be a part of these moments and we know that they are far from inconsequential. There is a lot of shit, both literally and metaphorically, that comes with this gig. Ah but the moments when I get to know that I had a hand in directly impacting another’s day for the better? So worth it! We get to lift people up. We get to fight for something bigger than ourselves. We get to have our lives impacted by others…what’s BETTER than that? It really is a hell of a job perk.
“I wish I could run around with my grandkids,” my client said wistfully, “I feel like half a Grandma.” I sighed to myself. It isn’t the first time she’s mentioned such things. I wish I could help my husband clean out the store. I wish I wasn’t such an ordeal to everyone. I wish…I wish. It made me so sad! What could I say to any of that? Sure, I could be a supportive listener. People say that’s helpful. I get that. I do!…but I’m wired to try and solve problems and I couldn’t shake the idea that I wasn’t quite as powerless to help as I thought I was.x
So I went home and obsessed about it, as I am prone to do. After about an hour of over complicating a fairly simple problem, I had a EUREKA! moment. HAIR! I know absolutely nothing about hair. I’m lucky if mine meets a hairbrush every other day. I know nothing about a LOT of things! Fashion! Apparently my Blossom hat is no longer en vogue. Who knew?! I’ll tell you who knew! My client! She taught cosmetology! She raised two daughters and has an eye for fashion! My limited cooking abilities give me ample opportunity to ask for recipes! She loves to read and could quote Shakespeare. THIS was what I need to be focusing on! Instead of feeling sad for her, I needed to remind her of all the things she could still do, not with words but with action!
The next day, I pulled up a chair as she ate breakfast. I looked her straight in the eyes and said with complete honesty, “My life has gone nuts! I’m going to New Orleans for a once in a life time opportunity, I’m on a big writing kick, I’m learning water colors, my paintings are hanging in a coffee shop, I drove back and forth to Long Island twice this year, walls that I spent years building have melted in a matter of days by the person who motivated me to build them in the first place, and I don’t know how to cook a steak. Most of that is amazing but it’s all overwhelming. You are now officially my life coach.”
She recognized the honesty and knew immediately that I wasn’t being condescending. I could see her eyes light up as we looked at pictures of dresses and discussed what would be appropriate for public speaking. I asked her for recipes. I sought her guidance. I watched and listened and learned. It was mutually beneficial. That shift, she wasn’t my client. She wasn’t her diagnosis. She was the teacher and I was the student. By stepping out of my comfort zone, embracing my own vulnerabilities, and expressing my flaws and fears, I gave her the opportunity to be genuinely helpful and I gave myself the opportunity to gain some clarity. Such a simple solution. Living with purpose and feeling useful are basic human needs. Sometimes we all need to be reminded that we are here for a reason.
I had several ideas floating around my somewhat addled brain for this week’s post. I have started this piece three different times on three different topics. Then I stopped. I stopped because I am broken hearted. I am angry and disillusioned. I am heartsick. Forty-nine people dead. Someone’s son. Someone’s daughter. Someone’s friend. Shot down. Their lives gone in an instant with no acknowledgement that they are a member of the very same species as the killer himself.
Again, the nation mourns. Again Facebook pictures change and memes calling for unity and peace and prayers in the face of this tragedy are everywhere, quickly followed up with statements of why and how such atrocities continue to occur. It’s the guns! It’s the terrorists! It’s the homophobia! And these statements become angry and fuel the fire as anonymous people spit their one-sided solutions to a complex problem that happens over and over and over again.
The more I ponder it, the more certain I become that the root of the problem is simply that we dehumanize anyone who is different from ourselves. It’s in the rhetoric we use. It’s in the angry and dismissive thinking that is based solely in proving that one is right rather than seeking truths. Read the comments on a news story some time. It’s scary. The anger and ad hominem attacks from every side are appalling and anonymity gives people a false sense of courage that apparently leads them to behave like a pack of rabid wolves.
But Alice, you may be thinking, isn’t this a blog about Long Term Care? How does any of this apply? I have witnessed that same dehumanization on a smaller stage every day in this field. The slow tearing away of the heart and soul of the sick and elderly in the system until all that is left is their diagnosis. They are dismissed. We, as their caregivers, are dismissed. That is how the dangerous flaws and cracks in the very system that is designed to protect them flourish. That is why society never really thinks about that particular demographic until they see some vague story on the news about elder abuse. Only THEN do they rouse themselves from apathy and express outrage but it’s always focused at the incident and never at the system that produced it. They do not see until their hand is forced and then they only see the end result rather than the causes.
The more society embraces this insanity, the more of these atrocities we will face. This idea that if people think, look, live, pray, believe or appear differently than you do, then they are not only wrong, but evil, or stupid or somehow less human is going to eventually lead to the destruction of the best of us. When will we realize that it shouldn’t take a tragedy to remind us of our humanity? How many more people have to die before we learn how to truly live?
See past the disorders. See past the challenges. See past the constant reminder of our own mortality. Look beyond the dysfunction of the broken system and the day to day gripes we all face in this field. Look beyond the bad mood of that one particular resident who seems to have it in for you for no reason at all. Work around the apathetic owners of these facilities and you will learn some truths about yourself as a person through your work as a caregiver.
We can’t fix the broken or heal the sick, but we can comfort the hurting and add a spark for another going through a day of despair. We can support and teach each other in a system that fails us in that area so often. We can reach people when we look beyond the surface. When we do not allow how we are viewed by others to define us; when we refuse to do the bare minimum in our workplaces, we set the example. We set the standard. The powers that be do not understand the nature of our work. They don’t know and many don’t care. They want the most cost efficient option and are willing to sacrifice standards of care in order to increase profit margin. I get it. They view it as a business, but they are not selling shoes and burying our collective heads in the sand is not going to work.
Are we going to accept this? Are we going to allow those within our care to be forced to settle for apathy and neglect? Are we going to allow this system that is designed to fail convince us that we are disposable and worth very little? We have choices here. We have numbers and we have a voice. We have to stop getting stuck in the minor irritations that so often distract us from the essential truths that all caregivers share: we are the protectors. We are the comforters. We are the voice of the most vulnerable among us. That is a sacred responsibility and that doesn’t change because it goes unappreciated or noticed by others. If we embrace this, if we are motivated by this consistently, then together we have the opportunity to fight for the changes that only us and those in our care really know are needed. We need to collectively look at the big picture and then get on with the business of doing what we can to improve it. It’s in our hands.