Tag Archives: certified nurse assistant

Long Term Care’s “Trans” Issue

 

 

Minstrel

When the issue of CNA wages is raised, the response is never “Sorry, we don’t think you deserve better wages. We’re not going to pay you enough to live on if we can get you to work for peanuts.” No: administrators will say, “Yes, we know aides are worth more and we would love to pay higher wages. We just can’t afford to. The money isn’t there.”

Are you sure about that? Show me the money. Let us see your budget. Every organization has a budget, detailing what comes in and what goes out and where it goes. Long-term-care administrators tell us they can’t find the money to increase wages or benefits of aides. Maybe so, but we aides would like to be included in the search.

This is about transparency in money matters. If you attend conferences and webinars and read articles on how to achieve quality care in long-term-care homes, you will often hear the word ‘empowerment.’ Residents need to be empowered. Persons living with dementia need to be empowered. And direct-care workers need to be empowered—that’s what the experts say. What could be more empowering than having a say in how money is spent? Including aides in a transparent discussion of resource allotment would demonstrate trust in us, respect for us, and appreciation for the creativity we might bring to problem-solving. There may not be a wealth of money being wasted or misspent. But aides are in a unique position to see opportunities for cost savings that others might overlook. As a CNA I saw the amount of food that, at the end of every meals wasn’t in the stomachs of residents but in black plastic waste bags. I saw the wastefulness in our use of disposable items like plastic cups, paper plates and napkins. Without impacting the welfare of residents, aides might find multiple ways of cutting costs so that money might be re-directed. We might bring fresh vision to decision-making about saving and spending. Give us a chance!

Perhaps administrators protect budget secrecy out of embarrassment over the wide gap between the salaries of aides and the salaries of the executive and managers. Or out of worry that this knowledge might lead to poor morale and workplace unrest. Maybe the organization worries about privacy rights; why should anyone’s salary be public knowledge? First of all, budget transparency doesn’t mean that individuals’ salaries have to be known. (However, if it did, would this be so bad? Americans are more open about their sexual practices than about their finances! We know the salaries of the President and members of Congress and of the CEO’s of publicly-traded corporations. It is a tool of accountability.) There are ways to protect information about individual salaries (as the federal government does for federal civil servants) while making information available about salary ranges, the percentage of the budget spent on various classes of jobs, etc. This privacy issue is an excuse, a ploy to halt discussion before it starts. It’s not a justification for saying no to transparency.

Aides aren’t children. We’re capable of understanding issues, of being reasonable. We can understand that some positions merit higher wages than others and that some employees will deserve to earn more than others. We can be patient about wage increases. But we shouldn’t be shunted off to the side when budgets are discussed, as if we were just another piece of mechanical equipment in the workplace. We need to breach this wall that seems to create a ‘them’ and an ‘us,’ the intelligent responsible people on one side and lower class workers on the other. We are all part of the care community; we all want to improve it. One way to do this is to make budgets more transparent. If we want to retain employees and attract new job seekers, salaries and working conditions must become more appealing. I suspect that money might be found to do this, if budgets were transparent to all stakeholders.

We hear a lot about the need for culture change in long-term care. Budget transparency is a culture change issue that we don’t hear about yet. Let’s hear a call for transparency from the leaders of the culture change movement. Let’s hear it now!

The Facts About CNA Wages

 

Bob Goddard

There is a great deal of confusion within the CNA community regarding the issue of wages and how it fits into the larger long term care picture. While there is general agreement that caregivers are underpaid, that perception is primarily based on personal experience, that of our own and of others. This anecdotal evidence is useful in its own right, if for no other reason than it is overwhelming. However, discussions regarding the wage issue are characterized by emotional responses and typically lack references to data that back up the arguments.  Solid facts are sometimes offered within the CNA online forums, but usually not in any kind of comprehensive or purposeful way.

In order to help us get a more accurate picture of the state of direct care work in this country, below is a list of just a few of the more significant statistics. The primary source for these is a PHI fact sheet published in August of 2017.

I think this kind of short list might be useful for those who argue for better wages for caregivers. In future posts, I’ll give my take on what I think these statistics mean.

First, just to get a sense of the scope:

15,400 long term care facilities in the United States

1.4 million residents live in these facilities

600,000 CNAs work in them

But those 600,000 are only 13 percent of the total of direct care workers employed in the United States, because…

4.5 million direct care workers are employed in all types of situations, including home care, Continuing Care Retirement Communities, Assisted Living Facilities, Hospitals, Centers for Developmentally Disabled, Mental Health, Substance Abuse, Employment & Rehab.

Second, the demographics of caregivers:

91 percent are female

Half are under age 35

Half are people of color

Half have some college, (about 1 in 7 have associates degree or higher)

20 percent were born outside of the United States

Third, the money issue:

$12.34/hr is the median wage of CNAs (half make more, half make less)

$20,000 is the average annual income

Half work part time at least part of the year

17 percent live below the poverty line (compared to 7 percent of all American workers)

40 percent receive some form of public assistance

72 percent of long term care is finance through public programs (mostly Medicaid and Medicare)

Finally, the demand for caregivers is growing:

60,000 more caregivers will be needed by 2024. It is one of the fastest growing occupations in the United States workforce.

1 in 2 caregivers leave the job within 12 months. And more LTC workers are leaving this sector than entering it.

I would encourage anyone who is interested to visit the PHI site where more information like this can be found. Of current interest is the ongoing 60 Caregivers Issues series where they tackle a whole range of issues regarding our work, such as caregiver wages, training, recruitment and retention, and advocacy.

Next week, I’ll share what I think some of these numbers mean for the larger long term care picture.

Lost in Translation

 

Corey

Where is my mother? Father? Brother? Husband? When these questions come from my residents at three in the morning, I have to do an on the spot assessment. If not handled correctly, these conversations can quickly spiral into an emotional meltdown that unnecessarily traumatize those living with memory disorders.

Too many people, from the doctors to new caregivers, make the rookie mistake of attempting to pull those living with dementia into their level of awareness rather than meeting them where they are. Instead of trying to convince those living with Alzheimer’s or dementia of our reality, it is better to actively listen through the words they say to assess the resident’s needs.

When I hear “where’s my mother,” I think about what my resident’s mother might have provided her that she may be missing in that particular moment and attempt to fill that need as best I can. It is not 100% effective but it has worked better than any other method I’ve utilized so far in this field. Where’s my mother at three in the morning could mean any number of things. Did she have a nightmare and need reassurance? Did she wake up hungry? Does she need to use the bathroom? Is she in discomfort? All of these basic needs were once taken care of by her mother and in recognizing that, I am usually able to put her at ease and through the process of elimination, discover and solve the problem my resident could not articulate.

Have you ever been anxious or frustrated or simply in a funk for no specific reason? Maybe you didn’t even realize you were feeling down until someone said or did something that pulled you from it? It’s happened to me plenty of times and it’s a strange feeling when my emotions don’t match with my reality. Imagine walking through that with severe cognitive impairment, when your reality is just as fluid as your emotions. It would terrify me if someone attempted to convince me that what I know in my mind to be true isn’t real. I would be too scared and frustrated to comply with even the simplest of suggestions. Part of caregiving is learning how to translate. There is a language and understanding that can only be developed by active listening, keen observation skills and empathy. It up to us to first understand that language and then translate it for those who don’t know those in our care as well as we do. It is how we make certain our residents do not get lost in translation.

You are the Solution


Corey
Hey you. Yes! YOU, reading this. Don’t ever allow yourself to be convinced that you are less than you are. Don’t allow anyone else to define you. You are so much bigger than your mistakes, fear, and struggles. I know you’re tired. I know you sometimes ask yourself what’s the point and I know sometimes you think your best isn’t good enough. Not one of those thoughts are true. The very fact that you are reading this post shows that you are defining your position in the world of long term care rather than allowing the system to define you. I know. That’s how this whole blog began. Two caregivers found each other online and decided it was time to let the world know what it is truly like from our perspective. We are no different than you. If we can be a part of the solution, so can you.
Step one: we have to get rid of the “I’m just” mentality. I’m just a CNA. I’m just a single mom. I’m just
a high school graduate. I’m just one person. No. You are not. You are a dynamic human being with ideas and value. Your worth is not to be measured by something as simple as a degree. You are not “just” anything. KNOWING that is the key to willingness and willingness unlocks doors you can’t even begin to imagine. Willingness produces action and action produces change.
Step two: we have to stop letting others dictate our behavior. Everyone calls out. I’m going to call out too. Right or wrong, that thinking just excuses their reasonings for our poor pay, awful work loads and disrespect. Is it fair that the best and the worst of us are treated the same? No. Hell no. But the system sees no need to change it. They treat us as disposable. We react to being treated as disposable. They use this as an excuse to continue to treat us as disposable. Collectively, we have power over this. I’ve said it before and I’ll say it again: mountains move from the bottom. Rome wasn’t built in a day. We need consistent and collective moves forward and that will not happen until we excel. Until WE define what we do and how well we do it. Until we become the leaders we wish we were provided, it’s going to be business as usual. We have to stop bullying. It’s a problem from the top down. I should not know what the office people think about the new nurse. But I do. It’s no different than the floor. The new kid on the block always has it rough. We can lead by example there. We can help the new workers, regardless of their position, rather than tear them apart. We can help other shifts instead of bitching about them. Having worked all shifts, I know they each have their challenges. We can not involve ourselves in malicious gossip like twelve year old mean girls. If we feel someone isn’t pulling their weight, we can discuss it with them like grown ups. We can speak up for one another when necessary and we can speak up for the residents. We do not have to get drawn into the drama, even when those in supervisory positions often seem to be the ones stirring it up. We can CHOOSE not to play ball, to respectfully decline to participate in bullshit. In doing so, we become examples for good. We show that it doesn’t take making another feel or look bad in order to look good.
Step three: Never give up. It may seem like no good can come from all this effort. I know I’ve felt that way. Press on regardless. Change happens slowly. It takes patience and sacrifice and even then, the satisfaction of seeing the outcome of all the effort isn’t guaranteed. Trust me, it makes a difference. Once, I was a whistle blower. My entire life was thrown into turmoil. I lost my job. Had to start from scratch and couldn’t see how any good came of it, but as it turned out, it wasn’t just their one facility that had glaring and dangerous violations that had gone unchecked, but several. By shining a light on one, all of them were on the radar. It was three years before I found out that my action had any impact. I was green in the field and naive at the time. Now I realize the most impactful change in this system is not an explosion but the slow and steady burn of passion that motivates this blog. The simple act of speaking your truth consistently will leave a mark. So leave your mark. Write your own piece. Email it to us for posting. Or reach out your hand to another person in this field. Teach with patience. And know we are all in this together and you are not alone.

Beneath the Roles We Play


Alice
Lucinda. To some, she is the manager at the super market on my corner. To others, she is the cashier, if they notice her at all. To me, she is a person with whom I interact with on a regular basis. She is a mother. She is a woman who worked from the bottom up and isn’t afraid or above hopping on a register when the store is short staffed. She is someone who managed to dig deep and find a genuine smile despite the fact that she had to show up to work after leaving the funeral of a loved one. I know this because I noticed the tracks of the tears that escaped her make up and I asked her about it. She knows my name and I know hers.
We interact with thousands of people in our lifetime. How often do we take a second to acknowledge their humanity outside of the limited role that they play in our lives? Do we see the person first or the service we expect them to provide for us,paid or otherwise?
My years as a caregiver have honed my ability to see a person beneath whatever descriptor they may hold. Quality of life is not improved by seeing a resident’s disorder before seeing them as a person. By knowing their individual personalities and preferences, I am able to provide better care and remind them that they are deeply valued as people. A person who feels worthwhile is less likely to be combative and angry. A person who knows you are a friend is more willing to trust, to be open about how they feel and less likely to feel alone and afraid. No one, myself included, wants to be seen solely as one thing. It is true on the job and it is true in the world.
Civility is slowly dying because our circles of empathy are shrinking. People view life through this filter of self. How do you and your actions affect me? We are all guilty of it. Just because I am aware of this doesn’t mean I don’t fall into that trap; that age old opera of ME ME ME ME ME when the reality is most of the time it’s not about me at all.
My work reminds me of that in thousands of ways, big and small. Those in my care manage to maintain their dignity through challenges that I can’t imagine facing. Even my most difficult and moody folks maintain the ability to occasionally laugh through constant pain. They help one another through the heartbreakingly tough days. Even those that don’t get along show each other support and notice when someone is missing from the hall. Somehow, through all of their troubles, most of them manage to smile at us and say thank you. It is impossible for me not to be humbled by that; to not strive to be just a little bit better every day at living well among other people.
We lost a resident this week. Sometimes it seems like I always see it coming but I never see it coming. I know the inevitable for the demographic with whom I work, but for me it’s always about their life. I never feel quite prepared for their death. This fellow left an impression that will stay with me for the rest of my life. A few weeks ago, I was working on his hall and saw his light on during my 2:00 AM hall check. Curious, I knocked on his door.
“Come in!”, he answered with more enthusiasm than I had at that hour. He was sitting in his recliner, listening to a book on tape as he carefully cut out a rectangle from the bottom of a square plastic cross stitch board. He had quite a stack of them piled on the side table beside him. This was no small feat as he was as close to legally blind as one could get. He explained to me that they could help the vision impaired to sign documents. Just line up the cut out rectangle above the space on which they need to sign and use the plastic as a guide for the pen. Voila! No more shaky, sloppy signatures. He asked me to hand them out to anyone I knew with poor eyesight. He went on to say that he was in a program that offered free audio books to anyone who no longer had the ability to read if I knew anyone who would be interested. I was thunderstruck with his courage. He didn’t even know he was brave and I knew instinctively that if I pointed it out, it would only make him feel uncomfortable. This was just who he was. To comment upon it as if it was an isolated event would cheapen it somehow. Still, I thought about it a lot for the next week. Here was a man who by all rights had every reason to feel sorry for himself. No one would blame him and yet there he was using his mind, creativity, compassion and his own personal struggles to make the lives of others better in a way that no one else could. It was nothing short of amazing and the fact that I was able to witness this empathy and gutsy perserverance in action was a gift that I will never take for granted. The very least I can do is get to know Lucinda; to do my best to see people beyond what roles they play in my life and what they do to me or for me. It is yet another reminder that the lessons are there. They are always there. I learn them when I become willing to see.

The Why’s


Alice
I do not understand why anyone would continue in this career if they don’t have a love for what they do. It’s not the money. It certainly isn’t the respect. I cannot tell you how many times I’ve heard a nurse offhandedly tell a caregiver that being a nurse is hard, that there are so many responsibilities; The unintentional implication being that we don’t know how good we have it. And I don’t doubt that the nursing field has challenges and rewards that I haven’t experienced as a caregiver but unless a nurse has experience as a CNA in a Long Term Care facility, the reverse is true as well.
I have developed a set of ideals, skills and standards that I consider both invaluable to being a quality caregiver and highly overlooked by the system at large. None of these skills include excellent hospital corners or perfectly folded laundry, both skills with which I could use improvement. It’s not that I consider those parts of the job without value; it’s just the least important of the skills we need to provide quality care and often the first noticed when the hall is inspected by supervisors.
“Did you make the bed in room 237?”, demands an imaginary boss I created to express this point.
“No not yet. Agnes is freaking out because she thinks Ida stole her dog and she’s refusing to let anyone but me in her room…let me just…” make-believe me replied.
“Are you kidding me?! The OWNER is on his way and he wants this hall to LOOK perfect. Leave her. She’ll be fine. Go make sure all the beds are made.”
Now, I made that scenario up. I’ve never actually had anyone named Agnes or Ida in my care. But I have had countless experiences with some version of the above situation; enough for me to know that the priorities in these facilities are WAY off the mark.
The residents come first. It is up to us as caregivers to make certain that is not just lip service. And let’s be really honest here, the top of the hierarchy in these facilities view it as a business. The amount of money it costs a month for an apartment here is mind boggling. I work in a really nice place that almost no one could afford. That is the sad truth. I’m not implying that these corporations shouldn’t take in a profit and I’m not saying that the one in which I work isn’t a decent place. What I am saying is that in the ten years I’ve worked in this field, with varying degrees of severity, the issues in each facility have always been the same; have always branched from the same root. Everyone pays attention to playing their own instrument without considering what it takes to create a symphony. So we end up with a cacophony of noise instead of harmonious music.
I’ve learned through the years that I personally understand the value and necessity in what we do better than the state surveyors. The seem to have a very limited scope of what is deemed important. So I don’t limit myself to their standards, many of which seem silly and misplaced and others that do not reach nearly far enough. It’s as if they have one fixed idea of who lives in these facilities and no ability to get to know the vast array of individuals living with a myriad of challenges, both physical and mental. No interest or time to get to know the residents or those of us who care for them. So I don’t flinch when they arrive to dot some “I”s and cross some “T”‘s.
I am in this gig because I SEE people. There has been much I’ve had to learn and skills that I’ve had to improve upon. My ability to see beyond an age or disability to the person beneath is not one of them. For whatever reason, that part of the job is innate for me. I love seeing bravery in action. I love the stories. I love going to sleep knowing I make a tangible difference in the life of others. I love that I’m never bored. I love that there will always be something new to learn. With people, there always is. These are my whys. Because I know them, have defined them for myself no one can devalue my job. I am not confused why I’m in this field and that has made all the difference. It’s prevented frustration from turning to resentment. It’s inspired me to continue to try to improve the system. It’s opened the door to be both teacher and student and has saved me from becoming jaded from burn out. I defined my career. I didn’t allow someone with little knowledge of it to do it for me simply because they had a degree on the wall. So I would like to know your “why’s” readers. Whatever role you play in the long term care system, what motivates you? What keeps you coming back? And how do you think we can work together to fix what’s broken?

Minding My Business


Alice
“I’ve had it! Second shift ALWAYS does this and now they want to put an extra shower on OUR shift. I’m going to the office.”
“It’s not like anything will come of it…”
“They left the bed pad in the drier AGAIN!…”
“Don’t do first shifts laundry, Alice. They’ll come to expect it…”
Sigh. Here we go again. It seems that regardless of the facility, the shift, or the home in which I work there is one constant and faulty idea that drives people: a problem can be solved by bitching at it and blaming others.
When I first started in this field, I simply tried to avoid those conversations. It’s difficult but not impossible to do. I would change the topic or find something else to do. A few years into this career, I was hit by the superhero bug. Somehow, not getting drawn into the toxic drama was not enough. I would FIX it! I felt comfortable with my co-workers and got along with all of them. It was only reasonable to impart upon them my worldly wisdom. Being “the Great Reformer”, I was surprised that my long winded and preachy speeches on the value of open communication and a sense of community were met with eye rolls rather than inspired applause and immediate action. What was WRONG with people?!
It turns out that I was asking myself the wrong questions. While blame and finger pointing never solved a problem, neither did dismissing the frustration and very real emotions that those involved in the situation may be feeling. A problem can’t be solved without acknowledging it either. So I started listening without offering solutions. I let go of what my co-workers were doing and began focusing on what I was doing. If I had an issue with a co-worker, I addressed it privately with that co-worker. If I have extra time and there is another shifts laundry to be done, I do it quietly. I know what it’s like to work first shift and any help is welcome. I make myself available to those who may need an extra set of hands when I am able. I make certain that I am consistently trust worthy. I don’t engage in gossip just to feel like a part of the group. I don’t seek approval. In other words, with varying degrees of success, I work according to my own standards. I put my money where my mouth is and let my feet do the talking. And it’s worked!
People work differently with me. They stopped bringing gossip around without my having to ask. If I need an extra set of hands, someone shows up. They know by my actions that I wouldn’t take advantage of them and that if needed, I’ll be right there with them too. The other shifts are friendly and grateful. They listen to shift report and I take my time rather than rush through it. There is a synergistic energy that stems from mutual trust.
Once I freed myself from the cage of minding other people’s business, I was better able to focus and improve upon my own. That is the simple and quiet path to actually making an impact on the world around you. Change is inspired by consistent and sometimes humbling steps forward. It isn’t about what you know and how loudly you know it. It’s about what you DO and how consistently you DO it. It’s a valuable lesson I learned from working the floor that I hope to apply off the clock. Society as a whole could use it right now.

My Old Work Partner

 

Bob Goddard

For a caregiver, there is nothing like a good hall partner to make the shift go right. Reliable coworkers that you get along with can help you maintain your sanity even on the most challenging days. They can make the difference between looking forward to coming into work or dreading it. During my 25 years as a caregiver in the veterans’ home, I had many such hall partners. One that stands out for me is my old buddy Russ.

While we worked well together, Russ and I had completely different personalities. Russ was loud, gregarious, and not afraid to speak his mind – to anyone. He was a big guy, with long hair and sported more than a few tattoos and body piercings. I was always more reserved, careful with my words, and more deliberate in my actions. And I was far more conventional in my appearance. However, he did talk me into getting a couple of small tattoos, one of which he did himself as a budding tattoo artist.

On the unit we complemented each other well. We were each assigned permanent groups, but we knew each other’s residents as well as we knew our own. When one of us had the day off, we knew the other would be watching out for our respective residents. “Take care of my boys tomorrow,” Russ would remind me before a day off.

We also knew each other’s routine and work habits. Russ was always around when I needed help. I always pretty much knew where he was and I didn’t have to spend a lot of time running around the unit looking for someone to spot me on a Hoyer lift or assist with a two-person transfer. And I did the same for him. I just kind of knew when to show up in one of his rooms. In fact, Russ referred to this as my “Jedi Wall Trick,” this uncanny ability to suddenly, but quietly appear – as if I walked out of the wall. It actually kind of freaked him out a little; he would grin and shake his head, and ask me to stop doing that.

We each took different approaches to our residents. Russ was more forward, sometimes a little too forward, and I would have to steer some of his interactions in a more appropriate direction. The same level of familiarity with certain residents in a care situation might not be as acceptable in a more public setting. At the same time, Russ had a knack of bringing residents out their shell and could reach them in ways that didn’t come natural to me. He showed me that being authentic, especially when laced with humor can help break down social barriers and actually strengthen the bond between resident and caregiver.

Due to the nature of the beast, caregivers in an institutional setting often have to work with a looming sense of turmoil and even fear. We may like the work and enjoy our residents, but sometimes we’re not so crazy about our place of employment nor the system under which we work. In this kind of atmosphere, we learn to rely on each other to keep it real. And more than anything, Russ helped to keep it real.

In my next post, I’ll talk about my current work partner.  She’s a few feet shorter and a couple hundred pounds lighter than Russ, but just as valued.

What do you do for a Living?

 

Lynn

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.

60 Caregiver Issues: Whose Issues Will We Hear?

 

 

Minstrel

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.