Tag Archives: long-term care

See No Evil, Hear No Evil … Fix No Evil





As aging impacts physical and cognitive health, many of us will eventually live in long-term care homes.  Thanks to poor standards of care, most people dread this prospect.  To improve care, experts advocate a person-centered model of care as an alternative to the traditional medical model.  Moving from one care model to the other calls for culture change.  Last year I visited the website of a leading culture change organization for information on their annual conference.  It was discouraging to see that among their many events, none included one of the critical elements of culture change, CNAs: our workloads, wages, and caregiving standards.  Hour after hour, day in and day out, CNAs are key caregivers.  Without us, there can be no culture change.  Yet CNAs aren’t heard.  Here is one CNA voice.

I first became familiar with LTC homes when a family member needed care.  I explored many places to find him a good home, then visited him frequently.  Since then I’ve worked in LTC homes and gone into others as a hospice volunteer.  When my uncle moved to a memory care home, I saw the aides who cared for him as angels: they did for my uncle and the other residents what we family members no longer could.  They did this with magical skill and saintly kindness.  And for wages that were obscenely sub-standard.  I was enormously grateful to them.  But in these years of being in and out of long-term care homes, this is what I’ve also seen: aides who sit talking to each other or texting while residents sleep in front of TVs or sit staring into space, alone.  I’ve seen a resident fall because an aide was busy texting.  Aides spend mealtimes noisily socializing with each other instead of engaging with residents, most of whom (at least in memory units) need some level of assistance.  Some aides announce, by their behavior, “Once she’s bathed and dressed and in the dining room, once he’s fed and toileted: once the ADLs are completed, it’s my time.”  Sometimes instead of interacting with residents, aides simply take time apart to rest.  It’s not that aides are intentionally mean or abusive.  And comradery among aides isn’t a perk; it’s essential.  But on every shift there are failures in attentiveness to residents, failures to engage them in an enriching way, lost opportunities for Creating Moments of Joy, as Jolene Brackey has written. 

Some will object, “Not in OUR facility!  We have awesome aides who go out of their way every day to make life better for residents.”  Yes, aides are often inspirationally caring.  But too frequently the quotidian reality is lackluster care, not the person-centered care promised.  Tellingly, the administrators who dispute this picture are often conspicuous for their absence from the daily fray.

Here’s something else I see: thanks to abysmal wages, many aides work two jobs.  Where I live, starting wages are $9 to $12 an hour.  Self-employed aides can earn more, but have no benefits.  Full-time aides are sometimes scheduled to work only 32 hours a week, to avoid overtime when an aide is asked to work a double shift to cover for someone who calls out at the last minute.  Many aides have children at home to care for.  By the time the aide starts his or her shift, which typically involves caring for six to ten residents, she is already tired in body and spirit.  How can this aide bring to work the physical and emotional energy needed to care for the chronically ill, the elderly frail, the cognitively impaired?  Is this what you want for your parent or spouse, or yourself?

How to improve care?  Administrators provide innovative training programs.  Workshops offer state-of-the-art information and creative care ideas.  Two questions not examined:  1. How do we get aides to buy into culture change and embrace person-centered care, once the trainer leaves?    2. Where do we find the money to increase staffing and pay direct-care workers a living wage, one that honors the physical and emotional demands they meet every day?  

Culture change seems focused primarily on training of direct-care workers and renovations to the physical environment.  A more effective approach might come from a change in what we expect of leadership.  Once upon a time, ‘Management-by-Walking-Around’ was the mantra.  An effective manager was expected to circulate on the factory or office floor, paying attention.  Not spying on employees, not micro-managing, but noticing things.  Sensing conflicts and stresses before these undermine performance.  Offering feedback when needed.  In care homes, how often do you see someone on hand whose role is to encourage, compliment, coach or critique?  To see that necessary supplies are on hand.  To offer an on-the-spot performance suggestion, transforming a moment of poor care into an opportunity to reinforce good care skills, per Teepa Snow’s  coaching model.  And at times, with a chronic slacker, to go down the road of discipline.  How much do managers engage with direct-care workers? 

Today’s code word for good care is engagement: aides need to engage with residents.  If administrators aren’t modeling this by meaningful interactions with direct-care workers, will aides believe that engagement is to be the ethos in their workplace?

We can’t improve what we don’t see.  If administrators don’t see the problems, it might be because they are buried in ‘CYA’ paperwork, medication management, marketing efforts, and time-stealing meetings.  Sometimes their offices are in some distant realm of the facility.  Culture-changing organizations might hire a clerk for paperwork and scheduling, freeing the front-line manager for a more constructive presence among staff.  Give this manager a mandate to convert ‘person-centered care’ from a slogan to a fact.   

Can LTC homes provide person-centered care, without the personnel?  Staffing levels are egregiously low.  They may meet states’ woeful requirements but we all know they are inadequate to ensure patient safety, let alone the person-centered care everyone espouses.   Inadequate staffing also leads to on-the-job injuries and CNA burnout.  Are any of the culture-change conferences addressing these issues?  Are leaders lobbying for better staffing and better wages for their CNAs?

Ah, wages!   One is tempted to wonder whether managers tolerate poor performance out of guilt or shame for what they pay their aides.  Even compassionate professionals don’t want to mention the issue of wages in public.  It may seem too daunting and discouraging a challenge—and an embarrassment.  Compensation levels reflect the fact that the job doesn’t require high-level academic or technical credentials.  But aides shouldn’t be thought of as unskilled.  Our skills lie in meeting the global needs of residents who are sometimes completely dependent on us.  A good aide needs to excel in kindness, patience, gentleness, flexibility, effective time management, communications creativity, appreciation for the diverse ethnic, racial, religious, cultural backgrounds of those in our care.  We care for residents regardless of their illnesses or diseases.  We don’t need to describe here the physical tasks we perform, sometimes difficult, often unpleasant.  When the person has dementia, the challenges are doubled, tripled.  We’re accountable to employers, to families, and to our residents.  Not everyone is up to the job.  Wages should reflect the importance of this work and the competencies it requires.  We need a mindset conversion among executives who still think it’s acceptable to sustain their LTC organizations by reliance on a bare-boned staff of underpaid workers who need public assistance to supplement their wages.  Care homes charge their CNAs to respect the dignity of residents.  What about respect for the dignity of CNAs, starting with a living wage?

“Where will we get the money to raise wages and increase staffing?” ask horrified LTC operators. The question is valid.  However, it begs the further question: How much are you spending now, and for what?  Until there is budget transparency (another piece of culture change), the industry’s position that these proposals aren’t affordable, isn’t credible or convincing.  Their question should be not the end of the discussion, but the beginning.  Reviewing the content of culture-change workshops, we don’t see these issues on agendas.  No one wants to touch staffing or wage issues.  Could it be that the profit motive plays too big a part in the culture of some LTC organizations? 

This isn’t rocket science: Be as zealous about improving supervision, staffing, and wages as you are about upgrading the chandeliers and countertops and holding conferences.  Put your assets where you claim your values are.  (Make your budget transparent!)  Invite CNAs to be co-leaders in culture change.  Then we might see culture change that leads to transformed care, transformed lives.  

The Deadly Illusion of Difference





  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?

Validation for the Cognitively Intact





I work on the dementia-care side of things.  One day an aide I was working with tried repeatedly to debate one of our dementia-unit residents about why she should just go and sit down and finish her lunch.  The resident left the table, the aide went after her.  The resident got up from the table again, again the aide brought her back, all the while scolding her.  This happened a number of times in the space of a few minutes.  I finally said to the aide, “Mary doesn’t want to sit at the table.  And we aren’t supposed to insist on keeping her there if she wants to leave.”  The resident was unhappy; her aide was unhappy.  Now I was unhappy with that aide.  And that aide was unhappy with me.  

I thought to myself, “I wouldn’t snap at a resident that way; why would I snap at the aide?”  I recalled something from my dementia training program.  One day the trainer asked, “Has anyone been able to use anything we’re learning, in your workplace?”  I thought of something that had happened that week on the train.  In front of me there was a little boy, three or four years old.  He was delighting in everything: in all he saw out his window, and in those of us sitting nearby.  Then his mother focused on this adorable, giggly little boy.  “Georgie, get over here.  Georgie, be quiet!  Georgie, sit still!”  In reality, little Georgie was actually pretty quiet and well behaved.  The only thing he was doing was enjoying his train ride!  But Mom kept on and on at Georgie for every little innocent move he made.  

Brimming with new knowledge, I was tempted to say, “Ma’am, scolding Georgie won’t work.  Repeating the scoldings won’t work.  Scolding him in a louder voice won’t work.  Georgie needs to be validated!”  [A common practice in dementia care.]  “Smile at Georgie.  Engage him; ask him what’s making him feel so happy.  Maybe give him a hug and tell him how glad you are that he’s so happy!  And soon Georgie may very well be focused on you instead of stretching backward to see all of us.”   

This was a Eureka moment for me: dementia-care training offers great lessons for relating to a child, to everyone, not just those with dementia.  This might sound condescending.  But dementia-care training is about how to transform resistance, stubbornness, and defensiveness in those who feel demeaned or threatened by us or confused by our demands — into cooperation.  We stay calm and positive.  We validate how the other is feeling.  We try to understand what the person is really trying to tell us when he rejects our attempts to get him to obey our wishes.  Instead of perpetuating the conflict, we try to discover—or create!—common interests.  Those who work among persons with dementia—and in any LTC setting that is most of us—become creative communicators.   Validating communication helps with dementia residents, and it might help us communicate more effectively with our families, our friends, our co-workers, even our supervisors.  (Now that would be sweet irony!)


National Nursing Assistants Week





Next week marks the 39th Annual National Nursing Assistants’ Week. “NAWeek” begins on June 9th with National Career Nursing Assistants’ Day – “a day to recognize nursing assistants who dedicated their lives to the well-being of others for 5 to 58 years” – and runs through June 16th. The theme of this year’s NAWeek is “I Choose Respect.”

NAWeek is sponsored by The National Network of Career Nursing Assistants. Longtime director of the NNCNA, Genevieve Gipson, has been advocating for direct care workers for over fifty years and is currently working with numerous National NA groups on legislation issues, promoting recognition of nursing assistants, education, research, and peer support development for nursing assistants in nursing homes and other long term care settings. We’re working to get Jeni to appear on CNA Edge as a guest contributor so that she can share her wisdom and insight with our readers and give us her take on NAWeek and the NNCNA.

Meanwhile, to help celebrate NAWeek, we will be offering a free download of the Kindle version of our book CNA Edge: Reflections from Year One from June 9th through June 12th. The book is a collection of over 80 essays originally published in 2014 as posts on this blog. We will post links here and on our Facebook page starting this coming Thursday.

For more information on NAWeek click here: National Nursing Assistants Week 

The Great Yoga Pants Debate




    Yoga pants. YOGA pants? Poor staffing, supply shortages, low wages, a world full of people who see a disability instead of a person, a world full of people who treat the elderly as if they were disposable, a broken system and a national elder abuse average of one in four but no. She’d rather put an embargo on Yoga pants. Stop muttering to yourself, Alice. You’re alone in your apartment ranting like a lunatic at something you read online. Take a breath.

      It was nothing, really; an innocuous comment on one of the support sites that got me going. The poster commented about a facility that contracts out to her agency that allows their employees to wear yoga pants. She thought it was inappropriate. That was it. So why did slowly work me into a tizzy? Why did it nag at me like a hole in my sock? 

      There is a smug superiority in some of the comments I read that concerns me. If you don’t like yoga pants, work at a facility that doesn’t allow them. Why pull others down in order to boost yourself up? And it happens often. First shift blames second. Hospitals are better than facilities. Home care has higher standards. This caregiver has tattoos and is unprofessional. We pull each other apart over nonsense when in reality, we are ALL running around and sticking our thumbs into the leaky dam as the water comes crashing around us!

      Don’t misunderstand me. I think the fact that we have online groups is great. Many of the questions are insightful and uplifting and funny and it’s wonderful to have sites full of people you’ve never met who all speak the same language. Long term care is a bizarre world and as caregivers we see it through different eyes and relate on a different level. Maybe it’s because I believe in the best of us. Maybe it’s because I know we are better than the powers that be treat us. Maybe it’s because I expect more from us, but for whatever reason, I was really bothered by that comment and could not shake it…but then Yang pointed something out to me. Maybe people resort to that sort of destructive behavior because they feel so powerless over everything else. That stopped me in my tracks.

       Let me assure all of you that we are not powerless unless we allow ourselves to be. We have choices! We can advocate in so many ways, big and small. We can be kind to the new co-worker. We can speak our truth to our employers. We can volunteer or start a support group, or write for a blog, or join the Alzheimer’s association. Most importantly, with our united actions, we can start a much needed conversation about changes that need to be made in the system from our own perspective as well as those for whom we care. 

    It’s not that we are “entitled” to a living wage. It’s that we’ve EARNED it. We have earned the right to safe work places and proper supplies. We have earned the right to be treated with respect and we have earned the right to be heard. We will never get to the real issues if we allow ourselves to stay stuck in a mindset where another person’s pants choice is of grave concern. Margaret Mead said never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. Isn’t it time to get started

The Roles We Play




       I started to write this post about more comprehensive training and higher standards for certification in this field. I stopped. Then I started writing about the need to constantly evolve and adapt as a caregiver. I stopped again. Both are topics I want to explore and on which I have many thoughts, but not this week. This week, I want to talk about the roles we play.     

         What defines us? I’m a caregiver. I’m also a writer, a starving artist, a scatterbrained and mildly neurotic advocate. I’m a sister and a daughter, a niece and a friend.

          I’m a caregiver but I’m also a granddaughter, two roles that do not go together as well as you might think. She has been a source of unconditional love for my entire life. How many people are blessed with that? No matter how lost, hurt, angry or sick I was, she was there with me.  She knows me better than anyone else in the world. She told me that I was beautiful; that life was beautiful during a period of my life when all I saw seemed so ugly. It wasn’t all sunshine and rainbows when we were living together. I know that. It was a very co-dependent relationship and there was no shortage of enabling. Still, I have never doubted for one second that she loves me and wants the best out of life for me. She has been in my corner from day one. She holds all of my fears and I carry all of her stories.

       I miss my grams. It’s hard to explain…it’s sort of like mourning a person while she’s still alive. I used to think that the families that would visit regularly in the facility were cold and removed. Working in private care and experiencing the impact of my own grandmother’s aging process has changed my point of view. It’s impossible to detach from a lifetime of memories and it’s close to impossible to step out of the role you’ve been in your entire life, be it daughter, granddaughter, son, or brother. It’s like simultaneously grieving the loss of the person you’ve known all your life and getting to know the person she’s become.

       Agitation, depression, slight paranoia, loss of appetite. Stubbornness. Desire to isolate.  The patterns are the same. Everybody loves her. Everybody wants her to live with them and the patterns are exactly the same as those who were in my care at the facility. No one said growing old is for the faint of heart.

     The caregiver in me wants to fix it. She’s physically in good shape and a daily consistent routine that includes activities with others would do wonders for her spirits. Or a trip to NJ to see her great grand kids. Or here to NC. I call her twice a week, fully intending to convince her of this and twice a week I fail. I crumble. I can’t change her mind, I can’t redirect well or set boundaries or negotiate effectively. The skills that have been so helpful in caring for my clients and residents are about as useful in this situation as calculus.

       Finally, I give up and listen as she curses the day she ever moved to be close to us when we were kids and I try not to take it personally. I listen as she lists her friends who have died. Sometimes I can redirect the conversation to her childhood or stories from when my dad and uncles were kids. I listen. I tell her I love her and just listen.

       She feels better after our conversations, wherever they may lead. I can hear it in her voice. I always feel keenly aware of my powerlessness afterward, but I try to keep my voice upbeat as I promise to call again in a day or two. It’s such a small thing, a phone call, a listening ear, but for now it’s the best that I can do.

A Family Affair




“Ma…MA, its right here!” I could hear the amused frustration in my Dad’s voice over the phone. He is staying with my grandma for Easter week and it’s her bowling league day. Eighty-nine years old and she still bowls on a league.

“She spent an hour looking for her checkbook. I gave her a twenty to take with her. She puts it in her wallet. Then she can’t remember which purse she put her wallet in. Finally, I find the purse with the money in it and she forgot that originally she was looking for her checkbook, which is fine because the checkbook is somewhere in the house and now she can bowl in peace.”

The great bowling money escapade. My Grams isn’t suffering from Alzheimer’s. She hasn’t been diagnosed with dementia. She is living with age related memory loss and it is progressing.

For me, losing my keys, checkbook, or wallet is par for the course. I’ve had thirty-nine years of experience of misplacing stuff and disorder. I’m lucky if my clothes aren’t inside out when I leave my apartment. Not her. This is a woman who dropped out of high school after her brothers enlisted in WWII in order to help support her mother and younger sisters. This is a woman who worked two jobs while raising six boys and still managed to make certain that everyone had dinner together. She and Pop moved to SC to help with my brother and I when we were kids. She buried a son and a husband, and carried me through my own troubled times, and still managed to stand on her own two feet. She is a powerhouse. She is also eighty nine and her age is catching up with her.

I can hear it in her voice when I call her; the anger and frustration and sadness and fear that comes from knowing that her mind isn’t as fast as it once was. For a woman who remembered every anniversary, birthday, whose checkbook was always balanced to the penny, who was always the caregiver, these mental slips are a scary, heartbreaking reality. Time is the great thief that none of us can outrun. The best we can do is carry each other through it.

My grams is one of the lucky ones. Everyone in her life loves her. We all want her. Any one of us would gladly take her in our home. The problem isn’t a lack of options. It’s a lack of options that she is willing to take. And I GET it. She doesn’t want to “be a burden”. She doesn’t want to leave her home. Every time I call her and try to discuss it with her, she shuts me down. She isn’t ready. She is the ultimate caregiver, which makes it almost impossible for her to accept the idea that she is the one who needs care.

So we are at an impasse and for now that’s ok. She’s ok. She can’t crochet like she used to, but bowling on a league at eighty-nine is pretty damn good. The time will come when that will change, and as a family, we will cross that bridge when we get to it. It’s so different when it’s a loved one with whom you have a lifetime of memories; a difference that I will be exploring further in my next post.

Let’s Prove Them Wrong




    We have received some wonderful and articulate emails from a reader who posed this question:  How do we make life better NOW for those living with dementia? She went on to explain how advocacy is what drives the flow of funding and most of the funding is going towards finding a cure for Alzheimer’s disease. While vitally important, it does nothing to help those currently living with the disease in the long term care communities. Who is speaking up for them? Who us speaking up for us?

       The frustration is that here on our level, there is little meaningful conversation of such things. We are expected to show up and take what is dished out. We don’t do it for the money, they say. It’s just a “stop-gap” job. If they were smart, they would have furthered their education. Treat someone as disposable for long enough and they begin to feel disposable; begin to act disposable. Is that what we want? Disposable people caring for the most vulnerable section of our society in their hour of greatest need?

      Or maybe it’s an indication of something deeper. They treat us as disposable because on some level they feel that those within our care are disposable. They have aged out. They no longer contribute to our society. Wisdom, experience, history, dignity are not valued commodities in this fast paced world of “me first and the give me! give me! mentality. Old, sick people barely make the priority list and those of us who care for them don’t make the list at all.

      No one SAYS that of course. I have never once seen a bumper sticker that reads Old People Suck and yet the situation in which many seniors and people with disabilities are forced to live is heartbreaking. There is no other word for it. They devalue them and by doing so they devalue us. And I’ve got news for you, folks…we allow it. Hell, sometimes we encourage it by our own behavior.

      One in four seniors will suffer from elder abuse. I’m no statistician, but I would say there is a probable correlation between quality of care and treatment of the work force. One in four. The injuries caregivers suffer on the job is sky rocketing. Again, this is supposition, but I would say exhaustion due to being forced to pull double shifts or multiple jobs to barely make ends meet would contribute to this. The standards for certification is low, the wages are low, the work is difficult, and the turnover is high. Why, why, why would ANYONE choose this quagmire? Because someone has to. Because those of us in the know have a moral obligation to do everything we can to be a part of the solution. Because it’s a battle worth fighting.

         How do we make life better NOW for those living with dementia? For all of those living with a disability that requires care? I have no idea. I’m winging it. I give the best possible care to my client. I write for this blog. I notice lonely people and try to make them less lonely. That’s the only way I know to make any difference that counts. I’ll tell you this though, the most meaningful changes are going to begin with us or not at all. They think we’re disposable. Let’s prove them wrong.       

The Public Image of Direct Care Workers





I wince every time I see the words “nursing home aide” appear in a news headline. More often than not, it involves stories of elder abuse, neglect and exploitation. In fact, the second most common CNA related Google media alert showing up in my email inbox every week involve negative stories about caregivers. The most common are help wanted ads for CNAs. The correlation there is a subject for another post.

Such media reports reinforce negative stereotypes and distort the public’s perception of who we are and what we do. But I’m not suggesting that the media is in any way obligated to balance these negative reports with positive stories about caregivers. It’s naïve to expect it. Unfortunately, the news media in this country has essentially become a subset of the entertainment industry and outrage is a perverse form of entertainment. A negative story gets our attention better than a positive one and it’s not uncommon for reporters to downplay or ignore details that would make the story more accurate, but less interesting. Besides, the headline for a feel good story about what direct care workers actually do would read more like a headline from The Onion: “Caregiver Treats Nursing Home Resident with Dignity and Respect.”

It’s just not news.

As part of its never ending struggle to improve public opinion of Long Term Care, the industry goes to great lengths to counter these negative impressions of direct care workers and present caregivers in the most positive light possible. In this effort, we are represented by the Brochure Caregiver: the lovely stock photography model with a warm smile and immaculate scrubs. Our model is almost always a few years younger (thus indicating a lesser status) than the stock photography models – also with warm smiles – representing the licensed nurses, assorted LTC professionals and administrators. For the LTC industry, image is king.

Caregivers themselves play a more direct, if limited, role in helping to fashion the public image of CNAs. Every time we interact with visitors from the outside, we represent not only ourselves and our facility, but our profession as well. Like it or not, how we conduct ourselves as individuals and the impression we give visitors is a reflection on all of us.

With the advent of a CNA community on social media, direct care workers now have a platform to address public misconceptions of caregivers that takes us beyond the walls of the work place. And we can do this quite independently from the efforts of our LTC bosses. We have the opportunity to directly address both the health care community and the general public and present something much more real and powerful than either the negative media stereotypes or the LTC industry’s glossy image of caregivers.  How we do this is a matter of articulating how we actually see ourselves and our work. We can – if we choose – define ourselves and create our own identity.

In my next two posts I would like to address how we move from image to identity, and ultimately to advocacy and an independent voice.

A Moment of Zen




  At peace. That is what I was feeling. It took me a minute to put my finger on it because serenity is often in short supply for me; a mirage just out of reach that fades as soon as I reach to grab it.

         I always thought it was sort of a tradeoff. I get passion instead of peace and I was more than ok with that. Still, as I breathed in and noticed how relaxed and comfortable I felt in that moment I realized that there is something to be said for inner peace.

        I have run my entire career in this field. Running to the news, running on the floor, running to Long Island and all the while my mind was running too, keeping track of my residents and learning, sometimes painfully, the inner workings of what makes a good caregiver. And make no mistake, that is very important to me. The idea that if we do this right, we are in a constant state of growing and learning.  Ask any seasoned caregiver if they viewed life the same after a year or two on the floor. This is a career that changes you, sometimes for the better sometimes not. The rules and the environment may change, but the very nature of what we do remains the same; we take care of those who cannot care for themselves. I’ve come to know that there is something sacred about that.

       In all of this running and thinking and day to day prioritizing, peace of mind got pushed further and further down on my list of necessities. I only noticed it was missing on the rare occasions when I stumbled onto moments of serenity, followed with fleeting thoughts of “oh! I don’t know what this is but its niiice. I should feel like this more often” and then it was right back to the running.

        Love, loss, frustration, humor, grief, anger, resentment, joy, heartbreak, exhaustion, powerless and empowered at various points, connected, and useful are only a few of the emotions involved in our work. Nowhere on the list is “calm.”  And yet, here I was after a twelve hour shift, perfectly at peace.

          I feel comfortable with my new client. I have slipped into the routine like a favorite pair of jeans. After my first day, I thought ok. This is going to work. It felt like coming home, though it’s private care instead of a facility. There was a familiarity about it and despite the new surroundings, I was in my comfort zone.

       I love that if she wants to take an hour to talk me through how to properly tease her hair because the bigger the hair the closer to God, we can do that. There is no need to rush. I can be on her time frame. I can read to her or just listen. This is a lady with stories and they are my favorite kind of people.

     “I used to be a worrier. Used fret this and that. Never slowed down. Then I had this stroke. That slowed me down. I don’t worry so much anymore.”

       She was only in her fifties when she had her stroke. It hit me like a ton of bricks when she told me that. I do not understand how I can forget so often to be present and embrace the moment I am in when I’m constantly surrounded by such courageous reminders, but I do. I forget all the time.

       I am taking my peace of mind back. Or at the very least I am going to make it a point to embrace the moments and not live so much in self-centered fear. It’s a journey and worrying has never solved a problem. The lives and experiences of every person for whom I’ve cared has taught me this lesson.