Tag Archives: nursing home aide

Heroes and Role Models





When I was 9 years old, my heroes were Detroit Tiger greats Al Kaline and Willie Horton. Like just about every other kid in the neighborhood, I rooted and watched in adoration, wishing someday to be like them. I mimicked their behavior on the field, giving special attention to what they did while at bat. 

Every hitter in baseball performs a uniquely personal ritual before each pitch. This ritual consists of a series of specific behaviors: stepping away from the plate, adjusting themselves (sometimes in PG rated fashion), glancing toward the third base coach for signs, more often than not they spit – no one spits like big league ball players – then stepping back into the batter’s box, perhaps tapping the plate or their cleats, before going into their stance. They do the same thing, the same way, every single time. While every hitter engages in these behaviors for the same reason – to help them focus – both the specifics of the ritual and the batting stance are highly individualistic; no two hitters do it quite the same.

While I imitated their behavior on the field and developed my own set of batting rituals, I knew very little about my heroes’ personal lives and didn’t really think much about it. I was far more concerned with their batting averages then what they like off the field. Since I didn’t know what they were like as real people, they couldn’t actually teach me much about real life. They were heroes, not role models.

The real role models were the people in my immediate environment: my parents, my older siblings, my teachers at school. They were the ones who taught me how to be responsible, how to conduct myself in public, the proper way to treat other people, how to respond to adverse circumstances, how to give and how to receive. And so much more. While they used words to instruct and correct, observing their behavior was what laid the foundations for my values and attitudes as an adult. The most powerful lessons came from what they did, not what they said.

As a young adult, the notion of hero worship seemed awkward and unnecessary. I had become much too sophisticated and cynical for something so childish. But I still had role models. They came in the form of my coworkers, other caregivers whose behavior I admired based on my own values. My formal training and directives from management instructed me to treat the residents with caring and respect, but they couldn’t tell me how to do it.  It was in watching how other caregivers approached and responded to residents, the real-life interactions with all the give and take within the context of care, that provided the model and showed me how to practice genuine compassion. The lesson was in the act and how it made me feel while I observed it.

Later in life, I rediscovered the concept of heroes. However, instead of the larger than life athletes of my youth, they came in the form of everyday people whose behavior I found inspiring in some way. Like a 9 year-old rider named Nathan who I met when I began taking horseback riding lesson a few years ago. Both Nathan and I were beginners, starting at the same skill level. We didn’t end that way.

Nathan was born with a moderate form of cerebral palsy. However, through treatment, including a long series of surgeries, a lot of physical therapy and tons of family and community support, Nathan was able to ride a horse. Not only did he learn how to ride, but he started performing as an equestrian vaulter.

Equestrian vaulting is a unique sport and performance art that combines elements of dance and gymnastics on a moving horse. The horse moves at either the walk or the canter and is tethered by a lunge line operated by an instructor or coach who thus controls the horse’s movement. This leaves the rider free to focus on his or her performance.

I participated in vaulting too. But I never progressed past the walk. While the movements at the beginning level are relatively simple, the fact that the horse is moving complicated things and I couldn’t master even the basic movements at the canter. But Nathan did.

By the time I discontinued my lessons four years later, Nathan was riding at a couple levels above me. As impressive as that was, what really inspired me was the manner and attitude he brought to the sport. As a performance art, so much of equestrian vaulting is about presentation: doing something that is very difficult and making it look easy. While the movements require technical skill and considerable physical exertion, each one is capped with a moment of showmanship: the graceful wave, the smile, the playing to the audience and judges. In these moments, Nathan excelled. He was a natural, the source of his audience appeal came from within. He absolutely loved being on the horse and performing in front of those people. It wasn’t just his success in overcoming the physical obstacles that I found heroic, it was his courageous and irrepressible desire to experience and express joy in what he was doing.

More recently, my concept of heroes has blended with who I consider role models. It’s just one thing now.  I am inspired by and want to emulate anyone who, like Nathan, refuses to allow difficult circumstances to keep them from finding happiness and meaning in their engagement with the world around them.

The reality is that if you live long enough, you’re going to experience loss and change, sometimes deep loss and drastic change. We all, at any age, can experience a sense of existential dread, that underlying anxiety that the things we rely on to give us our identity can breakdown and be taken from us. For our elders in Long Term Care, that dread often is their reality. I admire and learn from those who have suffered this kind of loss, but are willing not just to continue, but have the courage to redefine what to them makes life worth living. As I enter my seventh decade on this planet, these are my heroes, these are my role models.

As caregivers, we need not be passive bystanders, silent admirers to the courage of our elders. Since we are there, with them, we have an opportunity to play a crucial role in facilitating that courage. It’s not a matter of simply telling them that life is still worth living, but to discover to the best of our ability what that means for them, one person at a time. Because that definition is as unique and individual as the batting rituals of the heroes of my youth. 

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!)


More Than Meets the Eye





  People are amazing. I forget that sometimes. It’s easy to do, especially during an election year. I’m so often tempted to retreat into cynicism when I read the paper or hear the news or go on social media. If they were to be believed, we all hate each other. Democrats, Republicans, black, gay, straight, rich, poor, young, old; we just can’t coexist peacefully anymore…except I have a largely diverse group of friends who somehow manage to not kill,  berate, lament, or hate each other over differences of opinions. They are bigger than whatever overly-simplified label is slapped on them. So I know that outside of the 24 hour news cycle, most of us are living our lives and co-existing just fine. All of that rage and animosity toward one another is a mirage, but if we aren’t careful and vigilant that mirage can easily become reality.

     My client is the sweetest woman.  Growing up on a farm taught her to put a high value on work ethic and she worked right up to the day her body failed her and her life changed dramatically in an instant. And she was so young! Barely in her fifties. Her husband also has worked his fingers to the bone his entire life. They started with very little more than wishes and the willingness to work hard and save more than they spend and that hard work coupled with some luck paid off. They have a beautiful beach front house, complete with a dock and boat.

     He could have sent her to a nursing home. He could have and it would have been understandable. Suddenly, their entire life was changed. But he didn’t. For eight years, he cared for her on his own. He had the bottom level of his house redesigned so that she could maneuver. When he could no longer care for her by herself, he hired in home caregivers. 

       Before every shift, I have to take a deep breath and leave my political opinions at the door. I know that I’m in for twelve to fourteen hours straight of conservative talk radio and quite frankly, those people scare me. They make their money by terrifying people and I have found that it is especially effective on the elderly, who tend to view the past through the lens of nostalgia. I want to tell my client that these people who you think bleed red white and blue are the very ones who want to cut funding to the programs designed to help you and others living with similar challenges. But I don’t. I smile and nod and don’t mention how I think fear and insanity are the conductors on this crazy train campaign season.

      It occurred to me recently that there was a time not too long ago, that I would pass a house like that with a Trump sign on the lawn and immediately assign a label and disdain to whomever may be living within the dwelling. It’s instinctual. I would recoil from meeting such people without giving a second thought about it. Backwards thinking, greedy, selfish bible thumping bigots live in such places…except didn’t that make me every bit as guilty as them? Am I an elitist, lazy, ne’er do well who just wants money from the Government and weed? Of course not, but I am a Democrat and that’s how we are painted by the talk radio hosts I have to hear all day. That’s how they paint us and that’s how we paint them and the world crumbles around us as we yell at each other.

       My client is a mother, grandmother, survivor, loves music, Little House on the Prairie and coffee and chocolate. She is delightfully funny and kind. She also happens to be a Republican. Why should her political opinion override everything else about her?  The truth is it shouldn’t. We are ALL bigger than the labels slapped upon us.

       Differences of opinions should not tear apart the very fabric of our humanity. Indeed, this nation was founded in order to allow such freedom. We are free to disagree and it’s ok to be passionate. God knows I am, but the moment we forget that we all have a story is the moment that the tail starts wagging the dog in our society. We start to think that the only way we can be right is if everyone else is wrong. Not only wrong, but dumb, mean, and evil. We lose our empathy and start treating those with differing ideas as if they aren’t even human. It’s a dangerous path to tread. So I refuse to drink the Kool-Aid. I would rather believe my own experience and insight than what other people, from both sides of the political aisle tell me to think. We do not all hate each other, no matter what they would have us believe. There’s a market for panic and anger, fear and vengeance because scared, angry people are much easier to manipulate. This campaign season is the proof in the pudding.  I’m not buying any of it.

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.

The Moral Authority of Caregivers




Even in the worst work environments caregivers have the opportunity to make an immediate and positive impact on how residents experience life in long-term care. So much of what our elders experience depends upon the quality of the interactions we have with them. Whatever our difficulties, we are ultimately responsible for the manner in which we approach and respond to our residents. At the same time, how we conduct ourselves as caregivers has significance that can go beyond our ability to impact the immediate environment.

Caregiving is a practical art. Our role involves us in the details of the daily routines of our residents, but not necessarily in the larger issues of Long Term Care. While we are profoundly affected by things like poor staffing ratios, direct care staff turnover and disconnected management, the conventional wisdom among caregivers is that we simply don’t have the authority to do much about those things and the only option we really have is accept things as they are or find a different place – or field – to work.

Meanwhile, we leave the larger problems to those who we believe have the real power: the administrators, regulators, legislators and assorted LTC professionals. However, no one has greater awareness than direct care workers of how chronic understaffing and turnover rates actually impact the care and well-being of individual residents on a day to day basis. We know what it looks like and we know what it feels like to our residents in a very real way. We can give these problems texture and a real sense of the human cost. Our experience in the trenches of Long Term Care provides us with a unique perspective, a perspective that is very much needed if Long Term Care is ever to truly come to grips with its problems.

While caregivers lack formal authority, we can still influence those who do have formal authority. Our real world experience gives us something valuable to say. Our capacity to convince others that what we have to say is valid depends on our moral authority. But if we are not doing everything we can as caregivers to improve the immediate environment of our residents, then why should anyone listen to us about the bigger problems? By taking responsibility for our own behavior and conducting ourselves according to what we know by reason is right – in spite of difficult circumstances – we provide the basis for our moral authority.

And with that, we cannot be ignored.

We Need More Caregivers




Well, they’re at it again. Nursing home operators and advocates for quality nursing home care are bickering over nursing home regulations and how much regulation is enough. This time they’re facing off in Kentucky. The operators and their supporters claim the current regulatory environment in Kentucky invites “toxic litigation” and that the funds used in such settlements and other fines could be better used to improve care and reduce costs. The quality advocates and their supporters say that’s nonsense and that regulations and penalties are put in place to provide an incentive to put resident care above the bottom line.

This is an old battle. It’s been going on since the 60’s when Medicare and Medicaid came along and nursing home operators discovered how much money there was to be had in the LTC business. Long Term Care facilities were not as closely regulated as they are today and the resulting “hell hole” horror stories gave nursing homes a bad name. Then OBRA came along in the late 80’s and conditions seemed to have generally and gradually improved since.

While OBRA was landmark legislation, the above is an oversimplified version of events and it took much more than government oversight to put Long Term Care on the right path. It took – and still takes – many different people from many different directions to make Long Term Care work and evolve. And sometimes those people coming from different directions clash.

From a caregiver’s perspective, these two adversarial camps, the operators-administrators-managers and the regulators-advocates-surveyors, can be seen as one big group. As a group, they collectively create and enforce the standards and policies under which we work. However, by the time all of this gets to us, what they’ve come with often doesn’t make much sense.

Oh, the particulars are good. It always about making some improvement in our residents’ lives. No one is going to argue for bringing back vest restraints or argue against resident privacy rights. We all accept that regulatory oversight and the policies that result from it are both necessary and well-intentioned.

What doesn’t make sense from a caregiver’s perspective is that the additional duties created by these regulations and policies are rarely accompanied by a corresponding increase in direct care staffing levels. We are simply told to do more with what we have. When I started in 1977 my resident group included 12 residents on second shift and 10 on first. While some places have improved on this, that ratio is still pretty much the standard. And due to difficulties in keeping facilities properly staffed on a day to day basis, the reality is often worse.

Not too long ago, I conducted an informal Facebook poll of direct care workers regarding care plans. My question: “Do you feel that your workload is light enough to enable you to consistently meet the care plan goals of all the residents assigned to you?” The overwhelming response was “No,” often expressed forcefully – and sometimes, colorfully. Out of 303 caregivers, only four answered yes.

It reminds me of that classic definition of “a mess”: A mess is trying to fit ten pounds of manure into a five pound bag. When you simply pile on more work but fail to provide more direct care workers to do it, you’re going to have some kind of mess.

Dear Operators-Administrators-Managers-Regulators-Advocates-Surveyors and assorted LTC professionals: we simply cannot do what you ask with what you’ve given us. Believe us, we want to do everything you ask of us – and much, much more. Perhaps you could find a way to work together and help us out a bit here?

Why are CNAs so Poorly Paid?





This week there has been a lot of talk in the media about the movement to raise the minimum wage to $15 an hour.  While most of the attention was focused on fast food workers, advocates for direct care workers took the opportunity to highlight the negative impact that poor wages have upon caregivers and their residents. In a Wednesday article for McKnight’s, Matt Yarnell, the Executive Vice President of SEIU Healthcare Pennsylvania, pointed out that nearly one in six of the state’s nursing home workers are paid so poorly that they are forced to seek public assistance through the Supplemental Nutritional Assistance Program, Medicaid or both.

Yarnell wrote “If we are serious about providing the highest quality care for our residents, then we have to back our rhetoric with action. It means we have to provide living wages to caregivers to cut down on turnover, to not force caregivers to work excessive overtime and double shifts. It is about not forcing workers to have to look to the state for public assistance to provide for their families.”

Why are direct care workers so poorly paid? A common argument points to the low educational requirements necessary to work as a caregiver. Often this point of view comes from within the Long Term Care community itself.

It’s true that the technical skills of a caregiver can be taught relatively quickly. Things like the principles of basic hygiene, taking vitals, infection control practices and proper body mechanics are pretty straightforward and don’t require a lot of advanced study. However, while formal training serves to create a basic necessary skill set, the real education for a caregiver doesn’t begin until he or she starts working with residents and fellow coworkers. The art of caregiving is learned through a combination of practical experience and mentoring from other workers. For those open to it, this is a learning process that can last the duration of one’s caregiving career.

The real value of experienced caregivers cannot not be found in their technical skills – or in anything that formal education could provide. Rather, it is in their capacity to perform well under difficult – often unreasonable – circumstances without losing their basic sense of humanity. It can be found in their ability to engage residents on an emotional level while under the duress of constant time restraints. It can be found in their willingness to support and sometimes lead their fellow coworkers in an environment that lacks adequate formal supervision. It can be found in their desire to serve as an example of how one human being should treat another without regard to roles or circumstance.

Good caregivers have a monetary value to the Long Term Care industry beyond what their technical skills and education can provide. The industry could not exist in its present form without their effort and caring. CNAs are truly the backbone of LTC. And their heavy lifting does not always involve transferring a resident.

The real reasons why caregivers are so underpaid are rather complex and go beyond educational requirements or even greedy nursing home operators. It is a very real social problem with direct implications to the well-being of our elderly and disabled citizens and should be treated as such.  

The Value of Vulnerability






It’s no secret that caregiving requires a certain type of toughness. We often discuss the toll that the physical, mental and emotional stress of this career puts on our bodies. It’s not an easy gig and to consistently do our job well requires strength, fortitude, and willingness to sacrifice. Our patience is often tested on every level by everyone and still, we must carry on. So yes, though it may not be listed in the job requirements, toughness is a skill that is needed to perform our duties.

        On the flip side of that is vulnerability. I have discovered that one of my most useful assets in this field has been a willingness to remain in touch with my own personal vulnerabilities in order to better relate and connect with my residents.

       It’s not a comfortable feeling for me, vulnerability.  Outside of work, I adhere to a never-let-them-see-you-sweat-pick-yourself-up-by-the-boot-straps-and-look-at-the-bright-side philosophy of life. I like to take action! After all, it’s hard to hit a moving target.

      There is a certain level of denial in constantly trying to maintain such a mentality because the truth of it is, we are ALL vulnerable. It comes with the territory of being humans. For me, one of the greatest lessons of this career is that I’ve had to get past that intrinsic need to be a Pollyanna in order to truly reach some of my most challenging residents.

       Lonely, sick, hurting, scared people do not WANT to “look on the bright side”. They do not want to “smile”.  They DEFINITELY don’t want to be told that all things happen for a reason and that people are praying for them. As well-meaning as such sentiments are, they lack the substance to cut through the fog of depression and fear that most feel upon losing their sense of independence and, in a very real way, their freedom through no fault of their own.

        I do not know what it is like to live with cerebral palsy. I do not know what it’s like to have suffered a traumatic brain injury, or cancer, or severe mental illness. I would never tell any of my folks that I know what they are going through, because I do not. That DOESN’T mean that I’ve never felt the emotions that they may be feeling. THAT is where the gift of vulnerability comes in handy.

        When I dig within the deep wells of my own personal experiences, painful though that may be, I find a wealth of emotions, good and bad, that I use to empathize with my residents.  I know all too well what it’s like to feel alone, powerless, scared, hopeless, lost, stigmatized and like an outcast. I know what it’s like to feel anger at situations over which I had no control and I know what it feels like to lose your dignity.  I know this through my OWN life experiences and I know the tools that have helped me to get through it.

        This in no way qualifies me to “fix” my folks. I can’t fix anyone. What I CAN do is relate on a deeper level. I can share my experiences when appropriate and I can be open to being emotionally vulnerable to those who, by necessity, are forced to be vulnerable with me.

The Broken System





On CNA Edge, we sometimes describe long-term care as a “broken system.” I’m guessing that most caregivers who have been in the business for any length of time have a general idea of what we mean by that. They nod their heads, shrug their shoulders and go back to work. It’s just the way it is.

But, really… what do we mean by “a broken system?” I think we can look at three major areas.

First, the average workload for direct care workers often makes it difficult to meet even minimum care standards. Recently, I conducted an informal poll in one of the CNA Facebook groups, asking this question: “Do you feel that your facility has enough staff working direct care to consistently meet the goals stated in the resident care plans?” About three hundred caregivers responded. Two people said “yes.” The rest gave various versions – sometimes colorful and emphatic versions – of “no.” While this was not a scientific poll in any way, it is still supportive evidence for what most caregivers take as an obvious truth.

Second, despite some efforts to integrate caregivers into the decision making process, long-term care still relies heavily on hierarchical relationships. However one wants to sugarcoat it, caregivers remain on the bottom of the pyramid. While there is nothing wrong with this traditional organizational model per se, in long-term care it fails in one significant respect: it does not address the deep communication gap that exists between those who set the parameters of care on one side and those who are expected to work within those parameters on the other. On the other side of the gap, the primary focus is on words and the manner in which words are used for professional and public consumption. On the caregiver side, it’s about action. It’s about how one interacts with a resident physically and emotionally within the context of care. The higher up you go in a hierarchy, the further those in authority are removed from that context and upward communication loses its meaning. In effect, we maintain two parallel realities with each having its own set of priorities.

Third, whether it’s a matter of maintaining a well-organized routine, fiscal constraints or legal considerations, the needs of the facility all too often trump the needs of those who live there. While large organizations are able to centralize services and provide an efficient way of utilizing resources, this comes at the price of limiting flexibility. When facilities discourage workers to proceed according to their own discretion and do not trust their ability to apply common sense and act according to the spirit of the rules rather than to their letter, the needs and desires of individual residents are often considered unreasonable or simply neglected. The purpose of a long-term care facility is to return as much as is reasonably possible to a resident’s life what disease and circumstance have taken away. In the name of efficiency, we routinely work against that purpose.

To be sure, all these areas have improved over the course of the last 30 years. We’re getting better at it, but the progress has been uneven and there is no doubt that there is still a long way to go. The question becomes, where are we going? That is, from a caregiver’s perspective what does a system that’s not broken actually look like?

I’ll give you my take on that in my post next Friday.

The Short-Staffed Story



It’s staring me in the face the entire time I’m getting my coat on. It’s mocking me with its very existence. I want to smash it into nothing, I want to scream insults at it. Mostly, though, I want to go home and not come back until I feel like a human being again.
“It” is a list of all the open shifts for the month…there’s enough to fill a full-time position or two. Or several.

We’re all in overtime already: we few who have stuck it out during this incredibly rough period. Every place has its bad stretches–we’re in the middle of one right now.
Every aide that leaves puts more work on the rest of us. The heavier the workload, the more aides that get fed up and leave…and when it’s like this, overworked and understaffed, it is hard to convince the new aides to stay.
Why would they? It’s crazy and ridiculous and nobody is happy to be at work. Another newbie quits and we all sigh and try to prepare ourselves for another week of 10-12 residents per aide.
When CNAs are short-staffed, they’re also overworked. It’s just the way it goes.

According to the charts in the office, twelve isn’t that much more than a standard group of 8-10 residents per aide–no big deal, right? It’s an acceptable solution to the problem of not-enough staff. Just give every CNA a couple more people, maybe three or four and there you go: we’re covered for today. Whew. Saved by simple mathematics.
But on the floor, having twelve people instead of eight means more call lights going off at the same time, it means no ten-minute breathers. It means later lunches, messy rooms, soiled pants, too-long finger nails and unshaven faces. On the floor, it becomes a problem of subtraction, not addition. What it really means is that you’re taking time and care away from all twelve residents.
What it means is I don’t have time to change Mrs. Q’s sheets because Mr. W needs to get dressed. I don’t have time to walk Mrs. E because Mrs. R’s call light has been going off for 20 minutes. I can’t spend a few minutes chatting with Mr. T because Mr. Y’s alarm is going off. Mrs. U and Mrs. I can’t go to bed yet because they are mechanical lifts and I don’t have anybody to help me right now. Mr. O has to feed himself, even though he really needs supervision because Mrs. P can’t feed herself at all. I can’t brush Mrs. A’s teeth, because I can see Mr. S coming down the hall with soaked pants–understandable, since I haven’t had a chance to touch him all shift.
Understandable to an overwhelmed CNA, that is. Try explaining that to his family. Try explaining that to him.

And while it might be “understandable” to the aides, these kinds of situation are most certainly not acceptable. Not to the good aides. We who take pride in our work, we do not enjoy seeing our residents unkempt, soaked and soiled. But what can we do? Stop time, clone ourselves, refuse to work unless safe staffing laws are passed?
If only.
What we can do is come in early and stay over late; we can skip our ten-minute breaks, we can pick up extra shifts so that our residents can get the high quality care that only comes with adequate staffing. We can take on extra work during a shift in hopes of keeping the newbies for more than two weeks.
Sometimes these measures, so wearing on us, seem like fingers in the dike. It’s not enough. It’s never enough. We go above and beyond but we still can’t reach. Bad days and double shifts stack up into a wall of weariness; the higher it gets, the harder it is to remember why we cared enough to make these sacrifices.

I’m not quite there yet. I can still feel the shame and the anger that comes from a job badly done. I’ve failed them. I’ve failed my residents, who are both my responsibility and my friends.
But it’s not my fault. I didn’t ask to have a group of 12 residents. I didn’t ask to have a whole hall to myself. This wasn’t my choice, this isn’t on me. I’m only human, I can only power through so many short-staffed shifts. I am aware that at other facilities, the ratios are much higher–up to 20 residents per aide–but this doesn’t make me feel better about the twelve people whose care has seen a noticeable decline since we’ve been short-staffed. What more can I do? What more should I do? Is it always going to be this way? How much more can I take? How much more should I take?

There’s a note on the sign-up sheet. “Thank you for all you do,” it says. “It doesn’t go unnoticed. We know it has been rough. Hang in there, we’re trying to get more staff in. Just keep being awesome for a bit longer.”
I start to tear up. They see. They see. Some would say it’s a ploy to milk more hours from us, but from the dollar signs offered next to the note, I’d say they’ve got their money where their mouth is.
Okay, I think. Between the note and the big bonuses, I’ve changed my mind. I can work nine days in a row. I can handle a double in that mix. I can do it. My back hurts, I’m always tired, I never see my friends or my family, but I can do it. I can do it again.
Next week, though. Next week I cut back. Next week I rest.
Maybe next week, they’ll have a new aide in. Maybe.
I won’t burn out; I’m not drinking that poison again. I’ll fix a smile on my face and I’ll work this week because my residents need me. My employers need me and they’re acknowledging that. They see and they appreciate me; I’ll give them one more week of my free time.
Next week I’ll cut all the way back to 40 hours and I’ll take care of myself…because my residents are going to need me in a month, a year.
I’ll damn the broken system and laugh with my residents because I chose and am choosing to be a CNA. Nobody and nothing is taking away my joy in my vocation.