Tuesday, December 28, 2010

2010 Review; Will I finally NOT talk about work?

1. What did you do in 2010 that you'd never done before?
Bought a business (unrelated to nursing, my husband and I now co-own a small business in the town we live in).
Set a cookie sheet full of marshmallows on fire trying to make a toasted marshmallow milkshake on Valentines day.
Started watching Season One of Smallville and fell completely in love with that show.
Crocheted a very ugly "ruffly" scarf, and then donated it to Goodwill. Oops.

2. Did you keep your New Year's Resolutions, and will you make more for next year?
Er . . . some of them. I found a job I like that is full-time. I didn't stop drinking Diet Coke (far from it!) or get my NA certification, or spend a week eating raw. Ooops.

3. Did anyone close to you give birth?
Nope. That's fine, I think birth-giving is gross, although I like babies.

4. Did anyone close to you die? Nope. Several residents did, so I got to experience death up-close for the first time, but I wouldn't say I was especially close to any of them.

5. What countries did you visit? I didn't travel.

6. What would you like to have in 2011 that you lacked in 2010? Education. I want to go get my g.d. prerequisites DONE.

7. What dates from 2010 will remain etched upon your memory, and why? Maybe my birthday (March 18th) because I had a mysteriously swollen lip, took benadryl, started mildly hallucinating and then went out for mexican food and to see Alice in Wonderland. I made friends with a group of ladies wearing moustaches along the way.

8. What was your biggest achievement of the year? Surviving all those months of working 2-3 jobs at a time so that we could stay afloat until we officially bought the business.

9. What was your biggest failure? Lack of going to school or progress in my career.

10. Did you suffer illness or injury? Oh sure. I also got very afraid of zombies.

11. What was the best thing someone bought you? An election. That's all I can say.

12. Whose behavior merited celebration? Everyone who helped repeal DADT.

13. Whose behavior made you appalled and depressed? The dept. head that I got into it with the other day.

14. Where did most of your money go? Rent and food. Pretty important stuff, actually.

15. What did you get really, really, really excited about? THE PRINCESS AND THE FROG! Best Disney movie in AGES! So, so good!

16. What song will always remind you of 2010? "Almost There" from the Princess and the Frog. Watch that part of the movie. See her cleaning out the cobwebs from that building so she can open her business in there? That's ME! See her getting home from one job, laying down for 5 seconds, then getting up to go to her next job? That was ME! Anika Noni Rose, you put voice to my life in cartoon form this year.

17. Compared to this time last year, are you:
a) happier or sadder? A LOT happier. By about a million times.
b) fatter or skinner? Same-ish? Maybe skinnier?
c) richer or poorer? Same-ish?

18. What do you wish you'd done more of? Panhandling outside the Black Bear Diner in a bear costume by pretending to be a "Grrrrrr-eeter"

19. What do you wish you'd done less of? Worked until I could fall asleep standing up.

20. How do you plan to spend Christmas? Already done! Worked 6am-2pm Christmas Eve and Christmas Day. Eve, I stayed home with my husband, had dinner, opened gifts, and watched SmallVille. Day, I visited family which was fun but stupid because we were out till almost midnight and I worked at . . . guess when . . . 6am the next day. Ouch.

21. Did you fall in love in 2010? I stayed in love. November was our 8th anniversary and we're still very happy together and laugh a lot. It's pretty great.

22. How many one night stands? I don't have a night stand, I have a shelf by the bed to keep my books and glass of water on. And as mentioned before, I'm married. I did have, unfortunately, lots of nights where I had to stand up all night when I worked noc shift. NEVER AGAIN!

23. What was your favorite TV program? Smallville! I also liked Nikita. And Top Chef: Just Desserts. And Nurse Jackie and Scrubs on DVD.

24. Do you hate anyone now that you didn't hate this time last year? Yeah, I hate and always will hate the douche we bought our business from for making 2010 one of the hardest years of my life by being almost impossible to negotiate with. What could have been a pleasant process turned into months of me working nonstop trying to keep it together while that asshat dithered around bitching about nonexistent things and ruining his wife's life. I hate him for that.

25. What was the best book you read? Meg Cabot's Insatiable. That woman cracks me up and I was DELIGHTED that she wrote a vampire book. Made my month!

26. What was your greatest musical discovery? Rebirth Brass Band. Iron Maiden.

27. What did you want and get? To be a small business owner!

28. What did you want and not get? My NA certification. But I will soon.

29. What was your favorite film of this year? I've been talking about it nonstop, so let's say it together: "The Princess and the Frog". Even has John Goodman in it! I love him too much.

30. What did you do on your birthday, and how old were you? Inadvertently tripped on benadryl at the age of 28. Sheesh. I'm awesome.

31. What one thing would have made your year immeasurably more satisfying? To get to play one of those dancing videogames where it watches you with a camera and you dance around.

32. How would you describe your personal fashion concept in 2009? Scrubs/PJ's/Jeans and Goodwill.

33. What kept you sane? Hoodoo.

34. Which celebrity/public figure did you fancy the most? Ryan Reynolds.

35. What political issue stirred you the most? Healthcare reform.

36. Who do you miss? All those dumb hooches (college friends) that decided to move across the country. I miss them!

37. Who was the best new person you met? There is this dog that comes into our small business. His name is Legion. He's all low-key and nonchalant and doesn't even need a leash, ever. You can talk to him all casually and he gets what you're saying.

38. What was the best thing you ate? Red beans and rice with tempeh was my quick-and-easy staple.

39. Tell us a valuable life lesson you learned in 2010? Don't give up. Keep trying, and there are always more jobs out there; don't feel trapped in one you hate. But get a new one before you quit.

40. Quote a song lyric that sums up your year:
There's been trials and tribulations
You know I've had my share
But I've climbed the mountain, I've crossed the river
And I'm almost there, I'm almost there
I'm almost there!

Wednesday, December 22, 2010

Christmas Gifts for the Nursing Assistant in Your Life

Do you know someone who does the same type of work that I do? That actually enjoys it, I mean, not someone who'd rather not be reminded of their work?

Well get ready to impress 'em with your amazingly intuitive knowledge of what he or she would like to have for Christmas this year!

1. My FAVORITE EVER under-scrubs shirt: made by Skechers Medical Scrubs. I realize that the stock photo looks like I'm trying to get you all to wear a teal leopard-print shirt under your scrubs, but I promise this is not the case. It comes in different colors (I have it in dark blue, want it in white as well) and the pattern on it comes from little burnout words like "trust, hope, care" and little daisies. Reserve for the lady CNA's in your life, probably. Why I love it so much? It's warm enough to make me a little more comfortable when I've gotta leave the house before 6am in December, makes my unisex scrub top look a little more feminine, and protects my forearms from pinches and scratches (from residents, not coworkers!) without being bulky or overly hot to wear all shift. LOVE IT!

2. Travel/Sample size bottles of hand sanitizer. I know a lot of facilities have sanitizer stations bolted to the wall, but mine doesn't because that'd be unsafe for our residents (who might drink or eat it). So I like having a little bottle that fits in my pocket. I don't know if Germ-X is actually moisturizing, but it definitely smells the best of any of the brands I've used. Lemony, not flowery.

3. The only thing on this list I haven't actually tried yet, but am DYING to. Lots of people in the nursing homes/AL facilities I've been to have started wearing those Skechers Shape-Ups, and say they really are more comfortable for being on your feet for hours at a time. They're also really ugly and have thick soles, making them easy to fall off of. Same with the Masai Barefoot Technology shoes, which are pretty much the same deal for twice the price. That's why I'm drooling over these New Balance toning shoes that claim to do the same things, but with less risk for those (like myself) that fall over more than your average bear. Plus look how dang cute the black and pink ones are. AND THEY'RE SYNTHETIC, NOT LEATHER!! Can you feel my little Polly heart pitter pattering?

4. A home cooked meal. Seriously, we work really hard and get really hungry. I'd freak out with joy if someone gave me a frozen casserole or something that I just had to heat up and eat. Maybe that's just because I'm vegan and therefore end up cooking for myself 99% of the time. But even omnivorous CNA's would probably appreciate getting to eat something tasty and healthy that someone else cooked. Especially if it's free. We love free food. We're underpaid. And hungry! (One of our resident's daughter brought in multiple 3-foot-long subs for each shift and they disappeared so fast you'd think a football team had packed 'em away. But no, it was my coworkers, including the teensy tiny ladies. They can EAT.)

5. A Sappy Christmas Ornament; if he or she likes their work, and especially if he or she has ambitions beyond nursing assistant. I got teary-eyed over this one at Hallmark at the mall tonight. Yeah, really. Probably more to do with my delight over finding out I can become an RN faster than I thought (more on that later) but still. If your NA is a sap like me, get them something sweet like this. I know, I'm a freak, but I would love having one where I can look back and go "oh, that's from the year I realized I wanted to be an RN!". Okay, I'm seriously considering deleting all this now. But whatever. Almost no one reads this anyway, right?

Tuesday, December 21, 2010

The Tattletale Diaries

Sometimes, in Long Term Care, there's drama among employees. Shocker, right? I generally stay out of it, which has been particularly easy with how often I've changed jobs over the past year. The only one that's been constant was the HomeCare Agency and I worked solo there, only seeing other employees if we were doing a shift change or at the occasional meeting.

I'm also a firm believer in handling minor conflicts myself. It's really not that hard to say "hey, that bothered me" or "In the future can you please ..." to a coworker. It's a little harder to say to a supervisor.

Up until today I had only reported one other employee at any of these jobs; at the Crapdorable place, one of the caregivers was so rough with the residents that they would hold off on using the bathroom or going to bed until shift change so that they wouldn't have to be handled by him. Many of them told me this, more than once. So obviously, I reported him. And felt no unsureness doing so - I'd also have happily told him to his face, and did jump in to stop him once when I observed it firsthand.

So when, yesterday, one of the Department Heads interrupted an activity with our residents and started talking badly about gay people in front of everyone I had a problem with it. And I let her know, right then and there. And she wasn't deterred. Seriously, this woman STOPPED AN ACTIVITY for the old people and started talking about the repeal of Don't Ask Don't Tell. And how servicemen and women shouldn't have to shower with gays. And that gay sex "doesn't work" (illustrated with hand gestures). And that at best, she could "love the sinner but hate the sin".

My responses, for the record were, 1. If the most uncomfortable thing a soldier has to deal with DURING A WAR is showering with someone else, he is doing very well indeed. They know they're signing up for all sorts of horrific things, and if anyone is willing to do so, they should be able to. 2. Ew, that's gross, please stop with the gestures. 3. Oh . . . kaaaaaay?

It was astoundingly inappropriate and uncomfortable. And it was all in front of the people we're there to take care of. And she only stopped when, finally, the charge nurse came into the room and changed the subject.

So, since me cutting her off with "I have several gay family members and don't like hearing that stuff" at the beginning of her rant didn't work, I went over her head today. And was nervous about it.

And it went really, really well. I talked to my Director of Nursing, who asked me some questions about it (and sounded genuinely shocked that all this happened in front of the residents) and asked me to give her a little written statement, and promised she and the other Boss Lady would handle it. And to let her know if I catch any flak for this from the Homophobic Dept. Head.


I'm so relieved. I do really like working there (really enjoy almost all my coworkers and the residents I care for) and was super disappointed by this. But as long as it gets fixed, I can keep being happy where I work and proud of the place where I do it.

Thursday, December 16, 2010

We Heart Volunteers

We get a fair amount of volunteerism at the GreatRep. There are people that bring in dogs to visit with the residents, people that come read aloud to everyone, people that do crafts, people that put on musical performances. You'd think that all our volunteers would be pretty normal, but they're not. They're often just as weird as the rest of us in there (staff and residents both). There's the guy that comes to sing and play guitar almost every week, who's incredibly tone-deaf. There are people whose ideas of "activities" are so half-baked that I really worry they're going to get scared and leave. There are people who set off the exit alarm every. single. time. they come and go.

My favorite are the well-meaning oddballs. We've gotten lots of them lately, it being holiday season and all.

Yesterday was extra awesome because the musical volunteer of the day looked a lot like If Wayne Newton Dressed Like Merle Haggard. He had a special synthesizer-thingie that made his backup music, and a microphone and everything. He set up in the dining room, so we brought anyone who was willing in to listen to him while we passed out snack.

First of all, you've gotta have balls to show up and sing to a room full of people with dementia; they're not your typical audience and they won't be shy to let you know if they dislike what you're doing. And if they do like it, they may not show that at all. So I give the guy credit for that, plus he really did have a very nice voice. He sang Christmas songs for the most part, and did it well.

The part that really made him the December Standout in my book is that he'd stop between songs to do a little patter as if this were a nightclub. So after a rousing rendition of Rudolph, here's what we were treated to:

"So a few years back, my wife and I were driving home from cutting our Christmas tree and she looks out the window and sees some reindeer in the field we're passing by. She's shocked because she didn't know that reindeer were a real animal! So we pull over, and walk around the truck, and go up to the fence and look at the reindeer. About now I decide it's time to play a little joke on my wife. So I says to her 'Honey, what you might also not know about reindeer is that if you talk to 'em, they'll talk back to you.' She looks at me skeptically, but I'm insisting here, 'No baby, really, go up to one, and say niff and it'll say niff right back to you!' She told me I was full of it. So I tells her again 'Just say niff niff to them, it'll work! They'll say niff back to you.' "

(he went on like that for a while repeating "niff" a few more times to make sure we all knew he was trying to get his wife to say "niff" to the reindeer)

"I said really, I know it's strange, but you just go right up to them and say niff..."

which is when LeeLee (resident) decided she's heard "niff" enough times and interjected "What the hell is that?" which then made me laugh hard and silently.

Her reaction was way funnier than the climax to his story, which was that he came around the side of the truck and heard his wife whispering niff to the reindeer to see if it was true, and he laughed at her.

LeeLee knows what's up. "Niff"??? Really. What the hell IS that?

Monday, December 13, 2010

Picture David Letterman reading this aloud

Top Ten Ways you know Polly had a Difficult Shift
(her first evening shift off training, to boot!)

10. She missed the nurse giving report because she had to run and catch a man that was trying to walk but couldn't.

9. During report, she would have discovered that not only couldn't this man walk, but he was trying to because he needed to poo approximately every ten minutes.

8. She also would have found out that she needed to obtain a urine sample.

7. Since coworkers filled her in, she got the urine sample. And also got her own pants covered with someone else's tarry black poo.

6. The highlight of her night was when one old lady, overhearing another one screaming away in the shower room, looked at her and said "Is that YOUR baby?!?" incredulously.

5. Her proudest achievement of the evening was a toss-up between getting one lady to drink her milk by spoon-feeding it to her, and getting another to remove her dentures.

4. 10pm found her so sweaty from transferring this suddenly non-weight-bearing man that she needed to change all her clothes.

3. 11pm finds her in clean clothes, muscles so knotted that her husband gave her a drink before even trying to un-knot her shoulders.

2. She walked in the door wearing highwater stretchy corduroy pants from the lost and found, because her own scrubs were covered in that black tarry poo from before.

1. Contents of Polly's car: 1 pair scrubs, bagged up, waiting to be laundered and disinfected. One empty diet coke.

Saturday, December 11, 2010

Up to the minute technology

Okay not really. But I do like to try out new little tech stuff, even though I barely ever actually KEEP using it (sorry foursquare, I abandoned you a long time ago). So I was listening to one of the podcasts I like and they were answering questions they received via formspring. So now I have a formspring. Which I know very little about.

Basically it's so anyone can ask me questions anonymously, it seems like. In that little pink box over there to the right. And then I'll answer them, woo-hoo!

Let's all give it a shot and see if we can figure it out, huh?

And as long as we're on the topic of podcasts, here are some that I love:

1. The Nursing Show: News, Tips, and Commentary for Nurses and Students
(usually really, really informative and up to date, plus I LOVE the interviews with people that work in different branches of nursing and hearing how they ended up there).

2. Stuff You Should Know
(short overviews of a huge variety of topics, from Jack the Ripper to saunas to why we feel full after eating. Handy and entertaining).

3. Answer Bitch
(hollywood gossip & news, very funny, awesome for long drives or while I'm doing the dishes).

You can find any of them by searching in iTunes or whatever it is you use to listen to podcasts.

Formspring me!

Wednesday, December 8, 2010

Odds & Ends

I finished up my evening shift training this week, and it's official: I like 2nd shift better. Not having to wake up at 5am is a big plus, as is only having one meal (dinner) during the shift. The sundowning residents are a drawback. The biggest reason is the coworkers, though. The eve shift coworkers are much more laid back and helpful - day shift coworkers have (99% of the time) been helpful with me (probably because I'm new) but with one another? Not always. Plus one showed up with a disgusting infected finger and was about to go out on the floor to work until we all basically tackled her and got the charge nurse to look at it and send her to a clinic STAT. Ew. No common sense on that coworker, that's for sure.

Tip for the common sense impaired: if any part of your body is swollen and infected, and especially if it's leaking pus, GO HOME AND GO TO THE DOCTOR. Infection can spread to your bloodstream and kill you.

Moving on.

Funniest conversation I had with a resident this week:

Lady (freshly out of the shower, seated safely on dry chair & towel): Can you dry my back?

Me: Sure, here we go.

Coworker pops in, hands me a med cup full of ointment: This is her ointment from the nurse, can you put it on when you do her pericare?

Me: Sure, where?

Coworker: (makes incomprehensible hand gestures)

Me: Bottom or vagina?

Coworker: vagina.

Me: okay thanks.

Lady: Are you gonna put that on my vagina?

Me: Yes Ma'm, I am.

Lady: Do you know what you're doing?

Me: Yes Ma'm, I have my gloves on so I won't give you any germs, and I do know how to do this.

Lady: Well... all right then. Wait a minute. Are you married? (giving me the suspicious stink-eye)

Me (heroically not laughing): Yes Ms. Smith, I'm married. I promise this will not be a personal thrill for me, I just want you to stay healthy, and this is my job. Okay?

Lady (relived): Oh all right then.

I swear, I never know what these people are going to come up with. And what was up with my coworker's crazy gestures? I'm going to do that to her next time I see her. In no world is what she did a gesture for vagina. Maybe "pick up a lobster this way" or "the elves heads are shaped this way" but not "vagina not hiney".

Coolest medical phenomenon I saw this week: Raynaud's phenomenon. It's not harmful or painful or anything, just a startling color change in extremeties when someone is exposed to temperature change. Such as getting out of a warm shower. One of my resident's fingers looked a lot like this photo from wikipedia (the bananafingers not the blue ones). Charge nurse checked and confirmed that was all it was, and they were back to normal very quickly. I'd heard about Raynaud's on a podcast but hadn't seen it in person before, so that was cool.

Other than that, I'm doing my state-required training for the last 3 days of the week, so that'll be boring but maybe useful, and definitely not too tough. Which is good since I burned up my throat with an unfortunate burrito-from-taco-truck choice yesterday and it's still sore, so it's nice not to have to speak EXTRA LOUD for anyone for a bit. Sidenote - wish I could handle spicy food better.

Tuesday, December 7, 2010


Sometimes I want to hate doctors for no reason. Sometimes I probably wouldn't hate them for whatever if I actually understood what their reasoning is for things. This is probably one of those times. There must be a perfectly good reason for requiring a clean-catch urine sample to diagnose a UTI even if the patient has had UTI's in the past and the care staff can easily recognize the signs. Even if the nurse could do a dip on a regular sample or send that out to the lab for verification.

(note: UTI = urinary tract infection; little old ladies get these a lot and they can cause pain, low-grade fever and increased confusion. They're fixable with antibiotics.)

But it seems stupid and mean to me, the lowly caregiver, that we have to hold still a really sweet lady with dementia, and the nurse has to put in a catheter for a few seconds so we can get that elusive clean-catch urine sample. We were all almost in tears at the end of it; I held one hand and food, a coworker held the other two, the nurse did the cath, and another caregiver held the light for the nurse so she could do it as fast and accurately as possible. Our poor resident was upset, we were upset, and I thought the Doctor Is Stupid. We got our resident cleaned up and into jammies and tucked into bed, and then she was okay.

I hope there's some good reason for this though. Or if not, that we don't have to do this to my poor resident again.

Sunday, December 5, 2010

Huh, that's a new one.

Even though dementia progresses differently for everyone, there are certain little quirks that a lot of my residents share. I don't know why, and can't pretend to. I'll leave that to the more educated people. I bet you can find them by googling.

But here's my incomplete list of Weird Stuff that you might notice your Wife/Mom/Grandpa doing that never used to happen:

1. Dressing in lots and lots of layers.
I have no idea why people do this, but a lot of them do. I can name at least 6 of my residents that I MUST get up and dressed by 6:45 am because if I'm too slow in arriving to cue them, they'll come out wearing several pairs of pants (some backwards, some zipped, some not), a robe with a t-shirt on top of it, no underwear on but some in their pockets, and one shoe. This is so common that at my facility, all the people's closet doors are lockable in order to prevent this, peeing into closets (men do that one) or rummaging through their neighbor's things.

2. Eating really, really slowly and maybe falling asleep during meals.
The sleep thing is probably because days and nights don't necessarily mean a lot to these folks, so they get tired whenever they're tired. Sometimes it's from meds, but not always. And the eating slowly is just generally because they don't seem to process hunger the same way and get distracted from tasks (like eating) easily. In more advanced stages, they're likely to have trouble chewing and swallowing, but softened or pureed foods can fix that.

3. Having trouble with physical sensations, especially with verbalizing them.
Someone with dementia might feel cold all the time, even when sweaty and piled with blankets. Or insist they're too hot even though they've got goosebumps. Or holler at me that the shower water is burning even when it's lukewarm. And then when I have them test it again a second later without me touching the temperature dial, it's fine or chilly. Or be hungry one second and then not a minute later. Saying they don't need to go to the bathroom but then peeing for ages once you finally get them to sit on the toilet. This is why caregivers usually go by physical cues for assessing pain and temperatures, and by the clock for eating/toileting.

4. Spontaneous emotional outbursts.
I think this one has to do with the part of the brain that used to inhibit emotional displays no longer acting as gatekeeper. That's why someone might burst into tears or laughter for no apparent reason. And might not know they're doing it. Usually pretty short in duration.

5. Difficulty with noticing surroundings.
This could be because their field of vision has narrowed, or because colors look the same to them now, or for some other biological reason I have no clue about. All I know is, if I want someone to sit down, and they don't seem aware that there really is a chair behind them, they do better if I take their hand and put it behind them onto the armrest, pat the seat loudly, put gentle pressure on their shoulders, and say "Bend your knees now. Bend your knees." Or sometimes even if the place I'm taking them is a few more steps away, I should still hold both their hands, face them, and back up to it that way so they don't change directions suddenly. I don't really understand this one either, but I've definitely noticed that pointing and saying "right over there" isn't good enough for most people to get them there. I need to take them all the way over there.

Saturday, December 4, 2010

Why Dementia?

I was thinking about this last night, and then talked about it with a friend (hi Annie!) on the phone today; not everyone likes being around people with dementia and taking care of them, so why do I?

First of all, I don't always like all my residents. There are a few who really only react to anyone with physical aggression - no matter what you do, they're hell bent on hitting, scratching, spitting on, and choking you. Those few, I figure I just missed the window where they were able to get through their disease enough to react better, and now all I can do is provide the minimum care needed to keep them safe without either of us getting hurt. I don't get all fancy and try to put makeup on them or anything, because I know they won't enjoy it. And I don't have to like them, I just need to do my job and take care of them, so I do.

That's a very small percentage though. The rest have their quirks and behaviors for sure, but I genuinely really like them and enjoy taking care of them, even as they get further into their diseases.

It's hard to explain exactly why it doesn't really occur to me to think that watching someones dementia progress is depressing. The best I can liken it to is that my husband used to be a special ed. teacher, and would get all kinds of idiotic comments when he told people what he did for a living. "That's so sad! I would cry every day because those kids aren't fixable" or "That must be so HARD" or "You must be really special to be able to handle THAT all day". He'd always get mad because he didn't view his students as broken or worthless or burdens any more than any other kid. The kids don't hate their lives; they don't know any different, and have always been who they are. And sure sometimes they were pains, but every kid is sometimes. And sometimes they were very funny and fun and loving, just like any other kid.

I feel pretty similarly about my residents. I didn't know them before they got sick so I don't know any better than to expect them to be however they happen to be right now. And I pretty much like them how they are right now. And will still like them even as they decline. Knowing them when they're only somewhat confused makes the end/rageful stage (not everyone does this) easier to handle.

I think it's pleasanter to take care of someone who is in the permanently-combative stage if you know a little more about who they used to be. I always appreciate when I step out of the bathroom after getting a beat-down, my hair all askew, nametag crooked, covered in sweat and disinfecting myself like mad, one of my coworkers says "You know, Lily never used to be like that. When she first came here, she used to play the piano and try to tuck the other residents in at night. She was a cool lady." It makes it easier to go back in and face the Lily that's kicking me, if I can hold that picture in my mind and be trying to care for that past Lily even though she's gone already.

It's sad when someone is in the self-aware stage of the disease, and knows they're losing their memory and is powerless to stop it. It's sad because they're sad. But once they pass that phase and are living in the moment, they're often pretty content, and if not, then I can help them feel better usually. So that's not sad anymore.

With the rare residents/clients that I knew before they got so confused, it's more sad to me. Mainly just because I miss them, and I know that if they were aware of the whole situation, they'd be upset that they were missing out on so much. And I do understand that's where most family members are coming from, and it's really hard on them. It's easier for me because I usually get to live in the moment with my residents without mourning the past.

I think my favorite thing about working with people with dementia is the immediacy. I don't have to spend a lot of time building a relationship with a resident before they will trust me. If they like the way I interact with them, they'll probably go ahead and help me do what we need to do. If they like me, I get kisses right then. It's great, and very clear. And if they don't like me? I can go away, come back, and try again with a clean slate.

That probably sounds really lazy on my part. But it's true - I like the simplicity of my relationships with my residents. Affection flows freely and quickly, and anger vanishes fast, for the most part. Who wouldn't find that personality type easier to care for than someone who bickers and holds grudges? Right?

Tuesday, November 30, 2010


One of my bigger peeves about working in Long Term Care is that my coworkers tend to be unreliable as far as showing up for shifts on time. Or at all. In general, I don't call in unless I absolutely have to, because I know how much it sucks to be the one that shows up when no one else does. The workload doesn't decrease just because the workforce has; the same number of residents still need the same amount of care that they do every day, no matter how many hands there are to give it to them.

Which is why, just yesterday, I was smugly thinking to myself how glad I was I'd made it in during the snow we recently had, and that I should pick out something fun to get for myself with my "perfect attendance" monthly bonus that I'm sure to get.

And then I fell down my damn stairs on the way out the door this morning at 5:45 am. And landed on wet, cold concrete. I dragged myself back into my apartment, intending to put on dry scrubs and head right back out the door, until the pain hit me and I realized that 8 hours of walking, lifting, and standing were probably not going to make my knee and hip feel any better.

So I sucked up the embarrassment and picked up the phone, and called, teling the charge nurse what had happened and that I wasn't going to make it today, but would do whatever I needed to in order to be there tomorrow. And me and my ice pack hit the couch and took a 4 hour nap.

And here's the confession part: It was awesome.

I'm only mildly sore and bruised-up now, which makes me think maybe I should have gone ahead and toughed it out.

But an unexpected day off like this is actually really, really nice. Oops. Guess I should remember this next time I'm cursing my "slacker" coworkers who don't show up. Turns out I've got a slacker side too, it just took a wet stairway and gravity to show it to me.

Wednesday, November 24, 2010

Dementia in Groups

The GreatRep (where I work) is an Alzheimer's and Dementia care facility. It's secure, which means in order to get outside, you must know the keycode and enter it to get the doors to open. Well, there are secure courtyards outside that anyone can go into whenever they like, but this time of year they don't get much use. Although one of my coworkers did build a tiny snowman outside the window and then took each resident to the window to see it and look at it and talk about the snow for a while, which was cute.

My friend Annie just wrote a post on her blog about her first visit to see her Mom at a facility much like the one I work at. Go read it, she's great, her Mom is great, and her Dad is too! http://tinyurl.com/28tgzbf

What cracked me up about it is that we give graham crackers out every day at 10am at my job! And what made me think is when Annie said "In my head I guess I wanted to imagine that, while we don't understand her in her disease, once she got around other people who had the same disease they could somehow find each other out there in that place where Alzheimer's takes them. But I guess it just takes everyone somewhere different."

I think it's pretty fascinating to watch the ways my residents interact with one another. We have one set of roomates that we refer to as "the twins" even though they aren't related, because these ladies can often be found strolling around together, or in their room reorganizing the closets for the zillionth time, or reading aloud to one another. One of the younger residents there strolls around all the time, patting the hands of whomever she comes across, or just sitting with someone for a while. She doesn't often strike up conversations, but she seems to really like the companionship of just sitting next to someone on the couch.

We've got a few married couples that room together, one of whom hardly talk to each other (or talk much at all anymore) but every day after breakfast we put them next to each other on the couch, and the wife leans over and falls asleep resting her head on her husband. They don't sleep together in the same bed anymore (that sadly doesn't work out very well when there's catheters and memory loss involved) but they're in the room together and they doze next to one another on the couch. The other ones still walk and talk, and they bicker bicker bicker just the way I bet they've always done.

On the more acute wing, mostly the residents don't really talk to one another very much. They're far gone enough that if you want their attention, you need to address them by their name, try to make eye contact or hold their hand, and speak up pretty loudly. So obviously since they all need that, none of them can really do that for one another. There are a few exceptions, of course. One of my favorite people there, Bonnie, is also on the younger end and has excellent hearing. When I'm feeding her lunch, she'll quietly respond to what someone on the other side of the dining room says, so if a coworker way over yonder says "Is Maxine ready for dessert?" Bonnie will say, so only I can hear her "Yep, she sure is". Bonnie is the one who says really cute things sometimes, like when a coworker told her "Oh, Bonnie, you are something else!" after she'd cracked us up, Bonnie answered "No I'm not I'm always just a Bonnie".

With dementia, it seems like those little moments mean a lot to those of us on the outside. Little peeks into the universe our loved ones are living in right then. And when they connect with each other, and I'm watching, it can make me so glad to have been there. I love walking away after settling someone at the table and overhearing two of my little old ladies that I see every day go "I don't know who that is, but she sure is a nice girl" and another reply "I don't know either but I think she's very sweet". I even got happy when one of my most confused ladies gave me a kiss on the cheek and told me "You're a nice boy".

I know some of the people with dementia feel lonely a lot, because they don't know that you've just spent 20 minutes holding their hand and talking to them; if you're not doing it right then, it doesn't count. But I think a lot of them have some pretty rich inner lives, given the stuff that will occasionally come through in those moments of clarity. I just wonder if they value those moments any differently than all the rest of their time. I know us outsiders do, because those are the moments we feel like we really connected with them.

But today I worked West 1 again (remember how I got my ass kicked all day last time?) and when I went to get Genivieve up, her daughter was sitting, watching her sleep, and holding her hand. Her daughter kissed her Mama goodbye and chatted with me for a few minutes, then headed out so I could start getting Genvieve ready for the day. And you know what? Genvieve was shockingly gentle and relaxed for me. She didn't hit, bite, scratch or spit. She let me help her, and even gently patted my hands. Even though she was asleep while her daughter was with her, I wonder if that didn't make a difference for Genvieve. Maybe it was a coincidence, but maybe not.

Monday, November 22, 2010

This is what death looks like

Ever since I started working in long term care, I've been worried about the first time one of my residents dies. I've had a few that did die, but never while I was there. I'd hear they'd passed a few days later, or months later (former home care clients) and it was sad, but not surprising. Walking in and finding that someone has passed away remains one of my bigger fears, although after the experience I had this week, it's a lot less scary of an idea than it used to be.

Yesterday, after my shift ended, one of my residents passed away. Phyllis was very old and frail, and when I started training at the GreatRep, had recently stopped walking and become wheelchair and oxygen dependent. Her sight was failing, and she had very little appetite. Phyllis began to constantly, under her breath, chant things like "Oh God help me, I can't see, I'm so afraid I'm going to fall, Oh god won't somebody help me why is this happening to me, Lord, why?". No amount of reassuring, hugs, gentleness or anything would soothe her for very long.

Then around 3 days ago, Phyllis began refusing to eat. She started looking more frail, the little veins by her temple becoming more visible like they are on a baby. She seemed less afraid, but more tired. We switched her to a fully pureed diet, but she had difficulty with even that, even though we fed her.

Day before yesterday, Phyllis was put on comfort measures only for her care. We knew that her time was almost over. The night shift caregiver cleaned her room, picked a bouquet of flowers and greenery for her to look at, and set up chairs for her family at the bedside. Phyllis' son came and sat with her all day.

Phyllis is the one who taught me what it looks like when someone is dying; she couldn't drink from a straw anymore, so when she was thirsty, I gave her Ensure by dipping the straw in her cup, holding my finger over the end, and dropping in tiny sips at a time with an eyedropper. Her mouth was very dry, and needed frequent swabbing to keep it clean so she could be comfortable and breathe as well as possible. I did that with little sponges attached to lollipop sticks that were invented for that purpose. Dying people don't go to the bathroom anymore, at least not if they aren't taking in anything. Their circulation slows, so their extremities start to get dark, and look bruised. The last time I saw Phyllis, she was in bed, her son reading in the chair next to her. I wiped her lips, gave her a sip of water, and kissed her temple. Her hair was soft and fine like a baby's. She dozed on and off.

I don't know what the last thing she said or saw was, but her son was in the room with her when she went.

As far as death goes, it was much softer and sweeter than I would have imagined. Elderly people can often remind me in some ways of infants, but Phyllis didn't until right before she died. I wonder if that's common, and if it's the helplessness or the inward focus or what that made her seem so much more like a baby then. I can't think of any right word to describe it other than softness. Phyllis was very soft before she went.

And seeing that made death a whole lot less scary for this bystander. I hope that all my old people get to go as gently as she did.

...And then I come home crying

Even good jobs can give you bad days. Very, very bad days.

My current facility (the GreatRep) is divided loosely into two wings, East and West. Residents can circulate freely from one wing to the other, but the West Wing is more acute, and is where anyone who needs mechanical lifts to be moved, or consistently must be fed at meals lives. As you can imagine, the more demented people get, the more likely they are to be combative. And there is one little stretch of the West Wing that we may as well nickname Witch Wing or something else that rhymes with it, because there are 4 women there that will slap, spit, scratch and pull the hair of anyone who dares to try to toilet, feed, or bathe them.

I have no idea why the administrators decided that some lucky soul would get ALL of these women at once (plus a couple of pleasant residents) and put them all on one run.

So when I went to sign in and saw my name written next to the dreaded West 1 run, I got nervous.

The morning started out well enough that I was lulled into a false sense of security. Madge simply curled into the fetal position and refused to unclench the entire time I dressed her (while she lay in bed) and put her into her wheelchair, and cleaned her face and inserted her dentures. Lillian tried to slap me while I toileted and dressed her, but she was too tired for much and was easy to dodge. The others mostly cooperated.

Then it came time for the after-lunch rush to get EVERYONE out of the dining room, toileted or changed, into bed or a regular chair (no wheelchairs) and into clean clothes if they got food all over them. This didn't go as smoothly. Lillian grabbed a huge chunk of my hair and yanked, yelling "you said mashed potatoes! YOU SAID MASHED POTATOES! YOU SAID THAT!" and kicking me as I put clean pants on her. She also managed to slap me across the face while I tried to stand her up from the toilet. Madge was no longer content to curl into the fetal position and instead lost her damn mind when I had to pull down her pants to check if she needed a new disposable brief. Lots of kicking, plus another slap for good measure. Thanks, Madge.

I held it together, finished doing what I had to do, charted, and drove home. Walked in the door of my apartment and burst into tears like the giant baby I felt like being all day.

Days like that make me grateful for two things:
1. I will only have West Run 1 occasionally, and I'll know what to expect next time.
2. I'm married.

How horrible would it be to have a day from hell like that and then come home to a completely empty apartment? I couldn't handle it. I know lots of people like to live alone, but I will always want a roomate, a child, a family member, a spouse, or even a pet around when I have the worst day of my life like that.

As it was, I burst into tears, changed my clothes entirely (I was covered in pureed food after trying to clean the witches of West 1 after lunch) and got into bed. My husband fixed me up with ibuprofen, an ace bandage, a bowl of cereal and soymilk, and an episode or 3 of Jeopardy.

I survived, but I sure as hell didn't do it alone!

Oh, another thing I'm grateful for? They make halidol in cream form. That way when someone is totally freaking out, if they have orders for it, the nurse can rub some cream on them to get them to calm down. If I ever meet the person who figured that one out (and had the common sense to know that pills and injections are a Bad Plan for anyone who needs the halidol that badly) I owe them a medal or a plaque.

Thursday, November 18, 2010

Still Loving It

I'm finished with my training at the GreatRep, so I've had 2 days to hit the floor in earnest, and I still love it. My coworkers have been amazingly helpful and supportive, letting me know all the little tips to work with the residents' idiosyncracies. And when they got done with their work faster than I did (of course) they came and helped me make beds and get the rooms on my run shipshape. So nice.

Learning everyone's names is coming along pretty well. We have a LOT of Florences and Betty's, so last names are a must, even though we don't refer to them by Mr. or Mrs. (that doesn't work so well with advanced dementia). Thus far, I'll be on day shift for all of November, and this is my first time working that shift. At the other places, I did evenings and nights. Days are so awesome because you're done and home or doing errands by 2pm!

My days at the GreatRep usually go as follows:

5:15 am - wake up, get ready, pack lunch, etc.

5:55 am - arrive to work

6am - get report from the night shift about who had suppositories (top priority on getting to the bathroom, for obvious reasons) and who had a rough night or was changed recently or whatever. Check the schedule to see who I need to shower, who has appointments, etc.

6:15 - start getting my early bird residents up for the day. Some are fairly independent and all I need to do is wake them or lay out clean clothes for them, and they'll do the rest. Some are physically able but not mentally, so I need to cue them for every step, dress them, and brush their teeth for them. Some are physically and mentally unable, and I use a sit-to-stand mechanical lift to get them up and into their wheelchairs. The most difficult are the combative residents who will try to kick, hit, bite, scratch and spit on me while I'm providing care. I dodge like mad, get help as needed, and don't take it personally.

8am - If I did everything as fast as my coworkers, I'd have all my residents up and dressed, and seated at the dining room tables. There are several different runs, and depending on which one I'm assigned, I either serve, clear plates, or feed those who no longer feed themselves.

9:15 - breakfast is mostly finished. Time to get everyone out of the dining room, into easy chairs for activities, to the bathroom as needed. This is usually the best time to give my showers, unless the people were super quick and I got them done before breakfast.

10am - help with either snack or activities, or continue showers and toileting.

11:15 - start getting everyone back into the dining room, which often involves transferring them back into wheelchairs.

12pm - do lunch, doing the same role I did before.

1ish - lunch is over, I get everyone cleaned up and the dining room started (bus most of the tables) then be sure to toilet EVERYONE (in whatever level of help they need). Some will lie down for naps at this point, others will go participate in activities, visit with family members, or just hang out with one another.

1:50 - do a final walk through of all the rooms on my list to be sure the beds are made, the trash is taken out, and the bathrooms are stocked with supplies.

1:55 - do my charting and give report to the oncoming shift

2:07 - walk out the door to go home.


Day shift is probably the most hectic, especially with the 2 meals. But I love that it's busy enough to keep you hopping so it flies by, and then you are DONE while the rest of the world is still at work!

Wednesday, November 10, 2010

Faves Roundup

Today as I was using the equipment at the new job (still love it!) I got to thinking about how foreign all these object seemed to me at first, and now they're second nature. Though they have some at the GreatRep which are new to me as well (when I saw "nosey cup" on the dining room protocol list, I thought "WTF??"). Turns out they're cups with a cutout for your nose so you don't have to tilt your head back at all to drink from them. They're good for people who can't/won't tilt their heads and can't/won't drink from straws. See:

The things I'm listing as faves are mostly for in-home use, though you can have them in facilities too, especially in a family member's apartment or room.

For mobility challenged (if someone is missing a leg, or just plain getting old, or whatever):
This is my favorite kind of bathtub/shower bench. I like it because when you put it in a bathtub, it sticks out onto the regular floor so that all someone has to do is back up to it, sit down, and you can swing their legs up and into the tub after they're seated. Then you tuck the shower curtain around it, and use a handheld shower nozzle to wash them. To be extra nice, put down a hand towel so it's not cold on their bare hiney.

Also for mobility challenged people, this seems really simple but it's awesome if they can't bend down very well; it's just a little half tube with a rope on it, and you put the sock on it, then drop it on down, slide the foot into the sock, and pull it up. I had a lady with a recent leg amputation who used this so she could put on her sock without falling over, and I was amazed by how much easier it made her days!

For incontinence, if you have somewhere you can put it safely so that no one will get into it and hurt themselves (it really doesn't get hot, but it's an electric appliance that involves moisture) a wipe warmer is great. That's always the worst part of changing and toileting someone, especially in the middle of the night - coming in, taking off their warm blankets, and then swabbing them down with a cold wipe; no wonder they get mad! These are made for baby wipes but you can put washcloths in them as well, for cleaning hands and faces, or if you're earth friendly enough to use washcloths for pericare.

Also for incontinence, washable cloth waterproof pads are a must for beds. They're sturdy enough to last a long time and are strong enough to use to reposition people once they're lying down.

Last incontinence thing: Bag Balm. For barrier cream. Seems to work the very best, I don't know why. It's cheap, too!

Specifically for people with Alzheimer's/Dementia: a picture phone. You program it and put little photos on the buttons so that when they want to call someone, all they do is pick up the phone and push the picture of who they want to speak to. I think it amplifies the sound too, so they can hear you better.

Ta da! My favorite home medical care products. I don't have any specific brands to recommend, aside from Bag Balm. Also, if you need some of the durable equipment, your county might have a medical equipment bank. Mine does, and I'm sure it's a big help. It's also a good place to get rid of crutches, wheelchairs, shower chairs, etc. that you don't need anymore, if you've got them cluttering up your house.

Monday, November 8, 2010


I'm tired and haven't even really thought about making dinner yet (there's always bread, hummus, and spinach salad, right?) so this will be very brief. I started my new job today at the GreatRep, and I LOVE it.

There are enough staff that we get to actually take good care of our residents, the facility is designed and run well, there's an excellent housekeeping staff that does all the things that need to be done so that the care staff can concentrate on direct care, and there's lots of teamwork among the caregivers.

I really think I'm going to be happy there!

And dayshift (06:00-14:00) goes by really quickly, which is nice. I hadn't done it before, only evening (14:00-22:00) and noc (22:00-06:00. Three more days of training on dayshift, and then a WEEKEND (as in TWO CONSECUTIVE DAYS OFF) for me!

Love love love love love love love . . .

Friday, October 29, 2010

Choosing a Nursing Home Part 2

I did my last noc shift night before last, which means I have more time now again! In fact, my new job is split day/eve shift, but never both in one day, and I'll always have 2 days off in a row; isn't that called a weekend? I can't remember. It sounds heavenly though.

So now I have time to share my hard-learned lessons on choosing a nursing home to live or work in. I think they can be the same post, because if a nursing home is bad to work in, it's probably bad to live in. The reason residents are there is to get care, and if the employees are miserable, the care is going to be substandard. If the employees are happy, the residents are happy, and it creates a happy cycle.

I made some big mistakes on my last job hunt; I let schedule and pay dictate which facility I chose, and overlooked some red flags. I'm actually pretty embarrassed about that, but at least I can come clean here so any readers (hopefully) won't do the same things. I was just so focused on finding a job that would allow me to keep my homecare job that I chose the wrong facility. If I'd been willing to give up my security-blanket job at the homecare agency earlier, I think I'd have chosen differently. Oh well, here I am about to start at the GreatRep, so it all is for the best now!

Mistakes I made:
1. On my tour of the facility, I didn't insist on seeing into any of the resident rooms.
Realistically, this may not have saved me, because usually you don't get to see one that's currently occupied. The "model" room or apartment is usually empty and therefore looks perfect. But at the Crapdorable place, I had no idea that around 20% of the residents sleep on mattresses on the floor. It's for safety, to keep them from falling out of bed, which makes sense and all, but is incredibly hard on the caregiver's body that has to try to change their briefs and reposition them while kneeling on the ground next to them. This is why I was limping after each 4 day rotation there. The other reason to ask to see the rooms is to see what type of beds they have (if the facility provides them) and whether they're adjustable or appropriate for employee and resident safety.

2. I didn't ask the hard, slightly rude questions.
I did ask about aide to resident ratios, length of shifts, etc. But I didn't ask about how long management had been in place, whether there were any recent or upcoming changes there (new Executive Directors, new Administrators, etc). I didn't ask about their employee retention rate (20% at the Crapdorable place - huge red flag that I wish I'd known before I began there). I didn't ask about their call-out policy; if the answer is "you can't leave until the next shift arrives" this probably isn't a good place. Of course you can't leave, that's common sense that you cannot abandon patients. However, a good answer is "If there's a no-call no-show, your manager will find someone to come in, and will make sure the floor is covered in the interim". An excellent answer is "We provide an incentive for anyone who comes in on their day off so it's usually pretty easy to find coverage". A typical, reasonable (in my mind) policy is that if you call out, you must find your own replacement. The idea here is to discourage people from calling out hungover, or for other fishy reasons. Each employee gets a phone list, and usually if you're calling out for a real reason and have tried to find coverage and can't, a good manager will help you from there.

Another big question that's good for families AND employees to ask is "how full is your facility?" (aka what is your census like). If it's very nearly empty, proceed with caution. Sure, there's a recession, and more people are trying to make do with home care. But the good places will still be fairly full. Because locals have heard good things about them and prefer to put family there, rather than the sketchy ones. And if the answer is "lower than normal because of stop-admittance orders" RUN AWAY. Remember, that means they did something so bad they cannot allow new residents to move in for a set period of time. BAD.

3. Take a good look at the residents and employees you see during your tour. Do the residents look clean and kempt? Is their hair greasy, or is it combed pretty neatly. Do they themselves smell bad at all? Are their clothes weather appropriate and fairly clean? If it's a dementia facility, lower your standards a bit, because the residents often resist care, but still should get as much as possible. If they look visibly dirty, or unwashed, or their clothes obviously haven't been changed for days, this is a bad place. Now how about the employees? Are their uniforms clean? Is their hair reasonably done? Are they wearing inappropriate makeup? Do they look professional, or do they look like they should be smoking out back of a gas station? I know I'm judgemental here, but if the employees look trashy, it's a warning sign. If the employees look like they could be posted on www.peopleofwalmart.com it's not a great sign.

4. Lastly, smells. Any bad smells should be temporary. Or have a specific reason for them. If the entire place smells like old pee, it's because it's covered in old pee. The hallways absolutely shouldn't stink. Individual rooms sometimes might, especially if the resident living there has a habit of peeing on the floor (many do) or has frequent UTI's. Nonetheless, staff should be working on it to keep it to a minimum. A stinky place is probably not a clean place.

Saturday, October 23, 2010

Leaving my Blankie

I just realized that even though I told you all about leaving the Crapdorable place, I didn't say what I'm going to do instead! Duh.

My interview at the GreatRep place went very well, and they called back to offer me a job the same day. Even better, the position they offered me is one that I didn't know was available: full time, part dayshift, part evening shift (probably 2 days per week of each, one variable, 2 days off per week). That means NO MORE OVERNIGHTS!

And this time, let me tell you, I interviewed. I asked that administrator so many questions that I wish I'd asked at the Crapdorable place. Everything from "What's your employee retention rate?" to "What's the average census of your residents?" to "How long has the administrative staff been here? Any upcoming changes?". I'll explain all those in my next post about how to choose a nursing home, so if anyone reading that went "Huh?", don't worry.

I feel confident about the care the residents get at the GreatRep place, which means I'm very likely to be able to stay in my job there. Add to that the fact that I'm only working 5 days a week, and no more than 8 hours at a stretch, and I'm very likely to actually enjoy this job! It did, however, mean that I'm finally having to cut the apron strings and leave the Home Care Agency.

That place has been my only constant in the past year. I'm embarrassed to tell you how many other supplemental jobs I've had and left throughout my year at the Home Care Agency. Okay, fine: Four. About to start my Fifth. So leaving the Home Care Agency is me leaving my blankie, basically. But it was becoming a crutch, and preventing me from taking potentially great jobs that would have conflicted with my schedule there.

The GreatRep place has a scholarship program for nursing school. And if they ask you to come in on your day off, you get $2/hour more, which should translate into almost never working understaffed. They do a lot of things which mean members of the community come through all day every day, which makes it much less likely that anyone is being neglected; they're doing a fitness study with one of the State Universities. And they have a very, very cool program that I wish I could write about but it would give away which facility I'm talking about.

To make it more bittersweet, I just had my 1-year review at the Home Care Agency with Big Boss Betty (remember her from my first post here?), and it was awesome. They gave me a bonus equal to 25 hours of work, because that's what I've averaged for them over the past year. And they said I'm welcome back any time that I want. Awwwwww.

So I just have to get through my very last crapdorable rotation, then one week of only Home Care (should be easy as pie) and then I'll begin my new full time job at the GreatRep.


Thursday, October 21, 2010

Goodbye, Night Shift Polly

Just one rotation left at the night shift job at the Crapdorable facility, thank God. I'm giving my notice there first thing tomorrow morning.

What I learned/got out of my month on noc shift:

1. I hate working overnights. If I don't get enough sleep, I start randomly bursting into tears and just generally being a hot mess. Add a day job to that, and I'm sunk.

2. Noc shift is mostly changing briefs and toileting people that can walk. And redirecting wanderers. If the only good thing about it is "well at least I don't have to deal with crappy coworkers and management because I'm the only one here at night" then it's a bad job. Period.

3. Staying up working all night and then getting a little sleep and then working more? A good way to lose weight. I've lost another 5 lbs just during my first two rotations at the Crapdorable place. I told my husband this, and he said I should go back to Weight Watchers and share the good news, go up to the front and say "Here's what you do: get a bunch of old people ..." So if you think an overworked Polly would be a great new spokeswoman for the Nursing Home Overworked Diet, build me a website or something. I'll be happy to share all my tips with you.

4. Calluses. I already had some on my feet, but after being on my feet at least 8 hours out of every 24 for the past month, they grew freakishly fast. And my hands are effed as well. I started putting that really thick goopy Burts Bees stuff

on my hands every time I was going to get to sleep for 2+ hours and then putting socks over them to keep it on. Changing briefs all night, taking gloves on and off, and constant washing of my hands have made it hard to keep them from cracking and bleeding. And with the resident with the horrible skin condition, I want MY skin intact to keep whatever is plaguing her out of me. Way, way out of me. If I had what she has, I would be guzzling liquid morphine like it was gatorade. I feel so badly for this woman and I'm terrified of ever catching whatever it is she has.

5. If you want to work night shift, make that your only job. And come home after work, eat a meal, and sleep for at least 6 hours. And drink lots of water. And good luck to you.

I don't think I'll ever do it again.

Friday, October 15, 2010

I Bet on the Wrong Adorable Horse.

Remember how I was trying to decide between the Adorable place and the Well-Known place to work at next? And chose the Adorable one?

Looks like I chose wrong.

Today was the all staff meeting at the Adorable place, where they were introducing the new Executive Director. What I didn't know when I accepted the job is that the new Executive Director has been working there approximately 3 days longer than I have. And what I didn't know until this afternoon is that the nurse manager that hired me is now on a leave of absence after hiring 3 too many noc shift caregivers.

Also in the "things I didn't know" category: this facility has a 20 percent employee retention rate. When you end your shift, there's a decent chance that no one, or only a small portion of, the next shift staff will actually show up to relieve you.

The work itself is fine (if heavy) but not knowing if one can actually leave when you're supposed to? So not fine. I've been leaving anyway, because there's always a med tech on duty and they are charged with more responsibility, which means they cannot leave until they have someone to hand the keys to the med cart off to. I just say I have to go to my other job (whether that's true or not) and leave within 15 minutes of the end of my shift. And then don't answer my phone if they're calling to try to get me to come back.


Lucky for me, I got a call the other day from another dementia facility with a great reputation for an interview. It's also for a full-time, night shift caregiver position. The great reputation place is usually not hiring, but is the first one that people recommended to me when I started my search. I filled out an application, but didn't think much of it because they weren't hiring when I did so. I guess they are now! So I'll call them tomorrow and try to get in there to meet with them. I just really, really want one full time job with benefits that I can stay at long-term. The waitlist for nursing school is a year, and I'm not even on the list yet.

Maybe I should put a personal ad up on Monster:

Nursing Assistant/Caregiver Seeks ...
Assisted Living facility for gainful employment. Management must be willing to provide required training, and understand that gloves are not a luxury. Coworkers can say "ain't" and be trashy, as long as they actually show up for work on time. Facilities where residents have adjustable beds given preference, so this Polly doesn't have to mess up her knees and back trying to change people who sleep on the floor due to falls. If this sounds like you, contact me, Polly! I work hard, show up on time, don't call out sick, and will do extra things for my residents if the basics are already covered.

Alternately, I could stay at the Crapdorable place part time (2 shifts/week) while doing the 3 week CNA course and then reapply at the Skilled Nursing Facility of my dreams. Also a decent option, as long as I can continue to never, never get roped into staying when I'm not supposed to due to the flakiness of others.

Who Manages Nurses? Nurses.

After pumping myself up, studying my nursing assistant flashcards, and getting all dressed up fancy-like, I got to my interview at the Skilled Nursing facility only to find that in fact, they don't even consider candidates who aren't certified. Crap.

Since the facility is affiliated with a hospital, and the hospital is part of a multi-state network, they do all their applications online and have outsourced recruitment to a different company. This means that even though I applied online like I was supposed to, did my phone interview with the recruiter and did it well, it was only today that I actually spoke to anyone who knows about nursing. A nurse, and a nurse manager at that.

Oh well.

This is why nurses manage nurses. You know on TV shows how the doctors are always bossing around the nurses, telling them to do this and that? And sometimes even firing them or threatening to? It doesn't really work that way. Doctors and nurses are paralell professions that work together, but do not supervise one another except to serve as checks and balances against one another. Doctors are responsible for the health of the patients and so are nurses. If one staff does something wrong, it's the other one's job to catch the error and correct it. Sure, doctors make more money and are often more respected, but doctors are not the ones who hire and fire nurses. Nurse managers are.

So what happened today was a good example of why nurses hire other nurses (or nursing assistants): it's a complicated little world, nursing is, with tons of niches and jobs to fill. And non-nurses don't always know or understand all the distinctions between the various certifications.

And in Long Term Care (nursing homes, assisted living facilities, and the like)? You almost never see a doctor on premesis. Sure they come and assess patients occasionally, but for the most part, nurses do that. Nurses fax doctors to get meds and treatments ordered, and then once they get what they asked for back, they administer the treatment or med.

Have you heard the expression "Doctors diagnose, Nurses heal"?

Today it should have been "Human Resources interviews, Nurses hire".

Oh well, I'll be back with certification in hand by January. By the end of this month I'll have worked enough overtime to pay for a private CNA course out of pocket so that I can be finished in just 3 weeks, take the state exam, and get myself certified. Hooray!

Thursday, October 14, 2010

The Fury of the Little Old Lady

What I love about the generation that's old right now is the deeply ingrained sense of politeness and good language they have. There are exceptions, of course, especially when someone has dementia, but in general? Even when they are LIVID they don't tend to use curse words, and their expressions are antiquated enough to be funny and charming unintentionally.

I don't think the baby boomers are going to be that way. They'll be dropping f-bombs and the like, not exclaiming "Like FUN you will!" indignantly. And that's a shame.

One of my residents at the dementia facility is a perfect example of this cute-when-angry quality. Marla is in her late 80's and on hospice, but only recently became incontinent at night. Up until recently, she'd just use her call light to get up and go to the toilet when she needed to. So Marla is very, very unused to being changed in the night. And during the day, she gets Ativan and all the usual meds that help people remain compliant. But they wear off at night, so Marla gets feisty around 11pm. This means my rounds usually go like this:

I tiptoe into Marla's room, turn on her bathroom light so I can see, and say gently,
"Hi Marla, I need to check your undies, M'am, you can keep sleeing if you like"
I pull back the covers as little as possible and pat her crotch with my gloved hand, to see if her brief is wet or dry. 90% of the time it's wet. Shoot. I get a new one out, wipes, pull the trash can over to me, and ready a new incontinent pad.
"Marla honey, you're wet. We need to get you dried off so you'll stay nice and warm. These panties are wet. I'm going to take them off now."
(Marla groggily bats my hands away)
"Marla, sweetheart, I know you're tired but you're all wet. I'm getting you dry. It'll just take a minute."
(Marla wakes up all the way now, and oooooooh, she's not happy!)
"What in the HELL are you doing? Get outta here! Can't you let a body sleep? Go away! Get OUT!"
"Marla, I know you're tired, but you wet the bed, hon, so I'm getting you clean and dry."
"I did NOT! I've never done that in my LIFE!"
"Well somehow your underwear and blanket got wet, so you need new ones. You can just close your eyes, I'll do all the work and then let you get back to sleep."
"You are SICK! You people are sick! Quit taking off my pants all the time! Sick!"
"I'm sorry, Marla, we're halfway done now. Wet ones are off, I need you to roll towards the wall so we can pull up the new ones. Okay, I'm going to clean you with a wet wipe, there we go, okay, now one more big roll back towards me. Good. All done, you can go back to sleep now, thank you."
"You're sick. Don't come back."
"We'll see. Good night Marla."

The best was the time I forgot to bring a new incontinent pad to put under her, and said "I've got to get you a blanket, I'll be right back." Marla was angry to the Nth degree, and spat out "I WON'T miss you!" I know I shouldn't have, but I had to laugh at that one! How can you get mad at someone who says that to express their fury? It's adorable.

I do have one new resident who swears when I change him at night, but again, I can't take it personally. Warren starts out sounding fierce, but then drifts off again, sliding into "word salad" toward the end. So his tirades come out like "No no no no no ass BITCH get away bitch ass bitch no no no you can't you can't no fat bitch ass fuh fuh fiddle faddle diddle daddle doodle draddle . . ." and then he's out again. Starts out offensive, ends up silly. Every time.

And like every facility, there's that delightful 30% or so of little old ladies who are just sweet as pie no matter what. I wake them, ask if they need to get up and go to the bathroom, check their briefs, and usually get a hug and a kiss before leaving their room. It's pretty amazing. I really appreciate them, because I know I wouldn't be that sweet if someone woke me up every few hours every night of my life. But they seem to understand that I'm there to help them, and they love me for it. It's pretty great.

I like my old people at night, whether they're NOT missing me or giving me kisses for offering to help them to the bathroom. But that's not going to stop me from trying to rock my interview for evening shift at the skilled nursing facility!

Wednesday, October 13, 2010

Night Shift Polly, reporting for duty

As you might have gathered from my lack of posting, I started my night shift job. And boy did it kick my ass. Because I still have my daytime homecare job. Oops. This has led to me pretty much looking and feeling like . . . well . . .


I like the night shift job, though. It's definitely hard work, very physical, but by being there at night I can avoid any contact with management (often a plus at Assisted Living facilities where there's usually a conflict between nursing staff who want good care for residents and corporate management who want to cut costs). Also, I'm much more able to manage my own time - most of the residents are sleeping so while I must answer any call lights promptly, the rest of the timing is up to me.

During night shift, my work falls into 3 main categories:
1. Toileting and changing people, which is physically difficult and the hardest part of my job.
2. Cleaning and doing laundry, which I actually like doing.
3. Keeping an eye on the wanderers and trying to re-orient them and put them back to bed if possible (this is the dementia facility, remember?), which is the funniest part of my job by far.

The dementia facility is divided into two wings, each with 3 halls in them, and 8 rooms per hall. Some rooms are doubles, some are singles, and the whole facility isn't full right now. On night shift, each wing has one aide (me and this douchey guy that I'm so glad I don't have to actually see during work) and then there's a med tech there to give pain pills if needed, and cover our breaks, and clean the main areas of the building.

That means I'm responsible for about 30 residents during my shift, which sounds like a lot but in general is doable.

I arrive at 10pm and do quick rounds with evening staff, so that they can update me on all the residents, and if they didn't do their jobs, I have the chance to bully them into doing it before they can go home. More on that part later.

After they go, I read the shift reports, sign any care plan updates, and start my own rounds, changing and toileting everyone who needs it. This can take anywhere from 45 minutes to about 2 hours, depending on what state they're all in. Trying to change a fully grown person's diaper in bed when they are stiff and/or resisting isn't easy, and most of the residents have pull-up type briefs instead of side-tab, so there's a lot of rolling side-to-side involved. And frequently changing the waterproof pads underneath them. And occasionally, a full bedding change. Sheesh.

I do 3 rounds per shift, typically at 10:30pm, 2am, and 5am. In between rounds I do the laundry (sheets, towels, resident clothes), mop the dining room, fold the dining room linens and bibs, and answer call bells. It's enough to keep me pretty busy. If there's a really calm night, I may have the chance to sit and read for 15 minutes here and there, but mainly I'm up and moving the whole time. Which is good for keeping me awake all night long!

Ironically, as soon as I'd accepted the job at the dementia facility, the skilled nursing facility I've wanted to work at for MONTHS called me for an interview! I'm still not certified, or even in the course to get certified, but they have one wing I'm qualified for. So I go interview there tomorrow, and if they offer me the job I'll come up with a pro/con list between the skilled facility and the dementia facility to help me decide. I'll feel kind of stupid if I end up only working at the dementia one for 3 weeks, but like I've said before, there's massive turnover in this field so it's not like nurse managers are unused to it.

Wish me luck at my interview tomorrow!

Thursday, September 30, 2010

Night Shift Polly, coming soon!

As I wrote about in "(Temporarily) Hanging up my Stethoscope", I've been job hunting since leaving my last AL facility.

I started my final shift there pretty sad, and I did get teary saying goodbye to one of my favorite residents: Miss Millie. Miss Millie moved in right when I started working at the facility, and came to Assisted Living following a leg amputation. I was the first one there to help her with a shower, and she told me how much she appreciated knowing she was safe and wouldn't fall, and that I made it a comfortable experience for her. She feels self-conscious about her leg, and was anxious about having anyone see it, but she said I never made her feel uncomfortable. Miss Millie is an absolute sweetheart, on the younger end, and was always a pleasure to take care of; she'd show me the cute little outfits she got for her grandbabies, joke around with me, and fill me in on all the updates from the days I wasn't there. I gave her my phone number, so hopefully Miss Millie and I can keep in touch; there aren't any rules against that now that I don't work at her residence anymore. Hooray!

That final shift, though, apart from my goodbye with Miss Millie? It really kind of sucked. The night shift girl who was supposed to be coming in called off, and the new Nurse I was working under that night is one of those million-mph-always-in-a-kerfluffle people, so she didn't get that handled with any speed. I ended up having to stay more than 2 hours late until a fill-in could come and take over. Ugh. So I was glad to be leaving by that time, let me tell you!

With my job hunt, I went to every AL facility in my county, except for 2 because I already had offers before I got to them. I went to locked dementia units, I went to big national chain retirement communities, and I went to a janky run-down nursing home. I didn't apply at many Skilled Nursing facilities because I'm still not certified, just registered, as a Nursing Assistant. So I'm unqualified for the very medical side of things.

By the end of my applications, I had 3 offers: one at a super-crummy place (to work 2night shifts/week in their Alzheimers unit), one at this ADORABLE memory care place close to home (any shift I want, day and night are full-time, evening isn't) and one at a Very Well Known memory care place that does a lot of continuing education courses (5 nights shifts/week).

I took the adorable one close to home, mainly because with my schedule, night shift is the only one I can do, and they have 4 on, 4 off, rather than 5 on, 2 off, like most places. If I can work 32 hours a week and get benefits, rather than 40, I'll do it. I still have my part-time job at the homecare agency, and I'm committed to them through October.

So what's so adorable about the one I took? Well, first of all, the lobby (where they do the activities) looks like a frickin' Children's Museum. It's so, so sweet. They have a good schedule of activities, and the facility is clean and doesn't smell like urine or anything. Secondly, I like the layout; two wings with 3 halls, so each caregiver has a max of 10 residents to care for. The dining rooms are small and homey, so you're not feeling like you're feeding people in an airplane hangar. They have a small kitchen where day and evening shift can take the residents to bake cookies or let them wash dishes (or play in the water pretending to wash dishes, whatever they're up for). And they have a little "nursery" room (people with severe dementia often enjoy playing with baby dolls because it's such an instinctual thing, and many of them had babies of their own, way back when, so it can bring them back to a pleasant time and be soothing).

I observed resident care, and family interactions when I was there, and was pleased by both. The staff seem to really know their residents, and to be organized about keeping their health information up-to-date. They spoke to the residents kindly, even when what they had to say was "Hang on a sec" and even the front desk receptionist was able to tell funny stories about individual residents to visiting family members, which shows good communication.

I start orientation at the Adorable place next week. I really hope it'll be a good fit for me and that I won't be kicking myself for choosing it over the Well Known Place. I'm 100% certain I made the right decision in saying no to the super janky, crummy one.

And as for the facility I just left? It's in a difficult state right now. The Head Honcho Man just "resigned" (read: got told to quit or be fired) after some of his stuff came to light. According to the gossip, he was doing shady business practices (accepting and keeping residents who were inappropriate for the care offered there) and having an affair with one of his employees. Which is how he met his current wife. At his last job. Where he also "resigned". Ouch.

So all in all, it looks like I got out just in time, and I'm very hopeful about my future in this eldercare world of ours.

Monday, September 20, 2010

Ma'am, I Am Tonight

A fair amount of my old folks are pretty religious. I've got one who talks about Jesus like they're locker room buddies ("I told Jesus he's gotta help the Mariners tonight, because that new manager is from the minor leagues!") as well as one who used to be a pastor. I've got many who have paintings of Jesus up in their apartments, or rosaries around their necks, or crosses above their doors. The very religious aren't shy about sharing it, and in general I find it pretty charming. They found a faith that works for them and makes them happy, and I'm glad for them.

The difference between old folks and younger Christians seems to be that the elderly ones assume that anyone who is kind to them, and helps them, and cares about them (all of which I try to do every day) must also share their faith. And the thing is, I don't. At all. I'm an atheist. A big old nonbeliever.

You can probably imagine that this causes some problems. And you're right.

I think of myself as pretty tolerant, and also pretty practical. So when my Most Confused Woman Ever was alone while her husband was in the hospital, I hunted around her house until I found something with the address of her baptist church on it. And I took her there. And I grabbed her minister so that he could get his flock on board with visiting this woman, bringing her groceries, and visiting her husband. Because they needed community and support, and if that meant I had to sit through a hateful gay-bashing sermon to get it for them, then that was a tradeoff I'm willing to make. It doesn't mean I enjoyed it, but I did it. And then I never went back. But it improved my old peoples' quality of life, which was my goal.

And my octogenarian who talks about Jesus like they're pals who like the same sports teams and would be great fishing buddies? When he tells me he prays for me every night, I thank him and give him a hug. Because he's thinking of me, and wants my life to be good, because, as he tells me, I'm a "nice nurse and a sweet girl". I'm not going to tell him to quit praying for me, or point out that his God is probably sick of hearing about me and wishes he'd pray for someone more worthy. I may be imagining God rolling his eyes and saying "Ugh, not that dumbass Polly again!", but my old man is sharing his heart with me that way and so I like it.

But it starts getting sticky when, like my ex-pastor, my residents ask me directly where I stand on all this. The other night as I was laying out clean clothes for that man to wear the next day and helping him get ready for bed, he said "You are so gentle and kind to an old man like me. I know that Jesus Christ must have touched your heart to make you this way. Do you believe in God?".


Lucky for me, this man has memory loss, so I've gotten to try out two approaches with him: honesty and lying.

Honesty was: "No, I don't believe in God and I'm not Christian. Thank you for saying you think Jesus has touched my heart and that I'm kind to you, because I know that is a big compliment from you and I'm grateful that you like having me around". Unfortunately, that led to him wanting to minister to me, which made me late for giving out snacks to the diabetics, which isn't good for them, and then also late for giving a bedtime shower which meant that lady had to stay up really late, and I got off work late as well. All in all, not practical, and not useful. I'm still not converted, and Mr. Pastor isn't any happier than he was when we started.

Which led me to lying. Just saying "Yes" when he asked me again, and "Good night and God bless". He went to bed happy, and I got to give care to everyone else on my list in a timely manner.

I think you can probably guess which approach I'll be sticking with from now on.

And if their God gets mad at me for being a faux-believer when I'm on shift, then I hope he reads this: God, sorry I lied about believing in you. But while you're busy taking care of those people's souls, I was busy brushing their teeth, bathing them, feeding them, and kissing them goodnight. You can understand that, can't you? They need that stuff too. So don't be mad. I'm just doing the best I can. And so are they. And according to them, so are you. So let's be friends, and I'll see you at Monday night football.

Maybe I should double-check with some of my old folks about whether or not God can read blogs. And whether or not caring for the sick and elderly makes me exempt from wrath or not. I'll figure it does until otherwise notified.

Thursday, September 9, 2010

Choosing a Nursing Home: Part 1

Since I'll be leaving my current Assisted Living facility soon, I'm on the hunt for a new job. But not just any new job, one that I'll actually be able to stay at for more than a few months. It occurred to me that now that I've been "behind the curtain" at one facility, I'll have a much better idea of what to look for in the future, so hopefully I won't get burned again. And if anyone out there who's reading this wants to know how to find a decent facility for yourself (work) or to live in (for a family member) maybe reading my thought process on this will be helpful. Since I don't want to give out the real information about where I live, I'll do this as if I were looking for one for my faithful reader Annie's Mom, in Chicago IL.

I'll start by looking up nursing homes in Cook County, Illinois on the medicare.gov site.

This search gave me waaaaaaaay too many results, so I'm choosing to narrow it down by searching only for nursing homes with Resident and Family councils. I want this because it makes it easier for me to address issues if I have questions or dislikes about the way my parent is being cared for. Now we're down to just 59 nursing homes, which is tons more than we have in my whole county where I actually live. This is more results than I'm used to! What should I sort by now? STAFFING RATING. Using the pulldown tab, I can re-arrange the 59 homes in Cook County with Councils so that the most-staffed are on top. Staffing is so important because it doesn't matter how great the CNA's, nurses, and med techs are at any one place; if there aren't enough of them, the care will suck. And if a place is always understaffed, the staff there won't be great; the good ones will get out asap and all that'll be left are the people who won't or can't go find a better job.

You need plenty of staff in order to answer call bells in a timely manner, prevent falls from residents who get frustrated with wating and try to do things for themselves, prevent neglect that can lead to bedsores, and reduce medication errors that can happen when one person is overworked and trying to dose a huge number of patients. Staffing is key. Here are my 59 homes sorted now.

Next I'm going to look for some that are nearby, because I want to be able to come in regularly to see my family member. This is another great way to be sure someone is being cared for: be present. Don't bug staff if you can't find Mom's nonskid sock when she has more in the drawer, or to ask why she's not going to such-and-such activity if it clearly isn't within her skill set (hint: she should be able to move her hands and arms, hear, and see if you want her going to BINGO). But if she's not eating, offer to sit and help feed her for a meal; sometimes confused or stroke patients really need a lot of time and help to eat and staff just can't do it every time. Does she seem to be in pain? Ask about her meds: do they need to be increased? Do you need to call her doctor to get an order for this? That kind of stuff is invaluable.

From list I have now, I'm looking for ones that are in proximity to my home, are well-staffed, and have a decent overall star rating. Don't weight this star rating as heavily as you may be tempted to. In the county where I actually live, the highest rated home is only 3 stars, and the one that I personally (though observation) think is the best is only a 2. These are not crappy places and the people there aren't suffering. I don't know why they are rated so low, but I'd be happy to work or live in them.

The thing that I would check before making a final decision is to see what specifically, if anything, the facility is under "enforcement letters" for. This will tell you what deficiencies state inspections found and what they were, plus what the consequences for the facility were. In general, the more $ the facility had to pay the state, the more serious the problem. If they had to stop accepting new residents, it's because the wrong thing was considered serious. If they had to stop accepting residents for a long time and then that time got extended? I wouldn't want to live or work there. Management isn't able to resolve problems with any speed.

This is where it gets to be a pain in the ass. Not every county and state tells you exact details about this stuff online. Your best bet is to go via the county health department website, like this.

In my state, you can read the entire text of the enforcement letters. The facility I currently work at had some because staff wasn't then in the habit of searching residents' rooms for smoking paraphernelia or escorting them out to smoke every time, so it was deemed a fire hazard. This was corrected within the first "stop admittance" period, so I wouldn't say it's an unsafe place to live.

Another facility closer to my house that I was thinking about applying at has enforcement letters for failing to protect residents in the locked memory care unit from being abused by another resident. Yikes. This could be as simple as that Mr. Hennessey goes nuts with sundowning every evening and smacks whoever is in reach of him. But if that's the case, staff should be able to obtain an order for a sedative to be given to him every evening in order to keep other residents from being smacked. And since the type of abuse wasn't specified, I'm staying far, far away from that one.

Coming up in part 2: So now that we've narrowed it down to homes near your house, with good staffing, and no outstanding problems, we're ready to go visit in-person and see what we think.