Neglect

I see some weird situations in my line of work. Families who get up in arms about every little thing (such as how many fun-sized candy bars in the "for staff" dish are being eaten daily) and families who are almost impossible to get a hold of so we end up improvising mightily to try to get the resident's needs met. Old people who insist on wearing multiple pairs of underwear, or none at all. People who swear up and down that they lost a box of puppies, or that I work for the railway.

But the weirdest and saddest thing I see is neglect.

We got a new resident this weekend at my facility, who apparently was moved in by his private caregiver, to whom he pays the ungodly amount of $4,000 per month. Caregiver dropped him off and then took the weekend off. The marketing director at my facility apparently thought this was okay, even though she did the intake interview (not the director of nursing, which is who should have been given the opportunity to assess him before he moved in) and should have known that he cannot walk unassisted AT ALL. This is her job. To find out if people are a good match for what we can offer them, and to be sure they will be cared for adequately if they move in with us. She didn't do that. She failed, completely, at her job in this case.

So, since he was supposedly independent and his caregiver took off, this poor man spent the night in his armchair, peeing into a cup when he needed to pee. In the morning he tried to get up, and fell. Was taken to the hospital in an ambulance, and was readmitted to our facility and now suddenly needs to be on assistance. So I'm in his room, trying to figure out what stinks of urine (everything) and how I'm going to get this man cleaned up. His daughters have flown in from another state, horrified at the situation. They're in there, and I'm giving them a shopping list (waterproof bed pads, vinegar, briefs, hernia belt, etc.) and directions on how to get to the stores that sell this stuff.

The marketing director, who, along with the criminally neglectful "caregiver", created this mess, comes breezing in and pulls me into the other room to tell me to "call him Sir" rather than Mr. So-and-So, which I was doing. Then, as if to soften that blow, mouths "Don't worry, you're doing a good job" to me.

Oh. Hell. No.

Normally I appreciate hearing thanks or validation about my work. I love it when my residents say "Thank you so much honey" and give me hugs when I tuck them into bed. It makes me a little teary when they say "I'll miss you, doll, come say goodnight if you have a chance before you go home. Drive carefully!". This is a job where I feel I am making a difference every single day. And I love that.

But do I need validation from this woman who created a situation where the Director of Nursing's BEST option was to let this man fall so his family would see he needs help from sane people? No, no, no, I do not.

I'm not ashamed to admit that I fantasized about putting his filthy blankets in her office and suggesting that she wash them for Sir. Or tossing her the most disgusting hernia support belt I've ever seen in my life and watching her catch it with bare hands. Or telling her to brush this man's teeth, which were so discolored at this point, I won't even tell you what it looked like when I finally did get him to let me clean them.

What I do is difficult. And I don't need any fake-ass "compliments" from people who just don't get it, even if they work in eldercare and should know better.

And this poor man's "caregiver"? The family is prosecuting her. So my new resident is being cared for, and the person that neglected him is caught. Now that's a happy ending in my book. Though I may still have to find a way to put something disgusting in the marketing director's office ... and then tell her what a good job she's doing while she cleans it up.

Shift Reports: Take it to the next level

Even though we use shift reports to communicate among nursing staff about what our residents have been up to, sometimes a resident will misbehave so outrageously or so consistently that management decides ALL the employees should know about it and be on the lookout. This usually comes down to the people who keep trying to escape (ie "flight risk") and those who really, really, REALLY don't want to be on any kind of diet.

You wouldn't think those two things would be on par with one another in terms of inconvenience, but you've never seen an octogenerian ranting and raving in the dining room about having to eat "grass" at every meal (salads) or about not being able to get a second dessert. They can get loud!

So when someone takes it up to that next level, management prints up a flyer or 10 and leaves them in employee-only areas: kitchen, break room, nursing station, and by all employee exits. That way, when the teenage boys from the dish pit are headed out back to smoke, they know that if they hear someone on the other side of the fenced courtyard saying "Open the gate, let me out!" that they shouldn't. For example. Or when the waitstaff sees Mr. Whomever sitting there for an hour waiting for shift change so he can order a second lunch, they need to call an aide (like me) to convince him to move it along and wait until dinner time.

My favorite thing about these flyers is how much they look like Wanted posters at the post office. I like to imagine the "flight risk" residents strolling away from the building in slow motion, with Bon Jovi's Wanted Dead or Alive playing in the background. Who says that the "steel horse I ride" can't be a walker or mobility scooter instead of a motorcycle?

Add to that the complete awkwardness of most of the photos used in the flyers, and you end up with something like this:

RESIDENT NAME: Mrs. Ballyhoo
[followed by an awkward photo of said resident, such as this one I found by googling "Grandma"]

ATTN: FLIGHT RISK
DETAILS: Resident has Alzheimer's and is a flight risk. If you see resident unattended, please escort her back to the memory care unit. Under no circumstances should you open a door for this resident.

or something more benign, like:

RESIDENT NAME: Mrs. WhoDat
[another google result for Grandma]

ATTN: Diabetic
DETAILS: Resident is noncompliant with diabetic diet. Offer her the "special" pie and do not say it's sugar free. Resident will stay at table and order multiple lunches. Call nursing staff if this happens. Small portions only.

For whatever reason, these fliers crack me up. Especially when a lot of people have been rebelling and the walls are practically plastered with them. The kitchen always has a lot, saying who needs thickened liquids (ew) and who needs their food mechanically softened. But when the back door to the facility starts getting filled up, you know it's been a long week!

Shift Reports

One of my absolute favorite parts of my job at the facility is coming in and catching up on the week's shift reports. Each shift (day, evening, noc/overnight) the aides and nurses write down anything notable that applies to our residents. That way, each shift, as they come on, gets a verbal report where we hit the highlights (Mr. Smith needs to catch the bus to go to the bank, Mrs. Jones fell earlier, Mr. Brown is drunk again) and then can read in the shift report for any further details.

Generally what makes the reports funny is what our residents have been up to. This week, for instance included the following gems:

Noc shift "Mr. X paged at 4am. When I responded to his call light, he asked where his daughters are. I told him they had gone home two days ago and would be back to visit again soon. Resident was confused, asked, 'Well ain't I in heaven?'. Told him he's still alive and was probably dreaming. He said 'ok' and went back to sleep."

Apparently heaven is a giant nursing home where we all have page buttons to ask the big questions in life, or get our briefs changed. Who knew?

I also liked: Noc shift "Went in at 3am for location verification check on flight-risk resident in apt. 123. She woke and started screaming for me to 'Get the hell out'. Resident was in correct location, as expected."

Then there are the ones that are funny because of typos or spelling errors that the staff has made. I was signing off on all our new care plans for our new residents yesterday, and saw that apparently one old man is "ablaze to get in and out of bed unassisted". Damn, he must be motivated!

I also like ones along the lines of "resident has a bruise on butt cheek" or "small sores on both sides of the crack". Descriptive and clear, just not professional. Same with "Evening shift please remember to take out so-and-so's bathroom trash before she goes to bed. No one can stand the stench".

My final favorite things to see in the shift reports are about our residents who hide the stuff they don't like. Don't think that TED hose (tight socks for diabetics) are comfortable? Hide them. Dislike your dentures? Stash them somewhere weird. I love seeing "Housekeeping found TED hose under bed. Told resident if he keeps hiding them his daughters will have his doctor prescribe another pair at his expense. States he doesn't care and will never wear them. TED hose missing again". And "upper dentures found wedged in easy chair cushions. Removed and cleaned, put in soaking cup with polident. AM shift, please encourage resident to wear them tomorrow".

Shift report logs = comedy gold, don't you think?

Crossing the line

The other day, in between shifts, I stopped at a fast food restaurant for a rice and bean burrito. Tasty! Since the home I was headed to doesn't have any toilets without "hats" in them to collect urine, I figured I'd better use the bathroom there. I walked in and was hit with that cloying, suffocating smell, and instead of thinking "Oh gross, jeez!" like a normal person, I thought "Oh! It smells just like Mrs. So-and-So's bathroom! Does someone in here have an ostomy bag?". Then I saw that one of the stalls had an out of order sign on it and probably something ungodly was in there.

That's when I knew I'd crossed the line and would never have a normal sense of what is and isn't disgusting again. I think it's inevitable when you spend your days toileting, changing, bathing and all around dealing with sick and elderly people.

It takes something really beyond the pale to get to me anymore, and if something does manage to grab my attention through sheer revulsion on my part, it's probably making me laugh at the same time.

So in no particular order, here's the short list of things I still get grossed out by. It's not for the squeamish!

1. Changing a brief or doing peri-care on a male who has a "#3" in there. If you're not familiar with this term, use your imagination. It's not a #1 or #2, although the presence of either or both of these increases the horror exponentially. Nope, a #3 is the other thing that can exit the urethra. Yep. Ew.

2. Poop on the shower floor. Something about the wet plopping sound and the way the steam just turns it into a vaporizer of fecality that will have you longing for Vicks or anything strong and mentholated to coat your nasal passages in. And the cleanup is a real bastard.

3. The smell of old, stale urine, especially if the urinator has a UTI or has been drinking alcohol. You wouldn't think it could possibly smell as strongly as poop, but it sure can.

4. The smell of blood mixed with any of the preceding three ickies. Adding in the smell of blood to any of those is the only thing that currently makes me gag and dry heave immediately.

What about you all, which of these is the grossest to you? If anyone says "none" and means it, you deserve a bronzed section of intestine to show what a strong stomach you have.

See, it stuff like this that makes healthcare workers into a subculture. No one else wants to hear about this junk, let alone thinks it's as funny as we do!

Paternalism

I've written here before about dignity being a hot topic among those in the eldercare field. This month, I've been thinking a lot about rights and paternalism. We're working with adults, and they generally retain the rights all adults have: to vote, to make financial decisions, where to live, etc. A few of our residents have court-appointed guardians (family members) because they weren't able to handle those rights anymore. But for the most part, you can't really tell your parents or grandparents what to do unless they're so confused they don't notice you're doing it. We use words like "encourage" and "persuade" and "offer" a lot when talking about getting our residents to bathe, eat, take their meds, etc. Because that's all we really can do. It's easy to think of old people as overgrown children (especially because bald, toothless, and diapered describes babies just as well as very old people). But they're not children, and don't want to be talked to like they are. Usually that makes sense to me, and there aren't many rights that I want to take from the people I care for. The "right" that I have the most difficulty with at my facility, though, is the right to get drunk.

The idea of an elderly alcoholic is a little weird and off putting, probably because you either had one in your family, or because you think old people are unintelligible and clumsy enough sober. I wonder if we know fewer elderly alcoholics because the WWII generation tends to hide it more, or because alcoholics usually die younger?

At any rate, the fancy-shmancy AL facility I work at has a bar, and has a handful of alcoholic residents. This adds up to a lot of falls and a lot of belligerence for staff to handle. We're constantly speculating as to why the bartenders serve as many drinks per resident as they do, but my instinct tells me that they probably want to avoid the ugly scene that happens when you cut a drunk off, so they cave.

This weekend, I had a run-in with one of my drunken "frequent fliers/fallers". While he was still sober before dinner, I took him outside to smoke. Residents who smoke have to turn over their matches, lighters and cigarettes to nursing staff, and we store them where we keep the meds. If they want to go out to smoke, a lucky aide (sarcasm here - I'm a nonsmoker) gets their things and escorts them out, then takes the person inside again and puts their things away. This is because not only is it state law that you cannot smoke in a public building (including bars, even) but we've got a lot of oxygen tanks throughout the building for people who need them to breathe, and those are combustible.

Smoking and drinking go hand in hand, and the last thing we want is our drunk residents trying to smoke in their apartments, setting themselves on fire, and having their oxygen tanks fuel that fire. A lot of people could die that way.

So despite my general non-paternalistic approach, you can probably see why, when Mr.Perma-Rugburn (from drunken falls) whipped out his own lighter, I reached over and snatched it out of his hand. I've learned from past experience that he won't hand them over when asked or told. He was pissed. I was pissed. I labeled it with his name and room number, and stuck it in my supply bag to store with the rest of his smoking paraphernalia in the nurse's station.

And then another employee from a different department spoke up, "But I'm the one that bought it for him". Picture Pollyanna with steam coming out of her ears and red as a tomato. This jackass, also an adult, went and bought lighters for someone who could easily incinerate this building and all the people in it?!?!? I glared and shook my head at this employee, wishing desperately that there weren't uninvolved residents around who don't need to hear me chewing out someone they know and trust.

So what to do now? The next day I put out an APB for that employee, hoping to catch him as he went off shift, but he was too fast for me. Bah.

Later that evening, I was thinking maybe I was overreacting and should pull the stick out and calm down. Until I got a page and went in to see Mr. Rugburn sprawled on his floor once again, drunk as could be, furniture scattered everywhere, insisting that a very pregnant employee should be helping him up and slurring all the while.

This dude, plus the one who is buying lighters and cigarettes for him?

They need a little paternalism. Or a LOT.

"Dinner For Schmucks", Reviewed By Bev

For some reason, the local theater changed their scheduling, greatly limiting today's choices for my movie date with Bev. It was down to Step Up 3D, Dinner for Schmucks, Toy Story 3, and Charlie St. Cloud. You can imagine why I was on pins and needles waiting to see which one she'd choose. I was pretty sure she'd rule out children's movies, and sad movies (thank God, I don't need to spend 2 hours crying and looking at Zac Efron).

As I described the choices to her, Bev said, "Well, I guess that leaves us with the Dinner Party one. What's a schmuck?"

Don't ask me how a Jewish woman from New York doesn't know what a schmuck is, but she was genuinely stumped.

"It means an idiot, a goofball, a buffoon."

"Oh!" she said, laughing already "What a crazy title! All right, Schmucks it is!"

Bev giggled throughout the movie, leaning over to me several times, saying "There's the schmucks!"

As we walked out of the theater, Bev was still laughing, and exclaimed, "Craziest picture I ever saw! And the wildest title, too! Schmucks! I'm going to call my daughter today and say, 'Jill, do you know what a schmuck is?' and see if she does. Funniest picture I've seen in a long time!"

"Bev, did you ever know anyone like that? Did you ever meet any schmucks?"

"Oh, no dear! Well, there was this one woman. She was an accquaintance, not a friend. She asked me what my name was, and I told her Beverly. She told me I could say Bev-IRE-lee and I said NO I cannot! She was kind of a schmuck."

"Oooh, you could be Bev-IRE-lee and I can be POLE-eyanna, and those can be our schmuck names, Bev!"

"That's a good word for it. Schmuck! Oh, that was the craziest picture! I hope we see another one like it next week."

"Me too, Bev."

Dr. Bill

Dr. Bill is a homecare client that I had way back when. He had been a client of CareCo for a very long time even then, so I assume he still is - I just don't have him on my roster right now. Dr. Bill was a retired doctor who lives in a swanky gated retirement community. He also has Parkinson's. But unlike Bitsy, his Parkinson's seemed to have skipped through the more common symptoms (stiffness, tremors) and gone right into dementia. Don't get me wrong, he had some slight mobility effects, and was very stooped over, so much so that child-sized furnishings would have been no challenge for him. But all of that paled in comparision to the big, bright banner of paranoia that Dr. Bill carries with him at all times.

To begin with, you should know that Dr. Bill believes himself to be an employee, not a client, of CareCo. When caregivers come to his home, he often believes us to be conducting trainings, meetings, or on a break. Dr. Bill drafts endless letters to the CareCo staff, quitting over and over again, and blaming his Parkinson's on the workload he shoulders at CareCo.

Sometimes he writes these out longhand, in his tiny, cramped, Parkinson's "microscript". Sometimes, apparently I am his secretary, and he dictates them to me on his home computer. Sometimes he settles for leaving voicemails at the CareCo office line. But Dr. Bill is always certain he doesn't want to work there anymore, and that they keep trying to stop him from quitting.

Apart from these obsessive resignation letters, Dr. Bill's other main hobby is reading and rereading his bills, and trying to call and argue with any bank, credit card, or utility company foolish enough to send him one. I really don't know why his family doesn't have them sent to a PO Box instead so they don't occupy his mind so much, but perhaps they like him to stay busy in his own way.

Sometimes these two processes mix in Dr. Bill's mind, and sometimes his other preoccupation, the fear that someone is stealing his pills, creeps in there as well. That's when the letters get really exciting. Scrawled on envelopes, legal pads, catalogues, are things like "Last count: 62. Must make a list of HI suspects. Big Boss Betty. Office Assistant Annie. Caregiver Cathy. Bill for VISA $33.86. What is this for? Cost of replacing missing pills? Call police."

Adding to all this is the fact that Dr. Bill has one of those printer/scanners that can function as a copy machine. So if Dr. Bill has, say, two envelopes full of his rantings that he decides should belong on one sheet of paper together, he photocopies them onto one. Over and over. And then rolls up the paper into a long tube, puts a single rubber band around it, and stores it in his closet for further rumination later on. He had a large supply of these crazy collages.

As you can imagine, Dr. Bill goes through a lot of office supplies this way. So one day, he asked me to drive him to the office supply store for more rubber bands and printer paper. We successfully got his supplies and were on our way back to his home for me to prepare him some lunch, when a two-story dental office caught his eye as we drove by.

"Pollyanna! Stop the car! Turn around! That's where I need to go!"

Gamely, I swung the car around, and drove by again, more slowly.

"There! That's the place. I gotta call them and tell them I need to see them. The real office is on the second story, but YOU'RE not supposed to know that."

Always wanting to be polite and humor him, I just replied "All right Dr. Bill, we can look up their phone number when we get home."

I turned the car again, taking a side street to get reoriented in the correct direction.

"Wait, Pollyanna, there was something else there too. Where did it GO? Dammit all anyway."

Luckily, Dr. Bill has a sweet tooth and can always be redirected with promises of pastries. Especially at lunchtime. So we made it back to his place, supplies in hand, for lunch and then more photocopying. Just like always.

Eclipse, reviewed by Bev

I have a new home care client by the name of Bev. Bev is over 90 (not sure how far over 90) and every Sunday, I pick her up, we go to a movie, and then I take her home to the assisted living facility she lives at. To meet her, you wouldn't think Bev is sneaking up on a century of life. She uses a walker, sure, but she carries a cute little purse that I'd bet money she bought in the teenager department, will only wear sandals because she hates real shoes, and has plenty of energy. She hires caregivers to take her out and about because she likes to stay very busy and her kids and grand kids don't keep her quite busy enough for her liking. Bev's a little Bubbe, complete with New York accent and hebrew plaques adorning her walls.

The first movie date we had, I wasn't at all sure what Bev would want to see. Turns out, she wanted to just pop over to the theater and go to the first movie that was starting when we arrived. She'd been hoping to see Salt, she confided, but the timing wasn't going to work out that day, so we saw Ramona and Beezus instead. This last weekend, I printed out the movie times for our local theater in big print, listing only the showings that fell within our 3 hour movie date parameters.

Bev ruled out all children's movies, and had already seen Salt ("it had a terrible ending - she dies!") and Inception ("just marvelous"). This left us with The Twilight Saga: Eclipse. I warned Bev that it was about vampires and werewolves and tragic love, but she said "as long as the good guys win at the end, the rest is all right".

Bev and Eclipse got off to a rocky start, with her saying "I don't want to see this" during the opening vampire attack scene. However, a quick cut to sparkling love in a meadow saved it and we didn't have to leave the theater after all. She greatly enjoyed Bella awkwardly telling her father she is in fact, a virgin. As we left the movie, Bev broke it down for me:

"What was the name of that movie? Eclipse? What does that mean?"
"You know, Bev, like when the moon gets between us and the sun and it gets dark during the day."
"I know what the word means but how did it relate to the movie? Well anyway it was very unusual. Very well done. But very unusual!"
"Bev, did you ever punch anyone for kissing you, like Bella did?"
"Oh, no dear, I said 'more, more, more'!"

Bev's favorite parts of the movie included the Washington scenery, and the love story. She was neutral about all of the fighting, and greatly relieved that it wasn't sad enough to make her cry.

So see, sometimes my job is very easy! If Bev and I see any other standout films, I'll keep you all posted on her thoughts.