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 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.

Monday, September 6, 2010

(Temporarily) Hanging up my Stethoscope

Nursing Assistants are held to different standards of education and certification from state to state. Where I live, one can be a Nursing Assistant Registered (which I am) with very little classroom education. All of the practical skills I've learned, from taking vitals to transferring to catheter care, have been through on-the-job training and experience. If I were to become a Nursing Assistant Certified (which is my next goal) I'll re-learn a lot of those skills in a classroom environment combined with "clinical hours" at a participating facility. 75 hours worth of education, to be exact.

In order to be employed at an Assisted Living facility as an NAR (that's me!) I have to take this shorter, simplified training that is intended to cover all the basic caregiving skills. When I got hired at my current facility, the woman who hired me told me they'd be giving me that basic caregiver training. This is pretty standard for old folks' facilities in my state.

Now that the due date for that training is approaching, the woman that hired me has taken that promise back. She told me that I must pay for the training myself, and also that the facility won't pay for any of my training time. With the cost of the course plus lost hours & wages I'd be losing a full week's pay. A fourth of my monthly budget.
Nice, huh?

I went through all the channels, talked to the Nursing Director, and to Labor and Industries. Turns out this is a legal demand for them to make.

Which leaves me with just one option: quitting.

I turn in my notice tomorrow, and by the end of September, I won't work there anymore. No more Lanie disassembling her air conditioner, no more coworkers asking God "Where's my husband? I need someone to bang!" during dinner break. No more "flight risk" posters, or shift reports about someone's "butt cheeks". Sad!

And since my other job is as a private (nonmedical) caregiver, I'll be hanging up my stethoscope until I can find a replacement job.

The bright side is that by not wasting my education budget on a caregiving course, I will keep saving up for the Nursing Assistant course I really want to take. That'll open a lot more doors for me in terms of being employable not just in Assisted Living, but also in Skilled Nursing facilities or hospitals.

But until then, I'm frustrated and angry.

Aides and Caregivers are the ones who spend the most time with our elderly. We're the ones who know their quirks and personalities, the ones who are most likely to catch symptoms and advocate for treatments before a condition gets out of hand. We work incredibly hard for very low pay. And unfortunately, the management at this facility isn't at all unusual; a lot of times they suck. Being a Nursing Assistant means having to be vigilant to ensure you're actually paid for all the time that you work, and trying to avoid being put in impossible situations by management.

When I come up with a good solution for this dynamic, I'll be sure to let you all know. Obviously, the system isn't working right for the workers or the elderly. I know my residents will miss me, and I'll be worried about some of them. There are one or two right now that seem to only cooperate in getting bathed and dental care when I am doing it. Hopefully they'll form good relationships with whoever replaces me, and not refuse cares. But I'd rather be there doing it, and I'd guess their families would rather I was too. Something needs to change, here.

I just don't know how to do it.