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 . . .