Patience

One of my favorite, and oldest, little old ladies died recently at the GreatRep (the dementia care facility that I still work part time at).

Patience was seriously a bad-ass. She was the oldest living person I've ever met, at several years past 100. She still walked, fed herself, and talked when she died. She was chronically cranky, hated to get up early in the mornings, so we always let her sleep in and woke her up after everyone else had eaten their breakfasts. She was known for her particular style of combativeness - Patience would grab your scrub top's neckline, haul you in, and scratch the bejesus out of you while she shrieked "ouch! Owww! Hurting me!!".

But that's not all Patience was, of course. She still had a great sense of humor, and often seemed aware that her increasing deafness was a good source of entertainment. One day, in the dining room, she incited a food fight with another resident, a man. When the med tech on duty approached her to redirect her, she said "Patience, you're such a rascal!" and Patience stared at her for a beat, then said "I'm such an asshole?!?" then laughed maniacally.

Patience would constantly sing in a low, grumbling monotone, similar to her speaking voice. Very old songs, like Springtime in the Rockies, or The Battle Hymn of the Republic. She'd also talk out loud, verbalizing her thoughts, which she may or may not have been aware she was doing. If you were walking by her and stopped to say hello, give her a kiss, or wave at her, she'd often mumble "that one smiled. That one smiled. That one was happy." in her repetitive, robotic voice.

My favorite ever moment with Patience was when I was trying to put her to bed one night. She was being very resistive to standing up, not wanting to leave her comfy couch in the living room and walk down to her room. Patience had never had children of her own, but was a devoted aunt whose nieces and nephews still visited her until the end of her life. So, trying a different approach, I said "Auntie Patience, I want to go to bed but I'm scared to walk there by myself. Will you take me?". She grudgingly pulled herself up with her walker and headed to her room with me. She used the bathroom, brushed her teeth, put on her nightgown, and then, to my surprise, plopped down on her coffee table! She leaned back, pointed at the bed, and said, in her deadpan way, "Go ahead. You sleep now, I'll watch you. You go to bed. I'm here." Just thinking about that is enough to make me cry.

It's not often that the staff at a nursing home really loves and adores a combative resident, but we all loved Patience. Who else would repeatedly strip in the common area, to the point we had to go plunk her in her room where the nudity was more appropriate? And then when we checked on her later, we found her wearing only panties and a bedsheet tied around her neck like Superman's cape, singing Take Me Out to the Ballgame!

So, Patience, you were a delight. I miss you already. And I know you would understand that it's with great affection that I share the following photo of what you reminded me of at the breakfast table every morning, since you never mellowed out enough to get your hair combed until you'd been up for a few hours.

Best of Shift Reports, part 2

The other morning I got a really funny shift report, which was "Charge nurse on evening shift discovered resident trying to order pay-per-view movie entitled 'Slutty Girls Do It For Money'. Resident was not successful." my DON's comment was "Are you sure? I thought 'slutty girls' did it for free." and the dayshift charge nurse suggested that "No it's homely girls that do it for free.". What other line of work would you be having this chat at 7 in the morning?

Anyway, it reminded me I haven't shared any of my favorite shift reports with you people lately, and that's a shame!

So here's one "Caregiver accidentally bumped resident's head on headboard while transferring into bed. Resident did not complain of pain, but stated that she was now dead, and that the caregiver had killed her. Resident shows no signs of injury or death."

"Resident complaining of tiredness, has been walking around all day looking for her 'midget'. None has been found."

"Mr. X and Mrs. Y may not be seated at the same dinner table any more due to throwing food and splashing liquids at one another." came after a 102 yr. old woman started a food fight.

"Resident given an anti-anxiety drug due to her persistent belief that her roomate's oxygen concentrator was going to
kill her, despite it not being turned on."

Me + Med Cart = True Love

I fricking love my new job at my same facility. I have more independence and autonomy, which is AWESOME when my coworkers are being douchebags like they were today. I'm learning a lot and becoming more med-literate, which is helping as I do my nerdy stuff like look up decision making flowcharts related to different behaviors and how to manage them. Now I can look up "screaming" on www.alzbrain.org and am familiar with some of the medications they suggest.

Also, I'm good at getting all my residents to take their meds. Even the paranoid ones. And I'm starting to remember who takes what so if I see Sally Lou limping and say "Does your foot hurt?" and she says yes, I can remember whether I give her routine tylenol or not, and go run and get it right away. Or if I see Harry starting to get hinky and rearrange his furniture while wearing lots of layers, I can think "Do I give him behavioral meds? Yes! Now might be a good time for that!"

Now I'm feeling guilty that I said my coworkers were being douchebags. Really it was only 2 out of the 12 that I saw today. And it's the same 2 that are always like that. One is just honestly very dumb, and so it's really hard to communicate with her. Example: our facility has two wings, East and West. On East, most of the residents can walk, talk and feed themselves. On West, they don't. My dimbulb coworker has been there for probably 4 months and still cannot tell you which is which. Or where each resident's room is. These are things that normal people knew within 2 weeks of working there. Not the sharpest tool in the shed, that one!

So I love getting to wheel my cart around, popping pills, doing my paperwork and phone calls to family, and not having to chase down Dimbulb to help with a 2-person transfer or Lazy to watch the floor while I go give a shower.

Oh med cart, I love you so much!

I'm in like Flynn

Had my first day of med tech/med aide training today, and I think I'm going to love it. I like getting to learn how to read the MAR's, new charting, getting familiar with all the medications and what they do, and really getting to use my brain at work for the first time in a while. Caregiving is more social intelligence and brute strength combined, and this is more being meticulous, some critical thinking, and a ton of new things to learn.

The shifts are longer (10 hours instead of 8) so that is tiring, but I'm delighted to be getting done at a time when normal people get done with work now too. I'll be working med aide 3 days a week, and caregiving in between in order to keep me at full-time.

It felt really good to have my coworkers congratulating me today as they noticed that I was wearing regular scrubs instead of the caregiving uniform ones, and I love that in this role, I get to see the whole building and almost all the residents, rather than just the one hallway at a time.

Walking around there today was like seeing a new place; the people were all the same but my focus was very different. It's kind of like when you go back and visit your elementary school and can't believe how little the desks are. Familiar, but different enough to be disconcerting and charming at the same time.

Hopefully tomorrow I'll get my book learning session in with the DON and I think I may even be working the cart on my own (!) this weekend - yikes/hooray!

Promotion

My facility is fairly small, as assisted living facilities go. We've got just under 70 residents, and usually have 1 charge nurse on shift supervising 6 caregivers/aides who take care of approximately 10 residents per shift. During regular working hours we also have the Director of Nursing and a med-tech.

All told, we've got maybe 2-3 different charge nurses for each shift, and they just take turns, and have 2 med techs. One does M-F, one does Sat-Sunday.

That doesn't leave a lot of wiggle room for call-outs, so sometimes our charge nurses end up having to work a double, and this last weekend our Director of Nursing (DON) had to come in and work a med tech shift, which she didn't like doing since she also had to come be the charge nurse simultaneously. Oops! That means she had to do all the routine med passes, PLUS all the treatements and assessments PLUS all the charting by herself. Ouch.

Med techs/med aides are a fairly new position that mainly work just in nursing homes and assisted living facilities. They can hand out routine meds to people who are able to actually take them independently - meaning that I could hand them a little med cup, say "here's your medicine" and they could then take those pills. If they had to have them crushed and in applesauce, or they weren't able to comprehend that they're taking medication, the nurse has to administer it to them.

Med techs have to be trained, need to have a basic understanding of pharmacology (how drugs interact, what they do, when to give them vs. when to hold them) and be responsible enough to handle narcotics honestly and chart appropriately.

Our DON decided we need another med tech because right now there is no backup if one of our two gets sick or goes on vacation.

Normally she would advertise within the facility to see who might like to apply for it, but this time, at our meeting, she apologized for not doing so but said that she had one person in mind for the job for a while now and was glad that this person accepted the position. She'll be training the new med tech starting this week. The new med tech is ... ME!

That's right, guys, Polly is going to learn a lot of new skills, be paid a little more, get to wear cute scrubs for the first time, and get more responsibility!

This is huge for me. I'm really excited, proud, and nervous.

Med Tech Polly, coming soon!

Dementia Facility FAQ's: What family members are probably wondering.

We've had a few tours come through the GreatRep lately, as well as out-of-town family members come into town to see some of our residents. It's interesting to see how people react to the place their first time, and it made me think about what they're probably wondering but don't ask. So here's my version of what you might like to know about a dementia facility, and my answers:

1. Doesn't it bother them to know they're locked in here?
Surprisingly, no. None of my residents have ever said anything like that to me, and very few are aware that they cannot exit certain doors without setting off the alarms. We have secure courtyards they can go outside in, and we just redirect them away from the front door if they're up there fussing with the keypad (it requires a keycode to open it without setting off the alarm). People with dementia are very inwardly focused, for the most part, and get more so the more their disease progresses. So our little world inside the facility is usually big enough for them. It helps that it has a circular part of the floor plan which is good for walking/pacing.

2. Why are all those people dozing in chairs? Why aren't they awake?
The most common answer is that most of them don't sleep all through the night. I just worked my first overnight shift at the GreatRep and was very surprised at how often I was informing people that no, it's still the middle of the night, and helping them back to bed. I figure that even the ones who can't get up and talk probably spend a good portion of their time in bed awake too, so they just kind of doze off whenever they're tired. They're on more of a 24-hour schedule, like a newborn. And yes, if they're hungry or thirsty in the night, we give them snacks.

3. Why is that lady making that noise/yelling for help/hitting that chair?
I don't know. Sometimes repeating the same words or phrase over and over is soothing for people with dementia, it's called perseveration. Unfortunately, sometimes that phrase is something hard to listen to, such as "help me help me help me" or "hurry up hurry up" or a repetitive action, like banging on whatever is in front of them. We try to mitigate, redirect, and keep them occupied with other things but there's nothing we can really do to make someone stop doing a behavior like that.

4. What about privacy? Won't you sometimes be doing some things in front of other residents? We had a family member complain this week because the podiatrist was in to do foot care, and was set up in a room at the end of the hall which isn't closed off from the hall. They thought it was inappropriate to do foot care out in the open. The thing is, you have to consider the logistics; sometimes there isn't enough space in each person's room to set up a podiatry station. Also, see #1 about the inward focus. Very few of the residents pay too much attention to what the other residents are doing for any long span of time. Some have friendships and stick together, but then they don't mind if their friend is present while their feet are being worked on. We don't change their clothes or use the restroom in front of others, and if they're getting a brief change in bed, their roomate is asleep/cannot see over to their side of the room plus it's still quite dark.

5. Why are you feeding them? Why are they incontinent?It just happens that way; over time, almost everyone become incontinent to some extent, and eventually they stop feeding themselves. That's why they're getting 24-hour care now. We use mechanical lifts called sit-to-stands so that we can still give everyone the chance to use the toilet, and whether they void on it or not is up to them. That's what the briefs are for. I think this is probably one of the biggest reasons I'd have a hard time keeping someone at home and caring for them myself. Everyone incontinent really should be changed approximately every 2 hours. I couldn't do that at home. We've got a full staff and we all get to go home and sleep between shifts, which is why we're able to do our jobs well. Having worked in this field and seen how hard it is, I think I would be totally willing to put myself or a loved one in a good care facility; I just don't see how it'd be feasible to do otherwise.

What a Winkle

I absolutely love the weird conversations I have with my dementia residents, and there's one that pretty much always takes the cake. "Cookie" hallucinates and can be very difficult to deal with, but she's often very focused on wanting to see a doctor and wanting every person she sees to be a healthcare professional. So I usually address her as Ms. Oven instead of Cookie, and emphasize that I'm a nursing assistant rather than a caregiver in order to get her cooperation. I once had to wrestle a wet incontinence brief away from Cookie, who gave it up only when I told her I needed the sample for the Doctor. Gross.

Anyway, over the weeks, Cookie has come up with some good ones; telling me the Borg are trying to get her when I go to wake her up in the morning, hitting on the life-size dancing Santa that we had up at Christmas, telling my female coworker what a "gorgeous guy" she is.

The other day I went to get Cookie up out of her armchair to go use the bathroom, and she had a little stuffed animal sitting on her walker. "Look at my Baby!" she said, as I approached her, "Isn't he cute? What should I name him?"

Her stuffed animal was a little moose, so I said "How about Bullwinkle?"

Cookie blinked at me for a long moment, then said "He's from . . . where? He's a Winkle, you say? Is he a Winkle?"

I answered "I think he might be, what do you think?"

"Yes, probably. A Winkle."

Oh, Cookie!

Bathing the Reluctant: a How-To.

It's my first day off (finally!) after being on for 6 days in a row, so I'm predictably spending the day at home. On the couch, in the bed, or the bathtub. I plan to do laundry and roast some vegetables later, but that's about as enthusiastic as I'll get today. I'm Tired with a capital T.

So when I got a call from the HomeCare agency this afternoon (I'm still "on call" with them, though I've yet to actually go and work a shift for them since switching from regular employee to on-call) I screened it. And then was pleasantly surprised when it was a voicemail from the office staff saying that my former client Gary has recently begun refusing to bathe for his caregiver, the one that took over for me when I left. She wanted to know if I'd be willing for Gary's new caregiver to call me and talk it over with me to see if I could help. Sure!

So now I'm feeling like a (tired) Shower Expert. And wanting to share my super-important knowledge with the world. So if you've ever wondered "how the hell am I going to get that cranky old coot to take a shower?", this one's for you.

Step 1: Assess the need/reluctance:
Lots of elderly people don't like to bathe. They truly don't need to as often (2x a week is just fine - they have thin skin and tend to perspire less than younger folks, and dry out easily if you wash them too frequently). They hate being cold, don't want to get naked in front of anyone, are afraid of falling on a wet, slippery floor, and may have medical equipment (indwelling catheters, ostomy bags) that make showering a hassle. No wonder they say no when you ask them to go hop in. So think about it first; do they actually need one? If yes, do you need to shampoo their hair as well, or can you give them a shower cap and just wash their body, and shampoo their hair in a sink later? Figure out the bare minimum of what needs to happen today, so you know what you're willing to negotiate down to.

Step 2: Prepare.
Before you even mention the word shower to them, go get it set up. Heat up the bathroom so it's uncomfortably hot for you. Make sure their shower chair/stool is in there, as is their shampoo and everything else. Bring more towels than you think you'll need. If possible, put bathmats down from the toilet to the shower. Bring in the clothes you'll be dressing them in afterward.

Step 3: Approach.
Hopefully you already have gotten to know whoever it is you're trying to bathe, so you know what approach works for them. Some people hate surprises, so you really need to tell them ahead of time where you're going. Pitch it in a positive way, with a smile and enthusiasm, "Hey Betty! Guess what? Since today is your shower day, I went and got your bathroom all nice and warm for you, and pulled out that lavender soap you like! C'mon, let me show you what I did!". Others, it's a mistake to mention the word shower until they're already in the bathroom. I have several residents like this. For them, I just say "Let's go use the restroom" and walk them in there. Once they're seated on the toilet, I go ahead and remove their briefs, pants, shoes and socks (this is where the bathmats come in; no bare feet on cold floors). Then and only then do I say, "Okay, Bill, we've already got you halfway ready, which is great! Today is your shower day, so I've got the warm water running, and if you just walk along these mats to the shower, I'll help you get settled in and get all warmed up in there."

Step 4: Overcome resistance.
Once you've pitched the idea, you'll probably get some resistance. Common ones, and responses to them are things like

"I don't need a shower, I just took one"
"It's hard work being beautiful, isn't it?"
or "Time flies, doesn't it? Today is Tuesday, so it's been about a week since last time. It's going to feel so good to get that warm water on, isn't it?"

"Why are you in such a hurry to get me wet?"
"We're not in any hurry. But I want your skin to be clean and healthy, so we need to get you washed up for that to happen."

"I don't want to get in there! I don't want to get wet!"
"I know you don't always like it, but I set everything up really nicely for you today. I think you'll enjoy it. Give me 2 minutes to try it out, and if you don't like it, I'll help you get out and get dressed."

"I don't want my hair wet!"
"Okay, here's a shower cap"
or if that's not an option "Here's a dry cloth to hold over your eyes. I'll aim the water so it stays off your face."

If your patient has advanced dementia and can't really talk or be reasoned with, still set it up nicely, talk them through it in a positive way. They're likely to get combative when you start to undress them, so it might be best to get a buddy to come and help you get through that part as quickly as possible so they don't get any more riled up than they have to. It's fine to leave on socks, for example, if they really won't give them up. They'll want them off later once they're wet.

Step 5: Bathe.
Do whatever it is you promised to do. If you promised not to wet someone's hair, don't surprise them by suddenly hosing down their head. That's not nice. Get them settled on the shower chair, check the water temperature on your inner arm (above your gloves). Chances are, most elderly people will want their shower cooler than you'd take yours. Approximately body temperature. Have them check the temp with their hand first. If they're not able to do that and give you feedback, start at their feet and move up slowly, so they get a chance to acclimate before feeling the temperature on their chest or back. Have them help and participate as much as possible, even if that's only to hold a washcloth to (hopefully) stop them from punching you. Keep talking through what you're doing in a gentle voice "Okay, Sally, here's some warm water for your back. Now I'm going to wash your back with this cloth, and then we'll rinse off all the bubbles. Good! Next let's do your chest" etc. If they're freaking out, do it as fast as possible, and concentrate on armpits and pericare.

Step 6: Finish.
As soon as you turn that water off, cover them in towels as much as is possible. If they walk, put down a dry towel on top of the (closed) toilet lid and help them walk over to it and sit down. If they don't, wrap up their shoulders and back, drape one over their lap, and keep one to start drying their arms and legs. Get them dry, lotioned and dressed as quickly as you can. Usually once they realize you're putting clothes on and not off, they'll relax and help more.

Pat yourself on the back, wipe the sweat off your face, pick up the zillions of wet towels, and spray down that shower with bleach. You did it!

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.

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.

Ta-Da!

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!

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.

Quickly

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 . . .

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.

Whew!

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.

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.

Ugh.

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.

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?".

Eeek.

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.

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.

(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.

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?