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!
Saturday, January 22, 2011
Monday, January 17, 2011
I could go on Survivor
You might think that Nursing Assistant skills don't come in handy in real life. After all, it's not like I'm in the supermarket and someone yells out "Help! My Granny is sundowning! Someone convince her to take her pills NOW! " or like I'm winning big prizes on a game show for my speed & skill in changing adult incontinence briefs.
BUT.
If you (like some bloggers) live in a house that was built in the 1800's & then divided up into apartments, you might know how much it sucks to be without hot water. For a few days. In January.
BUT. If you had spent countless hours bathing old folks as fast as possible, including sponge baths/bed baths, you would (like this blogger!) be able to wash your hair super fast to minimize iciness. And would have the common sense to bundle up in jeans and a sweater and shampoo while leaning over the tub.
Then after drying hair completely, you might just microwave some water & get the rest of the way clean in under 2 minutes flat.
I tell you what, if I ever get homeless I'll be the cleanest one around my trashcan fire. I'm resourceful, like frickin' Batman.
BUT.
If you (like some bloggers) live in a house that was built in the 1800's & then divided up into apartments, you might know how much it sucks to be without hot water. For a few days. In January.
BUT. If you had spent countless hours bathing old folks as fast as possible, including sponge baths/bed baths, you would (like this blogger!) be able to wash your hair super fast to minimize iciness. And would have the common sense to bundle up in jeans and a sweater and shampoo while leaning over the tub.
Then after drying hair completely, you might just microwave some water & get the rest of the way clean in under 2 minutes flat.
I tell you what, if I ever get homeless I'll be the cleanest one around my trashcan fire. I'm resourceful, like frickin' Batman.
Wednesday, January 12, 2011
P-P-Pollyface has a P-P-P-Plan
The other day I got to play that dancing game for the kinect at a friend's house, and it is SO FUN. But now I think everything in a Lady Gaga way, which is why the title of this entry is full of P-P-P's like P-P-P-Pokerface. I also have been saying scu-ruh-huh-huh-hubs instead of scrubs.
Anway, the point is I have a Plan. Remember how I said I needed to get my butt into school to be a nurse so that I don't have to work this hard for this little money for the rest of my life? Well, I'm registered.
First I'm going to finally go get my CNA Certification, which will get me a (tiny) raise at my current job, and make me qualified to work in a Skilled Nursing Facility if I decide to leave my current job for a different place. I'll also be qualified to work in a hospital but that's more of a pipe dream; most CNA's would like to work in one, but pretty much every CNA works in long term care instead.
Secondly, I did my admission to our local Community College for fall quarter of 2011 to start doing my prereqs. Yeah buddy! I'll keep working while I'm in school, of course, so I'll probably just do one class per quarter. We'll see. I need to get good grades in them so I can be admitted to that baccelaureate program I want to get into to convert my BA into a BSN. So if I want to be a Straight-A Polly, I should probably make sure I'm also Has Time To Sleep Polly.
Look at me, I'm bettering myself! Not buttering myself. Maybe if I buttered myself, I could join the Haus Of Gaga. But buttering myself wouldn't be vegan. Or pleasant.
Anway, the point is I have a Plan. Remember how I said I needed to get my butt into school to be a nurse so that I don't have to work this hard for this little money for the rest of my life? Well, I'm registered.
First I'm going to finally go get my CNA Certification, which will get me a (tiny) raise at my current job, and make me qualified to work in a Skilled Nursing Facility if I decide to leave my current job for a different place. I'll also be qualified to work in a hospital but that's more of a pipe dream; most CNA's would like to work in one, but pretty much every CNA works in long term care instead.
Secondly, I did my admission to our local Community College for fall quarter of 2011 to start doing my prereqs. Yeah buddy! I'll keep working while I'm in school, of course, so I'll probably just do one class per quarter. We'll see. I need to get good grades in them so I can be admitted to that baccelaureate program I want to get into to convert my BA into a BSN. So if I want to be a Straight-A Polly, I should probably make sure I'm also Has Time To Sleep Polly.
Look at me, I'm bettering myself! Not buttering myself. Maybe if I buttered myself, I could join the Haus Of Gaga. But buttering myself wouldn't be vegan. Or pleasant.
Monday, January 10, 2011
Something other than work
Since I did that year-in-review quiz, I realized maybe I can occasionally mention something here that isn't related to elderly people or poop.
So here's one: the summer before last, I decided to learn how to surf. But I live in the Pacific Northwest, which means our ocean is very cold. So I worked a bunch of extra hours (this is when I was a nanny) and saved up, and signed up for surf camp at Surf Divas in La Jolla CA. I took 11 days off, and drove all the way down there, camped near San Diego, and surfed during the days. It was pretty awesome.
On my drive down, I stopped for lunch and saw the world's most amazing pinball machine.
I set up my tent
And spent my days like this (yep, I'm in this photo. I'm NOT the one in the instructor rashguard, sadly)
It was amazing and scary and one of the most fun things I've ever done. I didn't get good at it, but I did it enough to want to do it more.
When we first started learning, we were on the "inside" - closer to the shore, where the waves have already broken and the water is shallower. On the second or third day, we were ready to paddle out to the "outside" - past where the waves are breaking. To do this, you need to paddle really hard and strong to get through the "impact zone" where most of the waves are breaking. You don't want to spend much time there, so you try to power through it as fast as you can. Then you get to the outside where the waves are more like big sloping hills lifting you up and down as you bob around on your board. When you get lifted up you can see the shore, and it's so gorgeous and calm and peaceful out there. From there you try to catch the waves just as they're breaking and then you can ride them all the way to shore. When you get one, you go so fast it feels like you're flying. It's amazing.
Here's a wave diagram that may help you understand what I mean by inside and outside and impact zone. Where it shows a peaking wave, that's where you'd be catching the wave to take off on it. The breaking waves are the impact zone. Further out to sea is the outside, and closer to shore from the broken waves is the inside.
I've only gone once since then, back in my cold section of the Pacific. This last summer I was working too much to have time to get out to the coast. Hopefully next summer!
So here's one: the summer before last, I decided to learn how to surf. But I live in the Pacific Northwest, which means our ocean is very cold. So I worked a bunch of extra hours (this is when I was a nanny) and saved up, and signed up for surf camp at Surf Divas in La Jolla CA. I took 11 days off, and drove all the way down there, camped near San Diego, and surfed during the days. It was pretty awesome.
On my drive down, I stopped for lunch and saw the world's most amazing pinball machine.
I set up my tent
And spent my days like this (yep, I'm in this photo. I'm NOT the one in the instructor rashguard, sadly)
It was amazing and scary and one of the most fun things I've ever done. I didn't get good at it, but I did it enough to want to do it more.
When we first started learning, we were on the "inside" - closer to the shore, where the waves have already broken and the water is shallower. On the second or third day, we were ready to paddle out to the "outside" - past where the waves are breaking. To do this, you need to paddle really hard and strong to get through the "impact zone" where most of the waves are breaking. You don't want to spend much time there, so you try to power through it as fast as you can. Then you get to the outside where the waves are more like big sloping hills lifting you up and down as you bob around on your board. When you get lifted up you can see the shore, and it's so gorgeous and calm and peaceful out there. From there you try to catch the waves just as they're breaking and then you can ride them all the way to shore. When you get one, you go so fast it feels like you're flying. It's amazing.
Here's a wave diagram that may help you understand what I mean by inside and outside and impact zone. Where it shows a peaking wave, that's where you'd be catching the wave to take off on it. The breaking waves are the impact zone. Further out to sea is the outside, and closer to shore from the broken waves is the inside.
I've only gone once since then, back in my cold section of the Pacific. This last summer I was working too much to have time to get out to the coast. Hopefully next summer!
Friday, January 7, 2011
Matching Game
Here's a little game I like to call "I found what...WHERE?"
I'll tell you what I found, and you guess where I found it. It's a little like "find the saltine" on Scrubs except so far I haven't found any saltines anywhere unusual.
Let's play!
1. I found a flashlight.
a) In a cupboard.
b) In a garage.
c) In someone's underpants.
2. I found a pair of dentures.
a) In someone's mouth.
b) soaking in the appropriate cup with lid, labeled.
c) wrapped in a sock and in someone's pocket.
d) shoved down into a recliner.
3. I found a missing resident:
a) Sleeping in someone else's bed.
b) In the furnace control room.
c) trying to open the locked gate outside saying "Damn it!".
4. I found poop.
a) In someone's underwear.
b) Trailing from someone's bathroom to their bed.
c) On the shower floor.
d) Under someone's fingernails
e) In someone's mouth.
5. I found toothpaste.
a) on a toothbrush.
b) on the bathroom counter.
c) in someone's hair.
Keep in mind, this game is extra tricky because for some of these, every single option is true! My world is never boring. Or clean for very long.
Happy New Year!
I'll tell you what I found, and you guess where I found it. It's a little like "find the saltine" on Scrubs except so far I haven't found any saltines anywhere unusual.
Let's play!
1. I found a flashlight.
a) In a cupboard.
b) In a garage.
c) In someone's underpants.
2. I found a pair of dentures.
a) In someone's mouth.
b) soaking in the appropriate cup with lid, labeled.
c) wrapped in a sock and in someone's pocket.
d) shoved down into a recliner.
3. I found a missing resident:
a) Sleeping in someone else's bed.
b) In the furnace control room.
c) trying to open the locked gate outside saying "Damn it!".
4. I found poop.
a) In someone's underwear.
b) Trailing from someone's bathroom to their bed.
c) On the shower floor.
d) Under someone's fingernails
e) In someone's mouth.
5. I found toothpaste.
a) on a toothbrush.
b) on the bathroom counter.
c) in someone's hair.
Keep in mind, this game is extra tricky because for some of these, every single option is true! My world is never boring. Or clean for very long.
Happy New Year!
Wednesday, January 5, 2011
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!
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!
Sunday, January 2, 2011
Money Money Honey
You know what sucks? The pay. I make less than a dollar above minimum wage. Let's let that sink in. I'm someone who spends 8 hours a day feeding, toileting, grooming, talking with, dressing, and ambulating people with dementia. I notice changes in condition and report them to my charge nurse. I make sure their oxygen is on and at the correct flow setting. I chat with their family members, and update them on how their loved one is doing.
Most of my coworkers are on food stamps or some other form of public assistance. All of the ones who are single parents are.
The average cost per resident at an Assisted Living facility in my state is a lot of money per month. Remember, I'm in the Pacific Northwest:
The place I work at is always at least 95% occupied. We provide really good care to our residents (and their family members). The management is fair and reasonable. But we make just above a poverty wage, depending on how many people are in our households.
If my husband didn't earn any money, we'd be screwed. A lot of my coworkers also clean houses or do one-on-one care as a second job.
I don't know what the solution is here. Obviously individual families can't afford to pay more rent for their loved ones. Medicare subsidizes some of our residents, but some are private pay.
I don't have a solution for the whole system, but for myself, it's to get my ass back in school. I have a BA in Psychology, but found that I really don't enjoy the type of work in that field that a BA qualifies me for - it's direct care with very difficult populations. Tried it out, hated it, was unhappy, and fled to childcare instead. Then we relocated and I started working with seniors and have really enjoyed that.
I recently found out that I can do an advanced baccalaureate program to convert my BA into a BSN in just 5 quarters. As long as I complete my prereqs at community college first and get good grades in those. HALLELUJAH! My backup plan will still be to go to a technical college and get my LPN, but for almost the same amount of time, I could get my BSN (Bachelor of Science in Nursing) and be qualified to be an RN.
So that's my big goal of 2011. Get into school. Take my prereqs that I'm missing (microbiology, anatomy and physiology with lab, etc.). Because as much as I love my job and the people I care for there, I don't want to get stuck being broke forever.
So I won't.
Most of my coworkers are on food stamps or some other form of public assistance. All of the ones who are single parents are.
The average cost per resident at an Assisted Living facility in my state is a lot of money per month. Remember, I'm in the Pacific Northwest:
The place I work at is always at least 95% occupied. We provide really good care to our residents (and their family members). The management is fair and reasonable. But we make just above a poverty wage, depending on how many people are in our households.
If my husband didn't earn any money, we'd be screwed. A lot of my coworkers also clean houses or do one-on-one care as a second job.
I don't know what the solution is here. Obviously individual families can't afford to pay more rent for their loved ones. Medicare subsidizes some of our residents, but some are private pay.
I don't have a solution for the whole system, but for myself, it's to get my ass back in school. I have a BA in Psychology, but found that I really don't enjoy the type of work in that field that a BA qualifies me for - it's direct care with very difficult populations. Tried it out, hated it, was unhappy, and fled to childcare instead. Then we relocated and I started working with seniors and have really enjoyed that.
I recently found out that I can do an advanced baccalaureate program to convert my BA into a BSN in just 5 quarters. As long as I complete my prereqs at community college first and get good grades in those. HALLELUJAH! My backup plan will still be to go to a technical college and get my LPN, but for almost the same amount of time, I could get my BSN (Bachelor of Science in Nursing) and be qualified to be an RN.
So that's my big goal of 2011. Get into school. Take my prereqs that I'm missing (microbiology, anatomy and physiology with lab, etc.). Because as much as I love my job and the people I care for there, I don't want to get stuck being broke forever.
So I won't.
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