Month: February 2015
My sister and I told our Mother we would never put her in a nursing home. That’s what we told her, my sister and me, without a thought about our own job commitments and physical limitations or the fact that Mom might eventually need 24-hour care with her Parkinson diagnosis advancing. Although our intentions were courageous there finally came a day that we had to break that promise even though we fought hard for every option we could scrape up.
So what were we so afraid of that a nursing home would be the very last option? The fears were many and unfortunately all too common. The primary ones were lack of quality care and compassion, neglect, bad food, loss of autonomy and deterioration of her mental health. Like almost all grown children faced with this decision we were somewhat optimistic at first, thinking if we looked hard enough we would be able to find that one nursing home that really cared, and, they would take Medicaid.
Even though I worked in the disability field at the time with experience to the contrary, my hopes were high. We carefully screened three or four skilled nursing facilities and included Mother in all the decision-making. By the time two months had passed we were transferring her into a third one. The nursing homes changed but the problems remained.
This process was wearing on Mother’s normally strong, courageous and happy attitude. I can tell you from experience that even the most aware and extrovert personalities will succumb to the daily chipping away of their self esteem until all that remains is the defeated complaining, and most important, complacent, victim. That is what happened to our Mother and in the end fear resided within her and she begged us not to “stir up” trouble as they make her pay for it later with neglect.
There are circumstances that I feel give way to a propensity for corruption of nursing home services. I have listed these below.
- A lot of registered nurses, because of inexperience or just plain “burn-out”, are unable to see past the documents they are required to complete to the true priorities in caring for their floor – safety, hydration, and attention to serious medical problems, adequate nutrition and cleanliness. Mainly for cost savings, nurse’s aides fill these important roles while the nurse does the exhausting paperwork. My Mother and many others on her floor seldom saw a nurse even though C-Diff infection continually ran rampant throughout the nursing home.
- Lack of supervisory staff especially on evening and all night shifts allows thievery and neglect and even abuse.
- Nursing aides and C.N.A.’s are hired and kept on minimum wages. They are not honored or valued for the compassionate work they do. This leaves an employee pool of mostly inexperienced, undereducated employees that are more often than not in desperate financial crisis. And, as anyone knows desperate people do desperate things.
- Lack of sensitivity training and communication skills leaves patients and their loved one frustrated and angry.
- Social Workers for the Nursing Homes are responsible for the entire population of residents. Almost always they have the education but no hands-on experience as well as no idea how to apply the social work “theories” so neatly addressed in text books to the overwhelming reality of old age. Once again, social workers directly out of school with no experience are less costly for the establishment.
- A kind of desensitizing effect happens as patients become room numbers and bed numbers. Being kind or socializing means you might become “attached” and then lose them.
I have been in a few decent nursing homes; however, they did not take Medicaid. And, in the nurse’s defense I think they probably started out caring and ended up in such a governmental paperwork cave-in that they just gave up trying. I really see the focus of the problem being how the money is allocated through reimbursements from both Medicaid and Medicare. Below I have included some ideas that I think would go a long way to solve at least some of the problems.
- Wage Pass-Through – I was reading about this on the Internet as a way to get the money directly to the people who do most of the work. A certain portion of public Medicaid monies can be passed on directly to nursing assistants. States could look at this policy instead of Medicaid monies going for overhead, misuse and profit first.
- Minimum staffing laws that are strictly enforced. Training and testing that a new employee must complete before starting. Review testing during six-month reviews.
- Allow residents to spend time with the facility’s dog or cat for emotional therapy of unconditional love. Non-Medicaid expensive nursing homes do this and it is very therapeutic. It’s a shame that the no-pet restriction is usually only for poor people.
- Nursing Home Workers Unions – this is done in some states and the quality of staff and treatment of patients has shown a rise in quality.
- Put in severe consequences when prosecuting corrupt nursing home corporations that defraud elderly Americans of huge amounts of money that should go to their care. Let this country take a stand – if you steal money intended for the care of our mothers and fathers, you will go to prison for a long time.
- All managers and supervisors read the study, “Quality in Long Term Care-What We Can Learn from Nursing Assistants”
- Take residents for walks or get a tandem bike for those who are able to ride one. But, most of all get them outside.
- Put their pictures on their doors (Younger ones too) and who they were, what they did. Some nursing homes are doing this now.
- Give nursing assistants a break. Congress should consider changing the Federal Tax Code to include, for example, something like, “If an individual is employed as a direct caregiver and earns fewer than 30K a year, one thousand dollar tax credit is available.
- Let residents vote on a different “employee of the month” and give that staff a small bonus or gift certificate or time off with pay
These are just some of the ideas I had. I am sure there are many more by frustrated loved ones like me. There has to be a better way than the current “waiting rooms” for death approach. At least now there is an option for aging in place with home care assistants like the programs from Independent Living Centers but still no funding for 24hr care.
My Mother did not have a dignified ending like my sister and I had longed for. She suffered for almost a year with C-Diff infection that half the nursing home had. It causes fever, diarrhea, vomiting and weakness. Mother had lost nearly half her weight from hardly eating and vomiting what she did get down. She sat in her recliner one evening ringing and calling for a staff that never came to help her to the bathroom. Sitting in her own urine all night was more than she could endure. She pushed herself up but before she could safely reach her bed just a foot away, she slipped in her own urine and broke her hip. A day later we were told about it when they decided to take her to the hospital. She had successful hip surgery but chose death anyway and refused food and water rather than life at the nursing home. Three days later she died. They called it “failure to thrive”.
Marriage was my first life changing transformation point. In the 60’s it was still considered the most accomplished thing a woman could hope for. It defined who you were. It was even thought of as a promotion of sorts. You got a new title, “wife” and a new last name. It meant someone wanted you, couldn’t live without you. You were, most of, all desirable.
The music and the movies of the day exalted the dumb blond, the light headed sex pot and the silly, giggly, and most important, helpless little girl. I was none of these but understood that in order to be “desirable” enough to snag a man into marriage I would need to play a part. Of the choices I could see I chose the demure good girl. At least it didn’t get me grounded. The very first line I threw out I snagged a boyfriend who would become my future husband. It didn’t occur to me then that I was capable of catching many more.
By what seemed to be no time at all, it was the eve of my wedding day. Although I had dated him for my entire high school years I was still apprehensive. It meant leaving my family home. Daddy would no longer be my sole male protector. What if my new husband couldn’t do that? I would change forever, more responsibility, less privacy. This was a big, big move from the 18 year old graduate into womanhood. But, I knew I had to take the leap, so I jumped self- doubt and all.
With my old all or nothing pattern of transformation throughout my life stages I was determined to be the best wife ever. I would keep my stomach flat, never look messed up, shine the floors and have sparkling bathrooms. And, of course, I expected the exact same devotion from him meaning he must focus on me and me alone. There was no room for anyone or anything to squeeze between me and him and my obsession to be the best. I resented the friends, extra activities, his work, obligations and on and on. My intensity and insecurity of transformation into a married woman was a suffocating reality that was bound to fail. And, of course three daughters and twelve years later it did.
Looking back, I think maybe I was really trying to cover up a little girl who wasn’t ready to make those changes but felt pushed along by society’s expectation to do so. I just kind of closed my eyes and ran for it as fast and as hard as possible lest I weep over what I had left behind. He was the basket that held all my eggs of happiness, joy and contentment. I loved my husband dearly but the insecurity within me produced an obsessiveness that drove us apart.
I raised my three daughters very differently. I made sure they were empowered as individuals full to the brim with self-importance. Today’s young women understand so much more of their worth and potential. Society has progressed beyond “equal” to a man to defining the individual regardless of the category of species. I know the feminist movement was necessary at the time but it spent a lot of time proving women were the same or better than men. In reality we are different, unique from men. We should not be in competition but honored for the diversity and unparalleled gifts we bring as women. No need to compete because we already know our capabilities as the individuals we are. The chains of negative attitude against women can only be broken by the self- realization of each woman to acknowledge and honor their self-worth. To be successful the movement must start within.
Living inside an illness puts us, literally, into someone else’s hands. We lose our sense of autonomy and power. We are isolated, sealed into the private rooms of our own minds. We may be in pain but it is hard for those outside the illness to understand, even those extensively trained for such work.
Yet, despite the fact that no one understands we may still want someone to listen, to touch us, to remind us we are still part of the human race.
And, so it was for me. Even after endless painful turning of my body that had wasted to mostly skin and skeleton, I longed for physical touch. I wanted to know there was someone who would fight for my life. I became more afraid that no one might care than I did of dying. All my life my Mother had fought for me, had kept me safe. At even the hint of harm she threw open her wings of courage and fought the danger. But, she was not here and for the first time in my life I was starkly vulnerable and way too weak to fight for myself. No one left now in my isolated world, no one but God.
“I’m ready for the end”, I said silently to God.
“No”, he whispered to me, “you are ready for the beginning.”
And so, this vehicle that had failed me, that the doctors said had no hope of recovering from the severe damage the sickness had ravaged on it, began to heal itself. My vitals started to stabilize; my heart began to beat stronger and with balanced rhythm. My kidneys began to function and my ability to draw and push breath began triggering the ventilator alarm forcing them to start weaning me off of it. I was visibly awake and aware.
I was back, I knew it, and at that moment my cup runneth over with the desire to live again. The best part of my life lay before me in ways I could never imagine. Faith would take me there.
Life besieges us with trouble and
sometimes with strife
and we often wonder how our endurance
will last through this life
The further we go the
the steeper the hills
so we use our faith from within
and push on with iron will
Even though the friction wears us
we are honing our skill
each lesson a pearl
spun from courage instilled
Life marches on as we string
one pearl at a time
transforming our spirit
from the wisdom we find
Someday we cross over and
the Angeles will sing
as they see the beautiful pearls
We carry on wings.
The Family Conference
This was and still is, I might add, a very important part of our family tradition even as adults. I have always thought this was one of the most important ways to teach self-esteem and self-empowerment. Children long to be included in decision making. These “conferences” were a place where what they say counts and most importantly, and most of all what they feel counts. If memory serves me, I think I remember some of the more important reasons family conferences were held:
- Weekend plans
- Vacation destinations
- We are moving (again)
- Someone’s starting a new job
- Problems with friends or classmates
- Moving rooms or sleeping places
- The stars, the heavens & why are we here?
- Someone wants more freedom
It is a bonding experience where the older ones can help the younger ones cope and understand their problems using their own experiences. Children need to be taken seriously in this way. Our life style seemed to be always a chaotic frenzy of time schedules where most of the time I listened to them all with one ear while preparing dinner, throwing coins in the laundry machines at the laundry mat, picking up the house and french braiding someone’s hair while getting ready for work.
Family Conferences allowed me to “table” a decision on something until a day off and more peace prevailed. In the meantime the person who called the family conference would need to gather what they wanted to change and why. Listing on paper was highly encouraged in hopes of minimizing the blank look and shoulder shrugging. The kids all became quite the little litigators using this method. Most teachers were impressed by their quick reasoning powers. No one was allowed to state a problem without at least three solutions as options to decide on. This little rule drove them all crazy but made excellent problem solvers in the long run. Of course the solutions had to be reasonable. For instance, posting an index card on the laundromat bulletin board offering your sister for free babysitting, house cleaning, garbage taking out, would not be considered reasonable. Lots of little old ladies answered that invitation to my everlasting frustration.
If the conference was about moving there were pictures, maps and information about the proposed area. Exact dates and time and reason of moving was also open for discussion. The same was true for holidays, vacations and weekend visits to relatives.
Children, I learned, are bright, clear, aware, flexible, and come to the table uncluttered with old history or old society beliefs. They teach you to think out of the box. They were all very creative and astonishing with solutions. It made very clear the fact that we were all in this together and that knowledge made for a circle of bonding full of respect and caring. It taught them that there was nothing you could not get through. They found out that through it all no one knows you better than your family. No one is better to take charge when you can’t. They had experience beyond their years by solving, changing and being honored for who you are.
Honor your children and never lose the family empowerment circle of respect.
My father’s hands were huge and rough and calloused. When I was small my whole tiny hand barely fit around one of his fingers. He would use those big hands to gently lift the baby chicks so I could pet them. As I smiled his hand would envelop the top of my head softly patting it sending feelings of love like sparkling stars through my soul. I could feel those same strong hands holding the back fender of my Western Flyer bicycle as I was trying to learn to ride. When he felt I had learned enough to balance on my own that huge hand would slowly lift away. This would be his style for every period of growth I went through.
His hands would put every worm on every hook on my cane pole. In the high mountain streams his big strong hands would delicately snap and circle a trout line in a beautiful ballet barely touching the surface of the ice cold water. As his line skimmed the top he would snap it up spraying a fine mist that sprinkled like diamonds in the mountain sun. I watch those big rugged hands make tiny intricate flies for fishing and repair reels until they hummed.
Those hands would come home from a day’s hard work full of lacquer and specks of paint from house painting and he would drench them in thinner to clean them off enduring the sting in any open cuts. In the cold dry winter he would get cracks in them and have to treat them with heavy salves. But they still did their work, still had power, and they still gently held mine and kept me safe. In church they would find a peppermint hidden in his pocket and pass it to me during services before holding the hymn book while we sang together. As I grew and found a new love those hands reluctantly walked me down the aisle.
One day on my weekly visits to my parents’ home I noticed his huge hands were trembling ever so lightly and I realized age was taking its toll. Whenever I saw him I always reached for his hands for they had always been my connection to his great love. Those hands are at rest now but the memories still touch my soul in ways no other love has ever done. I can still feel his grip on my hand that brought so much peace in my heart and it guides me through every storm that life presents.
Are we warehousing our people? Institutions have been banned long ago but there is a subtle, ever so gentle push to contain, manage and control citizens who have similarities. These similarities are not physical but based on a much more pervasive demographic. These citizens are our seniors, the disabled and low income of our community. Senior housing, section 8, HUD housing and accessible complexes lure citizens by offering amenities specific to their needs. All fine and good but makes you wonder why the American culture is so dead set on categorizing its citizens. This categorization starts at the funding source itself. The qualifying criteria of government programs demands a label.
I agree there are gated communities where people choose to live around their own peers of the same social status. That is fine and it is their choice. It is America and we are supposed to have freedom of choice. But here’s the disparity, the financially stable “choose” and the low income citizens “qualify”. Money should not be the benchmark of a person’s worth to society. Unfortunately it is the standard by which budgetary funding also rest on. It’s always about the money. It’s more expedient to build apartments that are all user-friendly to the occupants needs. I get that. Instead of ordering one roll-in shower component the contractor can order 100 and get a price break. It’s easier to build senior units all without step entry rather than a few at a regular apartment complex. But we are using this justification to place individuals and separate them like cattle into appropriate barns.
Why not separate young adults from middle age adults? Separate smart people from average people and so on. I’m not saying wanting to be around people like yourself is wrong by any means. What I’m trying to say is that not having a choice is wrong. We desperately need more integration and less isolation. The wealthy in America represent only around 10% of our population. That 10% can make any choices they desire while the 80% must qualify, if not now, usually by late adulthood.
If housing was built using universal design anyone could live anywhere. The cost for building would be the same regardless of the occupants needs. Some seniors prefer to live with neighbors their own age but some do not. The seniors I’ve interviewed feel its depressing and one step from the nursing home but have no other option. Many of the residents I spoke with who live in expensive retirement communities have moved back to individual residents complaining their autonomy was compromised by the cruise ship activity mentality at the big retirement complexes. At least their own financial security allowed them to make that choice. Categories may make it easier to finance and serve the people with disabilities, seniors and low income but it smacks in the face of American freedoms.