“Scream as loud as you can,” I encouraged my companions before we plunged down the waterslide in our rubber raft at the water park on Independence Day. “There aren’t enough opportunities for yelling in everyday life. Let’s make the most of it while it’s socially acceptable.” The shouts of our foursome pierced the air as we flew down the steep slopes and then dissolved into laughter as we splashed to a halt at the bottom of the ride. “That was great!” we all agreed.
Our residents tend to be stressed out. At a minimum, they’ve suffered debilitating and often sudden physical losses, they’re living 24/7 in a communal environment and they have to rely for assistance on helpers they’re sharing with other people. Add to this unfamiliar food, financial stressors, physical separation from their homes and family and worries about the future.
Is there any one of us who wouldn’t be angry about something in that situation? Yet we as organizations strive to have units filled with residents without “behaviors.”
I’m not suggesting nightly “primal scream” sessions, but we could add into the rotation some activities where residents get to be “bad,” or at least aren’t expected to be so darn good all the time.
For example, I used to counsel a 100-year old woman, Claire, whose active life had slowed to a crawl due to age, arthritis and other maladies. She often let out her frustrations by making sarcastic comments to her aides and other residents, which led to conflicts.
To help her blow off steam, as we talked, we slowly set up dominoes in a circuitous row on a table. When the domino chain was completed, I’d give her the signal and she’d gently push the first domino over with one arthritic finger and watch with glee as the whole chain loudly self-destructed. On some days, Claire was particularly “bad” and didn’t wait for the signal. This activity allowed her to be “good” bad and her sarcasm diminished.
Perhaps, like me, you’ve recently had time off from work but the only break on the near horizon is a measly midweek Independence Day.
Or maybe, like a coworker of mine, you’ve scheduled your summer vacation for the last week of August and you’re holding down the fort for your coworkers in the middle of a heat wave, watching others return to work tan, energized and eager to show off their vacation photos.
Or possibly you’re just plain tired, exhibiting some of the symptoms below:
1. Wondering if the work you do really makes a difference.
2. Feeling overwhelmed by regulatory requirements.
3. Noticing every unfilled sanitizer dispenser and every chip in the wood veneer furniture.
4. Wanting to buy gifts for all the elders. (This is both a sign of and a contributor to fatigue)
5. Considering lying down on one of the resident’s beds for an afternoon nap.
If you recognize any of these signs in yourself, it’s wise to take note and to take steps toward self-care. Our work is important and the attitude with which we complete our tasks matters. Especially in jobs where we care for others, we need to “fill the well,” as the saying goes, because it’s impossible to “pour from an empty cup.”
How to get your groove back
If your vacation break is behind you, or so far ahead that you wonder how you’re going to make it, try these ideas to re-energize and add zip to your workday.
1. Complete your paperwork in a quiet corner of the nursing home patio.
2. Take up a new hobby or rekindle an interest in an old one. Tennis, anyone?
3. Take a mental health day, morning, or afternoon. For added mileage, don’t tell anyone at all.
From the 102-year-old Hulk Hogan fan to the doting, selfless caregivers doing behind-the-scenes work, there are numerous people in long-term care who inspired me this year.
Take, for example:
• The 102-year-old man, still remarkably handsome, whose favorite sport is professional wrestling and who recalls fondly the days of Hulk Hogan.
• The personal companion I encountered dusting the framed family photos on the windowsill while the blind woman she cared for was taking a nap.
• The new assistant administrator who stopped me in the hallway to introduce himself and who seemed genuinely interested in my response.
• The nurses who immediately come up with a solution to a resident’s problem and then follow through with it. (“If he wants to be down at rehab early, we’ll have the night shift get him up before they leave.”) Hallelujah!
• The housekeeper dedicated to controlling infection even though it’s been a tough year for her personally.
• The legally blind 90-year-old woman who avidly follows the news and the music scene and has a strong opinion on everything. That Gaga is great, she says. The president is not.
Cold weather. An uncertain world. Rogue shrinks making the rest of us caring, diligent professionals look bad. I don’t know about you, but I need a mood lifter.
I came across an article that suggests that exercise of all kinds, even small movements, can make us feel less depressed. In “Get up and move. It may make you happier,” New York Times health writer Gretchen Reynolds notes that people in a University at Cambridge study “turned out to feel happier when they had been moving in the past quarter-hour than when they had been sitting or lying down, even though most of the time they were not engaged in rigorous activity.”
How can we incorporate more movement into our days across the spectrum of long-term care?
Personally, I purposely forego my car so I can walk to and from the subway and I take the stairs instead of the elevator whenever possible. I encounter surprisingly few coworkers doing the same, so perhaps that can be number one on this list of get-moving ideas:
1. Take the stairs.
2. Use public transportation. Sign up for or offer workers a transit tax exemption if a program, such as TransitChek in New York City, is available in your area.
3. Kill two birds with one stone by walking around the facility on rounds and checking in with staff members and residents.
4. Join or begin a lunchtime walking program. Find a buddy to add fun and accountability.
After reading a recent New York Times Opinion piece about the uses of lotteries to solve social problems, I began contemplating their potential application to long-term care.
According to “For Better Citizenship, Scratch and Win,” lotteries have been used to encourage voting, reduce speeding and even to attend to health needs such as getting tuberculosis screening, practicing safer sex and keeping medical appointments.
In one example, to combat tax evasion on small purchases, the Chinese government encouraged people to obtain receipts by turning them into scratch-off lottery tickets — leading to tax revenue amounting to 30 times the cost of the lottery prizes!
The theory is that lotteries are appealing because people want rewards and they enjoy playing games. As the CEO of a company that designs games for businesses put it, “They could… have everyone get an incentive for $15. But they’d get better results for the same average price by having variability — some get $10, some get $100.”
An element of fun might be a welcome addition to what’s typically the very serious business of long-term care. Presenting awards with humor and the thrill of winning a game could help offset the strain of coping with the ongoing losses inherent in direct care.
In addition, offering a lottery might appeal to a larger pool of workers. I often hear about the challenges of inducing less-engaged employees to improve their performance. Typical rewards, such as “employee of the month” programs, tend to honor those who are already committed and doing their best. Perhaps a lottery would engage disenfranchised workers in a way that other incentives have not.
Here are some playful ideas for applying lottery-style encouragement to long-term care:
1. The Show Up on Time Game: In the SHOUT Game, all employees who arrive to work on a timely basis for the week get entered into a lottery, which takes place at the end of the month. Each employee therefore has the opportunity to enter four or five times, depending on their timeliness and the number of weeks in the month. Winners of the drawing would get various prizes, which could be monetary, gift certificates to local enterprises or perks such as a good parking spot.
Adaptive tandem bicycles allow residents the pleasure of riding a bike and feeling the breeze through their hair. As John Brunow of All Ability Cycles puts it in the video below, an adaptive bicycle event triggers reminiscence, stimulates appetites, and reduces depression. Sounds like a win, win, win to me!
Why are they keeping track of our peanut butter and jelly sandwiches? I appreciate their concern that we residents might have our lunches served late, but what about the tuna fish sandwiches? And the chicken? Doesn’t it matter if those are served late as well?
Speaking of late, what about the times when the call bell is rung and the aides don’t show up for 45 minutes and then say they were working short? Is the “call bell delay due to working short” on the five-star rating system too?
And regarding shorts, I lost mine in the laundry the other day and they haven’t been able to trace them. I spent a lot of money on those shorts and believe me, clothes in my size aren’t easy to come by. Usually they come in teeny-tiny-itty-bitty little sizes. I had to have my daughter-in-law go to Kmart and Walmart before we finally found them on Amazon.
I have good news about the Amazon, by the way. A friend of mine is working to plant trees in the Amazon, doing her part to give back to the world.
Now that I mention backs, I should tell you that mine is hurting. I went down to rehab to ask them to give me a hot pack, or a cold pack, I forget which it is that they’re recommending these days, but anyway, a nice young man whose name I can’t pronounce or recall, gave me one of them and it felt so much better. But now it’s aching again.
My mother has a knack for taking something awkward and, as she puts it, “turning it into a feature.”
For example, the previous owners of our family home placed the living room couch in front of a protruding radiator so that the sofa was oddly and obviously a foot away from the wall. By contrast, my mother had shelves installed above the radiator so that it became a pleasant focal point for books, photos and the stereo system.
I follow this line of thought with regard to the need for assistive devices such as canes, walkers, and eyeglasses. It’s possible to convert something unappealing yet necessary into an item that bestows confidence, evinces a sense of humor or becomes more useful.
Turning assistive devices into a feature creates a psychological shift for the wearer. It gives residents an element of control over mostly uncontrollable circumstances and allows them to retain their personal style in a situation that tends to strip them of their uniqueness despite our best efforts.
An organization providing the opportunity to purchase or design desirable devices can generate a change in their culture. Seeing residents sporting colorful walkers or personalized wheelchairs rather than standard equipment sends a message of individualized care and a zest for life despite disability.
In the spirit of giving your residents an emotional boost and taking the sting out of the need for assistive devices, your organization might try some of the following ideas (found through my handy search engine):
• Residents can purchase sophisticated walking canes featuring fancy handles or colorful shafts with a wide selection of items under $50. I know many residents who would find that an excellent use of their Personal Needs Allowance (PNA).
• Another company features a colorful range of walking canes for about $40 each. Choices include floral motifs, Irish themes, US military and biker inspired designs.
• With PNA funds being as limited as they are, a decorating event is a great addition to the recreation calendar. Help residents embellish canes or create personalized walker or wheelchair bags to carry their belongings using colorful duct tape, Velcro and other supplies, or sew a handy cup holder.
I’d read about the Genworth R70i Aging Experience and when I discovered the exhibit was making a brief appearance near me at the Liberty Science Center in New Jersey, I headed over with my 9-year old assistant to see what it was all about.
The Aging Experience involves a high-tech suit designed to help younger people gain insight into the physical effects associated with aging. When I told residents I was going to age myself via the suit, reactions ranged from an incredulous, “Why in the world would you want to do that?!” to “Great! We can compare notes,” to, “Can they make a suit to make you feel twenty-five?”
My assistant and I arrived 15 minutes before the 11 a.m. demonstration so that I’d be dressed and ready. The Applied Minds staff, who partnered with Genworth on this project, took us into the back of a tech-filled room where they Velcroed various parts of the suit onto me, adding an extra 40 pounds strategically placed to mimic age-related weight gain.
This resulted in the constant thought throughout the half-hour presentation that it would be really nice to sit down.
The helmet included goggles and headphones, so that they could give me various disorders including glaucoma, macular degeneration, cataracts, age-related hearing loss, tinnitus and aphasia. I was finally able to see what one of my patients referred to when she said, “I have macular,” as if she was intimate enough with the condition to be on a first name basis.
After undergoing vision and hearing loss, I was faced with rheumatoid arthritis and hip problems that made walking on the treadmill a chore. Even without the additional physical challenges, trudging on the virtual beach was so difficult that I estimated a two-minute hike would be enough before it lost its pleasure – and I love walking on the beach.
The audience was able to observe my heart rate and perceptions on the screens behind me and then to try on goggles and headsets and experience the ailments themselves.
It was the third week I was meeting with Mr. Schwartz, an 85-year old man with a thick mustache and a penchant for suspenders. I found him watching TV in the dayroom, surrounded by some of his peers. I crouched by his wheelchair so I could speak to him at eye level.
“Hi Mr. Schwartz, I came by to see how you were doing. Can we talk in your room for a while?”
“Sure, young lady!” he replied without hesitation, seeming eager to see me despite not being able to recollect my name.
“I can give you a push to your room,” I offered. “It might be easier since you’re holding that cup of tea.”
“Tea!” Mr. Schwartz exclaimed, with mock astonishment. “I thought it was beer!”
It was the third week I was meeting with Mr. Schwartz, an 85-year old man with a thick mustache and a penchant for suspenders. I found him watching TV in the dayroom, surrounded by some of his peers. I crouched by his wheelchair so I could speak to him at eye level.