“How’s it going?” I asked Larry, one of the maintenance workers I chatted with from time to time. He didn’t have his usual smile and his wrist was in a brace from a repetitive stress injury.
“I’m tired,” he replied. “I’m real tired. I was supposed to be off today but Jules called in sick and we were already short one guy. Tomorrow will make seven days of work in a row.”
“You’ve got to take care of yourself,” I encouraged him.
“I know,” he said, “but they needed me.”
A few months after my encounter with Larry, I noticed that an excellent nurse had “lost her shine.” I stopped by her med cart to see why.
“My sister’s very sick,” Shirley told me, becoming tearful. “She lives in Haiti and I’m worried about her.”
“Oh no! Do you have any vacation time? Can you go see her?”
“I do, but I don’t know if the director of nursing will sign off on it. I guess I could try.”
I followed up with her the next week as if she’d been one of my patients.
“No,” Shirley said as I approached the nursing station, “I didn’t put in for the vacation time.”
She’d lost weight since the prior week and her expression had become grim. I regularly observed her completing paperwork and tending to the residents an hour after her shift was over.
“Let’s do it now,” I insisted. I stood at the desk while Shirley filled in the form requesting time off the following month. That weekend she had a heart attack.
I’ve met many Larrys and Shirleys over the years. If asked, they’ll work the extra shift because they’re the type of people who don’t like to say no. While it’s tempting for organizations to meet staffing needs with someone who always says yes, good managers recognize that such requests can push employees to the brink. Encouraging employees to engage in ongoing self-care and to recognize when they need to “refill the well” can reduce their chances of burnout and illness, leading to better workers, improved care and fewer missed shifts overall.
Self-care for healthcare workers is, according to one research paper, “a proactive and holistic approach to promoting personal health and well-being to support professional care of others.” Team-care — a concept I learned while researching this article — refers to coworkers supporting and encouraging the self-care efforts of their teammates.
When I asked after the well-being of Larry and Shirley, I was engaging in team-care. While I often informally check in with my coworkers, team-care is much more effective if it’s a consistent, leader-supported element of workplace culture.
There are many ways in which individuals can engage in self-care and be supported by facilities and coworkers in their efforts.
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
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.
Last week, I attended an accessible design symposium at the Cooper Hewitt Museum in New York City to see what ideas I could use with elders in long-term care. Through listening to the symposium speakers, reading descriptions of works featured in the student design contest and viewing the Access+Ability exhibit, I found more than I had expected.
Crash course in accessible design
I suspect I’m not the only McKnight’s reader with a lack of knowledge about accessible design — even though we work with elders with abilities that are typically different than those of younger adults.
Patricia Moore, introduced as “the mother of universal design,” told the audience that her elderly grandparents inspired her work. They struggled to maintain their independence in a world that made it difficult for them. “Grandma wasn’t broken,” she said. “The tools we gave her were inadequate.”
In my crash course in accessibility, I learned that objects can be designed in ways that increase the mismatch between our bodies and the environment or, in accessible design, to intentionally decrease that mismatch. For example, the standard design of a walking cane allows it to fall to the floor, making it difficult to retrieve for someone with mobility problems. In the Cooper Hewitt exhibit, I saw canes that stayed upright when not in use.
Another speaker discussed how “designing for disability” very often results in products that are good for everyone, such as books on tape, height adjustable desks or ramps for building access that are used by parents pushing strollers and travelers with rolling suitcases, in addition to those with walkers or wheelchairs.
Nothing about us without us
There was a small, vocal group of disability activists present. When I entered the symposium I was handed a card from their organization that read, “Nothing about us … without us.” They echoed the sentiment of the speakers that increasing the diversity of people designing products and systems results in products and systems that work better for a larger number of people.
Including elders and direct care staff in more of the decisions that affect them within our organizations is likely to result in better decisions.
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.
One of the things that most brightens my workday is when I see long-term care residents hanging out together.
In particular, I’ve noticed two ladies who attend activities in tandem wearing dresses with hats and costume jewelry, a threesome of confused residents who sit near the nursing station laughing at jokes only they understand, and an African-American and a Caucasian octogenarian twosome who are amazed to be best friends since neither of them had a friend of the other race before.
Men gather for card games, guys group in the hallway offering wry observations on the behaviors of the staff and other residents, and rehab patients tell me how inspired they are by someone they meet lifting weights in physical therapy. Sometimes I’ll discover that the resident they mentioned is, in turn, inspired by them.
What long-term care offers, aside from medical help and safety, is the opportunity to connect with peers and to maintain a social life. One of our best selling points is the fact that folks can get to activities without needing a coat or umbrella. New residents are often surprised and reassured to learn that there are “transporters” who will bring them to and from daily recreation programs, all for free.
Perhaps, like me, you’ve heard of Aging2.0 but hadn’t had the opportunity to attend one of their events. When I discovered that they were holding a pitch session a subway ride away from my home, I jumped at the chance to be there. I was curious to see if any of the startups were promoting products to benefit elders in long-term care.
Here’s what I learned:
What’s Aging2.0?
According to their website, “Aging2.0 is a global innovation network on a mission to accelerate innovation to improve the lives of older adults around the world.” Moving beyond the development of medical products for seniors, Aging2.0 seeks to facilitate collaborations between senior care providers and entrepreneurs to create products and services that can be integrated into their businesses.
The scene
The event was held at the modern, tech-oriented community space of SeniorPlanet.org in Manhattan. (The tagline for SeniorPlanet.org is “Aging with Attitude.” One of their recent articles is titled, “Is it time for #OscarsSoYoung?”)
The large, windowed, ground floor room on West 25th Street was filled with the animated clamor of innovators munching on crudité and discussing products to better the lives of elders. The youngest attendees appeared to be twenty-somethings and the oldest participant was octogenarian and aging activist Muriel Beach, Chief Elder Officer and a judge for the event.
The format
Each inventor had several minutes to pitch their product and take questions from the four judges, who also included the CEO of 1-800-Wheelchair Joseph Piekarski, HealthTech Angel Investor Sacha Levy, and AARP’s Director of Market Innovation Jeffrey Makowka.
Aging2.0’s host Crispin Baynes kept things moving along swiftly and explained that the winner of the event would receive cash, mentorship and an international spotlight, going on to pitch at Aging2.0’s inaugural Americas Summit in Toronto on June 21, 2017.
The inventions
Nine people pitched their products, which were designed to assist elders with a wide variety of challenges.
Denise B. Scott, president of Drive Consulting, posted an intriguing story on LinkedIn the other day about a Scottish supermarket that partners with Alzheimer Scotland to help those with memory loss.
The workers are trained to understand how to help people with dementia, and the supermarket offers a “relaxed checkout lane” for seniors and others who might need a little extra time when paying for goods at the register.
On senior citizen discount day, the store posts a sign at the entry to the cashier’s line designating it as the “relaxed checkout lane,” allowing customers in a rush to go elsewhere. Those on the relaxed lane can check out slowly, without the pressure of worrying that someone behind them will get irritated.
The concept is so simple, easy and kind that I decided to ask my local supermarket if they’d join in.
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.
The theologian, Paul Tillich, once said, “The first duty of love is to listen.”
This quote came to my mind when I read the kind review of my book, “The Savvy Resident’s Guide,” by Yang of CNAEdge. It feels good to be heard. In return, I want to thank Yang and his colleagues, Alice and May, all current or former Certified Nurse Assistants, for their powerful work and writing. These courageous individuals write “from the front lines” of caring for the elderly, and I’m deeply moved by the honesty and vulnerability in their work.
In writing my book, “The Savvy Resident’s Guide,” I wanted to give new residents a road map to life in a nursing home. I developed the book through years of listening to residents — their fears, worries, happy moments, and everything in between. As staff in long-term care, we can get rushed in the demands of schedules, paperwork, and other top-down regulations.
Yet we began our careers motivated by the fact that every resident is a person first. It means a lot to me that Yang, a former Certified Nurse Assistant (CNA) for over 25 years, found my book to be an encouraging reminder of this. He wrote:
“There is very little in The Savvy Resident’s Guide that could be considered new information for experienced caregivers. But in a way, for us at least, that’s the point. These issues are so woven into the fabric of our work experience that they become second nature to us and sometimes we lose sight of the fact that what might be obvious to us might not be as clear to someone else….the book helps us step into the new resident’s shoes because it reminds us of when we as caregivers were new to the system. The whirl of faces and personalities, the jargon, the strange cultural norms and customs of the facility and care unit, were all things we had to adjust to. Now, with a little imagination, we can put ourselves in the place someone who might not be feeling well to start, who perhaps has gone through a sustained period of loss and now has to adjust to this strange new world. Our empathy can begin even before the resident enters the front door.”
Every day I work with long-term care professionals who fulfill the first duty of love with their residents. Together we are bringing warmth and compassion to eldercare. I’m grateful to be in the company of the of CNAEdge and so many other thoughtful LTC workers. Thank you!
