“No,” Diane said when I showed up at her door for our Thursday session. “I don’t want to talk to you. I’m too aggravated.” She turned her head and looked out the window for a moment.
“I’m surprised.” I replied. “We had such a nice conversation the last time. Plus, being aggravated is a perfect reason to talk to the psychologist.”
She looked back at me and sighed with exasperation, “Fine! Sit down. But I’m not going to be very good company.”
“You don’t have to be a star, baby, to be in my show.” I sang the refrain to the old song, mostly on tune.
She rolled her eyes. “They’re driving me crazy here,” she began, launching into an account of her recent fall on the way to the bathroom. “And now they won’t let me do anything by myself! They’re always yelling at me to wait for them, but then they don’t come when I call for them.”
It was the same tale I’d heard from two residents in my other facility that week.
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Maya was a frail woman in her late 70s who navigated around her room with a walker. She spent most of her time alone, crocheting colorful booties that she carefully tied onto the walker frame, which served as a display for her wares.
“Five dollars each,” she told me, when I commented on her handiwork. Her earnings, I learned several sessions later, were going to her disabled son, who came to the nursing home every few weeks to collect the money she’d made for him. “He’s a good boy,” she assured me.
Maya had been placed on the dementia unit, though she didn’t have dementia. Residents wandered in and out of her room, touching her yarn and the slippers. She yelled at them to stop, leading to chart notes saying she was agitated and eventually to a move to a different floor.
Once among residents more similar to herself and assigned to a consistent, experienced aide who took her under her wing, Maya’s mood and behavior improved considerably and we discussed concluding our sessions. I arrived for our last meeting with a $5 bill in hand and left with a beautifully crocheted pair of booties I didn’t need.
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.
In 2014, I wrote, “I finally visit a Green House (and it blows my mind).” The Green House is designed with a spacious common area, private bedrooms and showers, unobtrusive medical items and universal workers practicing person-centered care. The model shows that it’s possible to make dramatic lifestyle improvements in long-term care.
It seemed that Green Houses were the answer, if only there weren’t so many traditional facilities already in place. Traditional nursing homes can participate in culture change programs with great success if their leadership is committed to the philosophy through the transition period and beyond. They can retrain staff, add plants and pets and remove nursing stations, but the standard long hallways have remained – until now.
Last week I had the opportunity to speak with Rebecca Priest, LNHA, LMSW, Vice President of Skilled Services, at St. John’s Home in Rochester, NY. She’s presiding over one of the most exciting changes in LTC to come down the pike since, well, Green Houses.
St. John’s is taking a conventional nursing home built in the 1960’s with 32 beds to a hall and turning it into 22 small homes modeled after the Green House Project. Each floor is being systematically transformed into homelike environments with a large space for cooking, dining and socializing and universal workers called “Shahbazim” who are central to the model’s success.
Rather than having aides, housekeepers and laundry workers, the Shahbazim do it all. “The Shahbaz role,” Priest says, “is highly skilled and not for everyone. Shahbazim need to collaborate and be part of a highly sophisticated work team.”
Cross-training staff and flattening the work hierarchy reduces the likelihood that workers will find themselves in “systematically disempowered situations where they are set up to fail.” As a resident I knew used to say, “Amen to that!”
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.
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!
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!
I’ve learned a lot from listening to residents over the years, but it’s rare that I request specific advice. This month, I decided to change that.
In private conversations, I told residents that I was writing an article on advice from elders about how to live life and I asked them if they had any wisdom they wanted to share with young people.
Their responses were immediate and enthusiastic, as if they’d been waiting for someone to ask. They were so pleased with the question that I decided to ask my own elder relatives for their opinions as well. One family member, inspired by the inquiry, called to contribute further advice after her initial offering.
Many of the comments focused on wellbeing and taking risks in life:
• “If there’s something you want to do, go for it. Even if it doesn’t work out, at least you tried.”
• “Do what you can while you can do it. Take a chance!”
• “Do things you enjoy and keep as busy as your health will allow.”
• “Don’t overdo it.”
Others centered on maintaining independence:
• “Do the best you can and save a dime, because now when they jump me for money, I got a little something to pull out.”
• “Try to have something of your own, not your mother’s, not your father’s.”
Several people offered relationship advice:
• “Pay attention to your spouse but be an individual too.”
When Audrey Davison met someone special at her nursing home, she wanted to love her man.
Her nurses and aides at the Hebrew Home at Riverdale did not try to stop her. On the contrary, she was allowed to stay over in her boyfriend’s room with the door shut under the Bronx home’s stated “sexual expression policy.” One aide even made the couple a “Do Not Disturb” sign to hang outside.
“I enjoyed it and he was a very good lover,” Ms. Davison, 85, said. “That was part of how close we were: physically touching and kissing.”
Ms. Davison is among a number of older Americans who are having intimate relationships well into their 70s and 80s, helped in some cases by Viagra and more tolerant societal attitudes toward sex outside marriage. These aging lovers have challenged traditional notions of growing old and, in some cases, raised logistical and legal issues for their families, caretakers and the institutions they call home.
Nursing homes in New York and across the country have increasingly broached the issue as part of a broader shift from institutional to individualized care, according to nursing home operators and their industry groups. Many have already loosened daily regimens to give residents more choice over, say, what time to bathe or what to eat for dinner. The next step for some is to allow residents the option of having sex, and to provide support for those who do.
A few months ago, I was consulting at the Margaret Tietz Nursing and Rehabilitation Center in Jamaica, NY, when a remarkable woman named Trudy Schwarz walked down the hall. Her noteworthy qualities were obvious in several ways.
A diminutive woman, she nevertheless was pushing a sizable rolling metal cart filled with all manner of neatly arranged goods. This was despite being as old or older than many of the residents at the facility.
She exuded a calm, pleasant demeanor enhanced by her smile and her peach-colored lab coat as she purveyed merchandise from what I’ve previously termed an “independence cart,” an essential yet rare enterprise in long-term care.
“Trudy’s here!” exclaimed the resident I’d been speaking with, excusing herself for a moment to exchange a few dollars for a bottle of lotion. “She buys me the things I can’t get here. She’s a real lifesaver.”
It was a sentiment I heard echoed by many other residents over the next few months.
Overcoming systems failure
An “independence cart” is a small store on wheels that brings goods to residents. While many residents have personal needs allowances and therefore a small amount of money for purchases, it’s virtually impossible for many frail elderly to spend it due to a systems failure within long-term care communities.
Residents generally have no access to a store unless it’s one that visits their facility or they’re physically able to go off-campus with a family member or as part of a staffed excursion. Social workers are usually too inundated with other tasks to assist with online purchases and most residents don’t have access to a credit card, debit card or PayPal account necessary for web-based transactions anyway. Residents without family members to make purchases on their behalf are left to ask for help from staff members who sometimes assist them out of kindness — but against facility policy.
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.