Working At A Nursing Home Part II

In Part I, we looked at the trauma surrounding being in a nursing home from the patient’s point of view. But what’s it like for the staff at a nursing home? They’re dealing with people traumatized by the effects of aging, injury, and illness. These people are not happy about suddenly being in a dormitory-type setting with a bunch of other people with whom they have little in common except misery. You may be glad you’re alive but it’s not easy to be optimistic in that setting!

It isn’t easy on the staff either. They don’t have the immediate glory of saving a life quickly or seeing results on the spot. (Although I do work at nursing homes that post the number of annual successful discharges, which is optimistic and rewarding to both staff and patients.) But by and large, working at a nursing home means long hours, constant messes to clean up, constant medical treatment to be given, and everything that goes along with managing a large building full of very cranky people who are not particularly grateful that life put them there.

Imagine trying to handle keeping a large building clean, laundry restocked, meals prepared, etc., and at the same time that building is full of people who needs medicine administered, blood tested, physical therapy provided, baths and showers and changing of diapers and bandages on a regular basis… I could go on and on. But the point is, as we saw in Part I, those are people! Real human beings with all the complex emotions and behaviors they had before they got into this situation. This complicates the logistics and problems enormously!

All old and/or sick people are not alike. There are many possible ways a person can cope with aging and illness. Dealing with the shock, grief, and trauma that brought you here is just part of the situation. Finding the courage to take new steps is difficult when all about is already unfamiliar. Personality issues you haven’t resolved may resurface or become worse. “Activities” and hobbies are not passion; they don’t necessarily contain or encourage zest, an all-consuming interest, or motivation to continue

Repetition is not a substitute for motivation. Following someone else’s schedule is not the same as having a real life. Understanding and a sense of having choices is important to healing. Cognitive limitations and personality issues may interfere with this ability. Patients may keep up a front or drop masks entirely. They may be active or withdraw completely. They may try to consolidate the old and wish to explore new and unconventional behaviors. They may be feisty or stern or always cheerful. In short, you never know how someone will behave.

Worse yet, disturbing traits are likely to be exacerbated by stress, illness, and old age. The mean get meaner, the fearful get more afraid, and the apathetic sink into near paralysis.

But it denigrates their humanness to exempt the old and the ill from personal responsibility. They are not moral eunuchs. They can still do harm, and they can still atone. They are still capable of cruelty and greed and assorted misdeeds.

The good news is that, as human beings, we are never a finished product. We can refine and rearrange and reverse and improve. Change is inevitable, but it is up to us to use what choices we make to adapt to change with grace and dignity.

How can staff help these larger issues? By seeing their patients as the human beings they are. By knowing their names and respecting their humanity. By accepting that the patient didn’t ask to be in this situation. By keeping their focus on the larger goal, and not getting lost in the messy details. In a thousand tiny ways, everyday, nursing home staff can make healing more likely.

Remember that out of Chaos, through encouragement and initiative, can come Creation and Renewal.

Everybody who works at a nursing home (by whatever name it’s called!) has a vital role to play in the healing process. Because of all the differences among facilities, I’d leave somebody out if I tried to list all the jobs. It isn’t just Medical Doctors and Primary Care Physicians. There are Certified Nurse Assistants as well as Registered Nurses. There are Social Workers and Case Managers and Psychologists. There are Psychiatrists and PPN’s who function as psychiatrists. There are Physical Therapists and Occupational Therapists, Speech Therapists and Recreational Therapists.

That’s a partial list and it leaves out Administration, who have to make sure that the whole team and the whole building functions smoothly, because lives are at stake. Don’t make fun of bureaucracies because even those who never see a patient are making sure there are clean bandages, needed medicine, accessible medical records, and all the other things essential to the survival of the patients under their care.

Yes, I know there are nursing homes that get it wrong and lose sight of the very patients they are supposed to be helping. But before we can even discuss them, it helps to understand what an enormous job it is to begin with. I’m always amazed at the number of facilities that mostly get it right! I applaud the ones whose staff maintain their respect for the humanity of patients, who encourage healing and growth, and who, even when exhausted and trying to do the work of ten, remember to smile at a patient and greet him or her by name.

I ask for reform in many areas, and healthcare is a major one. But I always acknowledge the work of people who do do their jobs well, even under the most adverse conditions. Because they prove it can be done well! And I do work for understanding between different perspectives.
In this case, as with so many others, it’s very clear that both sides have a difficult job because of the very nature of the situation. There’s no magic pill or simple solution, not even throwing money at the problem. It’s going to take thought and creativity and personal responsibility, as well as a clear understanding of our priorities as a society.

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