Archive for June, 2009

Working At A Nursing Home Part II

Saturday, June 20th, 2009

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.

Why Is “Nursing Home” a Scary Phrase? Part I

Saturday, June 20th, 2009

The reality is that most people equate going into a nursing home with a fate far worse than death or zombiehood. And what’s even sadder is that most people who work in nursing homes feel they are dealing with the most difficult patients in the world. Both of them have reasons for the way they feel. So in this two-part series, I’ll try to explain the problem from both sides.

Remember that nobody goes to a nursing home because they wanted to. Call it a Rehab Center, or a Sub-Acute or Skilled Nursing Facility, the fact is that people are there because something terrible happened to them! They had a terrible injury, a life-threatening illness, or a disability beyond their ability to cope. Or they just got old and didn’t have the financial, physical, or mental capacities to handle everyday life itself. None of these are pleasant things. All of them pull the rug out from under you and knock you flat on your rear!

It can make you pretty depressed, anxious, angry, and just plain unsocial for a while.

First of all, getting old has some real disadvantages. Earlier aspects of your life do not remain the main purpose of your life. You may have retired from your career, lost your spouse through death or divorce, and your children are grown and have their own lives now. Nothing is the same, and that can feel very unsettling.

Then there is the nearness of death itself. If you were born, the only thing I can guarantee is that someday you will die. Proverbs to the contrary, death is more certain than taxes! If you have lived a long life already, death feels a lot closer. If you have just come from a life-threatening crisis at the hospital, it feels pretty close no matter what age you are. How do we prepare for contentment and peace when life ends? It’s not an easy task, even if it is a necessary one.

If the physical strength or beauty that you possessed, and the joys of the senses were among life’s greatest values, what do you do when they ebb away?

Besides, you’re still the person you always were inside. In fact, you’re likely to get more so as you age. The down side is that unresolved problems can become intensified, and some patterns of behavior that were only mildly maladaptive before are now making you dysfunctional.

I can quote from Greek, Chinese, even Ancient Egyptian sources, and show you that people have always recognized this. Did you think you would escape the fate of being mortal? Sorry, but we move from the familiarity, safety, and security of the life we’ve built to the uncertainty and vulnerability of another. And we have no other choice! No wonder we feel pain and grief.

Being in a medical care facility, whether hospital, nursing home, or rehab center just adds to the burden. 1) All of the burdens cited above are intensified. 2) The loss of independence, self-respect, and dignity are all exacerbated when we are struck down by physical illness. 3) We must trust our very being to the care of total strangers. 4) We loss all privacy, all choices, and have very little control over anything.

Yes, I know it’s being done to save your life. But when it happens to you, it feels more like life has been taken away. In a sense, it has.

Human beings are simple, like a piece of furniture. We are composed of many aspects, and all of them are affected by age and illness. Nothing is “all in your mind” because the last time I looked, your mind and your body lived in the same place! And they are always interacting. In fact, when I think of the human, I have to add the heart and the spirit into the mix, because human beings are feeling many more things besides just thinking and physical sensations.

Actually, you can use any schema or worldview you want. Just be sure it includes all the complexities of being human. Bear with me while I try to explain it in my fashion:

The Body is deteriorating and weakening. It is now fragile and easily sickened. It may lose control of unmentionable things like peeing, shitting, or bleeding. This is not only hard to comprehend when it happens to you, it is also terrifying!

The Mind finds that its memory and attention span are decreasing. As things become difficult, our own expectations of ourself can become negative and self-defeating.

The Heart is grieving. Many friends have died or moved. We’re in a place where the surroundings, the environment, even the language of people around us may be un familiar. Grief and loss predominate in our immediate feelings.

The Spirit may know that the need to move to an inner life is normal at this stage. Some cultures even have a description or place in life’s stages for it. But that inner life must be enriched and it must be supplemented by a full outer life.

The deepest misery comes from those who feel they are doing nothing. Patients may feel that their potential is locked up by their illness, their physical limitations, or just by being in a medical facility.

A dear, dear friend, mentor, and colleague of mine gave me the solution. Dr. Roy P. Fairfield, educator, historian, author man of almost unlimited interests and talents, is now 90. And he, in his firm New England way, decided that this nonsense wasn’t for him. Re-Firement, not retirement became his motto. And so, with his permission, I share it with you.

Re-Firement is the way to avoid getting stale and cranky. The delight of self-discovery is always available to us. This is also a time when you can become more authentic and find your own identity. Exercise and movement slow physical aging and help heal illness. And even more important, activities done with real passion and a social life that isn’t superficial slow down the other aspects of aging and help the soul heal itself.

The future can always be happier! How much time it contains doesn’t matter as much as how happy it is.

In the second part of this article, I’ll talk about the other side of the situation: some of the cautions and concerns involved, and the problems nursing home staffs face in dealing with them.

Pluralism is the Strength of Our County!

Saturday, June 20th, 2009

I keep getting myself in trouble at social dinners for the simple statement that I am mixed blood. I simply refuse to self-identify as “white”, a meaningless term with lots of baggage that does disservice to my family’s wonderfully rich background. (Obviously I am turning into a somewhat controversial guest to have at dinner, albeit inadvertently.)

For one thing the word “white” has no meaning and no real definition. As one young dinner guest pointed out recently, “I thought white was just what everybody aspired to be?”  That’s not an unfair summary of U.S. history. I still have a sign from Boston dated 1918 that says “No Irish Need Apply!” In some post-Civil War southern states hiring the :shanty” Irish was considered an nearly-acceptable alternative to owning the African-American slaves who no longer existed as slaves. Leasing convicts was about the only other option available.

And I’m used to hearing “Canuck” applied in various tones of voice to other branches of my family tree. And then there’s my great-great-grandmother, the Algonkin who married a French merchant in Quebec City, Canada. Not only did she gives up her native tongue when she married, she wore French clothes and spoke only French ‘til the day she died. How do I know? Because I was lucky enough to meet some of my great-parents when I was a child and heard stories told with some pride in her sacrifice but more embarrassment over her heritage. Only one picture (a portrait, a daguereotype?)
Existed of her because, as the family said in hushed tones, “She was a bit dark skinned, you know.”

In Canada today, which has First Nations terms not used in the U.S., I would be considered “Metis”. (Someday I’ll talk about Louis Real and the great Metis Uprising that actually got the Canadian Pacific Railroad the government funding it needed for compleion so the Royal Mounties could be speedily swept to central Canada to quell these uppity “savages.” The word Metis itself literally means mixed, but I was brought up to deck anyone who called me a “half-breed.”

And then there’s my grandfather Nikolai. I didn’t even find out his name until my father lie on his deathbed in 1995. You see, grandfather Nikolai had died in the War To End All Wars (WWI) and his memory was preserved by denying his heritage and pretending he was “Polish.” But when I worked in Poland in the 1980’s and tried to trace my family tree, my Polish friends sadly informed me that his last name was not Polish and most likely Russian. (And possibly not a “true” Russian, but a gypsy or worse yet, a Jew!) He had apparently passed for Polish when he immigrated to the U.S. because of all the languages he spoke. Lost in a semi-safe crowd at the height of the Cold War, he disappeared from family respect.

When I describe my childhood, I explain it was somewhat like the United Nations backstage, with everybody squabbling or ignoring each other in a multitude of mutually-unintelligible languages. God help the poor victim who married into the family from another background and was subject to the hostility vented on the “outsider.” My favorite maternal aunt was shunned from almost the whole family because she had the nerve to marry an “Eye-talian” whom she loved. Fortunately, he had a large family who took her in with adoration, she learned to be a great Italian cook, and they lived happily with their children for decades.

My poor mother was Irish & French-Canadian (both suspect) and was never considered to belong. Since the big goal of every immigrant to this country was to pass for Anglo-British, she bleached my fine baby hair to straw with undiluted peroxide, pinned it into painful Shirley Temple curls, and harshly slapped me or washed my mouth with soap if I dared picked up a word of the many languages spoken around me. I had to pass for “white”, as in WASP, which left a bad taste in my mouth forever after.

I was half-raised by my grandmother Mary Katherine Lynch from County Claire in Ireland, and thank God for her intervention and that of her large brood of my mother’s siblings. My ancestors sit beside me at every dinner table and I wouldn’t desecrate their lives by labeling myself “white” a bland and vague word associated with white supremacy, the KKK, terror, and a general, overwhelming assumption of superiority and power, especially if they are male to boot!

In my teens I was “adopted” by Matchwaya Rom in New York City, and treated and taught as a daughter. I lived in Hawai’I and saw true pluralism in everyday life. I was befriended by a Japanese family who had lived through WWII, and knew how close they were to being interred in a U.S. concentration camp as an not-white enemy. In Nepal and India I was given a name and a caste (Matwali that of Sherpas and foreign anthropologists) to bring me into the group, and in Haiti, my friends introduced me as their cousine and insisted joyfully that I must be part African.

I could go on and on, but the bottom line is that I have been naïve enough to be believe that E Pluribus Unum actually means from the many to One. I believe we are humans, and cannot see each other in groups of us versus them.

And the saddest thing to me is that we as a country cannot see Mr. Obama as our first truly mixed president because way too many people are so obsessed with just one strain of the many rich traditions and bloodlines that make him what he is: a man with just as rich a heritage as most of us have, more truly representative perhaps than any before him of the real population of this United States!