Category Archives: Hospital Professionals

Wisdom from a Friend with Dementia

 

Seek the wisdom that can be lost under the weight of memory loss in persons living with dementia.

Dementia hit close to home for me recently. It had probably been six or so years since I had last seen a friend and former co-worker. He had fallen out of sight, and now I know why. I learned of his whereabouts and paid him a visit. It started with mild cognitive impairment that has advanced to late-mid stage dementia.

I was so glad that he recognized me. We had a wonderful conversation and reminisced about people we knew and past work projects. But, as time went on, he became lost in the conversation. He was evaluating proposals, preparing to consult, and critiquing management.

Always contemplating, analyzing, envisioning, planning. That is what this man did. The beautiful thing, he still is.  The wisdom is there when entering his reality.

Wisdom

My friend said some pretty amazing things. The first was when we were talking about purpose in life. “We all need to germinate something wonderful and wise,” he said. My friend is eager to share his wisdom, and being surrounded by people who will listen provides him purpose and quality of life.

Referring to the people who work where he lives, he said that it is just as important for him to know them as it is for them to know him. It pleases him when people call him by name. It is important to him that they know who he is, and he delights when introducing his caregivers by name.

The importance of relationships between care partners is something my friend taught others back in the day. In fact, he introduced me to David Troxel’s philosophy, “Best Friends Approach to Dementia Care.” I saw before my eyes how incredibly important that is for my friend.

It is comforting to know that my friend’s personhood, the things that make him special, are still there.  Dementia does not define him. He has long-term memories with attached feelings. He continues to teach others about dementia- both how to live with it and what it takes to provide good care with quality of life.

I asked if I could share his wisdom in a blog. He said he had to think about it and then asked what the distribution and market reach would be. Yep- always thinking.

May we always seek to know the person living with dementia, and let them know us too.  Seek their wisdom, you will learn much.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Retention Culture: Antidote to C.N.A Turnover in LTC

Shaping organizational culture and respect for Certified Nursing Assistants can impact retention.

Kathy Dreyer penned a terrific post last week about Long Term Care Certified Nursing Assistants and turnover. This issue has been identified as a crisis. I submit that it is also a tragedy, because, we have ignored the problem with the lack of a national strategy.

Certified Nursing Assistants are the backbone of care in long term care. They provide care for those that nobody else can, or will.

Our nation’s 1.3 million nursing home residents depend on C.N.As  365 days of the year for personal care of all types and levels. This is not an easy job. But those that continue to do this work know that it is also soul-filling and rewarding. But, what else makes some stick with it?

Retention Through Culture and Respect

A 2009 study found that an organizational culture that respects and invests in their workers inspires retention. To that end, I submit that Certified Nursing Assistants in Long Term Care do not receive the recognition they deserve.

Nationally, nothing has been done to advance the vocation. Additionally, at the state level, dismal Medicaid reimbursement has a disastrous effect on wages. Consequently, all we can directly control is our organizational culture.

If we truly value our seniors, we should vigorously value the people who are taking care of them, day in and day out.  An article in Provider Magazine speaks to the importance of respecting certified nursing assistants as individuals to retention.

Concrete Steps

  • Invest in training and education. Help C.N.As grow,  and acquire new skills (refer to previous blog for more ideas).
  • Tell their wonderful stories. Profile C.N.As who live the values of your organization and contribute to a high quality of life and care.
  • Lift them to your residents, family members, and the larger community.
  • Arrange for regular scheduled time off the floor with coverage to participate in QAPI initiatives.
  • Ask for their opinions, ideas, and find ways they can contribute to decision making.
  • Intentionally incorporate into their schedule time for relationship building. In addition, allow them to spend time with elders outside of their job as a caregiver- as a human being that enriches life.
  • Find ways that your C.N.As can share their gifts and talents with co-workers, residents and family members.

Ponder whether your organizational culture truly respects not just the work, but the personhood of your Certified Nursing Assistants. In doing so, you may realize improved retention, the antidote to turnover.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Education First in Dementia Care

Foundational Education is critical for inexperienced caregivers of persons with Dementia. Don’t rely on understanding through experience alone.

Working in senior care for over 30 years, it takes digging deep to recall my early experiences interacting with the elderly and those with dementia.  I was a volunteer and an intern during college when my first encounters occurred.

My experiences were mostly pleasant and fun. The people were just older versions of my grandparents. I enjoyed visiting with the independent seniors. They showed me around their cute apartments and told me stories.  However, encountering people with dementia was another story.

It puzzled me when one lady repeatedly said, “I want to go home,” when she was at home. I didn’t know what to say. One lady forgot that I was picking her up for a concert, even though I reminded her the day before. I thought maybe she didn’t want to go after all.

Little did I know that these people had Alzheimer’s Disease.  Learning that their memory was impaired, I assumed they had NO memory.  Therefore, I thought it was my job to remind them of everything.  I thought their brains could be fixed. I was wrong about a lot of things, albeit well-intentioned.

Learning Through Education and Experience

Over-time, I “got it” and became more comfortable being around people with dementia.  My confidence grew as time went on.  I learned that the things they said and their behaviors didn’t define their personhood. Consequently, I came to enjoy being with them.

Looking back, I can see how extraordinarily helpful training like Dementia Live would have been. I genuinely think it would have propelled my understanding and improved my interactions ten-fold.  Webinars and lectures barely scratch the surface to learn what it takes to promote quality of life for persons with dementia.

Time and experience alone should not be our only path to understanding.  The valuable lessons that the  Dementia Live experience teaches learners include:

  • persons with dementia experience feelings, even with impaired memory
  • their behaviors are a form of communication
  • the environment makes a big difference in their ability to connect
  • purpose in life is still essential for their well-being
  • our communication approaches can make or break an interaction

Learning does comes with time and experience.  However, I submit that ground zero isn’t the best place to start.  People with dementia deserve better than to be surrounded by uninformed, clueless people, such as I was years ago.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

How to Prevent People in Nursing Homes from Becoming Invisible?

People in care can often feel invisible.

People living in nursing homes become “invisible” when they are regarded as feeble-minded and lacking in the ability to contribute to society in a meaningful way.

I once met a man named Frank, who lived in a skilled nursing facility, and his memory still haunts me. I noticed him because he wasn’t particularly old, and he was tall and muscular. He was sitting in a corner in the hallway near the nurses’ station. By his appearance, it seemed he had suffered a stroke.   The following day I noticed Frank sitting in the same spot– for hours, just sitting there.  He had no real interaction with anyone and pushed restlessly on the wheelchair footrests. He couldn’t propel the wheelchair himself. Lots of people passed by, but no one paid him much mind. To me, he seemed lonely, frustrated, and, yes, invisible.

I felt drawn to offer him a Compassionate Touch. I pulled up a chair introducing myself. He immediately looked me in the eye. He had trouble with language, but he could, with effort, carry on a conversation. A Vietnam veteran, Frank grew up in Illinois. He believed his age to be 37, moreover, other signs of confusion were there, too.  I held his stroke-affected hand. He was receptive to the touch. I gently rubbed his shoulders and back, and he told me it felt good.

At the end of our time together I asked him if he would like to sit somewhere else. He pointed to a spot about six feet away that was near a table, so, I maneuvered his wheelchair around so he could reach the table with his hands. He reached out took hold of a newspaper, and proceeded to read it. He engaged in something purposeful.  The restlessness stopped.   As I left, he said, “thank you for stopping.”

Frank still haunts me. He likely sat in that same corner spot the next day, invisible again. So, how do we prevent people like Frank from becoming “invisible”? In closing, Alisoun Milne, a gerontology academic in the UK, tells us, “There is evidence that well-trained staff can build up relationships with residents that help to reduce reliance on medication and the need for acute medical care. Because the more you know about the person in that chair, the more likely you are to see them as rounded human beings, and the less risk there is of neglect.”

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.