Wednesday, June 16, 2010

Nursing Homes can be bad For Your Health and Wellbeing

Nursing Homes can be bad For Your Health and Wellbeing

I knock on the door of Room 103 saying: “Hello, may I come in?” I peer around the door after hearing nothing. I knock again and wait, still no answer. I gingerly open the door a crack and see an elderly lady sitting on the edge of her bed in the room. I say, again: “May I come in?” a bit louder, in case she is hard of hearing. The lady looks up at the door: “Do whatever you want,” is her reply. I slowly enter the room. I am smiling, I identify myself and I ask the lady if I might ask her a few questions. “What for?” is her response. I answer: “We ask everyone some basic questions when they first come in. It helps us get to know new people, it is required by The State and it goes in your medical chart.” She looks at me, head lowered and the look appears suspicious, like she doesn’t believe me. I clear my throat and try to continue the conversation by saying: “Welcome to St. Barley’s.” She raises her head a bit, “Go to Hell,” is the reply I get. Not exactly the reply I expected from this frail looking person, but I am not surprised by her response as it is not the first time I have heard it from a resident, even though this is my first week at St. Barley’s Nursing Home and Rehab. I try the first question anyway. “What was your mother’s first name?” I ask her. She replies but in a tone that lets me know she is not happy with answering. I try the next question: “What was your father’s name?” Now she lowers her head again, peers up at me through squinted eyes and asks me: “Do you like this job?” “I’ll ask the questions here.” Is what I’d like to say. But I am a Social Worker, a professional, and it is my job to try to defuse her, put her at ease, as we are taught to do in Social Work classes. So my answer is: “Yes, I do. I like Social Work very much.” “Why?” is her next question. I have asked myself the same question recently, especially since working at St. Barley’s, but I try to give her the sincerest answer I can. “I like to help people and this job is a good way to do it,” I answer. “Can you get me out of here then?” She asks me, with tears welling up in her eyes. “You have only been here one day,” I say to her, “You dislike us already?” She looks at me again, this time tears streaming down her face and says: “I want to go home, this place is not my home it never will be my home.” “Do you understand?” I understand all too well what her words are saying to me.

Her words make me think back, years ago, before I went to college, about my own mother, who was elderly and became very sick. My family and my father had vowed my mother would never be assigned to a traditional nursing home, if we could ever help it. There were eight of us kids and we took turns helping my father care for my mom when she became too sick to care for herself. She did, eventually, go into a nursing home, but she was out of it, so to speak, and pretty much in a coma when the ambulance came to take her to the hospital, then to a nursing home. She was comatose so I am sure she would forgive us at that point, for our decision. But what about the people who are simply frail, but their minds are still there? Those people, who are aware, fear nursing homes because they fear losing the simplest things in life that we, living on the outside, take for granted. Being able to make even the simplest decisions, are often taken away in nursing homes. Nursing homes are not evil places, run by evil people. In fact, nursing homes have the best of intentions, but like the saying goes: “The road to Hell is paved with good intentions.” Good intentions are not enough to keep one’s quality of life at a level where they can be happy. My mom had always made us promise to never put her into one of ‘those places,’ as she liked to call them.

I turn my attentions back to Mary, the lady in Room 103 whom I am trying to interview. “I’m not a miracle worker,” I reply, “But I can set up a care plan meeting with the team here and with you and your family so we can discuss why you are unhappy. Maybe we can all work something out that you would be happy with.” Now Mary has the first faint look of hope on her face since our conversation began. “I cannot promise anything, Mary, but I can try for a care plan meeting.” She gives me a half smile and stops crying, for now anyway. “I will come back later, if you like, to ask these questions, when you are feeling better.” She looks at me, once again and says: “Maybe tomorrow, after breakfast,” she says as more of a question than a reply. “It’s a date then,” I say as I gather up my papers and clipboard and head for the door. I feel tears welling up in my own eyes, I want to hug Mary and say: “Things will be ok,” but I know things may not be ok, at least not to her satisfaction anyway. I cannot imagine a worse way to spend my final days of old age, having to live in a traditional nursing home, sharing my bedroom with a virtual stranger and having to get used to rules in a place that is categorically an institution.

I return to the Social Work office, “How did your first interview here go?” the Social Services Director asks me. “Not real well, she hates it here,” I answer. “Many people do,” is the reply the Director gives me, smiling, but with a pained look, telling me she fully understands why.

Crystal, the Social Services Director is all of 26 years old, but she has an understanding of people, especially the elderly, that goes way beyond her 26 years. She is a very good Director, but I also know, from the first time we met, she is not happy working at St. Barley’s anymore lately. When I had asked her why, she said it was a fine job until the new Administrator was hired and then everything seemed to change. When I asked her if maybe change is hard to adjust to, she told me, no, change is fine with her. But she said she gets the distinct feeling that Madeline, the new Administrator, hates her guts for some reason. I knew immediately, from meeting the Administrator during my interview, that Madeline was no touchy, feely sort of boss. I got the feeling, after only one week on the job, that Madeline didn’t seem to like anyone much. She was an efficient, cool as a cucumber, sort of Administrator who felt the authoritarian type of supervisors got the job done more efficiently. The woman was not exactly oozing with massive people skills. She was the kind of Administrator who relished in her authority over people and she shot down anyone who dared disagree with her. Her favorite habit, for keeping the staff in line, was to call out people in our morning staff meetings, those she felt ‘don’t get it’ or who just plain tick her off for some reason. She enjoyed embarrassing staff, be they nurses, Social Services, food service, maintenance, just anyone who makes her mad. She has the kind of personality (some circles may call it bi-polar) that makes it impossible to know what will tick her off, so all staff members were usually on edge all the time because of it. In fact one day in morning meeting, the Maintenance Assistant was filling in for the head maintenance person and said something the Administrator didn’t like. She had asked him what was going to be done about some mechanical problem in one of the resident’s rooms and apparently the Administrator didn’t like his answer. The Administrator all of a sudden raised her voice and proceeded to bust the poor guy’s balls over the subject. She ranted and raved, telling him he was an idiot, for about a good 15 minutes. Everyone in the meeting, especially the maintenance guy, was totally stunned by this craziness. The guy looked like he was going to cry or something, he looked very upset. The entire staff was embarrassed for the poor guy and it didn’t exactly start anyone’s day with a cheerful note. As it turned out, he obviously was much more upset than anyone realized and a few days later, the head maintenance woman came into Social Services crying her eyes out. “What’s wrong?” I asked her. “Charlie is dead,” she sobbed. “What?” I asked her, in a stunned voice. “Charlie is dead,” she repeated. “Did he have some kind of accident?” I inquired. “No, he shot himself in the head,” she wailed. I just couldn’t believe my ears. Charlie evidently must have had some crap going on in his personal life and his getting chewed out by the Administrator probably was the straw that broke the camel’s back. To say this woman was Attila the Hun in a dress is probably an understatement. Compassion was not Madeline’s big suit either. Her personality suited the owner of St. Barley’s though because whatever she lacked in people skills, she more than made up for in number crunching and saving him money to make him richer. Her personality would have been best suited as an accountant or a person who worked with computers, in a cubicle where she could be alone and not have to deal with people, but definitely not an administrator. Madeline also had her little snitches, her rats, her patsies, whatever you want to call them, whom she regularly met with to find out information or the dirt on other workers. This kind of work environment did little to encourage cooperation among staff members. In fact, driving a wedge between co-workers was more this Administrator’s style, making for a pretty stressful place to work every day. Maybe she was worried that the staff might become friends and mutiny or something, against her one day. Maybe the fear of losing one’s job just suited her by keeping everyone off balance. It seems ludicrous but her favorite speech to staff was about team work. I think she liked this because it was a nice buzz word and it probably made her feel like she was encouraging everyone to work as a team. She probably read the phrase in an article about the importance of teamwork, but she did not encourage anyone to actually practice it.

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