May 31, 2006
Jim's on the road tonight getting orientation for his new job delivering drugs...Or so we tease. He's taking meds to nursing homes when he officially starts on June 1. We're cautiously optimistic that he finally has work!!!!
While taking the dogs out for their midnight run tonight, it seemed so strange to be outside in the dark. It's been so long, I didn't realize we weren't wearing coats and gloves anymore! I'm often at work by 6:30 p.m. I'm missing the summertime! The grass is tall. The moon is a sliver of light and you can see planes coming in to the Columbus Airport! Last time I was out, it was overcast, snowing and downright bone cold! Poor Jim, he's the dog walker. Like the mailman, no matter the weather, they are out there!
Several friends have promised to help me promote my book. This isn't my area of expertise, so if anyone has ideas, please let me know.
Well I'm writing without the benefit of the spell checker and find myself trying to keep my words simple. I'm also dead tired having worked "last night" and getting woke up by the UPS man today delivering two more books. (Who's going to get them? Perhaps I should draw a lottery?)
I have ordered 30 books that should be here next week. I know some of you are watching the mailbox for your book. Soon. Soon. Soon.
Take Care on the Journey
May 26, 2006
May 30, 2006
Permission to use...
I was sitting on the couch missing Jim this quiet wednesday evening. I'm usually the one who's at work! Suddenly the room filled with an unexpected evening sunset after the summer's rain. It brought out the golden highlights on Ching-Ching's sleeping face. I ran to the balcony with my digital camera and opened the shutter and now invite you to enjoy my enchanting sunset!
I dearly love Katy's blog because it feels like we are right there. My blog sometimes seeps with ramblings of a crazy woman. (Although Jim says I should send my Adam and Eve articles to AARP...) Maybe my humble pictures will add warmth and personality to my blog.
I worked all night last night and will again tonight so I'm just about ready for a big sleep. Before I crawl into bed as Jim rolls out, Sheba and I thought we'd update the blog family on some good news.
I looks like Jim will be starting a job as a Courier delivering meds for the company that delivers meds to my nursing home. He will have a route every night 250 miles round trip. We'll believe it for sure when we see that first paycheck. He hopes to expand as he learns the ropes.
We had storms last night but no damage in our immediate area. Our Severe Weather Policy at work requires that we close all the drapes at the nursing home and be on standby to plug all the oxygen machines into "the red outlets". But the lights only blinked once - just enough to have to reboot all the computers!
Enjoy your day.
Take Care on the Journey.
May 25, 2006
This is written with tongue-in-cheek. I’ve not lost my mind. Just putting my ideas into a playful reality. Enjoy…but keep in mind...You may be the one in need someday. What ending do you want?
Let’s skip putting everybody to bed at our No-Name Nursing Home, Anytown, USA. I think you get the picture from my previous posts.
I’ve been informed that several investors have approved lending my company unlimited funds to establish a completely privately owned and operated facility.
You know the name: "The Adam and Eve Care Center". Or, is it "The Adam and Eve Place" ? Well, there’s still time. The employees may vote on this matter.
I’ve already hired several key employees who are meeting with me everyday as we discuss the exciting next few weeks.
Please note, my intent is not to create a sense of "richness" but to design an envirnment where the right people can have the freedom to make a difference for others!
These are the benifits I think all health care employees deserve. Medical Insurance is provided 100 percent. There is one four-week vacation each year with one paid round trip to any place of your choice. Unlimited education at any leval may be taken at any time. All educational costs will be picked up by the Company.
Administrators are expected to keep Tuesdays free for information and training meetings with Miss Linda, Mother of All Administrators. Training schedules will be e-mailed . If you are not on the schedule for that Tuesday, you may have the day off for leisure activities.
A mandatory round-table staff meeting will be held every Monday at 5:55 p.m. A daily fill-in-the-blanks report for your department should be e-mailed to Miss Linda by 6 p.m. every day except Tuesdays and Saturdays. All Administrators are on-call for specific departments 24/7, but hours are not recorded or regulated.
Here are the current Key People.
Ohio Gopher Jim - Administrator of Accounting, Networking, Grounds and Pets. Chief Advisor to Miss Linda, Mother of All Administrators.
Redneck John - Administrator of Two-Men-And-a Truck.
Lil' Sis Sandy – Special Assistant to the Mother of All Administrators! Advisor to Maid Services and Special Delicacies Cooks. All work may be done by e-mail from anywhere USA.
Gun Totin Craig – Keeper of the Wine Cellar. Administrator of Security. Special Assistant to the Special Assistant to the Mother of All Administrators. May be required to travel to exotic places with the Assistant to the Mother of All Administrators.
Big Bark Sheba - Assistant to the Administrator of Security. Master to the Mother of All Administrators. Special Assistant to the Spanish Translator. May have bones of choice in leu of pay.
Thrifty Katy – Administrator of Music Therapy. Advisor to the Decorators and Natural Foods Cook. Special Aide to the Educational Administrator.
Earthboy Teacher Billy – Assistant to the Grounds Administrator. Educational Administrator and Spanish Translator. Advisor to the Mothers of All Administrators. Special Assistant to the Advisor of Natural Foods.
Gameboy Teacher Philip – Special Needs Education Administrator. Assistant to the Educational Administrator. Advisor to the Speciality Cooks. Special Assistant to the Mother of All Administrators. Special Assistant to the Web Page Designer.
Homemaker Shelley – Assistant Administrator and Advisor to the Special Needs Education Administrator. Administrator of the Company Web Page Design.
Trusty Floyd - Maintenance Administrator. Assistant Music Coordinator. Administrator of Religious Services. Advisor to Natural Foods Services.
Gentle Tania - Administrator to Nurses Aide Services. Advisor to housekeeping. Special Assistant to the Religious Services Administrator.
We are still seraching for an Administrator of Physical Therapy to lead that department into the 21st Century.
All other positions are considered General Employee. The hourly pay and benefits are the same. The pay rate is is $25/hr. No overtime is allowed. (Staff are human and need to feel refreshed!)
All general employees get free uniforms, meals and day care. Free Pre-school through 6th grade education for day shift employees is provided on grounds. Medical Insurance is provided 100 percent from day one of employment. Transportation is provided to and from work with 24-hour notice and on an emergency basis. Tips and gifts from family memebers are acceptable. Each employee is entitled to 2-weeks vacation a year with one month notice. Birthdays are a paid day off. Each General Employee is given a free one-week pass to Disney World and round trip airfare for up to six people.
We are currently accepting applications for the following General Employee positions. Working conditions are condusive to excellent standards of care.
Laundry Services – Uniforms and coveralls provided. All laundry is in washable bags so there is no sorting of dirty laundry. 4-8-hour shifts anytime.
Housekeeping/Maid Service – State-of-the-art cleaning machines and supplies will be used. Uniforms provided. 4-8-hour shifts anytime.
Shift Cooks – Recipes and top-quality ingredients guaranteed for every meal.
Delegate Cooks – Aide to the cook.
Servers/Dishwashers – Dishwashers are the most modern available. Human hands do not touch dirty dishes.
Specialty Cooks – Create tempting delights fresh for each meal.
Dining Room Specialists – Assist one on one. No forcing patients to eat.
Bathroom Supervisors – Make the bathing experience tranquil and beautiful. No noisy showers. Comfortable temperatures. Body massages available. Unrushed and pampered.
Decorators – Design unique individual rooms and create beauty inside.
Grounds/Gardens – Flowerbeds, enclosed fountains, waterfalls, outdoor gardens for planting and growing food.
State Certified teachers and assistants for pre-school - sixth grade. See handbook.
Entrepreneurs for the employee/resident mall. Space cost based on profits.
Garden keepers and nature lovers are welcome.
Volunteers: Retired teachers, nurses, doctors, cooks, seamstress, housekeepers, homemakers, musicians, photographers, artists, attorneys, bookkeepers and all professionals who want to share the memories and skills with residents and employees of our facility are welcome.
Certified Nurses Aides – In house training provided. Teamed up with a seasoned employee. No more than one 8-hour shift in 24-hours. No overtime. Report to Assessment Nurse. Nursing and aide shifts will overlap by one hour each way for smooth transfer of care. Most remember the Golden Rule at all times.
Medication Nurses - Nothing but meds. Keep meds organized and up to date for each resident. Pass meds to no more than 12 residents. Summary charting once a week. Benefits same as Nurses Aides. Pay rate starts at $35/hr with monthly raises based on evaluation by Mother of All Administrators. Excellent PR skills required. Respect and loyality expected. No gossip or backtalk allowed. Remember, "The customer is always right".
Treatment/Bedside Care Nurses – Evaluate need for treatments and provides daily skin and wound care. Documents same. Benefits same as Medication Nurses. Four-hour shifts on each shift. Assist with bathing as needed while doing skin checks.
Coordination of Care Nurse – 24/7 staffing. 8-hour shifts. Makes out aide assignments. Works hands-on with aides to ensure sure each resident is getting all the appropriate care they need at all times. Provides constant orientation and training. Takes all breaks with her aides. Writes monthly reports and comendations on each aide for Miss Linda. Is not allowed to sit at the nurses station during work hours. Must possess "angel skills" in dealing with conflict and stress.
Desk Nurse 6 a.m. to 10 p.m. 8-hour shifts. Answer medical calls. Directs staff communication. Take doctors orders. Answers family inquiries. Provides good sense of humor and spoils everyone with compliments and positive thinking. Keeps dark chocolate candy in good supply. Stocks staff refrig with noursihing and not-so-nourishing snacks and goodies. Keeps the break room tidy, cheery and light. Reports any concerns to Miss Linda immediately. Benefits same. Expectations greater!
Scheduling staff person. Organizes all staffing. Delegates scheduling for other departments and enters all into computer program. Must be anal and detail oriented. Able to multi-task. Possess the patience of a saint. Holds no grudge and doesn't believe any excuse she is told. Keeps a paid on-call staff aide and nurse on stand-by for every shift. Supervises schedule 24/7. Pay is $35/hr with same benefits as nursing. Any call-offs will be reported immediately to Miss Linda. The employee may be dismissed on the spot and on-call person called in.
Assistant Scheduling Person - Covers days off and vacation for Scheduling Person. Pay is $35/hr with benefits same as nursing.
The physical facility will be constructed like a large wheel with the center circle housing offices made to order for each supervisor. The inner circle will also include a 24-hour child-care facility where all family members can gather to meet for meals and breaks. A fully accredited grammar school will provide free education to employees' children from pre-school through 6th grade. There will be a mini-mall (vendors invited) and a 24-hour food court - free to employees and residents.
The outer part of the wheel will be a circle of specialty units that include at least the following:
Alzheimers/Safe and Secure:
All units are in an unbroken circle for safe wandering. Beds are constructed on a lift that can make the bed even with or below floor level for safe sleeping. Showers are like a walk in a summer rain with "rain rooms" and warm walk-in tubs. There are "sleeping nooks" for quiet restful sleep 24-hours a day. The outer halls ways are enclosed with windows to the outside but with camaflaged doors that have 24-hour security. (No fighting to keep residents inside. The residents cannot 'see' the doorways.) There is no "day and night" schedule. Catered food and snacks are available 24-hours a day. A doctor who speclizes in Alzheimer medicine is on-call to provide sedation as needed for the agitated and other emergency meds as needed.
Assisted Living/Freedom From Stress: Everything is free. Housekeep and laundry services will be provided. Meals: Pick-and Choose. One-on-one staff for selected hours. Transportation provided on request. Groceries delivered. Meds in-house. Nurse on call. Doctor on-call. Pets allowed. Pet sitting available.
Golden Years/No Worries: 24-hour supervision for care as needs progress. Couples may stay together. Pets are allowed. Same as assisted living except whirlpool baths and body massages are available anytime. Meds may be set up and/or administered. Assistance with bathings offered. Beauty appointments are free. Manacures and pedicures are provided. Pets are taken outside on a 4-hour schedule if needed.
Beyond Words/Total Care/Bedfast. The inner circle of care. Private and intense care as needed. No set structure - staff provide care according to the needs of each individual patient. Comfort care with dignity. Ratio is 2/1 at all times to provide constant comfort and assistance to family members.
Join us on our journey
Take Care on your Journey,
May 24, 2006
Adam and Eve – Part 4
How often do you see a very old man drinking Pepsi? Look closely. He’s not drinking it. He’s holding the bottle with a reverence. He sits it on the table beside him and glances around to see if anyone is looking at his prize. There’s a cup of ice nearby, but he wants this luxury to linger within his reach. This old-man-Pepsi-thing was a mystery to me until a few days ago (or was it months ago?) when I noticed a bottle of Pepsi on the bedside table of an aging patient.
“There’s more in the drawer,” he says.
“You want me to get you some ice?” I ask.
“Sure. That would be nice.”
“Did you look in the drawer?”
“Yes. You have six more bottles of Pepsi.”
“My daughter brought those for me. She can get more.”
But for now, it’s a ritual at medicine-time in the no-name nursing home where I work. I hand him his medicine and the small cup of ice to go with his Pepsi. I carefully pour a small amount of Pepsi over the ice. It sizzles, and the man nods.
“Ahhh", he says after one long draw on the straw. "I never knew about this stuff. It’s good stuff!” He sits the half-empty cup on the table.
Hours later, water has displaced the ice and the sweet mixture is divided into clear and gray. He 'refuses' (a medical word) to take his glasses off. He’s still glancing at his beloved bottle of Pepsi.
When some millionaire gives me my grant to create the "Adam and Eve Care Center", there are a million things I’d do to make a difference in the lives of those who fought our wars, survived pandemics and the Great Depression. They never knew a day off from work. They were too poor to afford the luxury of a Pepsi or a mouth-watering banana split from the Dairy Queen.
When I open my Adam and Eve Care Center, there will be a pop machine that takes only dimes. A cold bottle of Pepsi will only cost one dime. All the old men will get Pepsi with their meds, and the women will get a piece of dark chocolate candy with every meal.
They are our parents, grandparents and great-grandparents of yesteryear who feel alone and isolated from an era we will never know.
But, back to the present.
It’s now 10 a.m. in the no-name nursing home where I’m rushing to get 9 a.m. meds passed to 25 patients before the new admission arrives from general hospital.
The aides can’t keep up with the call-lights because therapy is waiting for several residents to be cleaned up and pre-medicated with pain pills.
Showers took longer than usual this morning when “Mary” screamed and kicked and fought like a tiger in the shower room. She almost fell out of the shower chair and several aides were scratched badly.
I had to stop to make out incident reports (management dictates this be done immediately), clean the scratches and apply antibiotics. The aides were very upset and vowed to never give Mary a shower again. The Director of Nursing wants to know why we can’t keep up as she hands me a training log to have each employee sign on how to safely give showers. Dr. Iwantedityesterday is on the line, and the fax machine is overflowing with lab reports that need review for critical values.
As I reach for the medicine for the patient in Room 218, a family member comes to the med cart demanding to know why his mother is not out of bed and her unopened breakfast tray is still sitting on the table beside her bed.
I agree that sounds like a good question as I continue to punch out meds for Room 218 and glance quickly around for the aide that was suppose to have fed his mother this morning.
“I’m so sorry. Your mother had a cough and small fever today, so we decided to keep her in bed. It was unusual for her to stay in her room for breakfast and someone forgot to help her with breakfast.”
“Well, if that’s how this place is going to treat my mother, I’m taking her out of here today. I want to speak to your supervisor~ *%!!* “
“I understand. Actually I’m the supervisor. But, I’ll take you to the Director of Nurses.”
As we head for the front office, I notice the medics rolling in a cot from the ambulance. That would be my new admission. The patient is very quiet, but I notice a look of pure terror in her eyes as they pass by. I want to stop and give the little old lady a hug and say, “It’s all right, honey. We’ll take good care of you,” but if I stop, the man walking beside me will start afresh with his outburst. So we walk on.
At the director’s office, I try to catch her attention as she slams the phone down and turns to the assistant director of nurses.
“Well I never! Someone called the Ombudsman and complained that we didn’t pass ice water yesterday and we let a call light stay on for over 15 minutes. Who would tell a lie like that?”
“This young man would like to speak with you,” I interrupt.
As I leave the angry man with the Director to discuss the despicable way his mother has been treated, I overhear her assure the son that this has never happened before and those who did this will be disciplined or fired.
When I return to the unit, I’m met with 12 of 20 call lights blinking above the doors and two aides sitting at the nurses’ station.
“They’re not our lights. We answer “Lisa’s” lights all the time. She’s lazy and takes a smoke break every five minutes. We aren’t going to do her work anymore!”
Another family member is standing at the nurse station (overhearing everything). She looks at me and nods with understanding but with urgency in her voice. She asks when her father will get his pain pill. He asked for it over an hour ago. No one had told me he wanted a pain pill. I hurry to open the narcotic drawer.
Just then an ear shattering alarm goes off and all the fire doors slam shut.
The fire drill is announced and everyone rushes to get everything out of the halls and close all the patient room doors. We are being timed!
The medics hurry by pushing their cot at a fast pace. They aren’t gong to be detained by a fire drill today! Yanking open the fire doors, they high tail it out the front door. And, I will be given a bad mark on the fire report for allowing one of my fire doors to be opened.
Fighting back tears of frustration, I am consoled with the words. “Adam and Eve Care Center”. Or should I call it, “The Adam and Eve Place”?
Both seem like sweet music to my ears. I stand a little taller. My aching back eases slightly, and I smile a great big smile as I walk into Room 218.
"Here’s your morning medicine. Would you like a cold Pepsi with that?”
Take Care on the Journey,
Adam and Eve – Part 3
"The Adam and Eve Care Center"
There are many questions one should ask when anticipating nursing home placement. Just as importantly, the nursing home should be asking YOU some questions. If not, one should start to wonder if this is an appropriate placement for your loved one.
For many years I’ve wished I could whisper the honest responses to those who place their loved one in my care. Instead, I’m bound to uphold the policies and procedures of my employment. I am not in charge and I do not make the rules. If so, there are many things I would do and say differently.
I’d love to take all the experiences from my 30+ years of caring for the elderly and make one red-hot care center that people would flock to. Both staff and patients! But, instead I will create a make-believe place on this blog where perhaps some information will help you understand the concept of long term care and what it’s like to live the last days on earth in a no-name facility called a “Nursing Home.”
Lets call my care facility “The Adam and Eve Care Center”.
Let me introduce you to my staff. I have hired each employee. Each one has passed a background check, had at least two interviews in my office and one meal with me in a public place. My employees need to represent my personal standards so they must know what those are. I expect my staff to be good PR representatives, so I should know they understand that aspect of the job.
The Administrator: Each nursing home is required to have one but in Ohio, it does not have to be a full-time position. I hold this position in my Adam and Eve Center, but I also work as a nurse on every shift to keep my ear to the ground and in tune every resident and each employee.
The Administrator (ADM) holds the key to all aspects of the facility. Most leave the day-to-day running of the facility with the director of nursing. But, just so you know, the administrator can call the shots and can always make the final decision. The ADM can’t answer call lights unless they have medical training, but they can knock and enter a patient’s room to inquire how things are going.
I always watch the interaction between the Director of Nursing (DON) and ADM where ever I'm employeed. Sometimes the DON works closely with the ADM and other times, there’s conflict and distrust of each other. You should know who each person is and which one is the decision maker. When things go badly, you need to know who to turn to.
The Director of Nursing is always a RN. (This is why I have studied to become a RN and hope to someday be one.) Don’t expect a lot of “hands-on” from the DON because her desk is always piled high with paperwork, her voice mailbox is always full and her schedule is unpredictable. At best, she has a hard working and loyal Assistant Director of Nursing whom she can delegate day-to-day matters to.
The Staff Nurse is the nurse you see most often. He or she can be a LPN or RN. In this position, it doesn’t matter. They do the same thing unless the LPN is not IV Certified. Then the RN must do the IV meds.
Count on the staff nurse to have a regular med-pass every few hours and to be the supervisor of the unit. She is the heart of the unit and can make or break a good name. She is also the one most dumped on by the ADM, DON, ADON, the doctors and the nurse aides. He/she has to pass all the meds (on time), give pain meds (immediately), do the treatments, answer the phone, chart on the patients, take orders from the doctor, answer call lights, cater to family members and keep the aides running smoothly. Her patient ratio is anywhere from 20-40 patients.
My pet peeve is the perception that if the nurse is a male, he is god-like. It’s usually just the opposite, but I have never been able to figure out why it happens or how to change it. After following a male nurse, I’m usualy stuck with accepting comments like, “George gave me a Tylenol PM” (when none was ordered) or, “Andy put a new catheter in” (when there was no order to do so), or, “Greg gave my meds right on time.” Oh well. Neither of us are doctors.
The Nurse Aides: My first question would be, “Are they state certified or not?” Each nursing home chooses what to hire, but they are all called the same regardless of the training. If they are not certified, they will not know how to give a good bed bath and they will have no CPR or First Aide training. They won’t know how to take blood pressures and have no training on how to properly transfer patients to and from bed.
So, it’s 4 a.m. and the aides go in teams of two to make rounds. They have five patients each, but work as a team. Turning on small bedside lamps, they have piles of clean laundry for each room and they supply each bathroom with fresh soft towels and fluffy washcloths. There’s warm soapy water and a soothing “good-morning” for each sleepy resident. Faces are gently wiped clean, dentures are slipped in and sweet skin lotions permeate the air. Soiled depends and messy diapers are placed in a small laundry basket to keep the floor clean and odor down.
No. That’s not right. This isn’t the Adam and Eve Place!
It’s 4 a.m. and the aides have 15 patients each. With lights blazing overhead, they start going from room to room (alone) quickly removing wet diapers, throwing them on the floor and snapping on dry depends. There’s not a washcloth in sight. At best, they will wipe the sensitive peri area with a cold “wet-wipe” (and throw that on the floor too). Some residents will be dressed and rolled out into a day chair (at 4 a.m.)because with so many residents to get up before breakfast, they don’t have time to start getting them up any later.
Now, it’s 8 a.m. and breakfast is being served in the dining room. The radio gives the morning news and weather forecast as residents are wheeled to their favorite table to greet their ‘table mate’. First, they are served warm cereal and fresh toast. They select butter, jelly or other favorite toppings for their toast and cereal. Each resident selects a favorite juice from the rolling cart and every resident is assisted one-on-one to assure the food is perfect. A few minutes later, smartly dressed young people pass out the main course, and dainty little hot sweet rolls complete an attractive and pleasant morning meal.
No. That’s not right. This isn’t the Adam and Eve Place!
It’s 8 a.m. and breakfast is late again. The cook didn’t show up to work, and the kitchen staff had to make a “cold breakfast”. They skipped the coffee, and all 50 pieces of toast burned in the oven. Mr. Smith over at table 8 has a cold and is sneezing all over his table. No one has a Kleenex and no one thinks to take him back to his room. Grandma Jones is still in her wet hospital gown and granny Jenny still has last night’s supper on her face. The staff nurse who should be monitoring the dining room is late passing her meds, and the extra “feeders” (staff who assist feeding the residents) are still getting patients out of bed.
Oh well, administration won’t be in for an hour and families never come in before 10 a.m. This is the No-Name Nursing Home in Anyplace, USA.
I exhausted thinking about my story. You have much to think about.
There will be an Adam and Eve – Part 4.
Take Care on the Journey,
May 23, 2006
In my last article I promised to teach you what questions to ask and who to ask when evaluating for a nursing home placement.
Nursing homes are not just for old people. Diseases and accidents happen to anyone, and families are often unexpectedly forced to quickly find a nursing home.
Sometimes there’s just no one left but "dad", and the house is falling down. Heating bills are too high. There’s no transportation for food and meds. Loneliness and depression is often an issue causing the doctor to suggest a change. Or, the younger family members are raising children and working full time.
I see it all everyday.
Nursing homes are usually divided into two categories: Skilled and Long Term Care. Skilled is usually reserved for therapy and recovery after surgery or illness. Most of the time, residency in the skilled unit is no more than 1-3 months. After that, the cost is very prohibited. About $300 a DAY!
Long Term Care is just as expensive, but Medicare usually picks up most of the cost. (If I’m right about that.) The social worker can provide expert advice and information on the cost. I do know it’s all very expensive and very few so-called Long Term Care Insurances actually cover the cost! Don’t get misled by them.
So, let’s pretend that I have my debilitating stroke and I’m completely paralyzed on the right side and can’t speak for myself.
Planning for my discharge from the hospital will began from the moment I’m admitted to the hospital. Decisions about my future placement will begin immediately, so make sure Jim is informed on those plans and has a chance to provide input.
The hospital social worker may provide Jim with names of nursing homes. He should toss this into the nearest trash receptacle and open the yellow pages of the phone book and start making phone calls.
He’s going to be busy visiting facilities close to home. He will first walk the halls without talking to anyone. (As I do before I apply for a job.) He will use his five senses to their fullest.
Listening: What are the staff talking about to each other. What are the nurses gabbing about at the nurses’ station? Do they sound like teamwork? Are they complaining and if so, who or what are they complaining about? Each other? The administration? The residents? (Heaven forbid!)
At a former job, most every nurse disliked and did not trust the director of nursing. She wasn’t fair, honest or even knowledgeable about her staff and residents. But, she put on a real good front and most of the visitors who toured the place were very impressed. If visitors had actually spent time listening, they would have learned much!
Jim will listen carefully for beeping sounds of the “call-lights” that every patient has. State Regulators often cite nursing homes for making patients wait more than three minutes for a call light to be answered. The fast-beeping noises are the bathroom emergency light and should be answered within 30 seconds. I’ve seen and heard them go on for an hour at a time. I will not work in a nursing home where this is allowed to happen, so please don’t make me live in one.
Odors: My Jim has the worse nose ever. It has to be really, really bad for him to notice an odor. I’d suggest he take Sheba, but the objective would not be the same… There is always an odor problem in nursing homes. (Unless you bought one of those Alpine Units from Floyd Phillips.) It simply cannot be helped with so many people wearing diapers and using urinals and bedpans. There are bedsores, tube feedings, catheters and urine bags. If any of these are not cleaned well, there will be an odor.
Will Jim see housekeeping mopping under the beds and behind the toilets? How often is this done? (You may be shocked. Once I placed a kleenex box under a bed and it stayed there for months!) Look at the condition of the wheelchairs. (I almost hate to tell you this secret.) In most nursing homes, the wheelchairs are suppose to be on a nighttime shower schedule, but rarely does it happen. Most of us nursing home employees have conditioned ourselves not to look at the footrests and armrests of the wheelchairs.
Food odors and mealtimes tell so much I could write a book on what to watch for in the dining room. Is there a suction machine in the dining room for when I choke on my piece of bread because the kitchen thought bread was on a pureed diet? Are nurses passing pills in the dining room? (They shouldn't.) Is there a nurse monitoring the meal until the last resident leaves? (They should.) Is another resident taking food off my tray? Is the aide feeding me and another resident at the same time? Did they give me a pretty bib to wear, or just let the (pureed) food dribble on my dress. (Am I dressed for the dining room?)
Be there at mealtime and see if the meal sparks your taste buds. Can you smell the coffee? Or, is coffee limited for visitors and staff? Frozen meals provide little “home cooked” fragrance at mealtime. Homemade deserts are refreshing and a sign of better dietary services. Are confused residents given very hot food (or being fed steaming hot food?!)
If you can, notice the expiration dates on milk cartons and ice cream. Some nursing homes use outdated food to save money. By the way, what brand of ice cream, applesauce and milk do they use? Would I be willing to have this fed to me?
I hate to say this, but how do the staff look and smell? Have they worked double shifts and not had a shower for two days? Did they wear protective gowns when they cleaned up that last big accident? Do the women residents have make-up and perfume on. Don't stare, but have the men been shaved? (Every day!)
As you walk the length of one hall, how many staff people did you see? Not just aides, but at least one nurse – maybe two. (Do they nod or speak to you?) You should see the social worker hurrying by, physical therapists walking behind patients, a busy, smiling activity director and her activity aides playing games, a cook with a thermometer in his front pocket and kitchen personnel delivering snacks to the halls. You may see the admissions director showing a tour.
How often does the doctor making rounds (Be alert to evasiveness.) Actually, they usually rely on the nurses to keep them posted. I haven't seen doctors make rounds for many years!. Is there an 'eye doctor' on staff? Who will replace my glasses when they get lost in the sheets? Is there a podiatrist who actually comes in to cut toenails. I'm a diabetic and only a poditrist should cut my toenails. What about dental service? Some nursing homes have a dentist who comes in and checks those dentures and partials. (You should ask these questions later. I'll explain in another article.)
By the way, will I have my own denture cup for my little partial plate? Jim will need to make sure it gets removed and cleaned every night. Make sure they don't put my dentures in my roommate's mouth!
Later, you will need to know. Who is the administrator and how long have they been there? Frequent changes in administrators or the director of nurses indicate internal problems. Who is the assistant director of nursing (or is there one?) Later you should see the director of housekeeping and laundry. Who is the maintenance man? Is he dressed for ‘work” or as one who reads the newspaper in a back office?
At the nursing home where I work now, I made that silent walk through and vowed not to apply to work there. I saw some things that indicated sloppiness and lack of professionalism. These are just little things that mean a lot to me. When I did my tour, not one nurse asked if they could help me. I purposely walked into an area near a back entrance that had storage supplies and looked unused, but still no one asked who I was. I saw nurses eating at the nurses’ station (a sign of being too busy to take a break), and med carts messy with litter and disorganization.
But Jim was excited to have me working close to home (5 minutes), and when I (reluctently) applied, the director of nurses blew me away with her professionalism and courtesy. I gave her a hard time with many questions I knew she really didn't have time for. I pressed her to explain her system of organization and communication. (As I left her office, I heard her let out a deep sigh of relief) I figured I'd never hear from her again. But, I did feel like I would be appreciated – and this has proven to be true.
Next time I’ll write about more questions to ask and who to ask them to.
What's this about Adam and Eve? That's coming too!
Take Care on the Journey,
May 22, 2006
Some elements have been changed to protect identity.
Every time I clock in for work at the local nursing home, I wonder how many new admissions have arrived since I last worked. In two decades of nursing I’ve never ceased to marvel at the family expectations – and subsequent disillusionment of even the finest nursing home facilities.
I’ve never worked anyplace where the employees agreed, “This is where I’d like to live when I’m old.” Never.
Having said that, I do know some hidden secrets that make or break customer satisfaction. These I will share with you the next couple articles about nursing homes.
Last night our new admit was an 80-year old lady who had a hip replacement. We weren’t expecting a Sunday admission. The paperwork was not available and the staff were not prepared to change their schedule for the day. But, the ambulance pulled up right as lunch was being served and the nurse was trying to get noon meds passed.
Accompanied by a very concerned son, the patient and her son immediately began turning on her call light for various questions and requests.
“She wants side rails so she can turn easier.”
“Can we put the oxygen machine in the bathroom because it’s so noisy.”
“She’s constipated and needs a laxative. When can she have one?”
“Can she have a pain pill now?”
“Can we get her out of bed and up in the chair? She’s been lying down all day.”
“She has pneumonia. What antibiotic is she on?”
“Shouldn’t you turn her oxygen up? She can’t breathe good.”
“What are those pills? She can’t have any meds that make her heart beat faster.”
“She has a sore on her bottom. Can you put something on it?”
“Can she have another pain pill? That one didn’t help.”
“Are you planning to go home and get some rest?” I asked the son about midnight.
What they didn’t know was that her doctor had been in an accident over the weekend and could not be reached to confirm changes the on-call doctor had sent with the patient. We don’t tell “customers’ information like that.
What they didn’t know was that for every question that night, I had to make exceptions to the rules or call the on-call doctor to get an order on a Sunday night! Every time the call light came on over the door again we were saying, “There she goes again.”
I charted, “Patient seems a little insecure.”
Selecting a nursing home is not easy and it’s not something you do every day! There are many things you could learn about living in a nursing home that would help make life easier for yourself and those who take care of your loved one.
There is never enough staff, and if there was, I’ve learned that human nature being what it is, people would take longer breaks and those who demanded more would get the extra attention. So, don’t expect a perfect world in any situation.
A nursing home is only as good as you help make it. The families who really want the best for their loved one have to be involved. They must learn not to get what they want by constantly complaining (and there’s plenty to complain about), but by being involved and actually assisting with care.
Take “Martha” who has a loving daughter who is present every afternoon. She not only sits and reads to mother, but then goes into the bathroom and helps wash up. She lays out the clothes for the next day and leaves the room picked up and tidy. There’s fresh ice in the water picture and the drapes are pulled closed for privacy.
But there’s also, “John” who has no one left in his world of 90 years on this earth. He is alert and still has a good sense of humor. He must depend on the staff for his every need and he knows the staff by name. He knows whom to order out of his room because they are “worthless” and he is quick to praise the kind, hard working staff who cater to his every request like he was a king.
I sigh as I think of all the patients who are beyond knowing they are still in this world. They wander into all the rooms, dribble on their chins and green gunk matted in their eyes. Stumbling with every step and refusing to be assisted to the bathroom, they don’t smell good and they often fall down. We must give them the same unconditional love and tender loving care too.
You will find all these situations – and more – in every long term care facility.
So, what should you look for as you search for a place for your loved one? What questions should you ask yourself? What questions should you ask the admission director? What questions should you ask the nursing staff? What are the secrets to getting more attention and better care?
I’ll address these points in my next article and I'll introduce you to The Adam and Eve Care Center!
Take Care on the Journey
May 17, 2006
From: "Ryan McConnell"
Date: Wed, 17 May 2006 14:07:51 -0500
Your book, Dusty Angels and Old Diaries, will be live soon! I'm sure you're asking yourself, "Now what?" This email has the answers to some of the most commonly asked questions about a variety of issues.
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May 16, 2006
It's up, up and away!!!
Just this moment I sent the final approval for the galley of my book!!!!!
No more checking how to spell Pivotal or wondering if I should add one more chapter! Just one more poem? Maybe another picture? Did I end it right? Will it be boring? Who will read it? Will I actually sell one book? Or, just give them away for the rest of my life?
Does it matter? I WROTE IT! 283 pages, 55 chapters and 14 months since I first sat down and said, "It's Time". (I almost gave that title to the book.) I always thought I would title my book, "Have You Seen My Mother?" but it turned out to be so much more than about finding my mother after I started reviewing all my old diaries.
YES! A lifelong dream is fulfilled. Anything more is serendipity! (I always have to look up that word too.)
I'm floating on Cloud 9 and there's no one awake to share the excitement with. (I just got off duty from working all night. Mary slept well, by the way...) No one around to give high-fives or squeals and hugs. Even Sheba has sneaked off to bed.
But, I smile and pinch myself and am very pleased and happy. There will be more books, but "Dusty Angels" will always be my first love.
Take Care on the Journey,
May 15, 2006
For nearly 35 years I've wanted to sign the initials RN after my name.
Since 1971, it's been LPN and proud of it, but not quite perfect. My desires have been set aside as the needs of others have always come first. The opportunities just slipped by as the years rushed on and suddenly I'm 55 years old and still thinking about that dream unfilled. Jim's steady gentle nudge to find that dream has finally pushed me to apply at several local colleges in and near Columbus to find where I'll need to take the least prerequisites and travel would be realistic.
The advisor at Columbus State Community College informed me that I’ll only need two math classes and one Chemistry to be eligible for the LPN – RN transition program that starts in July 2006.
On the day I was there, all the math seats were taken for the Winter Quarter and I was a little discouraged, but someone advised me to check on the day after student loans were disbursed when those who didn’t qualify for those loans were be dis-enrolled and seats would be available again.
At midnight on that date, I got online and sure enough, a few seats suddenly appeared. I quickly applied for one of only three math seats available.
The deadline to pay for that 4-credit hour course was the next day and again, I was struggling with my decision. We really didn’t have $342 on the spur of the moment!
Jim was already asleep so I went to bed uneasy about my actions, but prepared to discuss it with him in the morning.
As he opened his eyes and stretched awake, I was ready with the question about that math class and the cost. He didn’t say much as he got out of bed, but a few minutes later he said he had put some money on the table – funds he had not spent for Christmas! Enough to combine and pay for my Math 102 course!
Still I procrastinated! Jim doesn’t have a job. Our financial future is the most uncertain it has ever been! I will have to work full-time to keep our insurance and pay the bills if he doesn’t get a good job! I can’t go to school full time and work full time!
Suddenly I heard an almost audible but persistanly firm voice that said, “It’s never been a good time. You will have to do this on faith!”
At the very, very last moment before the deadline to pay for the class or loose it, I deposited the money at the bank and quickly paid online before rushing out the door to work.
Well, class starts on January 3, 2006 and here goes a leap of faith into a New Year and new resolutions! Here’s a wish for a positive heart and good faith to us all!
May 13, 2006
Jim uses special days to add to my September birthstone collection. The necklace matches my birthday ring.
Those who know me may question my faith because growing up, I did not wear jewerly. I still have to fight the urge to cover my necklace with my hands when someone comments how pretty it is.
In my mind I hear the words, "Grandma was right. I'm just another Jezebel."
In my book, Dusty Angels and Old Diaries, there is a story abut the first dress I ever bought. It was soft white with a gathered skirt, long sleeves and dainty flowers embroidered on the front. I hurried home to show my beautiful dress to grandma, but she got very angry and made me hide it away because she said it didn't completely cover my knees.
I tell this story because many times I meet other woman who have to fight the same guilty feeling about things that are completely normal and "okay".
I love pretty stones and sparkling diamonds. And, I love Jim.
Don't let old rules "rule" the special person you are!
Take Care on the Journey.
May 9, 2006
A "basket" of flowers in a bright little pan!
From seedlings, it grows to a bouquet grand!
A tiny little Morning Glory!
Billy says there's quite a story
Of how this flower causes quite a worry.
Overtaking everything in a flurry!
How's that for a woman who said she
Would never work in a garden again.
A Poem dedicated to
As a child we worked from daybreak to end.
Plowing and making rows straight as a pin!
Planting each tiny seed like it was a friend.
Watching for shoots in the early spring wind.
Up with the dawn, all day we would spend
Hoeing and picking through the strange blend.
If a weed got pulled and tossed by mistake,
We would cry and beg, but it was too late.
A horrible thrashing would be our fate.
Then one day we laid down the hoe and closed the gate
No more corn to pick and weeds to rake
Potatoes to dig and beans to stake!
Boiling hot sun and deep backaches.
Hoe handles too long and bugs we hate.
We moved from Missouri. Was it too late?
Our childhood almost over. What was our fate?
The garden lives in pictures we take
Grandma looks happy! That's not a fake!
A picture. A thousand words make.
The dress. The bonnet. Heads that bake.
Today the garden land lays sweet and bare
The gate is fallen and lying there
Beside a dusty road - once a thoroughfare.
Testiment to a childhood memory - if I dare!
Take Care on the Journey
May 4, 2006
The snake took a turn towards me right after I took this picture.
Run Linda, run!
We love the new baby pine cones on the pine tree next to our second story balcony.
(If pictures this size slow you guys down too much, please comment and let me know. )
I lost this story while trying to fix pictures that were upside down. (Don't you hate having to re-create something!) The magnifying glass broke and a fly dropped in my Dr. Pepper. I should have just gone to bed with Jim...
But it was a wonderful 72 degrees sunny day with a slightly cool breeze that was great for walking along the little pond where we live or driving with the window down and letting my hair blow.
The snake swam in front of two geese while I was taking pictures. (The geese pictures are upside down and I can't get Adobe to fix them. The message says I'm low on space?) The snake was moving along at a rapid pace across the pond when it suddenly turned toward me! It came right out of the water toward me but I didn’t wait around to see how much of a bite he wanted to take out of my ankle!
Jim says that Ohio only has “black snakes” that swim, but this was dark brown with other brown markings – although truth be said – I really didn’t hang around to check closely.
There was laundry to be done at the quarter-hungry laundry mat. Winter spreads to wash and put away for summer. Dryers that took all my quarters and then stopped dead after 2 minutes and of course, no manager around to return my money.
While waiting for the film to develop, I wanted to wash the grass clippings off the car but that machine also ate my quarters and stopped after 15 seconds. With half the car wet, I had no choice but to spend $6 on the drive-through. I banged on the door, but once again, the manager was out taking a walk in the park, I suppose.
I tried to outrun two fire trucks and a police car and I’m sure the cop would have loved to pull me over, but by the time he came up behind me, I decided to pull over. Up ahead the two fire trucks ran the red-light and then realized they should have turned right – the way I was turning. They made a complete U-turn and came back to the intersection. What I saw when I came up to all the activity was two cars that barely bumped together, but two ladies were screaming at each other and being held apart by the firemen and police.
Floyd Phillips has a blog now, thanks to an “old friend” who encouraged the idea. Jim says Floyd’s writing adds new meaning to blogging or religion, he isn’t sure which. Floyd and Tania are friends from many years. He used to baby-sit Billy and Philip at Laurelbrook. He and Tania sang at our early morning sunrise wedding. He plays the piano by ear and can play anything he’s heard once or twice. My "seventh-heaven" is to sit and listen to Floyd play the piano. Okay, his blog site is clayfootsteps.blogspot.com Add that to your favorites for some unusually deep thinking reading. Comments would be welcome, I'm sure.
The News of the Day is that I am now the PROUD OWNER of an Ebay Store called Angelwings Attic. I’ve listed my book there. (It’s the only way I could list something I wanted to sell more than one of.) I’ve wanted to do that for years and last night I worked the Live Help to set it up. It will cost $15 a month to keep and feel free to let me know if you have something you’d like me to sell for you. I don’t know how to tell you how to find the store but I can send you a link straight from the site so you can view it.
Jim got an interview call today. It’s the orphanage here in Columbus where he was dropped off as a baby. (You didn’t know that about him, did you?) He will hear something next week, hopefully. He calls it “full circle” if he gets the job, but I'm not expecting that to happen. Guess we're both a little disheartened about the job prospects.
Today was grass cutting day for the apartment complex where we live. I missed the Mexicans! (Yes, I ran to the window to check when I heard the lawn mowers!) Cute blond American men and girls wearing short shorts just aren't the same! I'm saddened and worried because I know the Mexicans have families here and no place to go back to! They can't get unemployemnt or welfare! Yes, I know they aren't legal, don't vote and don't pay taxes. And, the government should address the problem of influx, but they do work harder than most Americans, and they do work no one else will do! I miss them even though the only words we ever shared were, "No English" and "No Spanish".
Everybody think of Sandy on Thursday as she gets an invasive test done on her back. Send her good vibes and get well wishes. Her email address is firstname.lastname@example.org . You know her blogsite as catsandsplats.blogspot.com
Take Care on the Journey - and watch out for those snakes in the grass!
May 1, 2006
Now that I’ve gotten my days right again (I get mixed up with I work a night), I’m ready for Monday – or is it still Sunday? I’m glowing a little because I got to chat with some of my favorite people over the weekend. Billy was in a bit of a hurry (understandably so - see Katy’s blog katyandbilly.blogspot.com) and Philip was taking a nap when I called. Denise and I caught up on baby news; and I chatted with good friends, Floyd and Tania.
Samantha is doing much better (again). She kept Jim up several times during the night wanting assistance from the bed to the dresser for food and water. He tried to move the kitty dishes closer but she still goes back to the old spot. Senile too, I guess. But, she seems happy and content. Not in any pain.
Work was busy. Some things I can't write about because of privacy issues. But, I can explain about the $9,000.
I was trying to get bedtime meds passed and it seemed that EVERYBODY wanted a bedtime pain pill. That means signing out the narcotic and recording it extra for every pill. It always takes more time to pass meds when they all want pain pills and/or sleeping pills. I had a couple patients who wanted sleeping pills at a certain time too, so I had to remember to go back.
Finally, I got to the 10:30 p.m. sleeping pill patient. I was mentally ticking off in my head how many more I needed to get done very soon before I would be out of compliance with med pass time. As I was turning to walk away, my patient said, “Do you have a minute to answer a question?”
Knowing that his roommate was restless for his meds, and the lady in the next room was expecting her pain pills now, I tried to sound sincere when I said, “Sure. How can I help you?”
“Well, they say I have two choices in the next few days. I can either go home or go to the other hall (long term care) because I’ve run out of days I can stay here. I was just wondering if I paid for it, can I stay here because I really like you guys and I don’t want to leave?”
I knew instantly what he was talking about. I work the skilled unit where most patients have 100 days for skilled care to be covered by Medicare. Most of the time, whatever therapy they need is successful and the patient is usually ready go home to family or spouse. But, occasionally a patient has no one else to take care of them, and they aren’t strong enough to live alone. It’s the ‘end-of-the-line' that we all think will not happen to us.
How do I tactfully explain to my patient that he can’t stay in this unit? He seems to honestly believe that it’s possible if he wants to stay there.
In this case, I remind him of all the nurses and other staff that he likes and explain that if he goes to the other hall, some of those same people will still take care of him because most of us work both halls.
But, he insists. “How much would I have to pay to stay here?”
“Honestly” I say with slow hesitation. “It would probably cost you about $300/day or about $9,000 a month to live on a skilled unit like this one. That’s why it wouldn’t be the best choice. I think you’ll like the other hall and I promise to come visit you over there.”
He still shakes his head no.
“I don’t ask for much. I've been in four different nursing homes in the last year. I have no one left. I'm afraid. Could I please just stay here where you are all so nice and I get such good care?”
I smiled and turned to his roommate.
There was nothing more I could say except, “I’ll see you on Monday where ever you are.”
It was difficult to fall asleep when I got home. I kept hearing his pleading voice asking,
"How much would it cost...?"
Take Care on Your Journey
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