Ode to My Other Family
I went to work in a nursing home, not because I always dreamt of working in a nursing home. Who on earth would dream of working in a nursing home? I went to work in a nursing home because I could ride my bike there, I like to manage people, I like a challenge, I would have a more flexible schedule - but never because I always dreamt of working in a nursing home. I do believe that most nurses on the contrary try very hard to avoid working in a nursing home.
Nursing homes are reminders of our biggest fear - that we will end up in one at the end of our life.
“Can you call my wife?”
“There are demons watching TV in my room.”
“Can you call my wife?”
“Someone took my flashlight.”
Yet here I was 40 years into my nursing career settling in to care for 54 residents, 60 staff members and countless family members. I took the job as Director of Nursing for all of the wrong reasons but fell in love with the job for all of the right reasons. In my 40 years of nursing it was by far the most challenging and most rewarding job of my career.
Before I worked in a nursing home I was a hospice nurse and at times had to see a patient that resided at a nursing home. I hated those visits. Nursing homes always seemed chaotic to me. Residents everywhere - sitting in the lobby, in the activities room, at the nurses’ station, wandering around and around the hallways. Some of the patients looked unkempt and uncared for and I could hear screams coming from a room down the hall. And the nurses seemed oblivious. Sitting at their computers working away, the residents constantly interrupting their work.
“Can you call my wife?”
“Bert is in my room and won’t leave.”
“Can you call my wife?”
“I need my daughter to come take me home.”
One day when I visited there was a resident sitting behind the counter with the nurses. She was digging through the box of individually wrapped graham crackers. I thought to myself why are they letting her back there? Why aren’t they paying attention to her? But then, I worked in a nursing home and I got it. Our residents do not live in our workspace, we work in their home.
Nursing homes become their own families. We spend 24 hours a day with each other, we share moments of joy on a daily basis, we go through health challenges together and know each others’ idiosyncrasies. The bond is deep. Like all families we have our ups and downs but we always watch out for one another.
Dawn in room 17 will tell me that Laura in room 18 seems off today and could I check on her. When Jeannie tries to walk out the front door Mr. Fimby will go after her and call for help before the alarm even sounds. When Tim doesn’t show up for the coffee hour the other residents will ask if he’s ok. Karen always sits next to Tina during the crafts hour so she can help her with the art project. Joan who has dementia makes the rounds every day in her wheelchair chatting with all of the residents keeping them company. If someone is transferred to the hospital everyone worries about them until they return and when someone is in the last days of their life somehow everyone knows and a quiet comes over the facility that doesn’t let up until the person passes and is taken to the mortuary.
We also have the challenging members of our family. Nick who curses us out on a regular basis, Mr. Simpson who refuses any interaction with anyone, Mitch who speaks inappropriately to the nurses, and Lorraine who steals clothes from the other residents. We still love and embrace them.
“Can you call my wife?”
“I can’t go to sleep because there are dogs in my bed.”
“Can you call my wife?"
“Can I get my money, I need to leave today.”
Most of the Certified Nursing Assistants (CNAs) in nursing homes are their own kind of special. They start their day by getting all 8-10 of their patients set up for breakfast - pass the trays, help feed the ones who cannot lift their own spoons and encourage the ones who are easily distracted from their meals. Then they collect the trays and morning care begins. They shower, brush teeth, change pull ups, laugh and chat with the patients. They change or make beds, dump laundry, clean up bedside tables. They get them up in their wheelchairs, get them to the activities and then when lunch comes they start all over again. Passing trays, feeding, encouraging, changing. While doing all of this they have to be certain that no one falls and everyone is safe. During Covid when 40% of my staff walked out the door and never came back these beautiful people would have to do this work for 12 sometimes 15 patients over one shift.
Once I started working in a nursing home I realized why it seems chaotic to the outsider. Residents are everywhere doing their own thing. Fay, Sandra and Jeannie calm themselves by walking around and around the hallway. Caroline sits behind the nurses’ station with us while we do our work so we can keep a better eye on her since she tends to fall a lot. Susie is often lonely so she too will sit with us behind the nurses’ station and if digging through a box of graham crackers keeps her happy and occupied then so be it. The reason we ignore Mr. Spencer who asks us to call his wife is because he asks us every five minutes even though she visits every day and we have found that if we ignore him he will find something else to do until she shows up for that day’s visit but if we engage him he gets more agitated. The reason we are not responding to Dawn’s screams for help is because we know that two of our best CNAs are with her trying to do her morning care and we have discovered if too many people go in to help she screams even more. We know that the reason Mr. Johnson looks dirty and unkempt is because he refuses to let us shower or bathe him, cut his hair or trim his nails and will lash out and punch us if we even try. Every once in awhile one of the CNAs will be successful in getting him to cooperate but that’s the best we can do. We know that between 3 and 5 pm is the worst time for nearly all dementia residents as they get what is called sundowners which leads to paranoia. They come out of their rooms and wander the halls sometimes crying or begging for assistance. It is a chaotic time since it is also change of shift and we do our best to keep them calm but mostly it is just a matter of letting the time pass.
“Can you call my wife?”
“I need to see the doctor. Is the mail here yet?”
“Can you call my wife?”
“My father is taking me to the movies today. Have you seen him?”
Some of the patients tell their families some amazingly imaginative stories. Stephen told his family we were keeping him in a cage at night and Bart told his family we push him around and around the facility in his bed. Gigi told her daughter that we were running a drug ring and Sandra told her husband that we were keeping dogs in her bed. Barbara tells her daughter that someone keeps stealing her stuffed animals when in fact her mother often gives them to a fellow resident. It seems we spend a good bit of each day explaining ourselves.
What I would really like to see in these long term care facilities is adequate pay for the nurses and CNAs who care for our elderly and an understanding from the residents’ families that we really do care and are doing the best we can with the resources available to us. I would like the paramedics to treat us with respect rather than disdain when we call them to our facility. I would like the State regulatory agencies to understand that our residents’ needs and safety come first even before their superfluous regulations. I would like upper management to care more about the residents and less about their profits. And I would like everyone to know that like most families the nursing home family has its weird uncles and eccentric aunts, its overbearing matriarchs and annoying “children” and like most families we are all just trying to get along and do the best we can.