In the long term care business, advocacy is critical to providing the best care. In conjunction with orienting new residents and families to nursing home schedules and protocol, the service of a professional advocate would have been helpful to my family during Mother's four years in and out of the assisted living and long term care facilities.
I experienced the need for an advocate when I complained to top administration in between my mother's nursing home stays. Several times, I encouraged my father to get home-based help. I called the head of the home care program to set something up. After three unreturned calls, I gave up. At the height of my frustration, I wrote a letter to his boss, the chief executive officer. I received no response. If you've gone directly to the top without satisfaction, what other recourse do you have? Like many tired and stressed out caregivers, I was at my wit's end. My parents were residents of an aging community that offers a wide range of services to which they should have had immediate access, but we were blocked from getting them.
A family advocate would have been an answer to a prayer. An advocate would have followed up on our behalf. In many health care centers, patient advocates come in the form of case managers, often connected with Medicaid. Private pay residents, on the other hand, usually have to make their way through the system on trust. It is the case manager who co-ordinates services for elders bouncing around on the contiuum of care; and it is because of the presence of state-funded case managers that I have always thought residents on Medicaid were assured the same basic services and care as those provided to private pay residents. I have not researched the presence of private case managers today; but five years ago, there were none in the area my parents lived.
An advocate would have done wonders for our comfort level; instead, we had to be ever vigilant ourselves. I'm sure staff were very frustrated with my dad and me at times. We asked a lot of questions and had a lot of concerns about my mother's care. Sometimes, assurance is all a family member needs; but when real problems occur, the advocate would also serve as a liaison to medical staff. There are patient advocates (i.e state ombudsmen), but families need advocates, too.
Family members have to keep an open mind and do their best to appropriately connect with the peole who are providing these critical services. If there is no professional or volunteer family advocate available, it falls on staff shoulders to let us into their world without making us feel like we are an intrusion.
Busy people are intimidating; doctors and nursing home staff are always pressed for time. Unfortunately, in a hectic work place, we encounter professionals and employees who avoid eye-contact, who don't smile, and who are in a hurry to get somewhere. They put us off; and whether consciously or unconsciously, this may be their intent. When I worked in a facility, I too, was guilty of rushing up and down hallways, hoping no one would come between me and my destination. Time was short, and every encounter, intense.
Family advocacy is the answer; a consistent, friendly, "I'm here-for-you" attitude is all some of us need. An advocate would help family members navigate the system, or facilitate communicaiton when there is a problem. Many families don't need a thing; others, like mine, needed more support and information.
Most importantly, an advocate would provide the soul connection we all need. Volunteer programs can train advocates to listen and follow through. The advocate doesn't necessarily have to be a nurse, case manager, social worker, or chaplain, though advocacy is a natural part of their jobs. An advocate can be an empathetic communicator whose main role is to help families make sense of life in a long term care facility.
(c) Sally Z McBain
Monday, September 24, 2012
Friday, September 21, 2012
Nursing Home Families
I used to believe families who didn't visit their institutionalized relative were uncaring; and I judged them harshly. I knew nothing about them or their lives, yet I judged. So many elders are lonely; and volunteers and staff try their best to help. But watching an older adult sit for hours at the door or window, waiting for someone who isn't coming, is heart-breaking; it always made me angry. Obviously, as a new admissions co-ordinator, I had a lot to learn about families.
After taking the time to get to know family members, it was clear my judgement was unfair, and in most cases, unfounded. Family members who purposely avoid the nursing home are rare. They are faced with many challenges: dealing with their own health issues, trying to raise children or earn a living, or having to travel great distances. Elder care facilities are a necessity for those who can't check in on a regular basis, let alone take care of their loved one at home. At best, a daughter or son may only have time to visit once a week. Sure, there is the occasional avoidance of an uncomfortable situation when a family member says, "I don't want to go in there any more than I have to; it's too depressing." But most families do their best; they agonize just as I did when my mother was a resident; and they visit when they can.
On the other end of the spectrum are family members who regularly enter the long term care facility to check on a relative. A 70-something daughter good-naturedly told me, "While my friends are taking cruises all over the world, I'm cruising to and from the nursing home." Another daughter came twice a day, every day, to feed her 90-year-old mother. She knew the older woman needed loving, relaxed attention during hectic meal times; in general, however, she was not convinced her mother was getting the best care possible. There always seemed to be a shortage of staff, which meant some residents had to wait for help; and she wasn't going to chance it.
These two women and my father, who was at my mother's side most of the day, every day, are the ones who have something to contribute to institutional culture. They are part of the connective tissue holding the system together. A wise head nurse once said to me, "We send our children to school, but do not presume the teachers will take over total responsibility for their rearing. The same is true for nursing home care. Families can't expect a nursing home to meet al the needs of a resident. It isn't that they don't want to; it's just one of those facts of life. Staff have to focus on a resident's physical health needs first."
The trouble with encouraging family involvement is that family members can be time-consuming and an emotional drain on staff. Some relatives are tenacious in their quest for answers and solutions. If they get nowhere with line staff, they head for the director of nurses or administrator. Starting out on the defensive, the relatives gird themselves for condescension and excuses. From the get-go, there is fear and distrust. There are others who prefer to complain to a staff person with whom they have bonded, but who then has to take the message to a supervisor, who has to take it to the next level -- all of which takes a lot of time, reassurance (sometimes, false reassurance), and tact.
As long as they are appropriate and non-threatening, family members are entitled to intervene on behalf of a relative who may be frightened of retaliation or too weak to advocate for herself. Sometimes, however, staff do not view angry family members as appropriate; and they don't always know how to work with them. Tragically, nursing homes have been known to bar an aggressive family member from their premises. If a resident cannot see her closest relative, what is the effect on the resident's overall health and well-being?
Open and honest relationships, along with quick attention to problems, are two major ways to avoid misunderstanding or confrontation in a long term care facility. There were a couple cases where, had it not been for my good relationship with the head nurse on Mother's floor, I would have called the state omudsman to report neglect. My concern about a call bell that hadn't been fixed for at least two weeks should have been a priority. Instead, I had to mention it several times, while trying to calm my parents each day we waited and were told it was being worked on. This highly respected nursing facility finally provided us with a door bell that sat on her night stand. The bell did not ring through to the nurses' station; but we were told they would hear it if they were in her hallway. If they were in her hallway? On many occasions, and for stretches of time, her hallway was empty.
This episode did not make any of us comfortable, given my mother's increasingly deteriorating health needs. She was discharged before the call bell was repaired. Any trust I had was gone; and when it came time for her to return the last week of her life, even with a Hospice nurse coming in now and then, I was more watchful and present for her than ever.
Families don't just sit around and think up things to complain about. They complain for good reason, and it is incumbent upon the rest of us to listen carefully and act on those complaints immediately. It takes a concerted effort on everyone's part to tame emotions and solve problems. For the family member who has stepped over the line, who has no time to participate in a parent's care, or who is coordinating care from three thousand miles away, there should be a family advocate.
(c) Sally Z McBain
After taking the time to get to know family members, it was clear my judgement was unfair, and in most cases, unfounded. Family members who purposely avoid the nursing home are rare. They are faced with many challenges: dealing with their own health issues, trying to raise children or earn a living, or having to travel great distances. Elder care facilities are a necessity for those who can't check in on a regular basis, let alone take care of their loved one at home. At best, a daughter or son may only have time to visit once a week. Sure, there is the occasional avoidance of an uncomfortable situation when a family member says, "I don't want to go in there any more than I have to; it's too depressing." But most families do their best; they agonize just as I did when my mother was a resident; and they visit when they can.
On the other end of the spectrum are family members who regularly enter the long term care facility to check on a relative. A 70-something daughter good-naturedly told me, "While my friends are taking cruises all over the world, I'm cruising to and from the nursing home." Another daughter came twice a day, every day, to feed her 90-year-old mother. She knew the older woman needed loving, relaxed attention during hectic meal times; in general, however, she was not convinced her mother was getting the best care possible. There always seemed to be a shortage of staff, which meant some residents had to wait for help; and she wasn't going to chance it.
These two women and my father, who was at my mother's side most of the day, every day, are the ones who have something to contribute to institutional culture. They are part of the connective tissue holding the system together. A wise head nurse once said to me, "We send our children to school, but do not presume the teachers will take over total responsibility for their rearing. The same is true for nursing home care. Families can't expect a nursing home to meet al the needs of a resident. It isn't that they don't want to; it's just one of those facts of life. Staff have to focus on a resident's physical health needs first."
The trouble with encouraging family involvement is that family members can be time-consuming and an emotional drain on staff. Some relatives are tenacious in their quest for answers and solutions. If they get nowhere with line staff, they head for the director of nurses or administrator. Starting out on the defensive, the relatives gird themselves for condescension and excuses. From the get-go, there is fear and distrust. There are others who prefer to complain to a staff person with whom they have bonded, but who then has to take the message to a supervisor, who has to take it to the next level -- all of which takes a lot of time, reassurance (sometimes, false reassurance), and tact.
As long as they are appropriate and non-threatening, family members are entitled to intervene on behalf of a relative who may be frightened of retaliation or too weak to advocate for herself. Sometimes, however, staff do not view angry family members as appropriate; and they don't always know how to work with them. Tragically, nursing homes have been known to bar an aggressive family member from their premises. If a resident cannot see her closest relative, what is the effect on the resident's overall health and well-being?
Open and honest relationships, along with quick attention to problems, are two major ways to avoid misunderstanding or confrontation in a long term care facility. There were a couple cases where, had it not been for my good relationship with the head nurse on Mother's floor, I would have called the state omudsman to report neglect. My concern about a call bell that hadn't been fixed for at least two weeks should have been a priority. Instead, I had to mention it several times, while trying to calm my parents each day we waited and were told it was being worked on. This highly respected nursing facility finally provided us with a door bell that sat on her night stand. The bell did not ring through to the nurses' station; but we were told they would hear it if they were in her hallway. If they were in her hallway? On many occasions, and for stretches of time, her hallway was empty.
This episode did not make any of us comfortable, given my mother's increasingly deteriorating health needs. She was discharged before the call bell was repaired. Any trust I had was gone; and when it came time for her to return the last week of her life, even with a Hospice nurse coming in now and then, I was more watchful and present for her than ever.
Families don't just sit around and think up things to complain about. They complain for good reason, and it is incumbent upon the rest of us to listen carefully and act on those complaints immediately. It takes a concerted effort on everyone's part to tame emotions and solve problems. For the family member who has stepped over the line, who has no time to participate in a parent's care, or who is coordinating care from three thousand miles away, there should be a family advocate.
(c) Sally Z McBain
Tuesday, September 18, 2012
The Helpers
The whole idea of compassion is based on a keen awareness of the interdependence of all these living beings, which are all part of one another, and all involved in one another. Thomas Merton
Describing how a nursing home is run and what actually takes place are two different things. Nursing home staff are generally dedicated to making life pleasant and safe for residents; but with staff retention problems, ever-changing state and federal rules, and soaring numbers of elders needing care, it is an ongoing challenge.
Families and people in the helping professions have lives separate from their responsibilities to an aging relative or their jobs as caregivers. They struggle with personal issues of their own. They, too, are lonely and afraid at times, just as are the residents. We have all met employees, professionals, and family members who are frustrated, tired, not focused on the task at hand, wanting desperately to be somewhere else, and feeling no one cares about them or appreciates what they do. But the focus on elders must remain paramount, since they are the ones receiving (and paying for) care. This presents us with a conundrum, because it is the need for attention, love, and human connection that gives helpers the necessary compassion and stamina to maintain that focus. They relate to the pain, frailty, and dependence of another person because they've been there themselves in varying degrees; it is this ability to relate that requires a new look at how we do business in aging communities and care facilities. We need to connect with one another on a more personal level, to appreciate those feelings we all have in common.
Institutional life is challenging on a good day; but when emotions run high and problems are overwhelming, we think we don't have time to tend to the people who are trying to make things better. Instead, we see them as part of the problem. By doing so, we point the finger away from ourselves. Everyone blames someone else for a responsibility we all share. While we are busy placing blame, we miss the opportunity to see what makes up an institution. At its core is a congregate of individuals. An institution is not just 200 beds filled with frail elders or disabled adults; they are separate individuals, just as are the people who deliver compassionate care -- the paid staff, the volunteers, and the families.
Improving care to the elderly must include active support of the helpers. Active support includes training, mentoring, advocating, and counseling. If we focused more on the helpers, what would happen? Would family members be less worried about the care of their loved one? Would it reduce the staff turnover rate? Would it save money? Would it increase tolerance and eliminate the opportunities for abuse? I think the answer to each of these questions is 'yes'.
Working with people day in and day out requires tact, validation, compassion, and a lot of patience. If helpers are drained of energy and hope, then we need to change the way we think about institutional care by changing the way we help the helpers.
(c) Sally Z McBain
Describing how a nursing home is run and what actually takes place are two different things. Nursing home staff are generally dedicated to making life pleasant and safe for residents; but with staff retention problems, ever-changing state and federal rules, and soaring numbers of elders needing care, it is an ongoing challenge.
Families and people in the helping professions have lives separate from their responsibilities to an aging relative or their jobs as caregivers. They struggle with personal issues of their own. They, too, are lonely and afraid at times, just as are the residents. We have all met employees, professionals, and family members who are frustrated, tired, not focused on the task at hand, wanting desperately to be somewhere else, and feeling no one cares about them or appreciates what they do. But the focus on elders must remain paramount, since they are the ones receiving (and paying for) care. This presents us with a conundrum, because it is the need for attention, love, and human connection that gives helpers the necessary compassion and stamina to maintain that focus. They relate to the pain, frailty, and dependence of another person because they've been there themselves in varying degrees; it is this ability to relate that requires a new look at how we do business in aging communities and care facilities. We need to connect with one another on a more personal level, to appreciate those feelings we all have in common.
Institutional life is challenging on a good day; but when emotions run high and problems are overwhelming, we think we don't have time to tend to the people who are trying to make things better. Instead, we see them as part of the problem. By doing so, we point the finger away from ourselves. Everyone blames someone else for a responsibility we all share. While we are busy placing blame, we miss the opportunity to see what makes up an institution. At its core is a congregate of individuals. An institution is not just 200 beds filled with frail elders or disabled adults; they are separate individuals, just as are the people who deliver compassionate care -- the paid staff, the volunteers, and the families.
Improving care to the elderly must include active support of the helpers. Active support includes training, mentoring, advocating, and counseling. If we focused more on the helpers, what would happen? Would family members be less worried about the care of their loved one? Would it reduce the staff turnover rate? Would it save money? Would it increase tolerance and eliminate the opportunities for abuse? I think the answer to each of these questions is 'yes'.
Working with people day in and day out requires tact, validation, compassion, and a lot of patience. If helpers are drained of energy and hope, then we need to change the way we think about institutional care by changing the way we help the helpers.
(c) Sally Z McBain
Tuesday, September 4, 2012
Soul-level Care
Even with the shift in national attention towards elder care, problems still exist. There is a gap between what facilities advertise in glossy brochures and what they actually practice. Many of these places are built and purchased as investments; as with all investments, the bottom line is profit.
The success of long term care of any kind, whether at home or in a facility, depends on the staff providing the care. They too, are part of an investment -- not only of money, but of the soul kind.
Most people go into the elder care business because they are dedicated to the well-being of elders. The problem is that many of these individuals are in danger of burn-out, which leads to exhaustion and turn-over, which lead to low morale all around, which can lead to verbal or physical abuse if not recognized and managed quickly. It may seem like an obvious conclusion, but challenges faced by staff in elder care facilities are directly related to the level of care and attention given to residents. We must address these challenges.
Only after months in and out of the nursing home which housed my mother, endless hours observing dynamics between residents and staff, and then finally having the chance to talk with staff members -- only then, did I come face to face with what I perceive to be the main threat to the delivery of good care. In spite of what some administrators and nursing home owners may think, it isn't just about needing more operating capital. It is as much, if not more, about the need for soul-level connections between people who reside, visit, and work in elder care facilities. When that is accomplished, less time will be spent on problems that arise out of fear, hopelessness, anger, and exhaustion.
Soul connections, those life-changing 'I honor you' moments that are exchanged between two people, are at the heart of Soul Portrait. When we start to look at institutional care more closely, one role at a time and one person at a time, attitudes and practices will change. Each of us needs the soul- connections that validate us as unique individuals -- whether resident, professional, or loved one. It takes very little time to make such a connection, yet it's not a priority in the delivery of care. We are too busy tending to physical needs and dealing with everyday problems; we can't be bothered with learning more about each other or getting to know one another on a deeper level.
My perspective on nursing home care and my opinions about improving that care developed not only out of my career, but also out of my role as a daughter-caregiver. Both roles frustrated and angered me at times; I felt helpless to change the system. Being a resident's daughter, however, helped me break through my paralysis; I mustered up the courage to write a letter to the 25-member volunteer board of directors of the aging community in which my parents resided and my mother died. I wrote about my experiences and specific concerns regarding Mother's care. Neither administration, management, nor board members responded.
As the weeks passed with no response, I began to feel invisible, just as I did when I walked down the corridors of the nursing home trying to make eye contact with busy personnel who wanted to avoid a connection.
No one was willing to take a step out of his or her comfort zone to ask pertinent questions about what I had experienced. Later on, I figured the total lack of response from anyone (including the chaplain to whom I sent a copy) had come out of advice from their attorney. Was I just another trouble-making family member, or worse yet, a lawsuit waiting to happen? They were afraid, and one way to deal with fear is to deny the existence of a problem. Because my family had long been connected to this church-owned community, I let it go; I was tired and grieving for both my parents.
Over time, and when my anger and disappointment passed, I got more determined to search for answers to the elder care dilemma.
(c) Sally Z McBain
The success of long term care of any kind, whether at home or in a facility, depends on the staff providing the care. They too, are part of an investment -- not only of money, but of the soul kind.
Most people go into the elder care business because they are dedicated to the well-being of elders. The problem is that many of these individuals are in danger of burn-out, which leads to exhaustion and turn-over, which lead to low morale all around, which can lead to verbal or physical abuse if not recognized and managed quickly. It may seem like an obvious conclusion, but challenges faced by staff in elder care facilities are directly related to the level of care and attention given to residents. We must address these challenges.
Only after months in and out of the nursing home which housed my mother, endless hours observing dynamics between residents and staff, and then finally having the chance to talk with staff members -- only then, did I come face to face with what I perceive to be the main threat to the delivery of good care. In spite of what some administrators and nursing home owners may think, it isn't just about needing more operating capital. It is as much, if not more, about the need for soul-level connections between people who reside, visit, and work in elder care facilities. When that is accomplished, less time will be spent on problems that arise out of fear, hopelessness, anger, and exhaustion.
Soul connections, those life-changing 'I honor you' moments that are exchanged between two people, are at the heart of Soul Portrait. When we start to look at institutional care more closely, one role at a time and one person at a time, attitudes and practices will change. Each of us needs the soul- connections that validate us as unique individuals -- whether resident, professional, or loved one. It takes very little time to make such a connection, yet it's not a priority in the delivery of care. We are too busy tending to physical needs and dealing with everyday problems; we can't be bothered with learning more about each other or getting to know one another on a deeper level.
My perspective on nursing home care and my opinions about improving that care developed not only out of my career, but also out of my role as a daughter-caregiver. Both roles frustrated and angered me at times; I felt helpless to change the system. Being a resident's daughter, however, helped me break through my paralysis; I mustered up the courage to write a letter to the 25-member volunteer board of directors of the aging community in which my parents resided and my mother died. I wrote about my experiences and specific concerns regarding Mother's care. Neither administration, management, nor board members responded.
As the weeks passed with no response, I began to feel invisible, just as I did when I walked down the corridors of the nursing home trying to make eye contact with busy personnel who wanted to avoid a connection.
No one was willing to take a step out of his or her comfort zone to ask pertinent questions about what I had experienced. Later on, I figured the total lack of response from anyone (including the chaplain to whom I sent a copy) had come out of advice from their attorney. Was I just another trouble-making family member, or worse yet, a lawsuit waiting to happen? They were afraid, and one way to deal with fear is to deny the existence of a problem. Because my family had long been connected to this church-owned community, I let it go; I was tired and grieving for both my parents.
Over time, and when my anger and disappointment passed, I got more determined to search for answers to the elder care dilemma.
(c) Sally Z McBain
Monday, August 27, 2012
Nursing Homes
There are times when even to live is an act of bravery. Lucius Annaeus Seneca
Even though I'm the one writing this, it is my mother's story as much as it is mine. Any anxiety I may have about aging is directly linked to her experience; and I am not alone. A friend shudders each time she comes away from a visit with her mother, a nursing home resident. "I hope I can figure out a way to commit suicide before I ever get to that point", she proclaims. I know how she feels. We don't want to think about getting old, let alone lying in a nursing home bed. We don't want to talk about it, and most of us don't even want to hear or read about it.
It doesn't matter that statistics are in our favor. Chances are good if we do go to a long term care facility, we will receive therapy, recuperate, and get back home. But as we watch a parent or elderly friend enter a facility, it's difficult to separate ourselves from the event. We look on as they trade individuality, privacy, and control over their lives for help they cannot get in another setting. We've seen the insecurity, loneliness, isolation, and fear that are an integral part of institutional culture. We've heard residents cry out, "I want to go home. Will you take me home?" Resignation and hopelessness are reflected in eyes that once lit up at the thought of a familiar kitchen, bedroom, or workbench. We wonder if someone with dementia is better off, not knowing where they are.
It has been almost six years since my mother died in the nursing home of a well-respected church-affiliated retirement community. I owe it to her memory, and to families of other residents, to write about her journey. As often as our family visited her, she had to take the journey alone. She was the one eating the baloney sandwich or small piece of fish inside a huge bun. She was the one trying to maintain her dignity while getting the cool shower, and as she said, 'feeling like a horse being washed down in a stall.' She was the one who couldn't get to the bathroom by herself and had to depend on a call bell (that didn't always work) to get assistance. She was the one lying awake in a strange bed in the deepest darkest part of night, suffering from a urinary tract infection and hearing a frustrated aide say, "You have to go again? You aren't the only patient we have, you know."
Such is the cold, hard truth of nursing home life, in spite of the fact that nursing facilites are filled with compassionate professionals who are doing their best to give good care. I didn't appreciate this until I walked into one as an employee. I had been hired as the admissions co-ordinator for a 120-bed facility in Nevada. Up to that point, and because my career had focused on shoring up the local community-based care system for at-home elders, I viewed nursing homes as dumping grounds for sick, older, and disable adults whose families didn't care or didn't have the time for them.
As the director of a five-county federal and state-funded area agency on aging in Oregon, I worked with a team of staff members who were trained in Medicaid nursing home rules and regulations. They were charged with surveying nursing facilities and reporting non-compliance back to the state office on aging. Our staff meetings didn't focus on the good in those facilities; we talked about bed sores, odors, soiled sheets still on beds, illegal patient restraints, and elder abuse. I didn't trust nursing homes, and I didn't try to understand life in them, least of all from the employee's or family's vantage point. I could not see beyond the misery of residents and depressing surroundings, which I blamed on bad administrative practices and poor staffing.
My thinking changed as soon as I admitted my first resident into the health care center in Nevada in the late 90's. It didn't take long for me to realize that not only had I judged all nursing homes unfairly, but I had dismissed the roles played by loving family members, volunteers, hard-working nurses, dedicated certified nurses aides, and support staff at all levels.
It became clear to me that a pardigm shift had been occurring right before my eyes. Society began to hold older adults in higher esteem, to consider them a natural resource deserving respect and protection. More laws were put into place and nursing homes were held even more accountable. Eldercare became a national priority.
next: Personalizing Health Care
(c) Sally Z McBain
Even though I'm the one writing this, it is my mother's story as much as it is mine. Any anxiety I may have about aging is directly linked to her experience; and I am not alone. A friend shudders each time she comes away from a visit with her mother, a nursing home resident. "I hope I can figure out a way to commit suicide before I ever get to that point", she proclaims. I know how she feels. We don't want to think about getting old, let alone lying in a nursing home bed. We don't want to talk about it, and most of us don't even want to hear or read about it.
It doesn't matter that statistics are in our favor. Chances are good if we do go to a long term care facility, we will receive therapy, recuperate, and get back home. But as we watch a parent or elderly friend enter a facility, it's difficult to separate ourselves from the event. We look on as they trade individuality, privacy, and control over their lives for help they cannot get in another setting. We've seen the insecurity, loneliness, isolation, and fear that are an integral part of institutional culture. We've heard residents cry out, "I want to go home. Will you take me home?" Resignation and hopelessness are reflected in eyes that once lit up at the thought of a familiar kitchen, bedroom, or workbench. We wonder if someone with dementia is better off, not knowing where they are.
It has been almost six years since my mother died in the nursing home of a well-respected church-affiliated retirement community. I owe it to her memory, and to families of other residents, to write about her journey. As often as our family visited her, she had to take the journey alone. She was the one eating the baloney sandwich or small piece of fish inside a huge bun. She was the one trying to maintain her dignity while getting the cool shower, and as she said, 'feeling like a horse being washed down in a stall.' She was the one who couldn't get to the bathroom by herself and had to depend on a call bell (that didn't always work) to get assistance. She was the one lying awake in a strange bed in the deepest darkest part of night, suffering from a urinary tract infection and hearing a frustrated aide say, "You have to go again? You aren't the only patient we have, you know."
Such is the cold, hard truth of nursing home life, in spite of the fact that nursing facilites are filled with compassionate professionals who are doing their best to give good care. I didn't appreciate this until I walked into one as an employee. I had been hired as the admissions co-ordinator for a 120-bed facility in Nevada. Up to that point, and because my career had focused on shoring up the local community-based care system for at-home elders, I viewed nursing homes as dumping grounds for sick, older, and disable adults whose families didn't care or didn't have the time for them.
As the director of a five-county federal and state-funded area agency on aging in Oregon, I worked with a team of staff members who were trained in Medicaid nursing home rules and regulations. They were charged with surveying nursing facilities and reporting non-compliance back to the state office on aging. Our staff meetings didn't focus on the good in those facilities; we talked about bed sores, odors, soiled sheets still on beds, illegal patient restraints, and elder abuse. I didn't trust nursing homes, and I didn't try to understand life in them, least of all from the employee's or family's vantage point. I could not see beyond the misery of residents and depressing surroundings, which I blamed on bad administrative practices and poor staffing.
My thinking changed as soon as I admitted my first resident into the health care center in Nevada in the late 90's. It didn't take long for me to realize that not only had I judged all nursing homes unfairly, but I had dismissed the roles played by loving family members, volunteers, hard-working nurses, dedicated certified nurses aides, and support staff at all levels.
It became clear to me that a pardigm shift had been occurring right before my eyes. Society began to hold older adults in higher esteem, to consider them a natural resource deserving respect and protection. More laws were put into place and nursing homes were held even more accountable. Eldercare became a national priority.
next: Personalizing Health Care
(c) Sally Z McBain
Friday, August 10, 2012
My Ideal Vacation
Towering trees, mountains, and a lake recently provided my ideal vacation. Nevermind this particular vacation lasted only 2-1/2 days; it was all I needed to forget the phone, internet, violent news, daily responsibilities, and myself. I came home feeling light as a feather and wanting more.
After several days of preparation and anticipation, we left town on a hot summer Sunday morning, canoe tied securely to the top of the car and a tote full of art supplies squeezed between two suitcases full of clothes for all kinds of weather and coolers with enough food for several days. We came home with a canoe that never got wet, water color brushes that remained in their case, clothes that never saw the light of day, and food that went right back into the coolers.
Since I have a tendency to analyze everything under the sun, I've been wondering why and how this break in our normal routines affected me the way it did. I think it was because nothing else interrupted the flow. My husband and I have always had a reason for traveling to incredible places: home re-locations, business meetings, or visits with family and friends. When one travels that way, there are timelines and few opportunities to wander around and really get to know an area. When we moved back to the Gorge, for instance, we passed the Great Salt Lake, an area I'd like to explore -- but not at 65 miles per hour. You don't lollygag when you know the moving van is ahead of you. And when my younger son was in school there, my husband and I couldn't stay long because of our jobs.
We've been all over the country, but rarely - rarely - have we ever just gone somewhere beautiful and restful for the sake of going somewhere beautiful and restful. This time, thanks to retirement and time on our hands, we did; and it didn't take long to get used to the luxury of sitting on the deck of a lakeside cabin and soaking it all up. I said to my sweetheart, "This is great. We are getting away from the world and each other - together!" Our husband-wife personas were left at home and we were content to sit with each other as old buddies inside Nature's best.
Not only are vacations good for a marriage that can get ho-hum or too often emphasize a couple's differences, they're good for the soul -- like a battery, they recharge all the senses. My husband is happy when he's fishing, which he did in earnest as soon as he unloaded the car. He looked at the 48 steps from cabin to water and decided casting from the dock into the deep lake would be perfect. As for feeding my soul, photography took center stage. We couldn't take a walk without my pausing every few minutes to catch the sunlight through heaven-skimming ponderosa pines, acres and acres occupied by grazing cattle and horses, an osprey's nest and its juvenile occupants learning to fly, or the green-blue lake and summer mountains streaked by thin ribbons of snow. I was totally relaxed, which is not my normal state; I'm usually up and doing something productive...something that has a tangible outcome (like a hairless carpet).
My mind is just as busy as my body. Yoga and meditation provide brief, quiet breaks from my daily brain bursts; but this vacation gave me the chance to get away from worrying about our aging dog, coming up with an answer to "What's for dinner tonight?", or thinking about my next Soul Portrait workshop and blog topic. This vacation reminded me of the value of relaxation and the fun of doing only what I want to do; but it also made me very grateful to have the extra funds to take this trip. All around us, we see people living hand-to-mouth; in fact, we met a woman who is trying to keep her business afloat. Single and 65, she is supporting a disabled daughter and working every day; retirement, let alone a vacation, is out of the question.
The morning we got ready to leave the cabin, I slowly scanned my surroundings, knowing I'd have pictures to remind me of the bliss, but feeling sad. With fingers wrapped around a last cup of coffee and tears welling up, I said to my husband, "I don't want to leave." I've never said that before; I've always been anxious to get home. Yet, even as the words were coming out of my mouth, I started to think about Molly and if she was doing okay at the kennel. That was another blessing about time away; she doesn't have many more years with us and I swore I'd never complain about her hair again.
"I don't want to leave." What is inherent in that statement? Was I content enough to stop the clock for a few more days? Am I pushing myself too hard at home? We are retired, for Pete's sake; I can stop trying to prove something to myself any time I want. Do I feel guilty when I'm not painting, writing, cooking, or knitting? Is aging gracefully about knowing when priorities need to change, when vacuuming or fixing the perfect meal or having shiny stainless steel appliances is secondary to sitting under a tree with a clear head and a full heart?
Most Oregonians know about Wallowa Lake, just outside the town of Joseph, and positioned at the foot of the Wallowa Mountains. Joseph (named after Chief Joseph) is founded on the history of the Nez Perce; it is also a Nature-lover's dream. In spite of all the summer visitors, it was quiet and serene. Residents of neighboring cabins and year-round homes were my kind of people -- quiet and thoughtful of others and the environment. It was heaven on earth and I can't wait to get back.
Friday, August 3, 2012
Why Write?
I'm just going to write because I cannot help it. Charlotte Bronte
The more entries I place in this journal, the more I ask myself why I'm doing this...and making it public. There are several reasons, and perhaps the first is the most critical for my sense of joy and well-being: Writing offers a protected world where I can express my dreams, emotions, and thoughts. It's a safe haven for discovery; and with that as my foundation, I integrate layer upon layer of Self.
Writing is one of my centering practices; it calms me and keeps me on my spiritual path. If I don't write, I tend to get restless. There are things I need to figure out, relationships I need to sort through, and problems I need to solve. In her book, Storycatcher, Christina Baldwin says, "I believe the kinds of writing millions of us are doing in our diaries and journals are attempts to heal the split in the human mind and in the human experience." Writing helps me get to my truth.
My writing is, on first glance, centered on myself; but I've always believed that to know Self is to know the meaning of life...at least a big part of it. It's all in my writing --the ever-sustaining universal breath, basic needs that connect me with everyone else, and a full range of human emotion. While it might seem that an over-indulgent ego is what propels me or anyone else to write, quite the opposite is true. Writing is my way of never forgetting that life isn't just about me; I know I'm a tiny fleck in the scheme of things. Like Virginia Woolf said, "When you consider things like the stars, our affairs don't seem to matter very much, do they?" I do a lot of thinking about those stars and everything around and beyond them, especially when I'm deep in an ego-propelled frame of mind. Writing helps me heal the split, as Baldwin puts it. It also helps me see life from someone else's perspective.
For most of my adult life, I have struggled with guilt and pain related to my two divorces. I wanted to know why, to understand my role in those failures. Today, I have my answers; threads of understanding and acceptance connect much of what I write. It took many years, but I reached this place by putting my thoughts onto paper with poetry and prose. Writing inspires me to take a closer look at forgiveness, love, and gratitude. Granted, it's a lot easier to write about these things than it is to practice them every day, but the act of writing is the inspirational nudge I need to move forward.
The best I have to share with my children is the essence of who I am. To hide my lessons or dismiss my progress is to deprive them of a basic part of who they are and will become. Someday, from their unique experiences of me, they will garner insights into one life that contributed to theirs. Perhaps they will be 60 years old when they feel like reading, just as I was when I reached for my grandfather's diaries. On those pages, where he wondered if anyone would ever read what he had to say, his adult graddaughter got to cuddle up in his arms again. I could see the metal head band of his hearing aid reach around and into each ear. I could taste the candy corn he always put within reach before he read Uncle Wiggly to me. Most of all, I felt an overwhelming compassion for the physical suffering he endured day after day. His diaries add to my sense of love, belonging, and personal history.
Finally, having my own blog is one way to reach out to others who experience life similarly. It also offers assurance that these writings will always be accessible to my family. Just a few weeks ago, a brush fire came dangerously close to the house. We were ready to evacuate in case the fire spread (which it did not), and had everything together. I was exhausted and had no energy to grab all my journals; but it was comforting to know that someday, a son or grandchild might just stumble onto my blogs.
(c) Sally Z McBain
The more entries I place in this journal, the more I ask myself why I'm doing this...and making it public. There are several reasons, and perhaps the first is the most critical for my sense of joy and well-being: Writing offers a protected world where I can express my dreams, emotions, and thoughts. It's a safe haven for discovery; and with that as my foundation, I integrate layer upon layer of Self.
Writing is one of my centering practices; it calms me and keeps me on my spiritual path. If I don't write, I tend to get restless. There are things I need to figure out, relationships I need to sort through, and problems I need to solve. In her book, Storycatcher, Christina Baldwin says, "I believe the kinds of writing millions of us are doing in our diaries and journals are attempts to heal the split in the human mind and in the human experience." Writing helps me get to my truth.
My writing is, on first glance, centered on myself; but I've always believed that to know Self is to know the meaning of life...at least a big part of it. It's all in my writing --the ever-sustaining universal breath, basic needs that connect me with everyone else, and a full range of human emotion. While it might seem that an over-indulgent ego is what propels me or anyone else to write, quite the opposite is true. Writing is my way of never forgetting that life isn't just about me; I know I'm a tiny fleck in the scheme of things. Like Virginia Woolf said, "When you consider things like the stars, our affairs don't seem to matter very much, do they?" I do a lot of thinking about those stars and everything around and beyond them, especially when I'm deep in an ego-propelled frame of mind. Writing helps me heal the split, as Baldwin puts it. It also helps me see life from someone else's perspective.
For most of my adult life, I have struggled with guilt and pain related to my two divorces. I wanted to know why, to understand my role in those failures. Today, I have my answers; threads of understanding and acceptance connect much of what I write. It took many years, but I reached this place by putting my thoughts onto paper with poetry and prose. Writing inspires me to take a closer look at forgiveness, love, and gratitude. Granted, it's a lot easier to write about these things than it is to practice them every day, but the act of writing is the inspirational nudge I need to move forward.
The best I have to share with my children is the essence of who I am. To hide my lessons or dismiss my progress is to deprive them of a basic part of who they are and will become. Someday, from their unique experiences of me, they will garner insights into one life that contributed to theirs. Perhaps they will be 60 years old when they feel like reading, just as I was when I reached for my grandfather's diaries. On those pages, where he wondered if anyone would ever read what he had to say, his adult graddaughter got to cuddle up in his arms again. I could see the metal head band of his hearing aid reach around and into each ear. I could taste the candy corn he always put within reach before he read Uncle Wiggly to me. Most of all, I felt an overwhelming compassion for the physical suffering he endured day after day. His diaries add to my sense of love, belonging, and personal history.
Finally, having my own blog is one way to reach out to others who experience life similarly. It also offers assurance that these writings will always be accessible to my family. Just a few weeks ago, a brush fire came dangerously close to the house. We were ready to evacuate in case the fire spread (which it did not), and had everything together. I was exhausted and had no energy to grab all my journals; but it was comforting to know that someday, a son or grandchild might just stumble onto my blogs.
(c) Sally Z McBain
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