Making Friends in High Places

I ate with Mom at least three times a week, and the meals was almost always good. The food in this nursing home was definitely above average. They worked at individualizing meals to accommodate the needs, likes and dislikes of residents.

They weren’t perfect, however, and there were times when my grandmother’s diet needed to be changed. She went through stages. There were days where she wanted bacon for breakfast every morning. Even though she talked to the CNAs about it, somehow her desires were not communicated with the workers in the kitchen.

Fortunately I had become friends with the director of nutrition. We had conversations on a regular basis, and I always let him know that he and his workers did a wonderful job feeding the little folks in their care. When Mom’s ‘bacon tooth’ became active, I shared her desires with the nutrition director and she had bacon every morning.

Yes, it makes life better for those in your care, if you make friends in high places.

First Rattle Out Of the Box

Before we moved Mom from the hospital to the nursing home, I spent a lot of time talking with the administrator and others in that facility. I did my best to make sure that everyone understood her needs, and I thought I had done a pretty good job.

That is until I walked in one morning just two days after her placement in the nursing home. She was sitting in her wheelchair in the hallway. When she saw me, she began to cry. In all my life I had never seen my grandmother cry. Not when her husband died. Not when her middle son died. Not when her oldest son died.

Needless to say, her tears on this occasion upset me. She told me that she had been treated roughly. She said that the CNAs had pushed and pulled her while dressing her and transferring her from her bed to her wheelchair. She told me that they caused more pain in her back. Oh man, was I mad.

I immediately located the CNAs and informed them in very concrete terms that Mom could not be treated in that fashion. Then I went to the administrator on duty that day. I clearly made my concerns known to him. He then talked to Mom, and she confirmed everything I had said. He assured me that our concerns would be addressed and the entire staff would be informed about how to help Mom transfer as well as other needs.

The administrator was true to his word, and within a day the staff knew about Mom’s needs. Things improved dramatically for her. Sigh.

The Very Small “Cubicle”

It looked so very small. I knew it would be small, but I still was not emotionally prepared to see the “cubicle” space that would be Mom’s home. Being faced with the fact that her life had been reduced to a few square feet, was almost more than I could handle. Yep, nearly had a meltdown right there in that room.

Getting Mom settled into the nursing home was a difficult, physically exhausting, and emotionally draining event. But I did it. There are many details about those days that I don’t remember. Perhaps that is best.

At the beginning of Mom’s residence in the nursing home I made a concerted effort to get to know as many staff people as possible. I remember meeting the marketing director, the administrator, the director of nutrition, the director of nursing and the head custodian. From that time on, I greeting everyone with a smile and kind words.

I wanted everyone to know that I was part of “the team”, and that when I was visiting Mom, I would be helping with her care. At first I could tell that the CNAs were a little nervous to have me around. Most likely they thought that I would be going to the administrator with complaints about them. After a few weeks, they began to trust me, just as I began to trust them.

Don’t think, however, that all was “sweetness and light”. There were some difficult moments. In the next post, I share the first one.

Nursing Homes: How to “Make the Best of It”

My grandmother’s stay in the nursing home was about 11 months. I learned many things about relating to all staff involved in her care from administration to CNAs. I made many friends there and o this day I cherish the time we spent together.

Over the next several posts I want to share with you some of the experiences Mom and I had in this nursing home. I want to share how I handled various situations that arose during the months of her residence there.

First of all, this nursing home is basically a good facility. It has an open, bright atmosphere when you first step through the door. It is beautifully decorated, and everything feels and smells fresh and clean. It is locally owned and well run.

Not all our experiences there were good. There were some very difficult moments, but I believe that the way I handled the bad experiences enabled my grandmother to have many more good experiences. Overall she was cared for very well.

The Empowered Patient, Part 4

In my opinion, an empowered patient is nicely assertive.  I have always believed in building positive relationships with healthcare professionals.  I want them to look forward to seeing me, never dreading my presence.  I want them to know that I am part of my health care team, and in no way their enemy.  I want the professionals who take care of me or my loved ones to feel comfortable with my suggestions and requests, never thinking that I am out to ‘get’ them in any way.

Please understand, however, that if I do have a concern that I think needs to be taken to a supervisor, be it nurse manager, or hospital administrator, I will not hesitate to do so. That is a given.

What I am saying in this post is that, I  believe much more is accomplished with health care professionals if we establish a positive working relationship as quickly as possible.  That foundation will then make possible the ‘give and take’ that is necessary during the treatment of illness.

The Empowered Patient, Part 3

As I continue my discussion of what it means to be an empowered patient, please keep in mind that sometimes the patient is empowered because of the family members who are involved,  Sometimes an empowered patient requires empowered family members.

An empowered patient makes suggestions.  Again, that is easier said than done with some doctors.   However, if you see a test or procedure that needs to be done or repeated, it is in your best interest or the best interest of your family member to make that suggestion to your doctor, even if that doctor does not always appreciate them.  Just think about how much you might regret it, if you don’t.

Because I was so involved with my parent’s treatments, medication, and tests, I knew which tests had been done and had a good idea (because I had asked question) when they needed to be repeated. Because I was always polite, never condescending in my tone when I made sugges Dr. B took my suggestions well. Dr. A, not so much.  However, in my mind it didn’t matter.  My parent’s care was more important than my feelings, or the doctor’s feelings.

An Empowered Patient asks for things.  This especially applies for a hospitalized patient, but is also applicable in other situation, doctors offices, testing situation, etc.

When my grandmother was in the hospital this past fall, the doctor decided that a tube needed a tube put down her throat.  The nurses had tried to do it when Mom was first admitted, but were unsuccessful in getting the tube in place.  For the second attempt, her doctor decided to ask the radiologist to do the procedure, using a camera to guide the tube down her throat.

Because Mom had been in tremendous pain, and because, well, because she was 96, and because I’d couldn’t stand the thought of her going through that procedure alone, I went with her as she was transported to the radiology department.  I walked into that area as if I had been there many times, never leaving Mom’s side.  The technicians did not ask me to leave and I didn’t offer.  However, when the radiologist came in, I did ask to stay.  By then I already had the special apron on and had taken my place by my grandmother’s head and was gently stroking her hair.  I did everything I could to convey that I was not going to be a problem at all.  The radiologist gave me permission to stay and so I did.  This would never have happened if I had not been bold enough to ask, then Mom would have had to endure that procedure alone.  Sometimes you must be ‘nicely’ bold. (my daddy would be so proud).

The Empowered Patient, Part 2

The Empowered Patient, in my opinion, is a good listener.  Especially when a diagnosis is first given that is serious or terminal in nature.  Some doctors are very good at sharing information with their patients.  It is in our best interest to listen carefully.  Sometimes it is just important to know what a doctor hasn’t said as it is to know and understand what he has said.

It is my suggestion that you have someone with you at doctor’s appointments, especially in the beginning, when they are sharing test results and treatment plans.  There is no way that we can hear, understand and remember all the details likely to be shared.

An Empowered Patient asks questions.  With certain doctors that is easier said than done.

When both my parents were in the hospital on the oncology floor in rooms right next to each other, we had two different oncologists.  These who men were partners and covered for each other frequently.

One doctor, Dr. A was, and probably still is, known as the best cancer doctor in the area.  He was the leader, the pace setter among the other oncologists.  He was also a cancer patient, having an incurable but treatable form of cancer.  So many people sang his praises. Rightfully so.  Many people had their years of life extended because of his care.

As you can imagine Dr. A, was extremely busy, and was burdened with a very difficult medical practice.  He was very focused and serious.  He came on the floor and there was no chit chat.  He went right to work and the nurses better be ready.

Because my parent’s rooms were side by side, he could go to one first then the other.  He was totally focused on the patient in that room.  He quickly went through the charts, verbally gave instructions to the charge nurse who was with him, wrote more notes into the chart, said a few words to us and was gone to the next room.  Five minutes, max!

I quickly learned that if I had a question for Doctor A, I had to be prepared to interrupt him, either when he was writing or talking, because he was not going to pause long enough to hardly take a breath, much less to see if we had anything to ask.  So that’s what I did.  I would interrupt him.  Even though I tried to interrupt him in a polite way, it was obvious to me he didn’t like it.

However, he did answer my questions.  That, for me, at that time of crisis in my life, was what mattered.  Please understand. I am not saying that he was a bad doctor at all. He was just focused.

Doctor B was entirely different.  We learned several things about his personal life while he cared for my parents.  He didn’t mind visiting for a few moments. He came in with a smile and a joke or two.  He would actually pause and ask us if we had questions or concerns for him.  I always looked forward to the days when he would be making the rounds.

Both of these doctors are excellent doctors.  They are examples of doctors you and I have known and will know during times of medical need in our lives.  There will be doctors that are easy to communicate with and doctors who are not.  We must accept this as part of their personality and as part of the ‘package’.

Our challenge is to somehow be able to ask the questions we need to ask.  For a ‘Doctor A’ type, I suggest that you have your questions written down before your appointment.  I know that is not always possible, because often questions come to our minds during appointments, depending on what is being discussed and what decisions being made.  Additionally, I suggest you be prepared to interrupt – politely – if necessary, your ‘Doctor A’.  No, he may not like it, but he needs to know that you have questions and you want answers.

For a ‘Doctor B’, well, your challenge here is to not get sidetracked into side conversations to the point that you forget to ask questions!  Again, it is always a good idea to have your questions written down.

More to come about The Empowered Patient.

When Nurses Make Mistakes…..

Write down everything.  Write down every mediation, dosage, and time it is given.  Write down what tests are taken and the results.  Write down everything.

That was advice given to my sisters and I when our parents were hospitalized.  We heard this advice not from just one person, but several.  Truthfully, this advice frightened me.  Are our health care professionals so inept that if we don’t ‘stay on top’ of everything, serious mistakes will be made and our parents could die?   I suddenly felt like their safety was in my hands.  When combined with the trama of their illnesses, this added responsibility was overwhelming.

Yes, we started writing down everything.  I had my spiral notebook and made a valiant attempt to record it all.  The fact was, I couldn’t do it.  There were times when I was wrapped up in the activity or emotion of the moment, would just flat forget.

I finally decided to let it go…..  I let go of the worry about whether or not something would go wrong.  I let go of concern that the nurses might make a mistake with their medications.  I finally relaxed.

There are things I continued to do.  I continued to ask questions about medications, tests, vital signs, etc.  I stayed very involved and aware.  I just didn’t write down everything.

All that said, there were mistakes made.  Not many and nothing serious,  but mistakes none the less.  Sometimes I picked up on the mistakes.  Sometimes another nurse found it.  There were a few occasions of vital signs written down incorrectly.  I don’t remember any serious mistakes with medications.

What should be done when a mistake is made?  In my opinion, it depends on the type and severity of the error.  Because the mistakes I saw were not serious and did not affect the health or safety of my parents, I usually mentioned the error to the nurse involved, making sure that she was aware of it, and then took it no further.

However, if I had become aware of something that was caused by carelessness and inattention to detail, or if I had found out that incorrect medications or dosages were administered, then I would not have hesitated to talk to the nursing supervisor.

I believe that nurses do a wonderful job each and every day.  They are competent and compassionate, accepting the huge responsibility of  administering medications with professionalism and accuracy.

Be Nice to Them—They Carry Needles!

This last month I have spent 10 nights with Mom, my grandmother, at the hospital, and 2-3 days a week with her at the skilled nursing facility.  Once again my respect for nurses and related medical staff has been renewed.  They work long hours, have many serious responsibilities, and still make time to do the small things to help make patients comfortable. They fluff the pillow an extra time.  They put on socks and take off socks.  They wipe posteriors for precious little old folk who can’t do it for themselves.  Yes, I am amazed at the ladies and gentlemen who work day after day with a caring spirit and kind heart.  I know there must times when they are fatigued, but they do their best to not show it when they walk into our room.  They work with a smile and caring hands no matter how stressed they may feel on the inside.

Yes, I admit there are nurses who should not be nurses.  I have seen them also.  I am not talking about them.  In every profession you will find people who should find some other job.  I choose not focus on them.  They are few in number and do not influence my feeling about medical professionals as a whole.

When I am in a hospital setting with someone, my parents, my husband, my mother-in-law, or my grandmother, it is my desire to become part of the team, working as one with the nurses and aides to care for my loved one.  I help get ice and water. I help the nurses when my family member needs to be repositioned in bed.  I do the things I can to help free up the nurses and aides so they will have time to do the things I can’t.

I like to get to know these caring angels, building relationships and even friendships with them.  I want them to get to know me, but more importantly, I want them to know my family member.

I want them to understand that my presence is not a threat to them. I am not there to evaluate their work or try to catch them if they make a mistake.  As I said, I am part of the team.

Next blog: What if the nurses do make a mistake?

Nursing Homes, Part 4

This is fourth and final (for the present) post on nursing homes. It has been an interesting process for me as I thought and remembered both the good and bad points about our Mother’s stay in a facility. Hopefully, my series of posts on this subject will be useful to you. Actually it is my hope that you are never faced with the decision of placing a family member in a nursing home.

7. Always make sure, on behalf of your family member, that his/her doctor’s orders are being carried out by the staff of the nursing home. Do not assume anything. Most of the time most staff members are very conscientious, and they will follow completely ‘doctor’s orders’. For them we are very grateful.

Then there are the others. There are not many of them, but they are present and always will be. I do not believe they are purposely neglectful, just inattentive. It is also possible that they are overwhelmed with their responsibilities and in their efforts to be sure that their residents are taken care of, tend to rush through tasks, not making sure to take care of the details. Example: When Mother’s feeding tube was put in, the doctor gave specific instructions for her bed to always be at a 45 degree angle. The reason being, if I remember correctly, so that should a problem occur with the feeding tube, she will be less likely t0 aspirate. When those orders were given, we put a sign at the head of Mothers’ bed stating that her bed be always left at a 45 degree angle, and we talked to the administration, making sure they had notified the staff about this very important instruction from the doctor. In spite of the measures taken on our part, we still, on numerous occasions came in and found her lying in a flat bed.

When the doctor changes the medication of your family member, always verify that the medication nurse has made the necessary changes on their chart. Again, don’t assume anything. You must make sure for yourself.

8. If you have concerns about your family member’s care, say something. Talking to a CNA(aide) will probably not fix the problem, because there are several CNAs taking care of your loved one on different shifts throughout the day and night. Not everyone will receive hear about your concern and therefore will continue doing what they have been doing. The best thing is to talk to the head nurse on that shift, or if necessary go to the director of nursing or the administrator. With a smile and nonthreatening tone, voice your concerns. Probably they will listen, take notes, and decide on a course of action to make sure the problem is solved and your family member’s care meets your expectations. Even then, I am sorry to say, you must check to be sure your concerns were communicated to all staff involved in caring for your loved one.

9, When you are first gathering information about a facility and deciding on placement options, ask about the ratio of CNAs to residents and if that ratio changes during the day or during then night. One of the things that concerned me, and I didn’t realize the full scope of this (in my opinion) problem at first, was that there were times during the day when at this facility, most of the CNAs were off the floor and the residents were left with almost no one to call on for help.

At meal time the CNAs took all the residents to the cafeteria to eat and stay with them to help serve the food. There were a couple of CNAs on the floor, but they were given the task of feeding residents who couldn’t get out of bed. These aides did the best they could if they saw a resident in need, but unless it was an emergency, that resident had to wait until the feedings were complete.

In addition to meal times, this nursing home had a ‘smoking break’ for residents and staff. The smokers would all go outside to the patio and puff away. It seemed that most of the CNAs smoked and they all went at the same time on this break. There were times when Mother needed assistance for something, and she had to wait until her CNA was back on the floor. In my opinion, the smoking breaks could be scheduled at a staggered time so the aides could cover for each other.

These times of short staffing on the floor became a personal problem for us during the short time that Daddy was a resident. About 3 days before his death, Rick and I decided to take a quick trip to Dallas to see our daughter and son-in-law, and also because I had a doctor’s appointment there. On our way to Dallas we decided to stop in at the nursing home and see Mother and Daddy. This was about 4 days after Daddy’s nursing home stroke. He had been semi-comatose for several days, barely responding to questions or acknowledging someone’s presence. We found Daddy fully clothed sitting in his lift chair sleeping. We talked to his CNA and she told us that she asked him if he wanted to get up that morning and he said yes. Therefore she got him up and dressed. There was no problem with her getting him up. I was thrilled to see him sitting in that chair. However, I could tell that he was getting tired and needed to go back to bed. Rick and I talked to him for awhile and he did seem a little more alert than before. About 11:00 a.m. we needed to leave. I went to the nursing station and told the charge nurse that Daddy needed to go back to bed. Daddy was beginning to be in pain, getting cramps in his She sweetly assured me that he would be transferred to bed. Something inside me told me not to leave until that was done, but I left anyway, feeling the need to ‘get to Dallas’. Because I continued to have this nagging concern, I called back about 1:30 p.m. to make sure that he was back in bed, and ‘sure nuff’ he was still in that chair. I told the nurse, the same one, that he had needed to be put to bed, reminding her that I had told her so over two hours ago. Once again, she assured me that Daddy would go right back to bed. Not completely trusting her words, I called again about 2:30 p.m. A different charge nurse answered this time and I asked again. He was still in that chair. She went immediately and put him back in bed.

Oh yes, I was mad. Yes, the administrator heard about it as well as the director of nursing. The reasons? Just after 11:00 a.m. every day, most of the staff is in the cafeteria feeding the residents. There was no one except the charge nurse available to transfer him back to bed. At 1:30 the facility was changing shifts.

In addition to being angry about my father being left in his chair for hours after he needed to be back in bed, I also felt a heavy burden for those little people who had no one to advocate for them. Were they left for hours also in chairs, beds or wheelchairs, in pain from being in one position for so long and no one available to help them? What if someone had a stroke or heart attack during meal time or a smoking break? My sisters and I voiced these concerns to our administrator, and though these concerns appeared to be well received, no changes were made while Mother was a resident in this facility.

I could make several more points on this topic of nursing homes, but for now I will write about other things. Please understand that reputable nursing homes are not inherently bad places and have bad staff members. Most of them are good facilities with staffing that is competent, caring, and compassionate.  However, as I suggested in a previous post, because the administrators and staff are human, mistakes will be made. It is up to you and me as family members to shoulder the responsibility of being aware when these errors happen and making sure they are fixed. No one else will do it on behalf of your loved one. We must ‘stand in the gap’ for them.