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.

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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.