elder abuse, elder care, hospice

Respect and Dignity for the Elderly – my experiences working with the elderly

I re-blogged that post about elder abuse because I spent many years doing elder care and I have a big heart for the old people. It makes me disgusted to think about people who physically and mentally abuse old people who have no one to defend them or advocate for them.

I have worked doing home health aide work for hospice and other help in the homes of the elderly. I have worked in nursing homes as a Certified Nursing Assistant and I was very god at dementia care and hospice care.

The problem with the nursing home jobs was that they did not care about the workers taking care of the residents. They would short staff the floor to save money and give each of us way way too many people to take care of. This is not a matter of not wanting the extra work. This is a matter of having 13 people that need full care and trying to take care of all of them with no assistance.

You could not get any help from the other aides any more than I could really help them very much. Everyone was overloaded to the  max. Many nights all I could do was toilet each of them before dinner and then sit them in front of the tv while I took them one by one to get them ready for bed.

There were always 1 or 2 showers to do. While I was in the shower with someone I would have extreme anxiety about one of the other people trying to get up and falling. On the other hand if I rushed in the shower I could have an accident in there.

To put  one person to bed I had to toilet them and change their clothes and get them to bed. Some people required a 2-person assist, so you had to wait for another aid to be free to help you. Everyone was busy and all you could do was wait for 10 – 15 minutes for help but you could not leave the person unattended.

In the mean time the other 12 people who were all fall risks, were in the tv room where I could not see them. Once I finally got the second person to help me lift someone into bed, then I would go and get the next person. In the mean time people were sitting in wet and dirty diapers.

Sometimes we had to go assist another aid to get someone in the shower, off the toilet or into bed. The whole time I still had people sitting in wet diapers and getting pressure sores because they had been sitting in the wheel chairs for hours. As fast as I could get someone into bed and get the next, there were still people that had to sit from dinner time until 8 or 9 pm,,,sometimes later.

Sometimes someone would fall and get hurt. Then I had to wait there for the nurse and sometimes it took a while to get help to lift them off the floor. Again everyone is too busy to help you.

If someone else had a resident fall then I had to help them get the person off the floor. But we had to wait for the nurse before we could lift them. So while I was waiting with another aid and their resident, my people were sitting in the tv room and begging to be taken to bed.

Sometimes they would cry, beg and plead to go to bed or to even go to the bathroom. There were people asking for the bathroom while i was trying to get people to bed. The longer I left people out of bed the more likely they would fall. But the longer you leave someone who needs the bathroom , the more likely they will fall because they will try to get up themselves.

No matter what I was doing, someone was being neglected for a long time. I could not leave someone in the bathroom to take someone else to the bathroom. Every time I left the room to take someone to the bathroom  or to bed, there were people being neglected, in unsanitary conditions, and at risk of falling.

So what time was there to care about someone’s feelings who just found out their wife died? What about the person with dementia that is crying because they are scared and do not know where they are? What about the person that has extreme back pain from sitting too long and is crying because no one cares?

I left that job crying every night.

I would stop when someone needed their hand held and when someone was sad. I would stop and take time to put on the right tv channel for someone’s favorite movie that was coming on.

But I would get scolded for taking too much time with the residents. I would get scolded for being too “soft-hearted” and for finishing later than the other people did.

I would stop and comfort the old woman who was in another aide’s assignment, because the person was crying that her family had not come to see her in a year. How could you not?

Well most everyone ignored them. I was scolded every night for “being too slow”/ In fact I was not slow. I did all of my work and I took the extra time to treat people like humans, as best as I could.

The facts…

People still sat in dirty diapers no matter how hard I tried and how fast I went because you cannot take care of 13 fall risk, dementia people in four hours between dinner and 10 pm when the shift ends. You cannot get 13 people to bed safely by 8 or 9pm. Some of them had to stay up until 9:30 or 10 pm, which means they were sitting in the wheelchair since about 4pm or 5 pm.

I cried every night on the way home. There were nights I had to pull the car over.

Nursing homes breed neglect. The owners care more about the money they make than the human people who live there or the people that work there.

I ended up changing jobs to an assisted living place and the care was much better there. I had time to sing with people and dance with some of them. I could tuck them in nicely and kiss them on  the head good night. I could hold their hands when they were sad.

But I was still scolded.

These places attract narcissistic supervisors and bosses. These people hate the old people because they are weak and sick. They rage at you for taking too much time with them.

I once had a resident that had a severe depressive disorder. She sometimes just could not deal with coming out to the dining room for dinner. I used to visit her in her room and she liked the company. She would ask me to order her dinner and have it brought to the room.

These people pay $9,0000.00 dollars a month to live there.

I went to order her dinner. The supervising nurse changed the order I had written to “All Liquid SIck Meal”

This is what we gave people who had the flu or some other tummy sickness. The nurse said “If she will not come out to the dining room then she will get a sick tray”

I explained that she was depressed but she was still hungry and would be better off to eat, rather than going to bed hungry. The nurse said if the lady will not come out then she will go to bed hungry. (of course when I explained this to the college kids in the kitchen, they snuck in real food to the lady)

I have hundreds of stories like that about the narcissistic supervisors punishing residents or retaliating  against me for taking time to care about the mental / emotional health of people.

It was sad. I cried many night on my way home and even on my driving to work.

This is why elder abuse is an important issue to me. I have seen it. It is unfair. These old people have already had so many losses. They have lost their friends and family to death. They have  lost their health and strength. They have lost their spouse. They have lost their home and their job. They have lost the freedom to drive and go places on their own.

They lost the control over their own money and expenses. They  have lost their ability to many of the hobbies and activities they once loved. They have lost their favorite pet because they are not allowed in the nursing home.

The list keeps going….

The least they deserve is a little respect and dignity.

death of a loved one, dying, dying loved one, hospice, hospice care, life

What is Hospice and What Can I do to Support the Care of my Dying Loved One?

I have worked with hospice patients for many years. I have worked with some really compassionate care givers and some that should  seriously change jobs. 

There seems to be a lot of confusion about the work hospice, even amongst healthcare workers. Many people think that Hospice is the name of an organization. That is not correct. Other people think that is it the name of a benefit given by the government and that is a  little closer to the truth, but also not correct.

Hospice is a philosophy of care that believes is comfort care of the dying.

Whether or not someone gets hospice care depends on a variety of factors. One of the terms that you will hear, if your loved one is receiving hospice care is palliative care.

Palliative care is the type of care that the hospice philosophy is based on. This is ensuring the dignity, comfort and pain management of a dying person.

Most insurance, including medicare covers hospice care if you qualify.

This is all tied up in a bureaucratic mess and sometimes it works and sometimes it fails. I have seen people qualify for hospice care and then “live too long: past the expected time. Then their benefits were pulled and they no longer had hospice care.

Sometimes they re-qualify after a waiting period, and the doctor gives a new diagnosis and submits it ti hospice. I believe that the family has to go through the entire application process again.

Sadly I have seen people die without hospice care, even though they had it a month ago, because the paperwork did not go through in time to re-qualify them.

So, that is the aggravating part to me. There seems to be no rhyme or reason to some of the particular cases I have seen, I have noticed, however, that people with private insurance get treated better than people on medicaid. Surprise , surprise!

The idea of hospice care to keep the patient as comfortable as possible in every way.

Each patient that is approved for hospice will get certain supplies provided to them including but not limited to, a special bed with an air mattress that is designed to prevent pressure ulcers, an oxygen concentrator, a wheelchair, and basic cleaning and hygiene supplies.

Each case is assigned a hospice nurse to supervise the care.

The nurse will visit the patient intermittently and if the family requests her to. The nurse will supervise the nursing assistants who are the direct hands-on care for the patient.

Medications are prescribed by the doctor and overseen by the hospice nurse. If the patient is in a facility then the charge nurse is given directions by hospice on the medications to be given.

The usual medications available to a hospice patient are Roxanol, Morphine and Atropine.

Roxanol is given for anxiety and calming. All patients do not need this but the family can request it. Morphine is used for pain and most patients are given this as they get near the stage of active death and during active death. The family can request or deny the morphine, but usually it is standard.

Many patients develop a death rattle near the last few days prior to death.

The death rattle is caused by extra secretions of fluids and it sounds like they have fluid in their lungs and throat. This sound is often very disconcerting if you have never heard it before. I may make you feel like the patient is suffering or drowning.

But the death rattle does not hurt the patient or cause them nearly as much discomfort as it will sound like to you. The atropine does usually work to reduce the secretions and make the death rattle less disturbing to the family.

Each hospice patient is assigned nurse aides. How often they come depends again on your insurance, if the patient is home or in a facility, and also how close to death they are. Usually there is a nurse aid around the clock for patients that are in the last stage called active death.

Active death usually lasts for 3 days to a week, By this time the patient has stopped eating and has greatly reduced or stopped fluids. They are usually placed on oxygen for their comfort.

The nurse aid should be tending to changing their diaper and also turning them in the bed to a different position, every two hours. 

The turning and repositioning of a person that is bed ridden is very critical.

Pressure sores, also known as bedsores or pressure ulcers can develop in a matter of less than two hours of any pressure being on the same spot of skin.

The pressure sores usually occur on the bony parts of the body, where the most pressure is causes. Places like the backs of the heals, the elbows, and the bony areas of the spine are the most common areas for sores to happen.

Pressure sores can get very severe and their are 4 stages to them. They should be prevented but if they occur then they should be tended to in order for them not to turn into stage 2 or stage 3 ulcers.

Here is a link about pressure sores and the four stages. 

This is a link to more information about causes and treatment of pressure sores.

If left unattended, pressure sores will become so deep that the bone is exposed. As you can imagine this is extremely painful to person who is lying on the sore.

Once a pressure sore begins then the nurse to evaluate it, after an aide usually reports seeing it. The patient will be re-positioned more often and in the way that is directed by the nurse.

If a sore appears on the back of the heal, then the heals will be elevated on a pillow, but good aides know that it is best to do this before any sores happen. The pillow should be placed under the lower legs, leaving the heals in a “free floating” position in the air, and not touching anything.

If the sore is on the spine, then there are special ways that the hospice aide is trained to use pillows to position the person so that they are never lying directly on the sore.

Someone with a bed sore should NEVER be laid in a position that the sore is touching the bed, unless they are being changed or rolled into a new position.

There are also topical creams, patches and antiseptics that can be used to treat the area, depending on the directions given by the nurse, or a wound care specialist.

These are some of the aspects of care that are part of hospice. There are other things that are usually done in order to care for the whole person, including their emotional and mental aspects. There are also more things involved in the physical care, but I think I have given you a good basic idea here.

I will write a second post about hospice care and explain about other aspects of hospice care. The best thing you can do as a family member, about their physical care is to learn about hospice care to make sure that your loved one is receiving the proper care.

If they are in a facility like a nursing home, the more vigilant you are, the better care your loved one will receive.

This may be sad, but I can tell you that it is true, from years of working in nursing homes. I have been instructed before to spend more time on a certain patient because the family is expected to visit. 

Being the person that I am, I always gave equal care to all of my patients, but the directors and charge nurses are more concerned with the how the patient’s care looks to the families that are visiting the most, or the most likely to visit that day. People who had someone visiting them every day, always received the best care and the most attention.

If you cannot visit, then phone calls can also help. You can also send a friend who lives in the area to stop by. As long as the facility knows that someone is keeping an eye on them, then your loved one will be more likely to be cared for on a proper schedule at a nursing home.

Once there is an around the clock aide, when your loved one is near or in active death, then someone will be there to care for them all the time. 

This is a difficult journey for you, if you have a loved one who is dying. Hospice also usually offers help for you in dealing with the grieving process. If you need help, please ask them what services are available to you.