Working in a Nursing Home

What working in a nursing home taught me about life, death, and America’s cultural values

The first thing I noticed when I began working in a nursing home was the smell. It’s everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It’s one of those smells that takes over everything — if you’re not used to it, it’s hard to think about anything else.

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, “I want Mommy.”

But it’s also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

People at the nursing home like to watch TV. It’s always on. How strange, then, that there are no old people on TV.For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It’s an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. “Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?”

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven’t gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

“This is all I have left,” a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that’s about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they’re worth fighting for, while we still can.

2) Having a routine is key to happiness

I’m a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the “rehabilitation room,” reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

“You are so handsome. Are you married?” is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn’t feel anything except physical pain — especially not any sexual urges. That’s not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip (“Did you know that this nurse is married to the social worker?”), flirt, make jokes, cry, feel helpless, complain of boredom. “What does someone in her 80s talk about?” a colleague asked me. “About the same things,” I replied, “only with more urgency.”

Some people don’t get that, and talk to old people as if they were children. “How are we today, Mr. Goldstein?” I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, “Did we poopie this morning?” Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It’s always on. How strange, then, that there are no old people on TV.

Here’s a picture I see every day: It’s the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let’s say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how “great!” their dish or their new movie is, or how “sad!” the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don’t see themselves there. They don’t belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn’t look “young!” and “great!” but might know something about life that we don’t.

There isn’t one Big Truth about life that the patients in the nursing home told me that I can report back; it’s a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: “Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore.”

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don’t. They talk about other things instead, and it’s rarely a sign of whether they are in pain or not.

Here’s my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that’s going to be the only thing you’re going to think about. It’s like a muscle — you developed the mundane muscle and not the other one.

The saddest people I see in the nursing home are childless.And you can’t start developing the spiritual muscle when you’re old. If you didn’t reallycare about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you’re not going to start when you’re old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you’ll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her “inappropriately old” appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don’t have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it’s physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That’s a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, “Trees die standing tall.” This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — “Look here; pay attention to this!” the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don’t want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that’s also possible.

I think of death as a tour guide to my life — “Look here; pay attention to this!”My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn’t. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

“It’s going in a very clear direction,” she told me. “Toward the end.”

“It’s true for all of us,” I replied.

“No, sweetheart. There is a big difference: You have much more time.”

Valery Hazanov, PhD, is a clinical psychologist in Brooklyn. He is writing a book about his training to become a psychotherapist.

https://www.vox.com/2015/12/2/9826772/life-lessons-nursing-home

 

THE NEGLECTED ONES BY C. L. SALASKI

Prominent landscape painter David Reid has just entered
the Twilight Zone.

After his mother is sent to a nursing home for rehabilitation, David soon learns the truth about Haven. Once a magnificent seaside hotel on the coast of Maine, the property is now managed by a greedy corporation and a nursing staff who neglect and abuse the residents. Dealing with the inept staff is an endless battle. And to make matters worse, David’s mother claims ghosts are haunting the facility.

Are the spirits hallucinations caused by her medications?

Or is Haven really haunted?

 

CLICK here to read the FIRST CHAPTER of
THE NEGLECTED ONES

THE NEGLECTED ONES by C. L. Salaski

Prominent landscape painter David Reid has just entered
the Twilight Zone.

After his mother is sent to a nursing home for rehabilitation, David soon learns the truth about Haven. Once a magnificent seaside hotel on the coast of Maine, the property is now managed by a greedy corporation and a nursing staff who neglect and abuse the residents. Dealing with the inept staff is an endless battle. And to make matters worse, David’s mother claims ghosts are haunting the facility.

Are the spirits hallucinations caused by her medications?

Or is Haven really haunted?

 

CLICK here to read the FIRST CHAPTER of
THE NEGLECTED ONES

THE NEGLECTED ONES by C. L. Salaski

The familes of two residents discover the truth about nursing homes in the novel, The Neglected Ones.

After his mother is sent to a nursing home for rehabilitation, prominent artist David Reid soon learns the truth about Haven. Once a magnificent seaside hotel on the coast of Maine, the property is now managed by a greedy corporation and a nursing staff who neglect and abuse the residents. Dealing with the inept staff is an endless battle. And to make matters worse, David’s mother claims ghosts are haunting the facility.

Are the spirits hallucinations caused by her medications?

Or is Haven really haunted?

CLICK here to read the FIRST CHAPTER of
THE NEGLECTED ONES

 

THE NEGLECTED ONES by C. L. Salaski

The familes of two residents discover the truth about nursing homes in the novel, the neglected ones.

After his mother is sent to a nursing home for rehabilitation, PROMINENT ARTIST David reid soon learns the truth about Haven. Once a magnificent seaside hotel on the coast of Maine, the property is now managed by a greedy corporation and a nursing staff who neglect and abuse the residents. Dealing with the inept staff is an endless battle. And to make matters worse, David’s mother claims ghosts are haunting the facility.

Are the spirits hallucinations caused by her medications?

Or is Haven really haunted?

 

CLICK here to read the FIRST CHAPTER of
THE NEGLECTED ONES

 

PRAYING FOR NURSING HOME REFORM

When facing the evils of corporate greed, deception, neglect and abuse so clearly present within the nursing home industry, it seems to us that prayer is definitely needed for significant, let alone long-lasting changes to take place.

The following is a list of concerns we encourage you to be praying about that will directly impact the quality of nursing home care.

You are welcome to suggest additional concerns that you would like to see added to this list. The owner of this blog is always glad to pray for specific individuals (caregivers and nursing home residents), so feel free to share your prayer requests.

— For God’s protection to surround at every moment every nursing resident . . . protection from abuse, abandonment, neglect and negligence . . . protection from all injury and harm for each nursing home resident from their caregivers, from themselves, from fellow residents, from volunteers, visitors and indeed from all persons who will come into contact with nursing home residents.

— That all legal rights of every nursing home resident be respected by the facility in which they live.

— We ask God to break the very backbone of corporate greed that exists within the nursing home industry . . . asking that this evil be replaced with a firm commitment (in both word and deed) to providing nothing less than compassionate care for each nursing home resident.

— We ask God to comfort nursing home residents so they are not overwhelmed by fear, loneliness and anxiety . . . May God grant every nursing home resident plenty of caregivers, volunteers and visitors who will spend quality time with them on a regular basis and in so doing ease the emotional and spritiual burden many nursing home residents feel.

— For the truly compassionate and hard working certified nurses aides and nurses working within the nursing home industry…we implore God to give them an excellent work ethic, an ability to be loving and kind to all residents who’s care is entrusted to them (even when the resident is not capable of being loving and kind to their caregiver).

— We implore God to protect nursing home residents from doctors and other caregivers who would prescribe medications (both the types of medication and the dosage) in a manner that would create a situation of “chemical restraint” to exist for the resident.

— We ask God to raise up a new generation of individuals to work within the nursing home industry who will have a heart full of loving compassion for their residents.

— We ask God to provide an adequate number of caregivers — especially certified nurses aides and nurses — to meet the need within the nursing home industry…and we ask that God provide the grace to nursing home management to make sure that they are staffing their facility with an adequate number of caregivers at all times.

— We ask God to touch the hearts and minds of legislators who’s vote has been bought by contributions from the nursing home industry…may the personal greed of these elected officials be overcome by a desire for justice and true compassion for nursing home residents.

— We ask for a true miracle: That nursing homes owners, administrators and staff stop lying, “spinning” and deceiving nursing home residents, their family members and health care advocates — and state nothing less than the truth when they record information in the charts of nursing home residents.

— For the family members and friends of nursing home residents: may they have the willingness to regularly visit their loved one and courageously advocate for nothing less than compassionate and quality care for the one they visit.

— We ask God to give courage to every person who wittnesses abuse, abandonment, neglience or neglect of a nursing home resident so that such incidents are promptly reported to the state…we also ask God’s protection from retaliation surround those who do report such incidents…we ask God’s protection from retalition for nursing home residents who report incidents of harm caused by their caregivers.

Praying For Reform

FROM THE WEBSITE “NURSING HOME REALITY”

Post from Nursing Home Reality Blog

Babyboomers, enjoy your life while you can!

My mom passed away in a nursing home in Colorado on Oct 13, 2008. I miss her dearly. My moms story is like most on this website and I just want to say that this torture and neglect is going to continue until the corporate greed is halted. In order to hold these corporations responsible for hiring undertrained and underpaid caregivers in understaffed Nursing Facilities we as middle class people have to come up with the money to seek legal help. Unfortunately in my experience even when an attorney says “contingency” you still will have expenses. The rich don’t have their loved ones in these hell holes so don’t experience these acts. If they did they could afford to bring justice. It is a no win situation. I want to say the aides that cared for my mom were incredible but how can one or two aides care for 35 plus people with dignity and completeness? They can’t. Shame on these Corporations.

 

Cindy Salaski is pleased to present her first novel, THE NEGLECTED ONES.

Prominent landscape painter David Reid has just entered
the Twilight Zone.

After his mother is sent to a nursing home for rehabilitation, David soon learns the truth about Haven. Once a magnificent seaside hotel on the coast of Maine, the property is now managed by a greedy corporation and a nursing staff who neglect and abuse the residents. Dealing with the inept staff is an endless battle. And to make matters worse, David’s mother claims ghosts are haunting the facility.

Are the spirits hallucinations caused by her medications?

Or is Haven really haunted?

 

CLICK THE FOLLOWING LINK TO READ CHAPTER ONE OF
THE NEGLECTED ONES.

TNO CHAPTER ONE

Post from Nursing Home Reality Blog

I think the respect that elders get in nursing homes is a sad reflection on our country. There is no respect for anyone anymore.
Who cares that someone 85-90 or older lays in bed with no water, dirty clothes, no attention, no affection for hours and hours at a time. The little attention they are given is someone shoving food down them as fast as they possibly can because they are short of staff and too many elderly that need to be fed.
No one to do dental care – that takes too long.
No one to fix their hair – that takes too long.
Barely time to throw a little water over them in the shower, sometimes cold water, and no time to rinse them well. And the administration of Nursing Homes has the nerve to say they are well staffed. The nursing home where my father just passed away in and my mother still remains, had a total of 2 CNA’S for a third shift to take care of over 70 patients. No Nurses. Is that sufficient care? Even when they are well staffed by their standards, the care of the people is so substandard, we treat our pets much better than these people get. I guarantee you can go into any kennel in Kentucky and find the animals getting more attention and care than our loved ones get in a nursing home. What a sad world we live in when an Administration can go home and sleep at night knowing the patients are not being cared for sufficiently. They really need to put themselves in the patients place and see if then they would feel they get satisfactory care.

A day in the life of England’s bad nursing homes

A day in the life of England’s bad care homes

You may not want to think about it – but it could be where you, or members of your family, spend your twilight years. Want to know what it could be like?

The Telegraph is tracking how a day in the life of some of England’s bad care homes could compare to your day. Follow it below in real-time, with updates throughout the day.

8am: Time to get up or eat breakfast? Perhaps not. Relatives at one care home said they often found their loved ones still stuck in bed by late morning. Staff in Summer Lane Nursing Home in Weston Super Mare admitted to inspectors that sometimes they were still helping people get ready for the day at 4.30pm because they were so short-staffed, despite trying their best to reach everyone.

The home’s operator Country Court Care said there were some managerial issues with the home at the time of the inspection, which had since been resolved, with new, additional members of staff also recruited and an urgent plan put in place to deal with the issues raised.

8.30am: What about a shower? “I get a shower when they have time,” said one resident at High Peak Lodge care home in Lancashire, and at other locations records suggested residents had not showered for months.

Health professionals at St Nicholas Nursing Home in Sheridan, Norfolk, found residents with faecal matter under their nails – staff said they had to use ripped up pieces of towel to wash people because they had run out of flannels. One staff member said to inspectors: “Would you want you relative cared for like this? It’s not very dignified is it?”

Since the inspection, the Care Quality Commission (CQC) took urgent action to stop St Nicholas from providing nursing care and limited its resident numbers to 11 people. The operators of St Nicholas said in repeat visits by the watchdog, the home had shown improvements. “All families are happy for their loved ones to remain at St Nicholas,” a spokeswoman said. High Peak Lodge said it “welcomed” the feedback and stressed that it had adequate numbers of staff on duty, with the CQC commending it for providing “effective and caring support”.

At China Cottage Nursing Home in Doncaster, an agency nurse gave medication to the wrong person.

10am: Fancy a cup of tea? Great. The staff have brought you one, and at most care homes you either drink it alone or they help you drink it, and that’s where it ends.

But at Albany Care Home in Oxford, in inspectors found one resident in bed with half of a cold cup of tea, a stale piece of toast and two biscuits on the other side of the room, out of their reach. “A cup of tea would be nice,” they said.

A spokeswoman for Four Seasons Health Care, which runs the home, said: “We are sorry that Albany care home fell short of the standards we expect all of our homes to provide. We have accepted the CQC’s recommendations and have implemented a comprehensive plan of action…The resident who was still in bed at midday was there entirely out of her own choice and had made clear to staff that she did not want to get up. Tea and other fluids are served regularly.”

11am: You walk past the lounge and the offensive smell stops you in your tracks.

At St Nicholas Care Home, where the CQC has already taken urgent action (see above), one resident told inspectors the smell in the lounge, particularly on hot days, was “overpowering…but I’m afraid I’m getting used to it.”

12pm: Lunch time! Oh, sorry. Not for you – or at least that’s the case at a handful of care homes. You’re pretty hungry and no-one is coming to help – you’ve been waiting for nearly an hour – so you try with your hands. It’s gross, undignified and you can’t even get much. Inspectors saw this happen at several care homes last year, including one incident at Perry Locks Nursing Home in Birmingham.

A spokesman for Perry Locks said: “We are sorry this happened and now have a new home manager and deputy manager, and the issues have been addressed. We reassessed resident’s needs on the unit concerned and, as a result, increased staffing levels, especially to support people at mealtimes.”

1.30pm: Have a look out of the window. Imagine not being able to go out there…

At lots of care homes, staff are happy to take residents outside where they can. But at The Old Rectory in Colchester, a resident told inspectors last year: “We have been stuck in here all summer and can’t get out into the garden; the door is locked because of the dangerous tree branches. I have always loved being outdoors. Summer has passed us by.” At the time of inspection, there was no timetable for finishing the work to make the garden safe.

Paul Mancey, chief executive of Orchard Care Homes, which runs The Old Rectory, said he would personally visit the home to ensure the garden was accessible.

“It is incredibly important to be able to go out into the garden, and it’s really important to me personally that people have the opportunity to go outside. I am going to go and make certain that people do have access to the garden,” he told The Telegraph. A spokeswoman said the care home staff were still awaiting guidance from the council on the tree in the back garden, but pointed out that the front garden was accessible.

2.30pm: You need help getting to the toilet so you’ve rung your call bell. But no-one’s come. How long do you think it could take?

2.45pm: You’re still waiting and it’s 15 minutes later. Incidentally, 15 minutes is the length of time some care workers have to spend with people who need care in their own homes. That means sometimes people have to choose between having a drink, getting clean, or going to the toilet.

2.50pm Back in the care home, it’s been more than 20 minutes. At Sunrise Operations Tettenhall, in Wolverhampton, 14 people raised concerns over the length of time it took for call bells to be responded to. A member of staff said they were also worried about this, and were “shattered” trying to cope with their workloads. One person said they were so desperate to use the toilet that they tried to go by themselves, falling over twice in their bathroom in the last two months.

According to the care watchdog,1 in 5 care homes do not have enough staff to make sure residents get good, safe care.

A spokesman said: “The most important thing to us is the health and wellbeing of the residents we care for. We strive to provide the highest standards of care and take this matter extremely seriously. Following the inspection, we immediately implemented a comprehensive action plan, including a review of staffing levels. We look forward to demonstrating these improvements to the inspectorate. We work tirelessly to deliver the highest quality care.”

3.30pm What are you up to? In many care homes, there are plenty of activities for you to try, from trips out to games like dominoes. But at other care homes there were reports that people had nothing to do – with reports from Ottley House in Shrewsbury of most people just sitting in their armchairs all day with their eyes closed.

Inspectors said: “We saw one person kicking the door to try and get out. We saw people walking round and round the unit and no one spoke with them.”

A spokeswoman said the home had taken “immediate action” including training for staff, appointing a new general and deputy manager, and upgrading the facilities: “We would like to reassure everyone of our commitment to provide the highest quality of care to those residing at Ottley House and to emphasise that their health and wellbeing is at the forefront of everything we do and are doing.”

6.40pm: Tired? Inspectors arrived unannounced at Corinthian House care home, in Leeds, at this time. They found 39 of 52 people in bed. Two people’s doors were shut even though they were awake and making continuous noise. At another home, one member of staff told someone who did not want to go to bed: “If you don’t go to bed now, I won’t be back, I don’t have time for this.”

9pm: Thirteen hours – the entire time this experiment has been running – is how long some patients at a care home, which has now closed, were left entirely unattended.

This is not the case at every care home – many are run well and compassionately. But 33 per cent rated under new inspection criteria were rated inadequate or in need of improvements and 1 in 5 do not have enough staff to look after people safely.

Do you want to put up with that for your family or yourself? If not, pledge your support for our campaign, or email us your stories, here.

This “day in the life” story is part of the Telegraph’s Justice for the Elderly campaign, which wants to see radical changes in the training and licensing of care workers and an improvement to elderly care across the country. While we know there are lots of professional and compassionate care workers, still 1 in 3 care homes rated since October by the Care Quality Commission were either “inadequate” or “requires improvement” and the watchdog says 1 in 5 do not have enough staff to provide good, safe, care.

The stories on this page are all based on inspection reports from the Care Quality Commission published between October 2014, when a new system came in, and January 2015.

The Telegraph has contacted all of the operators of the different homes to find out what has improved since the inspections, and their comments have been included.

Want to tell us your experiences or support our campaign? Click here.