PROJECTING THE PERCEPTION OF CARE AND CONCERN

 

OPINION:
As a resident of a state-run long-term care facility, I’ve been exposed to a management style  much different from my experience in the private sector.

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The most important characteristic of leadership is to convey the perception of competency and concern. Not only in the delivery of the final product or service but for the well-being of those employees that actually perform the one-on-one service. Visible leadership is essential at the time of adversity when employees are asked to perform above and beyond the ordinary. Employees and residents deserve and expect the same from management. To do otherwise creates a disconnect between management and employees and breeds disrespect, doubt and resentment.

During the blizzard of 2016 in Richmond, no member of leadership was on site to offer direction, leadership or control over the operation during the adverse conditions. Employees were told to risk personal safety and property damage to be at work. No “call outs” would be accepted! Confidence and respect towards management were shattered. If employees are considered “essential personnel” leadership, too, must be essential. Otherwise, why do we need management?

Visibility emits not only confidence and competency but concern for the outcome of the task at hand. It brings unity and strength towards the achievement of the goal: the comfort and care of resident veterans. Invisible leadership projects the image of incompetence and indifference.
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CRANKY OLD MAN

 

I ran across this from the National Consumer Voice for Long-Term Care and thought it should be shared.

National Consumer Voice for Quality Long-Term Care shared Max Philisaire‘s photo.

June 28 at 8:44pm ·

This has been circulating on Facebook for some time and has the feel of fiction, yet the sentiment it expresses of “see me for the whole and entire person I am” resonates across all long-term care. What do you think?

When an old man died in the geriatric ward of a nursing home in an Australian country town, it was believed that he had nothing left of any value.

Later, when the nurses were going through his meager possessions, They found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.

One nurse took her copy to Melbourne. The old man’s sole bequest to posterity has since appeared in the Christmas editions of magazines around the country and appearing in mags for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.

And this old man, with nothing left to give to the world, is now the author of this ‘anonymous’ poem winging across the Internet.

Max-Philisaire[1]

Cranky Old Man

What do you see nurses? . . .. . .What do you see?
What are you thinking .. . when you’re looking at me?
A cranky old man, . . . . . .not very wise,
Uncertain of habit .. . . . . . . .. with faraway eyes?
Who dribbles his food .. . … . . and makes no reply.
When you say in a loud voice . .’I do wish you’d try!’
Who seems not to notice . . .the things that you do.
And forever is losing . . . . . .. . . A sock or shoe?
Who, resisting or not . . . … lets you do as you will,
With bathing and feeding . . . .The long day to fill?
Is that what you’re thinking?. .Is that what you see?
Then open your eyes, nurse .you’re not looking at me.
I’ll tell you who I am . . . . .. As I sit here so still,
As I do at your bidding, .. . . . as I eat at your will.
I’m a small child of Ten . .with a father and mother,
Brothers and sisters .. . . .. . who love one another
A young boy of Sixteen . . . .. with wings on his feet
Dreaming that soon now . . .. . . a lover he’ll meet.
A groom soon at Twenty . . . ..my heart gives a leap.
Remembering, the vows .. .. .that I promised to keep.
At Twenty-Five, now . . . . .I have young of my own.
Who need me to guide . . . And a secure happy home.
A man of Thirty . .. . . . . My young now grown fast,
Bound to each other . . .. With ties that should last.
At Forty, my young sons .. .have grown and are gone,
But my woman is beside me . . to see I don’t mourn.
At Fifty, once more, .. …Babies play ’round my knee,
Again, we know children . . . . My loved one and me.
Dark days are upon me . . . . My wife is now dead.
I look at the future … . . . . I shudder with dread.
For my young are all rearing .. . . young of their own.
And I think of the years . . . And the love that I’ve known.
I’m now an old man . . . . . . .. and nature is cruel.
It’s jest to make old age . . . . . . . look like a fool.
The body, it crumbles .. .. . grace and vigour, depart.
There is now a stone . . . where I once had a heart.
But inside this old carcass . A young man still dwells,
And now and again . . . . . my battered heart swells
I remember the joys . . . . .. . I remember the pain.
And I’m loving and living . . . . . . . life over again.
I think of the years, all too few . . .. gone too fast.
And accept the stark fact . . . that nothing can last.
So open your eyes, people .. . . . .. . . open and see.
Not a cranky old man .
Look closer . . . . see .. .. . .. …. . ME!!

Remember this poem when you next meet an older person who you might brush aside without looking at the young soul within. We will all, one day, be there, too!”

 

Thank you…please comment and share.

 

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BULLYING IN LONG-TERM CARE

OPINION:

Bullying puts an emotional drain, not just on the target of such cruelty, but on those that witness such behavior and feel the pain in its presence. The casual onlooker is ill-equipped to intervene. The observer feels uncomfortable yet feels powerless to act. They see the bullying and remain silent. After all, it’s not their responsibility.

I am a witness to bullying every day, and it disheartens me. As I inevitably lose more and more of my understanding, will I become a victim of bullying—when my cognition weakens will I fall prey to taunts and ridicule from those residents around me? It’s a harsh reality on which to ponder as one grows older. I would be naive to think that the nursing home would shield me from becoming a victim. The nursing home staff is either not aware of the subtleties of bullying, or they just choose to ignore them.

Those people closest to the victim of bullying are not the best equipped to recognize and intervene…the trained staff of the nursing home. Other residents are complicit in the act of hurtful behavior toward the victim—joining in on the muffled snickers, laughter, and ridicule—not even aware of their actions.

Even those residents with the severest of disabilities will exhibit bullying on the weakest in the crowd to deflect attention away from themselves. To them, it is a show of strength and membership with the dominant group—a show of solidarity and tacit approval from the powerful. They will join in with their peers, mocking and making disparaging remarks. The most likely targets of such mockery are those that display delusional behavior.

The response from me is only a stern look of disapproval at such conduct.

The responsibility for eliminating bullying must fall to the nursing home administration. Emphasis must be placed on training the nursing assistants in identifying the subtleties of bullying. New hire orientation must include training done by in-house leadership to emphasize the importance. The training responsibility cannot be delegated! Those in leadership positions—department heads—must show their concern, and demonstrate that they are serious about bullying. The administration must be required to share the tools available to identify bullying and be proactive in quelling its pervasiveness. All staff members have to be able to recognize and feel comfortable reporting bullying to authorities without fear of reprisal.

Family members must play and active role. They must ask questions regarding the awareness levels of the administration regarding bullying. What kind of training, what frequency and what follow-up is in place? Inquiries must be made at the time of admission as to staff development programs and where the emphasis is being placed. Nursing homes must be able to document a continuing, comprehensive education and awareness regimen for those employees that come in direct contact with the loved one. Is the training spaced throughout the year or concentrated towards the end of the year to fulfill an administrative requirement? Is the nursing home proactive or reactive in their training program that identifies bullying? What role, if any, does the social worker play in the interaction between residents?  What role does the activities department play? The staff directly involved in activities should be trained specifically in identifying bullying behavior. Observe the activities. Does one resident continually dominate and control the conversation over other residents?  Are weaker residents being ignored or appear to be intimidated during activities or are they encouraged to participate?

All of the questions above will demonstrate whether the nursing home administration is aware of bullying and committed to its control and eventual elimination.

 

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MIGUEL: AN INSPIRATION

 

OPINION:

 

Miguel was born without front legs.  He came from the Dominican Republic to The Mia Foundation in New York.  The Mia Foundation is the only organization in the U.S. that solely rescues animals that are born with birth defects.  Miguel does not let his disability hinder him from living life to the fullest.  He is a happy, fun-loving little boy.

Miguel was born without front legs, He came from the Dominican Republic to The Mia Foundation in New York, The Mia Foundation is the only organization in the U.S. that solely rescues animals that are born with birth defects. Miguel does not let his disability hinder him from living life to the fullest, He is a happy, fun-loving little boy:

Miguel inspires me with his limitless strength and spirit.  A little living being with an abundance of enthusiasm and happiness.  He shows complete disregard for his shortcomings and lives his life with boundless energy and joy.

I have wondered how he can live with a disability without knowing he has a disability.  Is living with a disability a learned behavior?  Someone forgot to tell Miguel that he was supposed to have two front legs.  He must wonder how his playmates function with those appendages hanging from their shoulders.

I have become a paraplegic, losing the use of my legs very late in life, and Miguel is an inspiration—an inspiration helping me cope.  Coping, not with my disability, but with my modified mobility.

Thank you, Miguel.

 

A disabled veteran

 

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ADVOCACY: A RUDE AWAKENING

OPINION:

I am a resident in a nursing home. I am also the “responsibility party.” That designation means that I, and I alone, control my destiny while adhering to the policies and practices imposed by the nursing home. Policies and practices under which all residents and nursing homes must adhere. The policies and practices are outlined by the Centers for Medicare/Medicaid Services Manual—the U.S. Government. These guidelines are designed to protect the resident from abuse and assure that they receive the medical and palliative care they deserve. In the case of most residents, a family member, attorney, or a trusted friend is the responsible party. This is because most residents in nursing homes are perceived to have suffered a cognitive decline and are no longer able to carry out financial transactions or make sound decisions that affect their well-being. It is the “responsible party” that makes those decisions while conforming to the safety, comfort, and security of the resident.

As such, the relationship between the resident and the “responsible party” must be one of trust, understanding, and advocacy. The responsible party must have an intimate knowledge of the history, habits, and wishes of the resident. That is why the “responsible party” is usually a caring, involved, knowledgeable, family member. Unfortunately, this is not always the case.

I attended a “Family Council Meeting” as a resident/responsible party. Since my nursing home has 160 beds, my expectation was that the community room would be filled close to the capacity. Surprise, surprise! Initially, it was me and four other individuals. We were later joined by four others. Two of the other eight were individuals associated with the same family member. In total, only seven residents were represented. Seven residents represented out of a potential of 144 if the facility is filled to 90% capacity. Just under 5% of resident’s family members showing interest.

This is a grim statistic if it realistically reflects family interest and involvement. Significant regarding the level of accountability demanded of nursing homes. I see many family members frequently visiting residents, celebrating birthdays and holidays—some even come daily—showing genuine concern for their loved one. I also see family members discussing issues with nursing assistants, nurses, and social workers. These one-on-one conversations have little effect on the overall governance of the long-term facility or the care received by the resident. There are just too many different individuals involved with the care 24/7 to talk to one CNA or a charge nurse. At every shift change, someone new will take over, communication between shifts is weak, and accountability will be entirely different.

If this is indicative of the apathy in terms of concern for a family member in long-term care facilities, seniors are in big trouble. Older adults are left in the hands of a culture dominated by management more interested in meeting administrative and financial needs than the needs of the residents. Older Americans face a future with little support and even less advocacy.

Advocacy groups, although well intentioned, face an uphill battle with such apathy. As it turns out, advocacy groups may be the only hope for the aging population as family members couldn’t care less. Family members are glad to shed the responsibility of an aging family member and place them in long-term care thinking that they are getting the best care possible. The long-term care facility will make all the assurances in the world and paint an optimistic picture, but this is a well-crafted illusion. Some admissions personnel are not aware of what goes on in their facility. Department heads will shield the administrator from reality while ensuring their job security. Administrators are in denial—after all, their primary responsibility is fiscal in nature—filling the coffers of the corporation.

If families turn over the care of the loved one to unknown entities, why not give the advocacy responsibility as well? The evidence in my sample shows this is what’s happening. Unfortunately, advocates are underutilized and overworked.

The enemy faced by the elderly is silence. They are in a place where they have no voice. The professional advocate may be the only resource available; a well-intentioned,  underinformed, and overworked substitute family member. The information about the advocate, the name, contact phone numbers, and mailing address are all given to the responsible party during the admissions process or posted on an obscure bulletin board, soon to be forgotten.

The involvement of family members, as shown in my experience, has been superficial, assumptive, and depressing. Family members were given the opportunity to discuss their concerns and quality of care with the Director of Nursing or her assistant openly, yet less than 5% of the residents were represented. Is there a communication breakdown? Will no one listen? Nursing homes are reluctant to place undue emphasis on advocacy involvement for fear of operational meddling.

An advocate, no matter how good or how dedicated, cannot not know the life history, the habits, what gives the resident pleasure, the feelings, of every resident. At best, it is merely a temporary bonding. Lacking is the established and reinforced trust, confidence and intimate knowledge of the resident’s past, present, and future aspirations. The professional advocate can offer only sympathy, but no empathy.

A feeling of fear, emptiness, isolation, anger, and abandonment fill the soul of the resident.

Absent is any mechanism that offers meaningful, lasting, social support.

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ENDANGERED SPECIES

OPINION:

McGuire Veterans Medical Center endangers forty additional veterans. Security, safety, and needed emergency services are being jeopardized.

With the completion of the new forty-bed wing at Sitter and Barfoot Veterans Care Center, it brings the total to over two hundred employees and veterans at risk.

Sitter and Barfoot is a long-term facility for veterans honorably discharged from active service that need rehabilitation or long-term skilled nursing care. It is a nursing home.

Sitter and Barfoot is situated on the property of McGuire Veterans Hospital, yet security and emergency response falls to the Richmond City Police, Richmond Fire Department, and outside or city ambulance service.

In what could only be attributed to a cost-saving effort, the most direct route to Sitter and Barfoot is through a gate that is closed and locked at dark, and twenty-four hours a day on weekends, and holidays. The locked gate impedes all emergency vehicles; ambulance, fire, and police. This mistake causes emergency responders to take a more circuitous route through McGuire’s main entrance, putting over two hundred of the most vulnerable veterans and state employees at risk. Veterans that suffer from dementia and Alzheimer’s; many are unable to walk, and all suffer from medical conditions requiring skilled nursing care.

It is a fact that in an emergency, every second counts. The closing and locking the gate slows the response time for all emergency vehicles responding to life and death conditions—delays with dire consequences. Life-threatening delays.

For the safety, security, and well-being of employees and aging veterans, it is critical that Sitter and Barfoot be patrolled and the gate open 24/7.

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RESIDENTS’ RIGHTS: LONG-TERM CARE

OPINION:

RESIDENTS’ RIGHTS: LONG-TERM CARE

Ignoring residents’ rights is the most common form of abuse found in long-term care facilities. It goes largely unnoticed and unreported. It doesn’t leave bruise marks or fractures, but it can be equally insidious and painful—leaving permanent scars on the mind.

Residents’ rights are written on paper and trashed by the administrators of long-term care homes. They are considered trivial and get in the way of their day to day operations. Much more essential to management is meeting financial and administrative objectives—glossing over residents’ rights knowing that such abuses are difficult to detect and harder to prove.

The elderly are a commodity. Keep them comfortable, make sure they’re given medications, they’re clean, fed, hydrated; make sure they don’t fall and control and contain all grievances.

Nursing homes smooth over residents’ rights complaints using vague and elastic terms. They use words like: typically, generally, many, and few, when answering questions. The administration will avoid specifics at all cost. Direct, honest answers will not be forthcoming. The intent is to reduce all accountability on the part of the long-term caregiver.

Long-term care providers get away with these abuses because residents are thought to suffer from cognitive deficiencies or have delusional thoughts brought on by medications. That’s why abuse of residents’ rights is so pervasive. Residents are intimidated and given misinformation from perceived figures of power. They only believe what they are told. Residents don’t know the alternatives and don’t question authority.

I have raised my concerns to the administrator. They have been met with insincere and condescending responses receiving attention for only the short-term—then ignored and quickly forgotten. Rights abuses are trivialized and left unresolved. The trust between me and the administration has been severed.

I served my country with honor—to protect and defend the Constitution. Now my inalienable rights have been stripped from me.

I am a resident of a long-term veterans’ nursing home. I have no cognitive impairments. I am my responsible party, and my rights are being abused.

The abuse of my rights has left no visible signs—no bruises, no broken bones. However, the emotional scars; the anger and the frustration can never be erased, forgotten, or forgiven.

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NOT IN DEFENSE OF DONALD TRUMP: THE BIGGER ISSUE

 

OPINION:

The comments made by Donald Trump are indefensible, yet they were his thoughts. He has a right to his opinions and is free to express them. That is why the founders of this country were adamant about the First Amendment. That is also why they used the phrase, “We the people….” in the Constitution.  They didn’t say, “We the corporations….”

Intimidation, money and power are the favored tools of censorship. We cannot let the corporations dictate what we can and cannot see or hear. Particularly the communications companies that virtually control the flow of all information we receive ( Univision,” has the largest audience of Spanish-language television viewers in the world, according to Nielsen Media Research.”). There is no distinction between government censorship and monopolistic corporation censorship.  Mainstream media already caters to the whims of government as to the content of the information we receive.

We are entering the gates of the proverbial slippery slope if we allow major corporations to censor what we, as individuals, shape our opinions. We, as the people, have the right to hear and see what we think is an appropriate source of truthful information and entertainment. It is naïve to believe we cannot decide to boycott Donald Trump shirts and ties or not buy the products that sponsor Celebrity Apprentice and the Miss USA Pageant. Those decisions should be left to the free market and the people.

Recognize too, that media corporations have the right to choose those people they do business with.  But, they too, have an obligation to the consumer to present fair, objective, and occasionally entertaining content. All too often, mainstream media acts as irresponsibly as those of the ilk like Donald Trump. I find their actions as deplorable as surely as I would find government censorship.

I will miss Celebrity Apprentice. I found the program marginally entertaining and sometimes a welcome distraction from the usual dribble found on network TV.

Donald Trump’s words and expressions offended many people. Let those that were offended dictate the consequences without the help of controlling corporations. Corporations seize influence and favorable legislation through powerful lobbying machines. Corporations do not—and should not—manage public opinion or the creative process through intimidation and censorship. Censorship is censorship regardless of who does it.

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POOH: NO GOODBYE

POOH

The morning had begun as most mornings. I had gotten up, shaved, dressed, and prepared myself to face the day. The events of the past week and the decision I had made the previous night preoccupied my mind.

POOH'S PORTRAIT

Pooh, my Bengal cat and my sole companion for the past 10 years, patiently waited on the counter top for whatever was to be her breakfast snack. I could tell by her excitement that she had smelled the bacon cooking in the micro-wave. This morning she would snack on the little, crispy pieces.

I sat at the table trying to relax, drinking my coffee, my mind flashing back to the past week, and trying to anticipate the events that were about to unfold.

I had cleaned up the breakfast dishes and was about to resume watching the morning news with another cup of coffee, Pooh soft and warm in my lap, when I heard the anticipated knock at the door. I went to the door to let them in, and Pooh, as usual, scurried to the bedroom to evaluate the situation from a distance before making her introduction.

The EMTs positioned the gurney in the middle of the living room, “…you ready?”

“Yeah.”

I backed towards the gurney, placed my hands palms down on the side rail, and boosted myself on to it. I saw Pooh, cautiously trying to assess what was going while standing in the bedroom door.

There was no way of knowing what the future was to hold; the emotional scars and emptiness that would be left.

Pooh would never see me again.

 

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RESIDENTS AT RISK

OPINION:

Sitter and Barfoot continues to place residents and employees at risk through its poor hiring practices.

In the last three months, new hires have been put through five days of orientation and worked on the floor caring for residents only to be let go after failing background standards.

Most recently a new hire, not even completing his fifth day of orientation, was caught sleeping shortly after clocking in.  When confronted with his indiscretion, he became belligerent and confrontational to the extent that the Richmond city police had to be called to escort him from the building. Because of his erratic behavior co-workers had become fearful for their safety.

City police complained that they had to take a circuitous route because the main gate to Sitter and Barfoot was locked closed. The gate is secured every night and twenty-four hours a day Saturday, Sunday, and Holidays. This causes unnecessary and dangerous delays in all emergency response times, further putting residents and employees at risk.

These conditions are exacerbated by the anticipated opening of a new forty-bed unit and the rush to get it opened on time in July.

Sitter and Barfoot has a history of poor hiring practices and keeping quality personnel for the non-traditional shifts. This condition has worsened in recent months.  Going back as far as 2010 and 2011, Sitter and Barfoot has shown a lack of concern in their hiring practices.  The Virginia Department of Health, the ineffective agency that inspects nursing homes, noted in their June 10, 2010, annual surveys that: “At time of job offer the H.R. Department will confirm verification of license/certification is in the personnel file.”  The Department of Health further stated that: “If the verification has not been obtained/confirmed the new employee will not be allowed to work.”

Those directives had not been addressed a year later. On June 23, 2011 the Health Department cited Sitter and Barfoot again with the following:  “This requirement is not met as evidenced by:  Based on staff interview and facility documentation review, the facility staff failed to operationalize [sic] policies for screening employees for 3 of 5 employees (CNA A, LPN A, other B) in the survey sample.  The facility staff failed to conduct background check, reference checks, and timely licensure verification.”

Apparently, the leadership and the administration of Sitter and Barfoot did not take the safety and security of residents and employees seriously in 2010.  They took the recommendations of the Health Department and did nothing—they provided no action or follow-up.  Now, five years later, it appears little has changed.

The Department of Veterans Services, the state governing authority over Sitter and Barfoot, continues to collect state paychecks oblivious to the risks at their nursing home. They too are complicit in the neglect of veterans and in doing so, should be held accountable.

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