The past few weeks, I’ve been working in a skilled nursing facility with an active short-term rehabilitation unit. As is usually the case, the short-term rehabilitation unit is beautifully designed, modern, bright, new. However, there is a stark contrast with the long-term units which is appalling and screams volumes about how we think and care about the people who need to live in these settings.
The long-term unit is old looking, the walls are drab, the paint is chipped, the furniture in the rooms is often in disrepair, old, broken. There is nothing on the unit that is inviting; that says life, that says, this is the place you can call home.
I always feel somewhat complicit in a dysfunctional system when I return to work in these environments. My friends remind me that I am making a difference in individual people’s lives and hopefully, that some of the suggestions I make will make a difference, albeit a small one, in the bigger picture. Though I always lament returning, it is an important reminder of the need to fight for better care and treatment for those among us who need care today and who will need care tomorrow.
Now at age the age of 70, I am more and more surprised at the increasing number of people much younger than I who are relegated to living in these settings. Equally disturbing, is the people who are dismissed because they are at varying levels of confusion, and apparently ill and frail. They are thought to be unaware, and having nothing important to say about what they see going on around them and how they feel about it.
In thinking about writing today's blog, I'm sharing a few examples that speak to this directly.
A woman who was despondent over the fact that she is not only living in an assisted living community but now finds herself in this short-term rehabilitation setting which she described as looking beautiful but actually being horrible.
Her gown was torn, she was cold but was told they didn’t have another. She said the food was horrible. Her exact words, “how do they expect people to get well and stronger when they serve them this crappy food?” (A question I’ve asked many times)
A gentleman with Parkinson’s Disease who was alert, verbal and engaging became so lethargic in a few days after he was admitted that he couldn’t hold his fork or compete his meal. When I reported it to the nurse her response was merely that his vitals were fine. It was clear he had a drastic change in condition. I took it to the nurse practitioner who agreed to run tests, but more than the tests, she found he was taking thousands of milligrams of Depakote, an anticonvulsant to treat seizure disorders but it's also prescribed to manage the manic phase of bipolar disorder. Depakote side effects can be serious and sometimes fatal. This patient is neither bipolar nor has a history of seizures. The medication was withdrawn and he is now back to communicating and eating.* Likely most people don't pay him much mind which is a big mistake. He has astute observations about the environment.
*An important reminder question the medications prescribed for your loved one.
I told the nurse practitioner, that people would think neither of these two patients know what they are talking about. The reality is, people see, people know, people feel. If only people would listen and care enough to do something about what they are saying.
Another woman was admitted who recently had a stroke. Though paralyzed on one size of her body, and speech every so slightly slurred, she was alert, verbal and easily engaged in conversaton. When the nurse came to give her medication, it was wonderful to see the patient questioning the nurse about the pills she was about to giver her. The nurse seemed annoyed, It was obvious to both the patient and myself that she would have much preferred for the patient to take the medication without the questions. Furthermore, the nurse who was not a native English speaker, had a thick accent making it hard for the patient to understand what she was saying. I was glad to be able to help and explain what the nurse was saying. But what about the people who don't think to ask, who aren't capable of asking, who acquiesce because of the apparent annoyance, or who don't have someone to help explain.
A rather charismatic engaging gentleman in his 90s was admitted after falling in his daughter’s country house.
Though now in an entirely different part of the state, our roots stem from the same neighborhood. Our connection quickly became more familiar than professional when he told me he asked a question few people think of asking, “who owns this place?” He asked because for many years he lived in an area where many nursing homes with short term rehabilitation units were owned by a handful of companies with, shall we say, less than a stellar reputation for the care they delivered. Our conversation turned to the way older adults are treated and care for in these environments, but also in society as a whole.
He proudly informed me he cared for his wife who passed away from Cancer a couple of years prior that she never spent one day in an environment such as the one where we met.
The following story is one I’ve recounted this story to many people throughout the years. I also included it in my book; OVERDUE Quality Care for Our Elder Citizens. I am including it for its relevance to this discussion.
Who Do We See?
There he was, seated in a wheelchair, the right side of his face and mouth obviously drooping. He began to speak. The words were few and the sentences short. His speech was slow, somewhat slurred, and appeared to take great effort, but with careful listening, it could be understood. The voice sounded vaguely familiar, but his face was somewhat difficult to recognize. He had a severe stroke a little over twenty years ago at the end
of January 1996. At that time the doctors told his wife he most likely had lost the ability to speak. Not one to give up or be silenced, he endured daily speech therapy sessions for several months.
Finally, he did regain the ability to express simple ideas using short, simple sentences but had to speak slowly in order to be understood.
Now he is 101 years old. He had been an intense man with an extraordinarily successful career. One could hardly see that now. To the casual observer, not knowing his history, he was just an old man with impaired speech sitting in a wheelchair.
The audience erupts in applause. They rise to their feet, cheering wildly. The uproarious ovation reaches
a crescendo that goes on for several minutes until the audience is finally quieted and returns to their seats.
It is the nationally televised Golden Globe Awards. Who was this “old man” in the wheelchair that inspired such resounding acclaim? None other than one of the greatest actors of our time, Kirk Douglas.
The casual observer who might not know this motion picture legend would only see a frail man 101 years of age in a wheelchair with slurred and limited speech and probably pay him little or no mind.
Like so many other elder citizens in the community, in assisted living facilities, or in skilled nursing facilities, they would probably pass him by without a thought about his life, his achievements, his greatness, and they would pay little attention to anything he had to say.
See Me (a poem written by a nursing home resident)
What do you see, nurses, what do you see?
Are you thinking, when you look at me—
A crabby old woman, not very wise,
Uncertain of habit, with far-away eyes,
Who dribbles her 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 stocking or shoe,
Who is unresisting or not, let 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 looking at ME . . .
I’ll tell you who I am, as I sit here so still;
As I rise at your bidding, and 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 girl of sixteen with wings on her feet.
Dreaming that soon now a lover she’ll meet;
A bride 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 needs me to build a secure, happy home;
A woman of thirty, my young now grow fast,
Bound to each other with ties that should last;
At forty, my young sons have grown and are gone,
But my man’s beside me to see I don’t mourn;
At fifty-one more babies play ’round my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is 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 loves that I’ve known;
I’m an old woman now and nature is cruel—
’Tis her jest to make old age look like a fool.
The body is crumbled, grace and vigor depart,
There is now a stone where once I had a heart,
But inside this old carcass a young girl 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, nurses, open and see,
Not a crabby old woman, look closer, nurses—
“A society is judged by how it treats and shows compassion for those who cannot protect or fend for themselves. Black, white or mixed-race, there is an absolute duty of care owed to all. And anyone who wishes to exploit the plight of others for their own political or social purpose is beneath our moral contempt.” – Mahatma Gandhi, 1931
What can you do to make a difference in the life of an older person so they feel cared about?
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