'Be anxious for nothing..." ~Philippians 4:6

Tuesday, January 30, 2018

CAREGIVER DIARIES: THOUGHTS


1. My appreciation for those who do help has to be greater than my disappointment about those who don't.

2. Sometimes you have to lower your expectations...or not have expectations at all. Let people surprise you.

3. When inconsideration and thoughtlessness has been allowed, it will continue. Although people may expect you to tolerate what they never would, it doesn't mean you have to.

4. What some people considered a great help, or a significant contribution, actually created extra work and unnecessary expense for someone else. They'll never acknowledge it. Sometimes, you have to be specific about what is needed.

5. People you don't trust cannot comfort or support you. That doesn't mean there's nothing they can do in the situation. Let them.

6. When people don't care about you, don't expect them to care how their actions impact you. How you respond, however, matters. Maintain your peace.

7. Sometimes confrontation is your best option.

8. Preserve your peace and space. Boundaries matter.

9. Continue your routine, regardless. Always have an exit strategy. You need rest. Get it.

10. Actions will determine purpose and intention. What people say they're going to do, and what they actually do helps you to know what you must continue to do, or whether you can relax and take a break.

11. The gravity of a situation will never be felt by someone who is detached from it. Do the right thing first, explain later.

12. There is always something that can be done. Unfortunately, too many people believe that something is nothing. Don't become preoccupied with that. Remember the team of willing, consistent workers.

13. The value of "Is there anything I can do" is priceless.

14. Don't expect people who don't know you to know what is important to you.

15. Love and respect yourself more than others disregard and hate you.

16. Remember the principal thing, and stay hopeful and vigilant.

17. Once you recognize the distractions for what they are, you'll never be blindsided again.

18. Meditate on what will consistently strengthen and encourage you.

19. Smile more. It does something for your insides.

20. Never abandon the company of, or conversations with true, good friends.

21. Appreciate thoughtfulness and random acts of kindness.

22. A good and timely word is a good and timely word--no matter who offers it.

23. The things and people you love and like are still there. Reach out. Be inspired.

24. Look back. God has never failed you.

25. Music is a powerful catalyst. Use it.

Sunday, January 28, 2018

CAREGIVER DIARIES: QUESTIONS

Dad came home for a day.

I wondered Friday afternoon, as he was being taken from the specially equipped vehicle, "Where is the legion of people who would be helping me care for him?" 
I had imagined a happy band of people clad in gleaming white garments. There would be a doctor, nurse, PT, OT, CNA, chef, chaplain, masseuse, psychologist, and even a rep from Merry Maids. They would all pour out of a large vehicle like clowns in a circus show, armed with their tools and supplies and I would happily show them where they would all sleep. 
It was not to be.

Once Dad was wheeled into his room, the driver left. There Dad was, clad in his coat and hat, and pajama pants. He was looking around sleepily, and finally realizing he was in his own room. If not for two family friends who happened by, he wouldn't have been transferred to the hospital bed that had been delivered and assembled the night before. There was no transfer board; no bands to use; no hydraulic lift, just the upper body strength of two men.

One friend took Dad's suitcase to the laundry room for me so that I could wash the clothes inside. Each of them asked if there was anything I needed before they left. They brought back Glucerna shakes, straws, and bananas. I couldn't think of anything else I needed from a store. What I needed most was skilled, medical help. 
Things are different now. very different. Dad is an amputee.














Most caregivers may feel as if they should get an honorary medical degree based on their experience alone. Caregivers learn and do what they have to, but it is a harrowing feeling when you're tasked to do what you are not trained or qualified to do.

I kept thinking to myself, "Dad's home." 

It was like bringing home a new baby, only the baby was 150 lbs. and could talk. 
I thought about all of the things that were done all day, by multiple people, when he was in hospitals and skilled nursing facilities. People were taking shifts. They had equipment. They were doubling and even tripling up to get things done. 
Once again, after almost 6 months, it was just the two of us again. 
"Where is everybody?" I thought.

I laughed and was proud of myself as I wielded that big hammer and broke down the bed frame of the bed my parents had shared for years. 
In anticipation of Dad coming home, there were things to do. 
Moving the mattress and box spring to the basement was even funnier. I could almost hear Ross Gellar yelling, "Pivot!"

All the while though, and for a long time, I was keenly aware that I was alone. I was kind of proud of myself, though, for just plugging away and getting it done. I reminded myself, however, that I was no longer the 17-and-a-half year old who moved into this house in 1978; who could take two stairs at a time, and do cartwheels in the backyard. 
I had to pace myself.

I didn't sleep much the night that Dad came home. I left my room downstairs, and slept in the bedroom next to his, but I kept waking up to check on him. Someone suggested I buy a baby monitor. 
Every time I went to check on him, he was sleeping peacefully but the urine in his foley bag looked abnormal. 

The nurse who did eventually come, had checked him thoroughly, but she, too had left after telling me she'd see me in a couple of days. 

I logged on to Facebook. My high school friend Donna was awake, too, and sent me a Facebook message to let me know she was available to talk if I needed to. I needed to, and she kept me company on the phone until about 3 AM. 

I woke up again at 6:30.

Dad was awake. but too weak to sip water through a straw. I fancy myself an encouraging person, but none of my soft-spoken prodding and pleading was working. I popped in and out on him, and finally moved the high stool from the kitchen to his room just sit with him. My back hurt. 

The oatmeal, water, banana, and Glucerna were just sitting there. I resorted to putting water on a teaspoon and putting it to his lips so he could sip. 
I was happy when I noticed him swallow. I looked at his Foley catheter bag several times. I'd seen that cloudy, orange sight before. 

At around 10 AM, I got myself together. I heard the nurse's voice in my head, "You have to be your father's blessing", Fatmata told me.
“There are times when you have to make decisions and not care what other people think. You are here with him. You know what you see". 

I saw a man who should be getting professional care. 

"911 is always an option" has been a motto for a long time. I heard my phone ding. It was my cousin Frannie. She was crying. She told me how she'd been awakened by a dream. Her words were confirmation to me. 
I dialed 911. 
The paramedics arrived quickly, were kind, compassionate. and decisive. They told me that the nearest hospital was "closed". 
"We're taking him to Southern Maryland".

I followed the ambulance so closely, I have no idea what roads we took to get there. When Dad got to the ER, my stress disappeared. When I saw my daughter's face, my heart leaped. When I saw those IV bags, I knew Dad would be okay. Hydrate a person, and they'll have strength to do everything else. Fight infection, and a person can function. 
I knew he would be helped and more alert in no time. 

Kristi, one of the nurses in the ER. brought me a large cup of ice water. It was nice that someone thought about, me, too. 
As I watched everyone who laid hands on Dad, I knew they believed there was something they could do. Their movements were fluid. They were determined. 
I leaned back in the chair and relaxed. 

I have no patience for naysayers and quitters when it comes to seniors and children. When it comes senior citizens, they need advocates and cheerleaders; people who are aggressive and positive; people who don't just throw their hands up, but when they do, they grab whatever they know will work and turn a situation around. 
Seniors need people who believe they are valuable, indispensable, and capable of long life--provided they are given the help that will promote it. They need cool-headed, knowledgeable, confident, reassuring, able-bodied people who aren't indifferent, and whose strength doesn't peter out at the same time theirs does. 

Families need advocates too--not people who make them feel they are on their own; not professionals in name or title only. Families need people who have ready answers and solutions; not people who leave them bewildered and overwhelmed.

Years of being a caregiver have taught me many things. One is that America's health care system is broken in ways that are not irreparable. I know excellence exists because I've seen it. 

I have so many questions:
Why are people discharged from hospitals and skilled nursing facilities before they are well?
 
Why are there so many differing opinions about how, when, and whether to treat and cure a thing?
 
Why, when there is a known condition, are patients sent home to be cared for by amateurs, loving though they may be? 

Why doesn't every community have a state-of-the- art hospital, staffed by competent medical professionals? 

How can funds be found for casinos, monuments, stadiums, and museums, but not hospitals

Why aren't substantial scholarships given to high school students who seriously seek to become medical professionals?
 
Why aren't high school students who live in communities where hospitals exist, given incentives to pursue careers in health care? 

Why don't we pay those who deal with the ailing and elderly, a wage that demonstrates that we value what they do? 

Why is a skilled nursing facility EVER understaffed? 

Why do some people in skilled nursing facilities seem to be happy to hear the letters DNR? 

Why do we treat family caregivers like slaves and indentured servants?
 
Why don't we think that family caregivers need personal resources, and respite? 

Why do family members have to camp out daily in the rooms of their loved ones, in order to make sure they are being cared for properly by people who are being paid to do so?
 
Why, even when your loved one is in a skilled nursing facility, do caregivers feel as if they have another full-time job in visiting every day?
 
Although I am a fan of handwriting, WHY is information not being stored in computer files in some places so that it can be easily shared from one facility to another?
 
Why doesn't every hospital have a wing that includes a skilled nursing facility and rehabilitation center, so that when patients are discharged from their hospital rooms they can be easily transported within the building. or complex? 

Why, if the tools are available, are resources withheld from patients? 

Why is doping patients the go-to method for understaffed facilities? 

What is being conveyed and taught concerning work ethic to physical therapists, that CNA's need to know? 

Why are substandard skilled nursing facilities allowed to continue to operate? 

Why is the place ANYWHERE where food is prepared ever filthy and filled with clutter? 

Why is the food in some skilled nursing facilities and hospitals so abysmal?

Why are people who don't want to work at all working at skilled nursing facilities? 

Why aren't patient's wounds being treated when, and as they should be? 

Why are people showered so infrequently? 

Why is there no full time physician, podiatrist, psychologist, etc. on staff at every skilled nursing facility? 

Why is the weekend crew ever less skilled than the nurses and CNA's who work Monday through Friday? 

Why aren't people turned in their beds so that pressure sores won't occur? 

Why, all over the country, are elderly people sitting crooked, and sleeping for hours in wheelchairs when their legs should be elevated? 

WHY does the doctor assigned to a nursing facility only visit once a week? 

WHY don't doctors make house calls any more? 

WHY don't primary care physicians make rounds any more? 

Why do people, who don't like people, insist on working with people? 

Why don't people answer when patients push those buttons they are instructed to push?
 
Why are incompetent people hired--on ANY job? 

Why are some facilities top notch (shout-out to Inova) and others suck? 

Why does a veteran EVER have to do anything except show up at ANY hospital, ANYWHERE and be treated immediately and thoroughly? 

Why is money and profit the bottom line when dealing with the health and well-being of human beings? 

WHY is there so much red tape? 

Why are people so quick to say there's nothing they can do? 

Why is everyone so freaking litigious? 

Why are people afraid of doing what's right and prudent? 

Why are family members left feeling it's all on them? 

WHERE IS THE CARE IN HEALTH CARE?
















I felt better when I left the hospital yesterday. Dad is getting the care he needs in the place where he needs to be. 

It was bittersweet that he only spent a day at home. He smiled a lot through his sleepiness at the thought of being home, but he needed to be in a hospital

His nurse, Felix was kind and thorough. "I look at him. He could be my father, my papa, and I should care for him as if he were my own; as if he was in my own family. A patient deserves compassion. That is what I believe. That is how I see it." 

That's how everyone should see it.

I slept well last night…finally. 

Saturday, January 6, 2018

CAREGIVER DIARIES: MESSAGE IN THE MOVIES










They've been given direction. They see their goal in the distance. They've been through a lot. They have left all, and sacrificed. They are almost there. 

The self-absorbed Wicked Witch sees them, too. She sees the harmony, friendship, peace, trust, respect, and cooperation they have established. Infuriated and miserable, because she can't get what she wants, and no one is acknowledging her, or her perceived power, she casts a spell to stop their progress. "Poppies. Poppies will make them sleep." she cackles.

 As they run happily through the poppy field, under sunny skies, the motivated Scarecrow urges them: "Come on! come on!" 
Dorothy, however, is the first to be overcome by the toxic fumes. 
"I can't run anymore. I'm so sleepy! I have to rest for just a minute." she says. 
Toto falls asleep, too. 
The Tin Man, sensing defeat, begins to cry and rust. 
The Lion yawns and collapses saying, "Come to think of it, forty winks wouldn't be bad." 
The discerning Scarecrow shouts, "This is a spell, this is!" 
The Tin Man answers, "It's the Wicked Witch!" 

Unaffected by the poppies, the Scarecrow and Tin Man both begin yelling, "Help! Heeeeeelp!" 
Glinda the Good Witch appears, hears their cries, and doesn't  say a word. She just smiles, waves her magic wand, and causes snow to suddenly fall. The snow blankets them all, and the Scarecrow cries, "Maybe THAT will help!" 
It does help. 
The cold of the snow quickly neutralizes the poppies, and revives those who were asleep. The Lion looks around and remarks, "Unusual weather we're having, ain't it?" 
They dust themselves off, and continue on their way even more determined to reach their goal.

From a distance, in her castle, watching in her crystal ball, and realizing her scheming against Dorothy has failed yet again, the Wicked Witch shouts, "Curses! Curses! Somebody ALWAYS helps that girl!" 

I love that line. It gives me such joy. Think of your own circumstances. Look back. "That girl" who "somebody" is always helping, to the dismay of others who plot and scheme, and would rather see her fail or fall, is you.
 
#shoutnow  
#yourewelcome  
#thatfilmisanointed  
#noweapon  
#nodistractions

Friday, January 5, 2018

IT'S COLD OUT THERE

For the first time in a long time, December and January weather has been the stuff of childhood memories. We've cruised through mild winters for a while, so I guess it's our turn for lower temperatures in the DMV. I'm so grateful for shelter. The wind has been quite animated.
If you're venturing out, layering is your friend, and on days like these, particularly at the end of the day, a nice mug of dark chocolate cocoa is, too. 
Now, if I can just find my favorite left, black leather glove. Thank God for pockets...lol...
Stay warm everyone.

#itsthelittlethings

FRIDAY THOUGHTS: LESSONS IN THE NEWS
















Every day, political news stories teach valuable lessons.

Many people will align themselves with anyone if they think there's a shared interest or common enemy--including people they don't like, don't respect, have maligned, ridiculed, or criticized. 
To advance their cause, they will seek out people they think are gullible to do their dirty work for them. 
They will feed them lies and nonsense, get them all fired up, send them on wild goose chases, cause wastes of time and resources, deliberately fracture working and personal relationships, and launch campaigns against others--and then they sit back and wait for results. 

When nothing materializes, tables turn, and truth is revealed, however, many realize that the person they picked to do their bidding may not be as stupid, willing, or loyal as they thought. They soon find that their supposed ally has an agenda, too--and a mind-- of his or her own.  
In frustration, many people will throw their supposed friends and colleagues under the same bus they hoped would run over their adversaries. 
It would all be so amusing and entertaining to watch if it weren't so sad. 

Be careful whose side you take, and whose cause you support. Think. Stand on the side of righteousness even if you have to stand alone.

Miss Maya was right. "When people show you who they are, believe them-- the first time". 

Grandmothers everywhere were right, too: "A dog that will bring a bone will carry one", and "If you lie down with dogs, you get up with fleas."


#noweapon
#stayfocused 
#thinkforyourself

Thursday, January 4, 2018

CAREGIVER DIARIES: PEACE OF MIND

















I'd made an appointment for today, and knew I'd have to get up a little earlier than usual. 

I slept well last night. Sleeping through the night is a blessing.
I'd come home encouraged yesterday. I'd sat in on my Dad's physical therapy session, and although he was a little tired, he cooperated with the new therapists. He even stood up again.

This morning, it was easy getting out of bed. I'd gone to sleep listening to an outstanding interview Steven Furtick conducted with T.D. Jakes. I detected a bit of a spring in my step.

I went to the bathroom, then came back to my room and turned on the light. That's when I saw it. A spider. It was just sitting on top of my tunic I'd left at the foot of my bed last night. 
Yes. I annihilated it...with a towel. I smashed it on the tunic and then it fell onto the floor-- where I finished the job. The color of my carpet created a dilemma. "Where is it?" I thought. I looked closer at the spot I'd pulverized, and there was the spider looking like Beetle Bailey after Sarge had tied him into knots. 
Now I have a towel to wash...and a tunic...and a spot to clean...because they all have spider juice on them.

I laughed at the situation...then got all churchy deep, 
"When the wicked, even mine enemies and my foes, came upon me to eat up my flesh, they stumbled and fell.." 
That's Psalms."
 
I wondered how long that spider had been there. 
I wondered whether it had repelled from the ceiling, and was so glad it hadn't landed on my face as I slept. I wondered how long it would have taken for it to crawl from the foot of the bed, under the comforter, and onto my skin. How close had I been to being bitten? Was it just trying to flee the cold? How was it that I turned on the light at that precise moment and saw it? 
Of all the things I could have focused my attention on in the room, I zeroed in on that spider. I had no notice or warning. It had quietly come into my space and was just sitting there watching; waiting. Potential danger and trouble was near; poised and perhaps pondering to do me harm, but I was allowed, directed, inspired even, to see it first, assess its intentions, and be rid of it...immediately before it had a chance to impact me. Of course, I did all of that analysis after it was dead.
There would be no mutually satisfying cohabitation with an adversary. It would not be welcomed with open arms or a smile. I would not be finding an empty salsa jar and making it a pet. I wasn't glad to see it. It's comfort was not a priority. One of us had to go, and it wouldn't be me.
"It's time to secure the perimeter", I thought...and laughed. 
"Some time today, I'll get out the shop vac to vacuum the baseboards, ceiling corners, and window sills...and I'll break out that can of Raid under the kitchen sink, too. If there was one spider, surely, there's another one...or two".

I intend to sleep well again, tonight...and tomorrow, Lord willing.

A friend recently told me, "The enemy knows how much you value peace, that's why he's working so hard to use people, things, and circumstances to disturb it. But you have to remember the promises you have, and stay focused. Don't be distracted. You're well equipped to handle anything he throws your way."  

Like the spider, the snow that fell during the night was a surprise, too, but not a deterrent. It was the kind that could be easily moved with the broom. The wind even helped. 
"No distractions" I thought. 

#itsbeenagoodday

THURSDAY THOUGHTS: WORK ETHIC

"A lot of people don't want to work, they just want to supervise; you know, tell everybody else what to do. 

Who put you on the job? Remember that. Why are you worrying about anybody else, or what somebody else is saying? 

The supervisor is there for a reason. I was a supervisor. I know authority can be delegated-- not responsibility. 

Follow directions. Know who your supervisor is; that's who you get and take orders from; that's who you report to--and it's good if they have an open door policy. You got a problem? Go to THEM. 

You are an individual. You're not a twin. You're not on the job to make friends. If you do, that's fine, but that's not why you're there. 

People say they want a job, but then they want to revolutionize it. No. You show up. Do your best. Do what you're supposed to do. That's all you can do. Do YOUR job. That's all I got to say." 
~My Dad

THOUGHTS








Maybe we're all just guessing
And nobody really knows 
Maybe we're all just stressing 
And not sure how anything goes
Maybe we're all just messing about 
And don't see we're wasting time
Maybe our no's and our yessing 
Aren't worth a thin dime 

What if we all just stopped 
And decided that we would be 
Patient, honest, and careful 
Admitting deficiencies
When we don't know, just say it
And when we've reached our end
Say we need help, and receive it
Not break when we're supposed to bend
Not feel anxious when there's nothing to fear 
Not speak when there's no need to defend
Not rush there when it's more healing here
Not hurt when there's a hand we could lend

Sometimes you just want to go mute
Find a safe corner and just sit still
Clear your mind of all that's inside swirling
And surrender it all to the will
Of one who's been waiting and watching
But not one leave you alone 
But just waiting for an invitation
To grant joy and peace you've seldom known 

VRW 2018

Tuesday, January 2, 2018

CAREGIVER DIARIES: HEALTHCARE



















Senior citizens desperately need advocates. They need eyes and ears and hands to help them navigate the health care system on which they depend. Fortunately, the letter I drafted never had to be sent. A conscientious EMT made an executive decision that, once again, allowed me to see the care that should always exist in healthcare.

“Good Morning.

My father, was a patient at Inova Mt. Vernon from Tuesday, October 17 until Saturday, October 28. I am writing to request a copy of his discharge papers, to include the wound care instructions given to the Rehab Center. 

Three days ago, he was transferred to ___________Rehabilitation Center. At Inova, I believe, great strides had been made by Dr. Tabari, Dr. Anand, Dr. Rahmanian and others to restore circulation in his leg, isolate the infection in his gangrenous left foot, and slow further deterioration. I want to thank you for your part in that outcome. 

I also want to do all I can to ensure that your work was not in vain. 
I visited my father at _________late morning yesterday, October 30 and was horrified to find his sheet stained. Someone had put a sock (no-slip footie) directly onto his wounded, un-bandaged foot. No one could confirm to me exactly when or why this was done except to suggest that the foot needed to be "covered," during his physical therapy session. The sock evidently adhered to my father's wound because he cried out in pain while a nurse removed it. The CNA simply stood there dumbfounded not knowing what to do.

When deciding what facility to send my father to, __________was chosen over a much more conveniently located facility because, although we were told that we could not be steered to any particular place, it was “exceptional”. When my father was admitted to __________, I was assured that the staff would continue the wound care protocol followed by Inova through the weekend, and that __________’s wound doctor would assess the injury on Monday. 
I observed Inova's Dr. Yoon's treatment of the foot; how he took great pains to cut away any dead skin that would create pockets where fluid would gather. Each day at Inova, I observed twice daily application of Betadine and gauze bandaging. My father was also wearing the blue boots to protect his feet and heels. 
At __________, to lift the tight bedding and see him wearing a footie, and see his blue boots lying at the foot of his sleeping roommate's bed was extremely disheartening. He'd had no breakfast, and had not been showered.

I understand that each facility and doctor may exercise discretion in recommending and administering treatment, but I could not have anticipated __________’s wound doctor simply leaving the foot uncovered and unprotected, or the PT expecting the foot to bear weight. It departs entirely from Inova's protocol which had been demonstrably successful over the past weeks. The only explanation I've received in response to my questions is that __________ has its own doctors, nurses and plan of care. 

My father's Foley catheter bag was lying flat next to his foot on the bed. 
In addition, I could not believe my eyes when I saw a dog running through the lobby. When a cat followed the dietician into my father's room, I was informed that the animals "lived there". "Oh. You don't like cats? Are you allergic? Is he allergic? I just won't let him come into this room, then". 
She scooped up the cat and put him in the hallway, but as soon as someone opened the door, the cat walked back in, at which, the dietician simply shrugged.
The only thing that seemed clear to everyone at __________was that my father not be resuscitated should his condition worsen.
Based on this, and all that I saw and heard at __________on Monday, I am skeptical that I won't soon find my father in a similar or worse situation as when we first arrived at Inova's ER from __________ three weeks ago.   

In view of the above, in your professional opinion, is there ANY basis for him to be readmitted to Inova at this time?
Who determines the rehab objectives for him?
Is there any procedure for coordinated care between Inova and __________ (or another facility), whereby the treatment is directed by Inova?
Dr. Dunkle  was very forthcoming in his discussions concerning palliative care. I realize that my father is 90 years old, however it appears that the best and most diligent and compassionate care he has, and can receive is at Inova.”

I admit, Virginia's Inova facilities and their employees have drastically changed and colored my view of health care.
Mt. Vernon. 
Leesburg. 
Loudoun. 
Landsdowne. 
Maybe it's not fair to compare other places to them, but they are a testament to what is possible in health care. Every ailing human being deserves that level of excellence, and attention to detail. Why is it not the rule? Why don't all facilities win national awards like the one where my dad consistently made progress?

It occurred to me that I was regularly singing praises to the Inova brand for the care my Dad received. I witnessed a spirit of service and excellence from every person who came in contact with him. The standard of care was high and consistent--unlike anything I'd ever seen in all my years as his caregiver. It's not completely about the brand, however. It's the people
Tori, Meaghan, Richard, Albert, Whit, Kelsie, Alyssa, Kapil, Tammy, Donna, Catherine, Chris, Abu, Corinne, Mike, Jianbo, Huaying, James, Grace, Paramdir, Alexander, Shilvone, Val, Rebecca, Joel, Mary, Lisa, Siu, Larisa, Juana, Nas, Belinda, Frank, Leanne, Alicia, Poppy, Temidayo, Samantha, Jill, Mabel, Miriam, Amanda...
There are people--angels-- I've had the privilege to meet since October who I will never forget--one, because of the manner in which they treated my Dad; two, because of the manner in which they carried out their duties. Compassion has to be taught, as well as the importance of integrity. Attitude is everything.

























Alex, one of the Physician's Transport Service drivers I met in November, said "I have a 911 background, so patients first. It's a patient's worse day sometimes. It doesn't hurt to smile; be pleasant; let them know you care." 

You either have a heart for the well being of other human beings or you don't. You either have a mind to do the right thing and go the extra mile, or you don't. You either strive to do your part, and your best so that the team, of which you are a part, will succeed or you don't. When it's all about you; when it's all about titles, or being seen, preventable mistakes, unwise decisions, setbacks and failures are imminent.  

Health care is big business. It's refreshing to see health care provided where the bottom line is the restoration of ailing people back to their daily lives and routines, as opposed to profits. For some workers, providing care isn't just a job, it's a calling. It's a ministry
It matters greatly where ailing people go once discharged from hospitals. It can be the difference between major setbacks and awesome victories. 

By being given, or by usurping authority, however, selfish, clueless, disconnected, profit-motivated people ascribe to others what they would never tolerate for themselves: the unacceptable, uncomfortable, inhumane, cheap, substandard, and mediocre. As long as it doesn't inconvenience or impact them, it's just fine for you and yours.

The research involved in securing excellent skilled nursing and rehabilitation facilities for aging/ailing seniors is not very different than the research involved in locating excellent schools for young children to attend. No one wants their impressionable child to go just anywhere. There's probably nowhere that's ever good enough, but you can certainly pin down high performing places that have outstanding reputations for success. You won't just settle. So much is riding on your decision. If you care, and know what's available, you'll homeschool if you have to. Caregivers feel the same way--they'll assume the in-home responsibility themselves--but some ailments demand substantially more that a caregiver can provide. Caregivers, therefore need help, but because of everything they know; everything they've seen and experienced, not just any help will do. There's no walking away. Caregivers are the greatest advocates; the most viable and reliable source of information concerning the ailing person. A caregiver's input and presence is critical.

Why is the skilled nursing facility search so challenging for some families? The answer is "Location. Location. Location". There may very well be a facility that's close to home, but would you send a stray dog there, let alone your loved one? Why are facilities ever under-performing; understaffed? Why isn't there a skilled nursing facility adjacent to every hospital--large or small? Why is there not a push for continuity of care no matter where a senior goes to recover after being discharged from a hospital?

If medical issues preclude your loved one from returning home, (where you know what kind of care will be provided because you're the one providing it), you then want to find and secure a spot in the very best facility available. If for whatever reason your loved one can't return to the comfort and familiarity of their own home, you want them to be where their history is known, their condition thoroughly assessed, and an intelligent plan for care is established. You want them to be where they can thrive, be encouraged, motivated; be safe, respected, and heard. You want them to be in a sanitary, well-kept, state-of-the-art environment, where their needs are met by committed, highly qualified, caring, skilled individuals. Unfortunately, your zip code doesn't always deliver, so you have to search...and search...and search. You may not get help from case managers because of restrictions placed upon them. They should be able to recommend; point you in the direction of facilities that function excellently, and away from veritable dungeons, but they can't. It's disappointing. Some searches for skilled nursing facilities yield horror stories of abuse, neglect, and lack. You wonder how some places are even allowed to remain open for business. What is conveniently located and accessible for able-bodied people isn't always what's best or even acceptable, but many families have no choice than to surrender their loved ones to people and places that are wholly unsuitable and discouraging; places that do nothing to promote wellness; places that make you realize you and your loved one will soon be back in a hospital emergency room.

























When you DO have a choice about skilled nursing facilities, however, make it. Do your homework. Visit. Ask questions. Don't settle. Fight. Advocate for your loved ones. They deserve to be treated with dignity, kindness, and empathy. They deserve the best. If they can get the best--if it's doable--it's worth the cost, distance, time, sacrifice, and effort for your loved one to be a recipient of outstanding medical care, physical and occupational therapy, emotional and spiritual encouragement. After all, it's about them.


Mediocrity, laziness, and apathy are unacceptable in health care. The care factor must be restored. People have to matter. The tales I've heard from people seeking, or who have experienced the goings on at skilled nursing facilities are heartbreaking. In some places, people are left to languish; allowed to fall; patient's their conditions are allowed to worsen or go undetected; their cries are unheard and unanswered. Their complaints are ignored or minimized. Medications are forgotten or skipped.
So many seniors reach a certain age, and are treated as if their lives are over. "Oh he's old. let him sleep. He's tired". I had someone ask me, "Why do you want him to go to the hospital? What are they going to do there?" I couldn't believe my ears. 
In some facilities patients are given pain medications to the point where they are positively catatonic or incoherent. Patient's wounds are left untreated. Those whose meals should be attended, have trays placed in front of them, and the food sits there and gets cold. Rest rooms are unclean. Room temperatures fluctuate. Flies and fruit flies abound. Equipment is broken or malfunctioning. Food is unappetizing. Patients are left to sit or lie in their own filth, or aren't turned in their beds; someone decided that human beings only need to be showered twice a week or not at all; patients are left unattended to wander off; they're left to fall asleep in uncomfortable positions in wheelchairs. Trash litters floors. Workers cop attitudes  and act as if they're being bothered if they're asked to attend to what is clearly within their job descriptions. Excuse after excuse is made when preventable situations occur. It is no wonder why many families do what they have to do to keep their loved ones at home. It's why in-home, full-time caregivers need to be supported.

The skill factor has to be restored to skilled nursing. Caregivers shouldn't have to show professionals what to do. You should never wonder what wouldn't have been done, or what would have been allowed to suffice had you not paid a visit. For caregivers, visiting loved ones daily in many skilled nursing facilities has become a second, mandatory job. With some facilities, it becomes evident early on that the more eyes on your loved one, the better. You have to attend and participate in therapy. Learn. Take notes. Speak up. There's something about showing up consistently, and at random times of day, that gets some workers moving and motivated in ways they may not if they sense that a senior is alone in the world. When you show up, some workers are more attentive, efficient, friendly and conscientious. You don't have to hover or be a tyrant. Just show up

Why many skilled nursing facilities are so woefully substandard, though, breaks my heart. Who's hiring? What's the criteria and qualifications for employment? Why people who don't like people, particularly seniors, accept jobs working with people, is mind boggling.

A family should never hear from a case manager, "If you love your family member, don't send them there." After all, human beings are the clients. Anywhere seniors are admitted for long term care, there should be more than enough nurses, and CNA's. There should be full-time staff doctors, podiatrists, cardiologists, wound care specialists, therapists, dieticians, psychologists, beauticians, activities directors, counselors, etc. There should be people who have a heart for people more than profits; people who see the value of environment; people who are are invested in a patient's successful plan of care.

Sigh. 
I need to be independently wealthy. I'd buy land, and soon, east of the Anacostia River and in zip code 20744 there would be two new, state-of-the-art, fully staffed Inova-like hospitals and skilled nursing and rehabilitation facilities to serve the areas' aging populations.