The Cycle

Dementia is a unique and interesting thing. It may affect one person one way, and another, the complete opposite. Some days in our line of work, it is impossible to determine if dementia is the culprit to a certain behavior, or was the individual always this way.   I understand that not every single 90 year old was not always a sweet, cute ball of happiness , but geez, can there be so many vicious, mean ones?

Let me tell you about Shirley to give you an idea of what I am referring to when I say “mean.”     Wow. Shirley is a full packed pistol.     This morning as  I was walking through the facility, I encountered her or should I say, heard her.

” All of you can go to the pits of hell. All of you belong in jail. I am going to kill you all. You all are Godless heathens who need to go to jail and never get out. Let me get up from this chair and you will find out what kind of person I am. I don’t mess around. I mean it. I will kill you all. You hear me? Answer me!!!!!!   Fine, don’t answer. But I tell you one thing, when I get my hands on you, you better get running and hope I don’t catch you….”      Shirley continued on and on, and seemed to be working herself up, so i felt the need to visit with her for a while and see if I could redirect her and reduce her anxiety.

” Hey Shirley, how are you this morning?”  ( Okay, that was a dumb  question. )

“How am I doing? I will tell you how I am doing. You are a heathen. You hear me? I hate you. You are stupid, stupid, stupid, stupid. You belong in the jail. No you don’t. You belong under the jail. you dumb dumb. I wouldn’t feed you a scrap from my table. I will give it to the cow before I give it to you. You hear me? Huh?” Stand there looking dumb ‘cuz that what you are. Dumb.”

Well, goodness. I wonder what re-directional technique would work? Hmmm. Certainly with all of me experience and education I can calm her, right?

Kneeling down beside her, I tried to adjust the volume of my voice to hopefully have her match mine….

” Ms. Shirley, what has you so riled up today? Is there anything I can do to help you……”  Before I could finish, Shirley drew back to throw a right hook punch, aiming for my nose.  I quickly moved out of the fire.

” Anyone ever tell you how ugly you are? Ugly. You are ugly, ugly ugly.I bet you aren’t even married. Nobody would be stupid enough to marry an ugly thing like you……”         She continued on and on with her insults, carefully crafting her next plan of attack.

Without hesitation, Shirley changed gears.  ” Who did you say was getting married? Tommy? Well I hope he finally found somebody. He may be son, but he is one useless man. He ain’t worth the dirt he drags in on his shoes. Nothing worse than a useless man. Wonder who is marrying him? I hope it ain’t Patty’s daughter. That girl ain’t got good sense. Maybe they will make  a fine pair, useless pair………   She continued for 15 minutes discussing Tommy and his  lack of use..

It never ceases to amaze me at how dementia creates a whole new personality that differs dramatically from the who the individual use to be.       Shirley, prior to the onset of dementia, was an elementary school  teacher.   Now, we all know the patience needed to be a teacher, especially an elementary teacher!       So how did Shirley go from that person to the one screaming hateful words today?

The brain is a mysterious thing, yet carefully studied by the greatest minds of all times, yet some questions will always remain unanswered. The best any of us can do is to simply try to understand, reassure and comfort.

The key being try. All of the sweet talk in the world is not going to redirect someone who has lost the emotionally connect. The medial section of the brain may shut down, causing a loss for impulse actions as well an emotional balance……… who really knows?

Shirley continued to vent, rant and rave….eventually calming down after the nurse gave her her morning meds.   After a few hours, the meds will wear off and she will once again return to her previous state……..until it is time for her afternoon meds……..and the cycle continues.

People who do not advocate the use of psychotrophic meds have never seen the results of an unmedicated dementia resident who has absolutely no impulse control.    The purpose to medication is not to sedate or create a zombie, but rather to decrease anxiety, promote a sense of well being and overall sense of peacefulness.

Shirley is sleeping now…….all is well for the moment, and that is a all that matters…….for now.





Forgiveness vs Forgetfulness

During my almost 30 years of working in long- term health care, I have encountered residents from every possible walk of life. Rich, poor, black, white, red and mixed race;  from the trailer park to Fifth Avenue, with personalities ranging from “precious” to extremely violent.   I have sat in my office and listened to the  family members summarize the person their loved one was  before dementia.n

” Daddy was a hardworking man. He took care of mom at home for 4 years.”

“My mother was always the caretaker in the family; from laundry to lunches, mother did it all. Hard to see her like this.”

” My husband was such a kind man.”

” Pops was a good church-going man. Breaks me down to see him like this”

” My dad was a mix between Hank Williams Sr and John Denver. Just a good ole boy from the southern part of West Virginia. ”

” My mother was the sweetest, kindest, most tender -hearted person I have ever known.”

” My father was the meanest, most evil and abusive man. He tormented my mother and us kids every day of our lives until we were old enough to get out of his house. He was a bastard then and is a bastard now. Now that he has Alzheimer’s he has forgotten to be the monster he was.”

” My mother was not the nicest of people. You could say she was just plain mean. She would cut switches from the tree out back of our house and whip us until we bled. Now it is my duty to make sure she is cared for. It’s harder than I thought.”

” Nevermind what kind of man my husband was back then. He is old an feeble now. Just take care of him.”


I admit, listening to the family describe their loved one from past experiences, can at times, be very difficult. I sense their obligation to the parent or spouse, but also feel their hatred for them.  I had one fellow tell me ,” Send me the bill for dad, but don’t expect to see me or anyone else for that matter. He wouldn’t walk across the street to see his own father when he died, so don’t be expecting anyone to come see him. Just bill me. Call me when he dies, after you call the funeral home.”

Tell me how to I should respond to that.  A simple one word ” Okay” ?  Hmm, that seems too cold, distant and wrong.   Do I try to explain that he, himself should try to forgive his father for whatever grudge because his father will die soon?

I simply nod at the son and leave all words unspoken. My job is to care for and insure  the wellbeing of every person and not pass judgement on anyone for past present or future behaviors.  Yet, I am troubled by the patient who must die alone, without the family he/she once had.  It is also hard for us as caregivers to visualize a feeble, confused, incontinent person as  abusive, commanding and mean-spirited. We contribute any type of aggressive behavior to the disease process, not personality.


It truly must be difficult to be in the position of the adult child who must care for his/her abusive mother or father. I honesty do not know how I would handle such a situation……..But I do know this; even the most aggressive resident responds to love. The other day, a resident was raging with anger and had somehow ripped a baseboard off the wall, which he was swinging at any staff member in his path.  When I arrived on the unit, I never stopped walking toward him….my arms were wide open as I said “Mr. Marks! I am so glad to see you, can I have a hug?”  I never took my eyes off of him as I walked directly in front of him.   His response?

” Hi baby, sure. You look pretty today.”   After a few minutes of hugging and talking I had secured the weapon, calmed him and had him sit in a recliner to watch TV.       All it took was a hug.      Am I saying that every time a resident become behavioral I rush out and hug them to change the behavior?  No. I am saying I use wisdom and always approach with compassion, kindness and empathy.  It is my opinion that regardless of the disease process, people can always feel love and will respond to it.    Mr. Marks was, according to his daughter, one of the ” worst monsters a child could ever have”.   Today, no one visits, no one calls…..he simply exists and rages out of control every so often.    I sometimes think that he and others like him, think about the things they have done in life, stewing on the facts until they explode.  It is my opinion that dementia does not disable repressed memories….as a matter of fact, I believe the memories can become more active. Here is the problem. How does a person ask for forgiveness when they no longer can hold the memory long enough to remember what they need forgiveness for? The short ” breakaway” memory of being a “monster” is forgotten as the thought changes……So forgetfulness prevails.

The victim will always remember the abuse  but at what point does  one look deep into their own soul and find emotional healing?  Can that ever be achieved?     Will the victim ever be able to look at the aged, infirmed, helpless abuser and feel any emotion?      

I don’t know the answer. I simply know it is painful to see both sides tormented and know that resolution is more than likely, not ever going to happen.

We all need to remember that how we treat people today, will affect both of us for the rest of our lives. Some things in life can never be undone.  So treat everyone  in your life well while you can……because one day, it will just be too late.

It’s Time to Pack

Growing up as a preacher’s kid our family moved around a great deal; living wherever my father was sent to pastor. My siblings and I had learned the routine of “packing up and moving out” long before we dreamed of being a grown up. I can remember my mother folding our clothes and neatly packing them into boxes, carefully marking each box with our names. She would then collect toys, tricycles, bicycles and skateboards and place them into a heaping pile in the front lawn.

I can hear my mother’s voice as she commanded us kids to do what we could to help.     ” Each of you are to go out and make sure you still play with or use the toys in the yard. Anything that is not used, is to be placed in a pile, NEATLY, to be donated.”

Six kids, one pile. We always found a need for every Cabbage Patch doll, teddy bear, ball and glove that was in the heap. We would alert mom to our discovery that every toy was indeed a necessity to our lives. My teddy bear, ” Roy”, had a pull string on his back that would say maybe 3 different things….he was worn, stained and tattered, but he managed to move me throughout my childhood, all the way through college. There really wasn’t anything significant ( that I can remember) about Roy, other than he was was simply mine.    I’m not sure when and where I lost Roy; if I threw him out when I left college or if he landed in the trash after I got married.

As an adult, I have packed up and moved many times and found myself to be as methodical as my mother had been. I would make piles of ” necessary”, “trash” and “no clue what this is or why I have it”.  Packing was second nature to me. Just load me up with suitcases, boxes and a few trash bags; give me a few hours and I will have everything packable, packed, tossed or piled.  This has been true for me, except for two times in my life………

August 28, 2000 was the day my father passed away.The hospital room was filled with balloons, cards, flowers and half eaten bags of food. His well-worn Bible, Sunday School Book and notebook all laid on the over bed table beside him.  My oldest brother began the process of packing up the room.

” Jessie, go ask someone if we can get a box or something to put dad’s stuff in, Grab a trash bag too from somebody.Is there any of this stuff that belongs to any of us?”  My brother had become the well oiled machine my mother had created so  many years ago.  childhood memories

October 26, 2002, my mother passed away. The same drill of packing up her belongings, sorting through what was important,what was trash……. But then came the most difficult challenge of all. Going through the house our parents had called home. Pictures covered the walls…the yearly church Olan Mills family portrait for the church directory took up at least two entire walls.School pictures of each child from 1st grade through the cap and gown senior portrait. The pictures of my siblings who had joined the military, each posing with the American flag in the background. I would say our parents were the proudest people in the world. They celebrated our lives with constant reminders of the children they had raises. The fireplace mantel was adorned with football, baseball and tennis trophies we had earned from little league on up. My father’s study was filled with polaroid instant camera pictures taken of each of being baptised in the Jordan River on one of our trips to the Holy Land. Pictures of us teaching Vacation Bible School, singing in the choir and being in character in the annual Christmas Story church play.  On his desk was his another worn, tattered Bible. memory

We, as adult children stood in the house, unsure as to how to pack up the parents who had taught us everything we knew. Finally my sister spoke up and said, ” This is too much for any of us. Why don’t I bring some guys from work and have everything packed up, put in storage and we can go through it later.”  That was the best idea she ever had.

What made it difficult for us was not the chore of packing, but rather, the memories that were etched in every single thing in the house. As I turned to walk out, I looked one last time at my daddy’s recliner. Laying on the arm was the remote to his TV. Without a second thought, I grabbed the remote, stuffing it into my purse. My daddy loved to watch the evening news….and the remote was something he always kept on the right arm of his chair….. My youngest brother turned to me and said ” Did you grab dad’s remote? Are you wanting the TV?”       ” No, I wanted the remote to have something of his, something that none of us would fight over….” I replied.

Over the years, I have dealt with families at the facility after losing a loved one. Each would say, “I will clean out the room this week Is there any way I can donate some of the stuff in there, like the clothing and other stuff?  Sometimes, packing up after losing someone is just too painful.  The old saying ” one man’s junk is another man’s treasure” is so very true in dealing with losing a loved one. Every single thing becomes significant, filled with memories. To help the families, I offer boxes…and a trash bag……and tell them to leave anything they don’t want in a pile.

Death is difficult in any aspect. Losing a loved one hurts deeply. Packing up memories is equally, if not more, difficult. If only it were as simple as boxes, trash bags and piles……………Memories.

When did I become a Mrs.?

Growing up in a strict Christian home, I was taught to always address my ” elders” as Mr. and Mrs.. I would have never thought to call Mr Jim Smith ” Jim”. By addressing them formally, it showed respect for their age and wisdom. It was also a sign of respect.

Yesterday, a young marketing representative came into my office and asked to speak to ” Mrs. Steele.” When I say young, I mean she was in her 30’s……. I stood up to acknowledge her and stated, ” Hi, I am Jessi”.
She quickly thanked me for taking the time to speak to her by saying'” It is so nice to meet you Mrs. Steele….”

Mrs. Steele. I don’t think I like the sound of that! I am simply Jessi!!!!!!! I am not that old , am I?????

After she left, I walked through the facility, speaking to every resident I encountered. ” Hi Mr. Jamison, hello Mrs. Davis; good to see you Mr. Mitchell; Hey Rita, you okay today? Good afternoon Toby; Hey Diane, what’s going on?” I continued on throughout the facility, calling each by name.

The more I have thought about it and listened to the staff interact with the residents, I heard things like :

“Come on Fred, you have to go the bathroom.”
“Evelyn, sit back down before you fall.”
“Ivy, drink your juice.”

“Peter, come back to the table”

The staff are simply doing their jobs, but the longer I listened, the more I thought on the importance of how we address our residents. We should never interact with them as if we are running a preschool or daycare center. These are men and women who should always be treated with respect, kindness and dignity. Dementia has robbed them of their identity, their person-hood and their ability to recognize their loved ones or even themselves.

So where is the fine line drawn between addressing the residents with respect, yet reminding them of their own identity?

” Good afternoon Sir”, clearly is not how to remind someone of who they are, yet it is very respectful.
” Good afternoon Mr. Evans” surely sounds better than ” Hey Fred”. But, how many people in Fred’s life addressed him as Mr. Evans?

How do people address you? Brian? Diane? Art? Steve? Barb? Dave? Jim? Your friends call you by name….Not Hey Mr. Hamilton, right? So, as you age into your eighties, how will the 20-30 somethings address you?

You have probably never been addressed as your Mr. or Mrs. name on a daily basis routinely, so why do we do it to the elderly dementia patients?

Respect is so important, an expectation I hold for every employee, but I want to also want what is best for the resident.

Thoughts anyone on this issue?


Dementia Does Not Define Who We Are

Yesterday I was sitting in my office shuffling papers from one side of my desk to another. This process is called “hoping to clear my desk by the end of the day”. The pile on my left is the completed, ready to go live in a filing cabinet; while the pile on my right awaits sorting, signing, discarding or to be stuffed in a drawer for later use.  State and Federal regulations mandate every slither of paper that sits on my desk; care plans, UAIs, notice of this, notice of that, blah blah blah. I find the paperwork side of my job to be a chore….I would prefer to be out mixing and mingling with the folks….but I must do what I am required to do. Ho hum….

As I was shredding, tossing and scribbling away, in walks one of the residents; Sam. He proceeds to pick up a few of the documents on the left side, carefully reading out-loud the first sentence.

“Individulized Care Plan. Resident requires assistance with bathing due to dx of dementia and progression of the disease process.”imageofcareplan

Sam, clearing his throat, returned the paper to the pile and began to speak.  ” Disease process…went, year I saw.” Chuckling, he continued ” Wait a minute, okay, yes, did you get it?”

” Yes sir, I sure did. Thank you so much.”

” Good, good. Thank you.” He replied.

Pleased with himself, he began to venture back into the hallway and was gone.

Sam has dementia and often fails to find the right words to express himself. Even though I had no idea of what Sam was trying to say to me, I knew whatever he was trying to convey was important to him, and simply needed validation.  You see, Sam is more than a dementia patient. He is so much more than the man we see on the outside. He is the father of 5 daughters, a former head Deacon in his church; a talented  baritone for his church choir and a former MD.   A doctor.

Prior to the onset of dementia, Sam knew more about disease than I ever would hope to know. I am sure he has treated countless illnesses and diseases  during his medical career; everything from the common cold to the most serious medical complications.      Yet, standing in my office, Sam was not able to carry a conversation or understand what is going on around him.    In his mind, I believe deep down, he is still a doctor. I believe he thinks he is making rounds as he checks in on the other patients….unaware that he, himself, is now a patient…………

As I walk through the facility, every resident has a similar story. Each person, at one time, was no different than you or I. They had responsibilities, obligations, and people counted on them to get the job done. Homemakers, factory workers, construction crew members, doctors, school teachers, college professors, military officers and enlisted WW II  soldiers….on and on the list goes.                   The point is, they are now simply defined by their disease.  Their contributions to society have long been forgotten.  They depend on the nursing staff to meet their needs instead of being depended on.

I truly believe long term health care today has become more of a warehouse  than a place to recieve personalized care. We as health care providers spend so much time on paper compliance that we lack the time to get to know the residents we are caring for. Nursing home nursing assistants usually carry a case-load of up to 30 patients. Who has time to do anything but meet the need with such high numbers?   In most instances, if Sam had wandered into such a busy nursing home, he would have been ushered out, redirected and removed.  Long term care facilities, in general, allow the disease process to define who the resident is, discounting who they once were.

It is sad how dementia residents are treated just because they have dementia. I hear things in my building such as “Sam sit back down”, ” Emma, come back here”, ” Ray dont do that’!”  If I didn’t know where I was, I would think I worked in a day care center.   My staff is trained to treat our residents with respect, dignity and understanding.  But we all fall short of seeing the person underneath the mask of dementia.

One day, you and I both will be 95 and  will possibly need nursing home care.   The young 20 something year old nursing assistant will wander into our room;cell phone in ear and begin stripping us of our shirts and pants without saying a word to us. They will continue to talk to on their cell, ignoring our presence as they wheel us to the shower room; down the hall with only a sheet draped over us for privacy.  Another nursing assistant will enter the shower room and the two will carry a full conversation while wiping our bodies with a soapy facecloth. You and I are invisible to them. We are something they touch, but are not touched by.   They will dry us off, clad us in a sheet and wheel us back to the room, dressing us in a pink shirt with red pants. They lack the time to find clothing that matches……..

You get the point.

It is my hope that long term care workers will look for the person they are caring for and see past the disease process and not allow dementia to define who they are.   I hope that when I am 95 and needing care, that the staff will talk to me, and validate what I am trying to convey, regardless of whether it makes sense to them or not.   You know why? It  probably makes sense to me.  I may shuffle into the administrator’s office, thinking it is my own. I may start sifting through the papers on the desk………..It is my sincere prayer that the administrator simply smiles at me and says….” Wanna run the place today Jessi? I hear you did a bang up job back in the day………………”


Covert Missons

Everybody has a story. Mix in a dab of dementia, a ton of family dynamics, a slab of money and you will have the recipe for the Perfect Storm and a great story.  Having spent close to 30 years in the long-term health care industry, I have heard every possible version of who takes the” best care of Daddy” , “who in the family could not care less” and who is strictly a” player waiting on his inheritance.”      Quite honestly, it is all very irrelevant to me, but I am forced to listen to every single son, daughter, grandchild and any other interested party of the resident who feels the need to explain their ” status”  and position.


Over the past few months, I have been dealing with one resident, six sets of lawyers, eight adult children, Adult Protective Services and four different medical doctors. Each day, my time is consumed by this group of people. It is a drama filled excursion to say the least.  One son wants mama to live in another state, closer to him. One daughter wants mama to move to another part of Virginia to be closer to her. Another wants mama moved to a hi-rise, luxury facility on her side of town. The middle child wants mama in a nursing home. The resident’s husband says his wife is to not be moved anywhere, at anytime, by anyone.   The question I have yet to have the answer to is so simple, yet so complex.  Who exactly calls the shots here and is the actual Power of Attorney (POA)? 

One would think the spouse has full rights to dictate his wife’s care. He has a notary sealed POA.  Ummm, well, so does 4 of the children. Each one can produce their own legal documents stating they are  “in charge”.   My legal beagles tried to clear matters up by stating, ” Whoever holds the most current document is the actual POA. Follow the date trail and adhere to who holds the most current one.” 

Well, that sounds simple enough, I study each document, finally determining which one is “most current.” Seems like the third child wins.

I draft a letter to all eight children  and the husband stating my finding.  I conclude the letter with ” I do hope this brings a resolution to this matter.”   Resolution, Yeah right.

For the next two weeks, my office was bombarded with certified letters, phone calls and a host of emails from the family.

” Mother was not competent when she signed that document. I will see you in court.” 

You are not in the position to make this judgment call. My lawyer will be contacting you personally to clarify your letter.”

Your concern Ms. Steele is noted, however, you are biased and have no place in our family matters. My lawyer will be contacting you.”

“My mother is fully competent and can make her own decisions. My sister has ulterior motives which involves monetary gain and exploitation of my mother’s affairs.”It is your duty to protect my mother, not feed her to the wolves. I am pursuing legal action.”


Oh goody. So much for problem solved.

The next day, the middle son walks into my office, hands me his POA and a ” No Trespass” document that was clearly a product of google search.  He explains to me that he received my letter however unless I am prepared to be sued, he expected me to honor his POA and his ” No Trespass” which he had filled in with all of his siblings names, blocking them from the facility.    Ummmmmmmm……….hmmmmmmm.

The following morning, the middle daughter arrives at the facility at 6:30 am, She told the staff she was taking her mother out to breakfast.  When I arrive at work, the staff are in a full panic over the resident being ” abducted” by the daughter. I explain to them that it is all ok…that she is the POA…….

Within hours, the husband called, demanding to know why his wife was at the bank trying to withdraw five hundred dollars from their joint account.  I explained she was with the POA and that I had no control over where they go……

By 2 pm, I was beginning to worry….I tried to call the daughter’s cell phone…no answer. I left a voicemail. Around 3 PM, the oldest daughter called, demanding to speak to her mother on the phone. I explained she was still out of the facility with the other daughter, which caused a major explosion.

” I’m calling the police.”   Which she did. police-to-protect-and-to-serve

By 6 pm, the resident was returned to the facility, safe and sound. The daughter was livid. ” You really called the police Jessi? Who do you think you are?”   Before I could answer, she stormed off………Wait, I didn’t call the police….

The following Tuesday morning, I received a full medical report stating that the resident had seen a ” house call doctor and his finding were” patient is deemed competent and can make her own decisions and does not need care.” I was perplexed…when did she see this doctor? The address provided for him was over four hours away……..hmmmm.  So, the day the daughter took her out for over 12 hours was really not a breakfast outing but rather a doctor’s visit …HMMM.   Very covert.

By Thursday, I had lawyers lining up at my door. Each presenting me with a ” Notice of Hearing” document, to determine who would be appointed Guardian IF the court deemed one necessary. I almost needed those “name tags that read ” Hello My Name Is” just to define which lawyer went with each son or daughter. Each lawyer would try to have a conversation with the resident….asking her various questions which the resident could not answer….remember, she does have dementia.

The saga continues and will probably be drug out for some time as does with any legal battle. But what really is the motive for so many opinions? Could it be due to the fact that the resident is worth millions of dollars and the POA will have full access to the bank accounts, condos and time shares?  Could it be that this family is just dysfunctional to the point where each has to control the other?      I honestly do not know the answer.

The lesson I hope we all take from this story is, make your important life decisions while you are of sound mind. Have a set of Advance Directives drawn up legally, appointing the most trusted person in your life as your POA. Only appoint one person, not half a dozen. if you choose to revoke a POA, do it correctly and maintain copies of every letter sent or received in regards to the POA.  People that do my type of job will make sure you are safe, comfortable and well cared for, but we can not protect you from your family unless we have a tidy paper trail clearly identifying who’s who in your life.     By doing these things, you will enable us to be your greatest enforcer of your life choices. Otherwise, you may be the next “covert operation”.covert





Mama Can’t Afford It

Last week a daughter of a resident asked to have her mother’s medication reviewed by the house doctor, to insure all medications were necessary. The MD was a bit annoyed by my request, unsure why he needed to review meds he, himself, had prescribed for her.

I called the daughter quickly as the doctor saw other residents.

” Hey Susan, the doctor is here today. I asked him to review your mom’s medicines….he wants to know what he is looking to adjust? ( I thought if I made it sound a bit more comprehensive and concise,her reply would be specific.)

” It’s simple, mama can not afford to pay for all those medicines. He needs to pick which ones she really needs and get rid of the rest. Matter of fact, tell him to get rid of the most expensive ones and and maybe we can afford the rest. We will just have to see.”

I knew that this news would annoy the doctor even further. But what could I really do? The daughter was fully empowered to carry out her mother’s Power of Attorney and Advance Directives. I was simply the messenger.

” Dr. Smith, the daughter stated that her mother can’t afford all of the meds, and would like to have her taken off of the unnecessary ones.” I braced for his reply.

” What is this? What do you mean? Unnecessary? What is this? If the medications she is on, have been prescribed by me, they are needed, necessary and are to be given.” His thick accent became more difficult to understand as the volume increased.

” I understand what you are saying Doctor. However, the daughter who holds her Medical Power of Attorney has told me she can not afford to pay the pharmacy bill, so she needs you to discontinue the most expensive ones.” Brace for impact number 2.

” Price? This is about price? What is this? Her mother needs the medications to stay in health. What does she want me to do? Stop them? What is the point to her being on any if she can not afford all? There is no point to this. What is it you want me to do, you tell me, Ms. Steele. I am here to make sure all the patients are healthy, not harm them. What is it you want me to do?” Whoa, hold the phone. This is NOT my decision to make…..nor should it be. I can not advise the MD of what he ” should ” do; but rather I can only convey the message to him, and back to the daughter.

Thinking quickly on me feet, I offered; ” I think it would be appropriate for the daughter to bring her mother to your office and discuss with you options….generic or samples….”

Before I could finish, he shut the chart and stood up. ” You tell daughter to bring mother to my office. I will tell her what I have told you. If she wants to stop medications, we will stop. My services will then terminate and the Hospice physician can assume her care.”

I knew the phone call back to the daughter would be just as thrilling. Brace for impact number 3.

“Hey Diane, Jessi Steele. I spoke to the doctor and he would like you to bring your mother to his office to discuss her plan of care and medications….”

” Jessi, if we could afford to pay his office co-pays, we would not even be worried about medications. Why can’t he just stop the medications? What is his problem? All these pharmacies and doctors want is money. Money, money, money. My mother lives off of her pension, social security and interest from her investments. When she is dead and gone, I know she will want to have something to give to her grandkids. But these people want money, money money, money. I pay you every month, pay them, pay for her diapers, pay for this and that and by the time I am done, she doesn’t have a dime left. So what am I supposed to do? Sell off her investments, that she worked hard for all her life to pay for medications and your place when she has no quality of life? She doesn’t know us from the man in the moon. I will call him myself and handle this.”
With that, she slammed the phone so hard it vibrated my ear. Wow.

Investments. Annuities. Afford. Grandkids. Hmmmm. My mind raced. I went to the nurses station and decided to see for myself what medications we were talking about. The list was relatively short. Hmmm. I decided to take it one step further. I called the pharmacy and priced out the meds. The total per month?? Brace for impact number 4. $51.00. Fifty-one bucks. Hmmmm.

“Mama can’t afford it or the daughter doesn’t want to pay it Which is it?”, I asked myself. I may never know the answer but I do know as time pushes forward, I expect to see more people not electing medication administration, but rather, hospice care. I know firsthand, how difficult and frustrating it is to watch a loved one slip under the control of dementia; losing the ability to recognize family and friends. But how do we make decisions that could potentially have adverse effects all because of an inheritance? Now, this would be a totally different question if indeed, mama could not afford medications or services.
But geez.


It is certainly not my place to judge anyone for the choices/ decisions they make in regards to their loved ones. I know my siblings and I did the best we could for both of our parents, even chipping in money to make ends meet. We stood by as our mother forgot who we were. We visited, supplied her with her favorite junk food and her often sought-after Mello Yellow. We made the tough decisions, always doing what we thought was the right choice….not driven by any other motivation.

Brace for impact number 5. We are all getting older, and one day…..we too, will be at the mercy of our children, grandchildren….

do unto

Got People?

I think I have discovered what is wrong with the human race. Be warned though, this may turn into one of my much needed rants! Before I take off with my ramble, remember I have dedicated my entire career to serving those in long term care facilities……I started at the bottom of the ” peon” list and worked my way up the food chain until finally landing the title of ” Administrator”. I have cleaned floors, washed dishes, scrubbed windows, washed and folded resident laundry,served plates in the dining room at meal time and plunged clogged toilets… name it, I probably have done it. I have walked on the roof of a 4 story building to hang Christmas lights, fell off of a 7 foot ladder while handing wreaths on windows, stood in knee deep sewage and sang along with the residents while playing the piano. I have had employees threaten to kill me; had a disgruntled”gang” of employees waiting for me in the parking lot; broke up a fist fight between a contractor and his employees and stood face to face with psycho/drug addicted employee who didn’t take too kindly to being fired…….Yep, I would say I have seen pretty much everything in the 25 years I have devoted to this profession.

This week, I was sweeping and mopping throughout the facility since the housekeeper decided to call in sick. As I was moving about, a visitor stopped me and asked, “Don’t you have people to do that?”
Hmmmm. Out of all the things, he could have said, why did he choose those words?

I smiled at him and replied, ” Look at the shine on that floor, doesn’t it look nice?”

” Well yeah, but why do you have do it? I’m sure you have people to do it, right? It doesn’t look good to see the boss-lady out here mopping. ” No he didn’t.

Before I could stop myself……my mouth opened and words formed and flew out……

” You know Mr. Rogers, that’s whats wrong with people today. People worry about how things look to others instead of focusing on what needs to be done and just doing it. We worry about offending someone with our actions when we know what we are doing is right. Just look at our Country. Prayer in school offends, so we take it out. The Ten Commandments offend in our government buildings, so we take them down. People prefer to sit and home and draw welfare instead of working for a living because they are “entitled”. Kids can’t say the Lord’s Prayer at the beginning of school, but they can do a word search puzzle based on the trashy book 50 Shades…….Our President called Air Force One his “spiffy ride” while servicemen and women lay their lives down for the very freedom he pokes fun at…..Those people in front of me at the grocery store with the high dollar steaks don’t have to embarrass themselves by tearing the food stamp coupons out of the booklet, they now have a debit card so they don’t have to feel ” ashamed”….. So you see Mr. Rogers, I don’t give a rats rip about how it looks for me to be mopping a floor.”

With that, Mr. Rogers nodded and walked away. But come on, he knew what I was saying was the utmost truth. We live in society that has diminished work ethics, morals and values. Everyone has a sense of entitlement.

I was driving through the streets of DC this past week and noticed groups of young people who should have been in school, yet they were shooting hoops at a brand new community ” youth park”, proudly displaying their Air Jordan shoes. While sitting at a red light, I couldn’t help but notice the tent sitting in the median, obviously belonging to a homeless person. The cardboard sign displayed on the tent read ” Disabled Veteran”. Let me get this straight. The government felt if the youth had a ” park” with skateboard ramps, basketball and tennis courts, they would not join gangs of find trouble. Here is my thought. If parents would raise their own children and stop relying on the system to raise them, we wouldn’t need ” parks” to entertain them. They would be respectable young people showing respect for themselves and for others. If they didn’t, they would be punished….simple as that. The money the government spent on that ” park” could have been used for housing for the veterans that live on the street. But wait, that wouldn’t look too good, would it? We have to invest in the youth, since they are our future and besides they are entitled to it, right? All I can say is, Lord have mercy on us all.

We need to return to the nation that we once were. A Nation of People that lead by example.
We work for what we have. We take pride in our work. A society that helps those who fall on harm times to get back on their feet, but not allowing the person to prop their feet up! A society who stands for the very things this Nation was founded on….If you don’t like prayer in schools, go back to your own country and pray to whoever it is that you serve, but leave us out of it. If the Ten Commandments offend you, locate the border of this great Country and step outside of it. If you can’t control your child, jerk a knot in his bellbottoms until he learns manners and respect and stop blaming others for your own lack of parenting skills.

You see, the problem is not our Nation, but the people we have living in it. We need to simply do what we know is right, and stopping worrying about offending someone. PERIOD.

So Mr. Rogers, to answer your question, yes, I do ” have people” to do this job, but I choose to lead by example…….