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?

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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………………”

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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.

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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.

Power-of-attorney
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.

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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….

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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…..you 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…….

Cheering For Both Teams

 

Friday was a very sad day for us at the facility. Willie passed away during the night; slipping quietly away from us…… For those of you who follow my blog, you know Willie’s story. He had told us numerous times that he was done with life, having nothing left to accomplish and was wanting and waiting to die. Just last March, he lost Maggie, his beloved wife. Since then, Willie has waited…..and waited…..for nothing other than death.  According to Willie, he had no family left.  No one. Just himself.       The court had appointed a guardian to oversee his affairs, which made Willie furious. I can still hear him yelling…   ” I have served my Country for all of my life, served in wars, fought off evil and lived to tell about it and now they tell me I need somebody to take care of me? To hell with you all! ”     

Willie was a strong-headed man, set in his own ways but yet determined to have the final say in all things, including his death. What he did not consider, was who would be the authority on what his wishes were; where he would be buried, service protocols and arrangements. The court appointed guardian’s ” appointment” ended upon death….so now what? We as a facility have no authority to make plans, give consent or anything else, so hmmmm.  The local funeral home had told us they could not come to pick him up until someone had signed forms, contracts and agreements.  

After a few hours of arguing on the phone with the former court appointed guardian, she agreed to contact the funeral home and have Willie picked up. We all watched as Willie departed the facility, feeling the pain of loss and the sting of death. He had become important to us, a man we loved and would miss…. I don’t know, maybe it was because we knew he didn’t have any family, so we rallied around him, becoming surrogate family to him….I just don’t know.

Leaving work Friday evening, I knew I had one more task of significance before I could go home. A little girl in our community had battled cancer since birth and had lost that battle earlier in the week. The ladies I play softball with felt that we as a ball club needed to go to the “viewing” since her mother  also played softball at the same place as we did, So we all dressed in our jersey shirts and gathered in the parking lot.Once we entered into the funeral home, the crowd of people was overwhelming. I would guess 200 people easily, waiting to pay their respects to this family. As I stood in line with my group, I noticed countless jersey clad groups, some local, some from far away….all waiting …….I personally did not know the little girl, or her family….but yet, there I stood.

My thoughts suddenly were locked on Willie. The quiet chatter of those around me faded as my mind raced…” Willie is here too, somewhere. There is nothing anywhere signifying his existence, nor his death…..why???” My thoughts would not relent….” What will happen to him? Who will see that he is given a proper funeral?…Stop thinking like this, you are here for a seven year old girl, her life cut short….Willie was 92…he lived a full life………but  grief does not see age. Willie mattered. These ball players could go see him too…..they didn’t know this little girl or her family either, yet they have come to show their support…..so why not…”   My thoughts were interrupted…

” Isn’t this a beautiful celebration of Stacy’s life? She would have loved to have seen all these ball players here. Lord knows she loved to watch ya’ll play every Friday night. Each of you ,were her hero. She may not have known you, but she cheered for you as you ran the bases, sliding in the dirt and creating a dust storm. You see, my daughter couldn’t run because of the cancer…but on Friday nights, you were her legs. She cheered for both teams because it was YOU, the runner, that she loved.  The running, the diving, the throwing of the gloves and the dust…oh that girl loved the dust ya’ll kicked up.   She couldn’t play ball like her mama, but with each crack of the bat, she lived the moment. I loved my little girl so much and I want to say thank you to every ball player who allowed her to live out a little of her life through you.”  
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Wow. I was suddenly jarred from one reality into another.   This family will never see their daughter graduate high school, college, get married….Will had seen the world, all on his own and lived out his life….Stacy lived hers through every person who had the ability to run, catch….slide….and spit inhaled dust……….

Death is a painful event, not considerate of age, time, place or date. But, life too, is an event. It does not yield to age, time, place or date either……..But we can be considerate of the life that each of us has been given and live it to the fullest. I never knew Stacy was in the crowd, cheering, yet there she was….living her short life out….through us.  As we go through life, we should always remember that maybe we are living out someone else’s dreams…..Life is to be celebrated, lived and hey maybe we should cheer for both teams………….

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Light Bulbs and Email

Have you ever had someone impact your life so much, that even after they are no longer around, they continue to speak to you in subtle ways? I have such a person that is always there, in her own folder in my email, named ” Peggles”.  For those of you who have read my book, God’s Waiting Room, the story of Peggy, the obnoxious family member, clearly stood out as an entertaining, yet forthright person.

Today, I was once again reminded of her.  Peggy’s mother, Marge, was in my care for over 8 years; even moving her mom to my facility when I changed jobs.  Yet, every time you saw Peggy, she always had something to complain about.   ” The food is too cold. The food is too hot. The bathroom is dirty. The lights are too bright. There are cigarette butts in the parking lot. Your employees are wearing their uniforms too tight. The uniform polo shirts are sloppy“…..on and on and on and on she would complain. If I saw her coming before she saw me, I would duck behind something and hide until she left! Those days, when she could not find me to express her complaints in person, she would jam my email box with a flood of emails all titled ” Concerns”.  I neatly moved her “Concerns” over to her very own folder……the ones I replied to, they too went in a folder.  She was the most annoying family member I have ever encountered. I considered her an unhappy grouch that just had to find fault with something.

You see, Peggy had a way of holding every caregiver and hot shots like me, accountable. Accountability is something no one likes……and probably why we didn’t like her. She visited her mother every single day…every single day…..sometimes TWICE !  She was not only an advocate for her mom, but for the entire facility…..pointing out what was wrong in every area and department.  It became my goal to have at least ONE DAY that she would not be able to find anything wrong, out of place or unacceptable.

I would start in the parking lot, picking up even the smallest piece of trash. I would troll the hallways, checking to see everything through Peggy’s eyes.  I engaged the staff, telling them we would celebrate if Peggy came and went without finding fault…..(pizza parties motivated them like no tomorrow).

We would fail at every attempt.

” The water temperature in mom’s room is lukewarm. I know there are laws about what it should be.”

“There is a light bulb out on the left side of the front patio”.

“The piano is extremely dusty.”

” The back bathroom on the left wing only has  2 paper towels remaining…..”

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I never met the goal of perfection.  But you know what? I learned so much from Peggy. I learned to notice everything, pay attention to every detail, and show interest in every aspect of the facility.  What I considered to be a chronic-complaining problem, was actually a life lesson in progress. Tuning in to all aspects of what was going on around me, I began noticing the dust on my own piano keys in my home. I began replacing the roll of paper towels at my kitchen sink when it was down to the last one. I would stop as I was backing out of my driveway, to pick up the trash in the ditch.  I took notice of the back porch light, that had burned out, probably two centuries ago……. I began taking responsibility for the things in my life, and changed what needed to be corrected.

The facility became a better place, as myself and the staff paid attention to details. Shirts were tucked in, burned out light bulbs were changed, the piano was spotless and bathrooms were stocked. I didn’t think Peggy knew we had made her our challenge…..but she did.

” Jessi, your staff has improved a lot in the past months. You see, if you don’t take care of the building and grounds. and take pride in it and yourself, how can anyone place their loved one with confidence in your facility? Good Lord child, if you can’t take care of a thing, how can you take of a human being?”

A few years ago, I attended Peggy’s funeral. Cancer took over her body, eventually consuming her. As I sat in an overflowing church, I looked around and saw Four Star Generals, highly decorated men and women, business leaders and government officials all showing their respects to her and her family.

Peggy made a difference in my life. She made me a better person both in my personal and professional life.  Each time I open my email box, there she sits, watching. As I attempt to write a colorful  email to a family member, I have to pass by Peggy to do it. Accountable. That’s what Peggy would call it. Accountable.

I miss her…..and I hope that she glares down at me from the heavens and says….” Jessi, your staff is greatly improved, but.………….”

accoutnability

When Can a Person Be Forced to Receive Medical Care?

Originally posted on TIME:

Last week, the case of a Connecticut teenager, identified as Cassandra C., 17, made headlines. Diagnosed with Hodgkin’s lymphoma, Cassandra wanted to forgo chemotherapy altogether—a decision her mother reportedly supported. But in early January, child services took the 17-year-old into custody and on Jan. 8 the state Supreme Court denied the teenager’s request to not receive the drugs.

The state’s interference in a personal decision about health care provides a rare lens into when and how health officials can mandate health care. Forced treatment is rare, but it happens when people, most often minors and the mentally ill, find themselves in extenuating circumstances.

“We subscribe to the principle that people should get to make decisions for themselves almost all the time,” says Paul S. Appelbaum, a psychiatry, medicine and law professor at Columbia University. “The exceptions to that rule are rare. What we’re seeing play out in Connecticut is really…

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Mama’s Rent

Have you ever felt as if you were the only person on earth that feels a certain way about things?  Either I  have gone bonkers, or society is a few fries short of a happy meal! Let me explain.

I was approached in the hallway by one of the nurses. last week, who reported to me a conversation she had had with a family member earlier in the day. Evidently, the family wanted a detail account of every medication “mama” was taking including who ordered it, why it was being given, how often it is given and how much it cost.     The nurse explained all that was within her scope of practice….everything but the cost.  Apparently the family was very dissatisfied with this …..

” I know what you people are up to. You are just keeping mama alive so you can collect her rent money”, the,  family screamed through the phone.  The nurse, who was caught totally off guard by such a powerful accusation had no clue as to how to respond. Scrambling for an appropriate response, she stated, ” I follow the doctor’s orders. If you would like, I can connect you to the Administrator to discuss the financial side of things…..””      The family chose not to talk to me, but rather, they slammed the phone down.

The nurse began justifying to me the medication “mama” was taking…carefully explaining how the resident needed each of the pills…one for acid reflux, one for edema, one for pain, one for fluid build-up, an aspirin and  a B12 injection. Hmmm.

Let me get this straight. The family thinks we are intentionally keeping her mother alive so we can collect her “rent money.” Wow. I don’t think I have ever been accused of such!  

I decided to call the family myself and sort through her concerns. I certainly do not tolerate anyone screaming at my staff and am quick to state my opinion to those who do so.           Once on the phone with the family member, I could tell the conversation was not going to go well….

” Listen Jessi, I know you are doing the best you can over there, but look, I can’t keep paying these bills that come in, and the pharmacy bill is out of control. Some times I think you just keep half the people over that at your place alive just so you can make money off them. Admit it, you know so many of them would be better off if they died; put out of their misery, but that would affect your bottom line.”      Before I could stop myself, I switched from Administrator to all HUMAN……..

” Mrs, Simon, stop right there. I am not God. I do not control anyone’s fate; their life, nor their death. It is my duty to my profession and to my own  personal character to provide care  and to indeed keep everyone alive! But you are the daughter and Power of Attorney, so the choices you make control life and death.  Do not shift your responsiblity onto me or the staff.  Furthermore, how dare you insinuate that we keep people alive for a profit!! We not only care for every resident in our facility, but we also CARE about them as well……….”    I quickly regained the tone and volume of my voice, knowing I was treading a fine line of unprofessionalism.   Mrs. Simon seemed unmoved by my rant.

” Do you know how much I owe the pharmacy?”She asked.

Before I could answer… she ylelled ” 72 dollars and 94 cent. You may as say 73 dollars.”

I sat at my desk, holding the phone in my ear, speechless. The words I wanted to say, were far from appropriate.  Seriously? 73 dollars?money

What is wrong with people??????????????????  The world has stopped for Mrs. Simon over $72. 93 and it is the fault of the facility that her mother is still alive.    Just wow.      Let me say it again…..WOW.

If she felt so strongly about her mother not NEEDING to spend  $72.93, then why bother having her in a facility such as mine? Certainly there are much cheaper facilities, or why even bother with a facility at all. Why not drive her to an assisted suicide state and drop the hatchet?

People love to talk about their right to die……and they are right to do so. We all have an appointed time to die, BUT, we also have a right to live.

Just wow. 72 dollars and 93 cent.

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