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The Whirling Dervishes Part II
This is chapter from a new book by Grace Rudolph, Ice Floes and Polar Bears: An Inside Look
at Nursing Homes. You may purchase this book of nursing home articles by clicking here.
As social workers we have a responsibility to contribute to the knowledge base of our work and to share that knowledge. We have the responsibility to keep ourselves current on what's happening in the field. What's new? What are the emerging problems? What are the possible solutions? We have a responsibility to attend lectures and seminars, to learn from our residents and our peers, to read journals, books, and newspapers critically.
Health care providers aren't the only ones gathering information on a daily basis. For my residents their TVs are their reality, their only access to the outside world. Do you know what they're watching? Do you know how it's affecting them?
A few years ago a man came to our facility due to a serious head trauma. James had gotten out of a cab and slammed the door as the cab pulled away from the curb. His coat was caught and he was dragged beside the car before the cabbie realized what was happening. James was a quiet gentle man who occasionally shouted out in a loud terrified voice while watching television programs that involved car chases and crashes.
At that same facility another resident didn't have a television but was in the TV room and overheard a special bulletin linking the violence at Columbine High to the anniversary of Hitler's birthday. Irma, a concentration camp survivor began to chant. Months later I was working at the nurses' station. Irma was reclining in a nearby Geri-chair. I opened a chart, closed my eyes and while I tried to focus my thoughts I slowly became aware that Irma was chanting endlessly, "Why God? Why God?"
Social workers are responsible for helping to ferret out fraud and theft. I hadn't been working long before I knew what I was doing and what everyone else was doing as well.
Part of my first job was helping families fill out Medicaid applications. I loathed the job because, like most social workers, I hated math. I also came from a generation that had been raised to never ask questions about religion, politics, or money. Occasionally, when working with a family facing a long term placement, I would mention the words ‘spend down.' A glassy look would cloud their eyes, a heavy silence would seep into the room and they would break eye contact to stare at the wall just above my head. When this happened I would quickly shift into first gear and caution them gently that, "of course I know you would never try to hide assets but believe it or not there are families that attempt to do that. Of course these crooks, these slimy felons," shifting into second gear, "always get caught because a check on your financial information is run through all banks everywhere EVEN IN THE CAYMAN'S and if they catch you cheating, you are never eligible for Medicaid. Ever." Now into third gear and heading towards a crescendo, "and you're private pay for the rest of your life even when you're destitute and living in a paper bag on the side of the road wearing newspaper clothes and eating cat food!"
If you're one of the unfortunate social workers that has to help families apply for Medicaid give this approach a whirl and see what happens!
Sometimes an investigation of internal theft has a happy ending. Consider the case of Betsy, an 85-year-old bright eyed, flirtatious lady who was visited daily by her boyfriend, a tall gangling 80-year-old guy with a lopsided ‘aw shucks' grin and a ratty dog named Jerome. Betsy and her boyfriend shared bags of potato chips, smuggled thermoses of Manhattans, and mild cognitive deficits. He was completely in her thrall. They would sit side-by-side on her bed and neck while her roommate was busy in the activities room.
One day her roommate came back from a cutthroat Bingo game to find all her stuffed animals were missing. Betsy told her the cleaning staff had stolen them.
Serious interrogations began. The cleaning staff became paranoid. Everyone watched everyone else from the corners of their eyes, like hawks circling for mice until one Monday when the gently confused boyfriend asked Betsy, in front of her nurse's aide, if she wanted him to bring back her stuffed animals. Case solved. Next?
Human nature being what it is there will always be a next time. Sometimes the ‘next' involves making an example of an employee who preyed on a resident. Social workers often present the resident's rights section during new employee orientations. When I present resident's rights I underline, highlight, stress, do anything in my power short of cartwheels and card tricks, to show that my facility has a zero tolerance for not only physical, verbal and sexual abuse but for financial abuse as well. I firmly agree with Mathew Muratore, an administrator I once worked for, who believed in following through with investigations and prosecuting offenders to the fullest extent. He believed that anyone who stole from one of his residents should be slammed, and slammed hard.
During orientations I warn employees that when an investigation begins and the police and insurance companies become involved you can run but you can't hide. It's like the old Tina Turner song, Big Wheel Keeps on Turnin'. You can move on to another job in another place but someday, somewhere, when you least expect it there'll be a knock on your door and it won't be Ed McMann with a fistful of multicolored balloons and an oversized check.
Social workers should take part in quality assurance and policy improvement committees but not to the detriments of residents. Use meetings to advocate for revisions that will improve work standards and the quality of resident's lives. Speak up. Speak out. Make waves and recommendations that will reduce paper work and increase time spent with residents and struggling families. Choose your battles wisely, and then commit to them.
Keep your Rolodex updated and when involved in discharge planning utilize as many different community resources as possible. If a single agency snatches too large a slice of the market other agencies will wither and die. Trust me, I know. Years ago I was a copywriter for a small ad agency on the Boston waterfront and we operated on the premise that if you could eliminate the competition you could call the shots.
Not too many years ago you had a wide array of home heath agencies to choose from. Today, many have vanished without a trace and you're told by one of the lucky survivors that their agency nurse will evaluate the need for services.
On admission include residents and families in team decisions and encourage them to identify problems and set goals. Read newspapers and listen to the news with a critical ear. Are there winds of change in the air? Are they the harbinger of brewing storms on the horizon that will wreak havoc on the nursing home industry? What do long-term care providers need to do to stay the steady course?
Be proactive in assuring that residents live full lives and that they maintain their optimal level of independent function. Make sure their goals are realistic and not just paper whimsies found on care plans to pacify surveyors.
Humanize residents as soon as possible after admission by developing full, rich, readable psychosocial histories. I have a problem with the current popularity of psychosocial check off lists. A good narrative history is a harvest of information that can ease a pathway through periods of frustration, grief and eventually through death. If the resident is a poor historian involve family, partners, and friends but be aware that everyone you interview stirs their own social history into the soup.
When Ruth, my sister, and I reminisce about mother I often wonder who Ruth is talking about. Who is that woman? We choose colors; all of us, from memory's palette to either soften or highlight our recollections. Shared memory is quite often a myth.
And, lastly, social workers and all those involved in long-term care have a commitment to themselves. Set limits and give more than 100% while at work but take a deep breath of fresh air when you leave the facility each night and leave it all behind. Listen to the wind in the trees around you or the bustle of the traffic in nearby streets. Read a good book or write a better one. See a funny movie or spend quality time with someone you love. But, above all, carve out a quiet piece of each day that's yours and yours alone. Maybe it's the drive home or only the walk to your car but nourish yourself. Don't burn out and leave residents in the ashes of your exhaustion and defeat. No matter how consuming commitments seem or how hectic days are – persevere. Keep on keeping on.
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