An Appreciation of Sunrise

Barely three months removed from my abbreviated employment with Sunrise Senior Living, which I would otherwise call my sunset at Sunrise,  I discovered a few things about myself. What I loved most about the job were the interactions with the residents. I learned a lot about caregiving and will hopefully keep that knowledge for a long time and be able to apply some of the skills in the psych unit setting. The training provided by the company was invaluable, but the job itself was harder and more physical than expected. By learning about the Sunrise way of managing the care of its residents, I also learned that I wasn't very good at it. In theory perhaps, I was good since I aced most if not all of the tests I took in company's The Learning Channel (an internet based education program). Maybe if I stayed longer I may have become somewhat competent in the physical side of the job, however I couldn't pass up the opportunity to work in more familiar situations and surroundings. I sincerely appreciate what Sunrise Senior Living of Seal Beach has afforded me and I will truly miss the residents, the pets, and my co-workers who have been more than patient with me with all my fumbles while learning to do the job those few months I was there. Let me emphasize that my co-workers there were very good at what they do and I was very impressed. I feel a tinge of embarrassment for not being able to last long but I just had to jump at a different opportunity.

I tried my best to learn how to become a decent care manager, but based on my personal standards, I really sucked (for lack of a better word) at that job. Maybe that negative self assessment is due to being a perfectionist sometimes.

I also am not a natural people person but I had to transform myself, albeit even just slightly, because despite all the duties and responsibilities of being a caregiver, a huge percentage involved customer service especially if you were working the morning or evening shift. Not only did you have to be good with the residents, but their families, visitors, and potential customers touring the place as well.

I did not resign from Sunrise due to dissatisfaction with the job but rather because an opportunity came up which are few and far between nowadays.

In all the places I've worked, I've never said goodbye to the patients until this time, when I said goodbye to most of the residents assigned to me who were awake between 4 a.m and 6 a.m. (since I was on the overnight shift). I left a piece of myself in Sunrise Senior Living of Seal Beach because the residents and pets stole my heart.

If there is one thing I wasn't comfortable with in the treatment of the residents, it was rushing them through meals, although I can only say that about dinner since I never worked in the morning for the breakfast and lunch service.

My last couple of weeks at Sunrise Senior Living was full and hectic (for me anyway) - working on the PM shift on Thursday, midnight shift on Friday, high school reunion on Saturday and Sunday, hospital orientation at my new job on Monday and Tuesday, tending my one week notice of resignation on Wednesday, then working my last 3 shifts on Thursday, Friday, and Sunday. I was glad to have a few days off before my return to the psych unit. No, I didn't relapse and become a patient, but rather finally found a job as a behavioral health worker after being out of that field for almost a whole year. Goodbye Sunrise. Maybe I’ll consider living  there if I can afford it in my sunset years.

Rainy Days Are Here and I Don't Mean The Weather

Rainy Day Fund

          You all know the phrase "save for a rainy day"? It's something that I practice almost religiously. Along with the unemployment checks for 6 months, it was reassuring that I had saved for a rainy day.

          Since I finally got gainfully employed 3 months ago, there seems to be more rainy days occurring in my life. First was the plumbing problem I had where a new garbage disposal system had to be installed because the old one was corroded. This happened just right after I got my first paycheck.

          Next came the car repair which involved brake pads and rotors replacement, plus a new battery because the old one had 10% charge left. The front brakes had been a problem for several years and I had been putting it off. I had been avoiding driving on the freeway because sudden or hard braking from full speed made the front wheels shake violently feeling like the wheels were going to fall off.

          Then just as winter started, my wall furnace went on the fritz. For the past 22 years, I've been able to relight the pilot on my own by following the manufacturer's instructions. This time the pilot light won't stay lit despite several tries. I called the Long Beach Gas Department and they sent a technician to check it out and he said that there was a problem with the electrical system. So I had to call a heating company whose technician first diagnosed a thermocouple problem. So he replaced that but the heater still didn't work. That could only mean one thing: the price of repairing the heater would get steeper.

         Sure enough, he had a second diagnosis and this involved the generator. He explained to me how the gas, the pilot light, and the electrical system worked. I asked him if he was sure that if replaced the generator, the heater would start working. He said "well, there are really only two parts of this particular heater: the thermocouple that I replaced and the generator". So I asked him for a price quote and again, sure enough, the price more than doubled. Well what choice do I have other than freeze in the wintertime. Unlike the movie Frozen when one of the characters sang "the cold never bothered me anyway", I prefer to keep myself warm because cold bothers me. I had to take a nap before work, so I asked the technician to come back the next day.

          So there you are. Three major rainy days in the past three months of full time employment. The timing couldn't get any better because at least I now have the income to use as an umbrella for the unexpected precipitations. Thank GOD! Oh boy, living in the United States sure is expensive! Too bad my rainy days isn't helping the drought in California.

Update: November 22, 2014 - Well my old Asus Transformer TFT 101 is on its last legs. Sometimes it works and sometimes it doesn't. The thing I like about this device is the 16 hour battery life when attached to the keyboard and nothing comes close to it at a reasonable price in the market nowadays. Time for another rainy day expense to replace it?

CHLB Center for Mental Health NOC Shift BHW Duties and Responsibilities

          I just finished my 3 month probationary period in my new job as a Behavioral Health Worker, and while in orientation the first couple of weeks, I learned about my duties and responsibilities, which I now list below. Although the list may  be longer than what I had to do as a care manager in assisted living, it is not as physically demanding. At least not yet.

          First of course is clocking in to work, then checking the assignment sheet to find out if I'm assigned to Unit A, Unit B, or the Geropsych unit one floor up. Then all the staff hang around the lobby area between Unit A and Unit B in what they call the huddle. During the huddle a short report is given on the number of patients on each unit, how many possible admissions are expected, and how many are being evaluated in the emergency room downstairs or in other hospitals. Reminders are also given on any special things that need to be done. After the huddle, we proceed to our assigned units to listen to report about the patients from the day shift.

          Then we do our first rounds checking the location and behavior of the patients. We do this every 15 minutes throughout the shift. Next, we check the vital signs of all patients (temperature, pulse, respirations, and blood pressure). We are usually accompanied by a registered nurse so they can also check on their assigned patients. After all vital signs are done, we give a copy of the vital signs sheet to each nurse, then we enter the results in the Epic electronic medical records on the computer.

This is as far as I will write in narrative form. What follows is the list of my other duties:

• Make sure water container has cold water (add ice from freezer as needed).
• Assist with admissions as they come in (vital signs, papers signed, belongings; contraband; valuables check).
• Snacks at 2030, Canteen run to vending machines,  and Contraband time right afterwards.
• Prepare new rounds sheets for next day. File old rounds sheets at midnight.
• Break down discharged patients charts & keep dividers in binders. Place D/C chart in cabinet near copying machine.
• Make admission chart packs after 2300. Put nursing paperwork and admit packs in empty binders for new admissions.
• Clean tables in dining room with disinfectant wipes. Order staff pantry supplies from Dietary Department as needed (fill out form then fax). Straighten out dayroom, contraband room and donated clothes (in solarium) as needed.
• On geropsych unit, give a shower to at least one patient in the morning (red key in nurse's station for shower & vending)
• Continue Q-15 minute checks throughout the shift. Approximately 5:30 a.m., enter patient's number of hours of sleep and sleep quality in EPIC./ Print out vital signs sheet and meal/shower/BM log for the a.m. shift./Serve decaf coffee at 0600.

Admission papers:  BHW - Release of Information, Notification of Patient Admission, Telephone List, Consent to Photograph, Patient's Rights, Valuables List, Rounds Sheet.

                                 RN - Medication consent , Interdisciplinary Treatment Plan (multi page), Physician's Initial Assessment, Skin Assessment, Patient Education Record, Discharge Recommendation.

EPIC for BHW's:

• Log in. To find your patients: Click System List on left side, Click Units-CMH. Click CMH 4A or 4B or 5. Click and drag Unit chosen to My list on top of left side of screen.
• To chart vital signs: double click on a patient's name to open his/her chart. On left side of the screen, click Doc Flowsheets. On the tabs on top, click Vital Signs. Enter the vital signs in the designated areas. When done, click File on upper left corner. Close the chart by clicking the X next to the patient's name. Double click on the next patient name on the list and repeat above instructions.
• To print labels and ID wristband: on the left side where you found Doc Flow sheets earlier, click Form Reprint. Click on what you want to print and enter how many, then click Print.
• To chart hours and quality of patient sleep: as above, click on Doc Flowsheets, click Sleep on left side, enter number of hours in designated area, click Quality of Sleep, choose appropriate description from drop down list or type in your own comment (F6 key), click File on upper left corner, close the chart by clicking the X next to the patient's name. Double click on the next patient name on the list and repeat above instructions.

Public comments below, private comments: E-mail Me!

P.T. For The M.F.

          Forgive me, I don't mean physical therapy for the mother fu...er. It's for the mallet finger. After having a consultation with the orthopedic specialist, he said that I didn't need surgery even though my middle finger was drooping slightly. He asked me if I needed physical therapy and I said yes, since I felt I needed more guidance with what rehabilitation exercises to do other than just sending me home with Theraputty® like the previous doctor did. 

 

          So I was given six sessions of physical therapy (three times a week for two weeks). During the first session, the physical therapist asked me about the history of the injury then proceeded test my grip strength

and make measurements of how much angle I could flex and extend the finger to get a baseline. She then told me to show her what types of exercises I had been doing with the Theraputty® and showed her two ways I would squeeze it. She showed me a few more things I could do which included digging into the putty with my fingers and other extension and strengthening exercises. In addition, I was shown exercises I can do with a rubber band and a dumbbell. Afterwards, she held my hand (without even buying me dinner first!), and started torturing me. OK, just kidding, but it sure felt that way initially. What she did was hyperextend the finger ever so slightly to the point of pain indicated by my yelling OWW! She did that a few times until the finger looked slightly straighter. She also did some passive range of motion exercises to the point of resistance which also resulted in some pain. Not that I wasn't expecting any pain at some point. Then she provided me some relief by attaching four electrodes on my fingers - two on top and two on the palm side. She connected the electrodes to a T.E.N.S. unit (transcutaneous electrical nerve stimulation) and turned up the power and started electrocuting me. Well not exactly. She turned the knob slightly and asked me to tell her when my fingers started to tingle and when I indicated as much, she stopped. The same was done for the electrodes on the palm side and a timer was set for twenty minutes. Oh I forgot, my hand was also wrapped with a heating pad. The T.E.N.S. treatment was supposed to improve circulation and break up scar tissue. 

          So I sat there and explored the room with my eyes to pass the time, wishing I had picked up a magazine to read from a rack at a corner of the room. Other patients came and went to do their therapies. Pretty soon the timer started beeping and I survived my time on the electric chair or Taser. The electrodes were removed and kept in a plastic bag with my name on it to be reused in the next session.

Lastly, they tried to make strike anywhere matches with my left hand which was dipped about 5 times in a container of lavender colored hot paraffin wax, then it was wrapped in white paper which somehow reminded me of fish and chips, then the papered hand was inserted in a terry cloth fingerless glove to keep the heat in. When the paraffin wax cooled in 5 to 10 minutes, off came the glove, the paper, and the wax had to be peeled off from the hand like a second skin. The lavender scent from the wax remained in my hand for a few hours and people were probably wondering why I was sniffing my hand so much despite the absence of white powder on it. 

          The session went for slightly more than an hour which I thought would last only half as long, although the time passed pretty quickly. Except for the initial measurements, subsequent treatment sessions were similar to the first. In my subjective assessment, after 5 treatments, my finger feels slightly stronger and more flexible, although I have more work to do by myself for further improvement after the 6th and final session.

          Much thanks are in order for the physical therapist and her assistant for guiding me and helping improve the function of my left hand and more specifically my healing middle mallet finger.  For privacy reasons, they declined to allow me to use their names. Even though the finger injury has been a major inconvenience to my daily activities, whenever I went in for physical therapy and was asked what my pain level was from 1 to 10, I always felt no pain. In contrast, the other patients who came in always mentioned some pain.

Hell of a Night at the Psych Ward

          And then there was this assignment in the most acute Psych Unit of the hospital. The first night was unremarkable and that was when I was able to make those 70 chart packs which I mentioned in my previous post. I was surprised when I was assigned there a second night in a row when things didn't go as well. For starters there was a plugged up toilet because the patients in that room were throwing their trash in it. So I donned a pair of gloves and dug out the trash from the bowl but despite my efforts, the toilet was still clogged and it took a few plunger attempts by the maintenance person later to fix it.

         Meanwhile a female patient was awake and laughing all night long for no apparent reason other than whatever funny things was going on in her head. Another patient was retching and throwing up in his room except for one time when he did it on the full length of the hallway. Guess who had to clean that up? 

         An insomniac who had been complaining of being unable to sleep for days finally did so only to be woken up by the loud snoring of a newly admitted roommate. So he got upset and tried to sleep on the toilet floor (no, not the plugged up one) which wasn't any help because it was too hard. Another man was compulsively pressing the call light near his bed and in the bathroom, and also punching in numbers on the exit keypad. Not because he needed anything or was trying to escape but rather a compulsive habit. 

         A woman was trying to talk to staff all night and was demanding and argumentative at times when she didn't like the responses. A newly admitted religiously delusional pregnant woman who was calm when she was being interviewed, suddenly went postal on a male patient whom she thought was going to harm her baby. She said she was going to protect the baby with her life. The surprising thing was that she went from speaking proper English to ghetto English when irate. Unfortunately she couldn't be medicated at that time due to her pregnancy until properly evaluated by her doctor. After resting for a couple of hours and waking up very early in the morning, she underwent another transformation and started bouncing around the room and talking about how blessed and holy her baby was, all the while bowing and praying and lying on the floor.

          The staff were counting the slow minutes until it was time to clock out. It was just another day at the office. Would you believe I was assigned to that unit 4 consecutive nights that I was on duty?! On that fourth night, 3 patients became menacing towards me because I couldn't give them a second cup of coffee in the morning. I had to request the supervisor for a reprieve and assign me to another unit the following night and thankfully, he did.

Center for Mental Health Orientation, Chart Packs, & Epic Electronic Medical Records

          After hospital-wide orientation, Crisis Prevention and Intervention training, and Epic electronic medical records training, I had unit specific orientation as a Behavioral Health Worker at my new job last month on the Center For Mental Health and Wellness, and I was glad that my preceptor was a pretty cool woman who was gentle with me. We started with the assumption that I didn't know anything, which was what I preferred so I could learn the ins and outs of how they wanted things done. The duties and responsibilities were thankfully very familiar to me since they were what I was doing before I got laid off, and was a stark contrast to my brief foray into the assisted living job. The only problem I had was having to wake up at 4 a.m. so I could work out before what was supposed to be 4 day shifts. Well my body isn't quite used to that since I've been working nights for three decades so the body rebelled and my stomach was in knots. So much so that my preceptor and I requested our director to put me on night shift orientation after just 2 day shifts. After that I got three more nights of orientation from three different preceptors on the three psych units of the hospital. Then I was released to fend for myself.

          One of my first projects was learn how to make admission chart packs. The forms were significantly lesser since the hospital started using electronic medical records on September 1st. What used to be about 40 to 50 forms were down to 14 (even lesser than what I used to handle at the job I was laid off from). On my second night post orientation, I made 60 chart packs even though the supervisors only required 5 each night. Well I'd rather make a lot more during nights that are not busy rather than scramble to make them when there are numerous admissions or when patients are acting out. Later, I was surprised to learn that nobody ever made that many before. Before electronic medical records, I probably wouldn't have either. I just lucked out by being hired there at the time that I was. A couple of weeks later, I made 70 more. Apparently I made so many in such short time frame that the psych units ran out of some forms and welcome folders. To add to that, between the time I made the first 60 charts and the next 70, there were four changes in what forms were needed because they were trying to sort out what they can include in the electronic medical records system. After about three weeks, it appears like they have settled that issue.

         One of my coworkers, upon seeing that I was new, asked me how I became a behavioral health worker. I said I used to be a psych patient, and having observed what BHW's did, I figured I could do the same as well, so I applied for the job. My new journey has began.

Left Middle Finger Injury Update - From Stax to Oval 8

From this makeshift splint
to

the Stax splint,
and now

the OVAL 8 splint

          The 8 week period for me to wear the splint on my left middle finger passed 2 weeks ago, and I was looking forward for the doctor to tell me it was okay to remove it and begin rehabilitating the finger. After 8 weeks of wearing the Stax splint as recommended for mallet finger injuries, the finger had become very stiff and swollen and I've been having a difficult time restoring the range of motion due to scar tissue that formed around the joints. Not only that, but the other fingers also got stiff because with the splint, I couldn't close my fist. I was given a week trial without the splint and was instructed to do active range of motion exercises and try strengthening my grip with Theraputty. When I returned to the doctor a week later, he didn't like the way the finger looked so he ordered the Stax splint put back on and also got authorization for an orthopedic specialist consultation. Unfortunately it would take another 3 weeks before the orthopedist can see me. Since I can't make a fist with my left hand and have a hard time grasping, at work, I am not able to assist my co-workers in case we have to restrain a patient.

          I've been searching for other kinds of splints and found the Oval 8 splint, but I've been holding off buying it myself hoping that 8 weeks on the Stax was enough to heal the torn tendon of the DIP (distal interphalangeal joint)or the knuckle near the nail. The advantage of the Oval 8 is that it's more open and less restrictive so that I could try bending the PIP (proximal interphalangeal joint) or the middle knuckle of the finger. When I learned that it would take more time to see the orthopedist, I finally measured my finger and ordered a set of 3 Oval 8 splints from Amazon.com. Since it was not supplied by the doctor, I had to pay for them myself. The set came in 3 different sizes and was recommended that way so in case my finger became swollen, I could switch to a bigger size or if the swelling went down, the finger would fit better in a smaller size. The Oval 8 also didn't require Coban tape to be used so I was able to wash my hands better. With the new splint, I could start to aggressively restore the range of motion to the PIP while the DIP remained immobilized and kept straight to hopefully continue to strengthen the healing tendon. I find that the joint is tight when I wake up in the morning, gets looser when I exercise it, then becomes more swollen in the evening thus more stiff. Meanwhile, I hope the orthopedist has better news when I see him in a couple of weeks.

Farewell to Assisted Living

          

          

          Wednesday, August 20th is or was (depending on when you read this) officially my last day of working at Sunrise Senior Living of Seal Beach. Although in reality, last Sunday night was my last day of work since I'm off from work for a few days. Because I wasn't able to give them a 2 week notice, I was informed that they may not rehire me if I apply there again in the future. I'm okay with that. Other than the finger injury I got from there (of which I'm still under a doctor's care) and the transient back pain the first few weeks which was relieved by doing lower back workouts, they have treated me fairly well during my short employment there.

My resignation means no more:

·         *Doing loads and loads of laundry which included folding and hanging clothes back in resident's closets

·        * Setting tables before dinner on p.m. shift and before breakfast on noc shift

·         *Serving dinner like a waiter

·         *Clearing and bussing tables after dinner like a busboy

·        * Doing dishes like a dishwasher then putting them away in the kitchen cabinets

·        * Wiping down tables and sweeping the floor like a housekeeper

·         *Keeping the residents entertained like an activity therapist

·         *Giving scheduled showers

·         *Using a mechanical lift to transfer residents to and from bed to wheelchair

·         *On the noc shift - cleaning the refrigerator, popcorn machine, coffeemakers, steam tables, cat litter, refilling cat food and water, and sweeping the carpet with a carpet sweeper. Refilling the sweetener caddies and cleaning the salt and pepper shakers. Waking some resident up every two hours to escort them to the bathroom or check their diapers

·         *Training in passing medications like an LVN without a license

·         *Answering walkie-talkies and pagers

·         *Folding table linens

·         *Dressing residents for bedtime

·         *Taking care of hearing aids and dentures

·         *Picking up trash, emptying waste baskets and replacing the plastic liners

·         *Wearing maroon aprons for resident care and gray/green aprons for serving food

·        * Positioning body pillows, bed wedges, portable bed rails, and cushioned floor mats

·         *etc. for other things I may have forgotten

So even though I will miss my interesting conversations with some of the residents, I will not miss what I listed above so much.

Hey, at least I got a t-shirt out of it!

Public comments below, private comments: E-mail Me!

Random Notes of a Caregiver in an Alzheimer's Unit

          When she was still alive, my mother when asked by her friends what I did in the U.S., always told them that I was a caregiver. Now I can truly say that she was correct. For the last 2 months, I’ve working as a care provider to residents with dementia and Alzheimer's disease.

          One of my first encounters with a resident: he woke up in the morning and upon seeing my Asian features, asked me in a confrontational tone where I was from, and I told him I was from Long Beach. In a much softer tone he said “so you're a local”. He mentioned that has been in two wars. I asked him if it was WW2 and Korean and he said I was right. I’m guessing that because he perceived me as a local and knew about those wars, we made a connection with that brief conversation.

          The difference between a geropsych unit and Alzheimer's unit is that in an Alzheimer's unit, you get to learn the needs and care of the residents (whether easy or difficult) because it is long term care and they live there until their families move them out or until they die. In a psych unit, you may only get to know the patient briefly before they get discharged, but the advantage is if it is a difficult patient, you only take care of them until they're stable enough to return to the long term care facility they came from or back home. After a couple of weeks on the job, I started to question what the heck I've gotten myself into. But, it seems like I'm starting to get used to it.

          Some of the challenges I have encountered especially on the P.M. shift is trying to give showers and convincing some residents to change into a nightgown to get ready for bed. A lot of them have reservations about being cared for by a male caregiver. Good experiences involve communicating with them like that one time when a group of 3 saw me folding napkins in the dining room. One of them (a former teacher) said I did it so well. I told them I learned it by watching short movies on the internet and proceeded to try to explain the internet to them. They were astonished that there was such a thing.

          Before I injured my finger, I was assigned to the advanced care area several nights a week and a female resident complained about having a male caregiver though the other 6 didn't mind. The thing about dementia is that a few seconds later, the resident might not recognize you anymore and it’s like they are meeting a new person all the time. After a couple weeks of seeing me working there regularly, the resident who complained became more friendly.

          A fringe benefit of working at this community are the hugs and kisses one sometimes gets from some of the residents. A disadvantage as I mentioned before is being a male caregiver, because a lot of residents have reservations about a man touching them. Apparently, that goes for private caregiving agencies too since I haven’t gotten any calls from them.

          I always thank my assigned residents for helping me help them. Examples of how they help me: when they transfer from chair to bed or toilet and vice versa, when they bear weight on their legs, when they lift their hips up or turn to their left or right sides when I'm changing their diapers. I also always apologize for having to do what I have to do to take care of them.

          Things that make me feel bad about this job: the frailty and helplessness of some if not most of the residents specially in the back area. And a major concern is the potential of hurting a resident by accident (skin tears, dislocation, etc.) while caring for them.

          In this business, as I presume in a lot of others, a lot of food is wasted - thrown away even when they are not spoiled. Lots of plastic bags are also being used for trash that end up in a landfill somewhere where it doesn't degrade. But then, that’s the secret why the place doesn’t smell like a nursing home. Dirty diapers are bagged right away and lots of baby wipes are used to clean up the residents. So far, I haven’t seen any dumpster divers scavenging for food otherwise they would have had their fill and still have a doggie bag to take home. That is if they can separate the food from the human waste.

          A care manager's job actually consists of 4 positions: nursing assistant, housekeeper, server/dishwasher, and medication nurse - all of which are done by 4 different departments/people in a hospital setting. It's like being a Jack (or Jill) of all trades and you have to master each one of them. Cumulatively, even with just minimum wage calculation (considering that a degree is not required), the pay should be $36 an hour. Instead, it's only over 1/4 of that.

          In the short 2 months that I've been working there, 4 residents died. In contrast, while working for 33 years in psych units, I've witnessed 5 deaths, 4 of which I administered CPR and 1 who was DNR (do not resuscitate).

          It pisses me off that the finger injury happened (as seen in the above photo). Who would have ever thought that the tip of a finger can alter every other movement you have in your daily activities? It's like everything gets unbalanced and uncoordinated. Not only that, I’m getting a physical exam this coming week and I hope that hospital will still hire me despite the injury. The splint doesn’t come off till September 1^st.

Public comments below, private comments: E-mail Me!

Qualifying for Medi-Cal Due to Obamacare

          

          In other news, since I officially don't have any more unemployment benefits and don't know where and when my next income is going to come from, since you remember I've only been hired as a part time employee with no guaranteed working hours, I've re-qualified for Medi-Cal (Medicaid) insurance. (Did that sentence run on?) It was supposed to be effective June 1st, 2014 but due to government backlogs, I didn’t get it till mid July. In the meantime, I stopped paying Healthnet the monthly $135 I’ve been sending them since January. I thought that  I still have to continue paying Keenan Healthcare $45 a month for dental insurance thru COBRA from my previous employer but it turns out Denti-Cal was reinstated by California effective May 2014.

          Let me backtrack a little bit. In May, I had to call Covered California (the California Healthcare Exchange) to make the changes and was glad the wait time on hold wasn't as long as it was late last year. Charlie checked my eligibility and in a few minutes was transferred to the L.A. County Medi-Cal representative Lily who had me scan my last EDD unemployment check notice and upload it to the Covered California website. There are still some bugs in the system, but not as bad as it was before because the representatives have found workarounds to bypass the bugs. It also seems like the reps have more latitude to approve the changes based on the proof you upload. I thought that was it and that free Medi-Cal insurance would kick in on June 1^st. I made a doctor’s appointment and the medical assistant confirmed my eligibility. However on May 27^th, I got another call saying my Medi-Cal was deactivated. I called the L.A. County Medi-Cal office and was told that I had to wait for it to be reactivated again but without an approximate time. A few days later I got a letter in the mail informing me that a caseworker has been assigned to me at the local Department of Public Social Services (DPSS) office. I was also expecting another packet in the mail to pick a managed care plan.

          So I waited, and waited, then waited some more, and I called the DPSS every other week. Meanwhile I was getting tons of mail from Covered California which said I qualified for this and that federal subsidy which was basically what I was paying Healthnet for 5 months. It seemed that Covered California’s computer system finally caught up with the applications and the eligibility information I uploaded way back in October 2013.

          On the second week of July, I called the DPSS office again and my caseworker said that my Medi-Cal would be reactivated the next day, but to wait another day for me to make a doctor’s appointment. When the time came, I called the doctor’s office and they verified that my insurance coverage was again active. Hence, I made an appointment for the following week.

          So I finally made use of the free medical insurance last week  and went to see a doctor for a checkup almost a year since my last doctor's visit. Not just any doctor mind you, but one who accepted Medi-Cal and someone I used to work with as a mental health worker 20 years ago before he went to medical school and haven’t seen since. I went to the clinic 10 minutes early, filled out the necessary paperwork regarding my medical history, then waited in the examination room. When the doctor finally entered, he greeted me, then had to do a double take. He said "hey, I know you!". I was going to ask if he remembered me but it was too late for that. He asked me if I was in touch with any of our former co-workers, which I was not. So he mentioned a couple of nurses whom we used to work with and that they were his patients too. Hopefully, there was no HIPAA violation there since we were all friends way back when. So I had my checkup done, blood drawn for lab tests right there in the office, had my maintenance medications refilled, and experienced the advantages and joys of free Medi-Cal insurance: no doctor’s visits co-pay, no lab co-pay, and no pharmacy co-pay. All thanks to my much much lower income and Obamacare. I already addressed this in my blogpost way before Obamacare kicked in : http://aboutlifeandrunning.blogspot.com/2013/04/an-obamacare-loophole-for-early-retirees.html

Seeking a Financial Sweet Spot

          Now I have this dilemma of finding a full time job with benefits or working part time (and semi-retired) to keep my income within the limits required to stay eligible for free Medi-Cal. I'm torn between staying semi-retired and earning less (with free coverage for medical,dental, vision, and most prescription meds) or getting full time employment and earning more while paying for regular medical insurance with all the co-pays. I was offered a full time job which starts in mid-August which more than doubles what I earn  now, but in exchange, I have to work longer hours. The decision has to be made soon on whether to stay poor and get free insurance as long as Obamacare is in effect, or earn more money and start paying for employer sponsored insurance with all its co-pays. And perhaps, not too far down the line, since my mortgage is already paid off, finally take vacations I never took in the past 34 years of working so much.

           A final note on free Medi-Cal: when you choose a managed care plan, they even supply a postage paid envelope. That's your tax dollars at work folks. No wonder a lot of people pretend to be permanently disabled like some of the psych patients I've worked with.

Public comments below, private comments: E-mail Me!

A Freak Diaper Change Accident With Unforeseen Consequences

Stax Splint from Urgent Care

          No, it didn't happen while I was changing my own diaper, but this freak thing happened in the business of caregiving. In the annals of medicine, I challenge you to find anything close to what happened to me while changing a diaper (or continence care product, as my company wants it to be called). Sure, you can jam your finger at anytime or anywhere, but on a diaper or on bedsheets? Probably only I can experience that even though I don't consider myself accident prone. This happened at 3:00 a.m. While pushing a diaper under a residents' body to remove it and replace it with a clean and dry one, I heard a pop and thought it was just a sound made when you crack your knuckles. So I didn't think too much about it and continued to give care to the resident. It was only several minutes later when I finally took my gloves off that I noticed the topmost knuckle of my left middle finger was bent at a right angle. My first thought was that I broke my finger! I tried to straighten it back in place but it just returned to the bent position. So I went to my lead care manager, showed the finger to her and told her what happened. She went to find a tongue blade and some tape and fashioned a splint out of them (she is a nursing graduate from the Philippines).

Tongue blade splint

          I then filled out an employee incident report and asked her what I had to do next, like how to obtain a authorization for treatment form so I can be examined at the urgent care clinic that our facility uses. She didn't know and neither did the lead care manager a floor below, nor the maintenance/security person. The consensus was for me to go to the wellness office at 6:00 a.m. when the nurse arrives. In the meantime, I managed to finish my shift, being careful not to poke the residents with the stiff middle finger with the tongue blade splint, nor injure the finger any further. Fifteen minutes before the end of the shift, I called the acting coordinator for the unit or neighborhood I work in and left a voicemail message asking how I should proceed, since I'm not yet familiar about how they do things, having just started working there the month before. When I went to the wellness office, nobody there knew about obtaining the treatment authorization form and I was to call back at 8 or 9 a.m. to find out. So I clocked out and went home to get a few winks in. A couple of hours later, I got a call from the wellness nurse giving me a toll free number to the Nurse Hotline of Sedgwick, the company that handles workman's compensation claims. I was directed to go to an urgent care clinic closer to home. I had to wait for them to email me the authorization form (which was initially sent to the wrong email address) before proceeding to the clinic. The urgent care clinic was surprisingly empty and the doctor was trying to fix the TV antenna to get a better reception to the World Cup. Meanwhile the medical assistants were debating whether I actually got proper authorization since the place I work wasn't on their list, and they couldn't input my data on the computer. The doctor told them to just do it on paper and clear it up on Monday. Then he asked me to take off the makeshift splint and the moment he saw my finger, he said "Oh, that's a mallet finger". I spelled out m-a-l-l-e-t for him and asked, that kind of mallet? He said yes. I guess it's because the finger is shaped like a mallet (darn, I should have taken a picture of that!). Here is a pretty simple explanation of what it is: http://www.patient.co.uk/health/mallet-finger . X-rays were taken of my hand and there was no evident fracture other than the ruptured tendon. It appears like this is quite a common injury since there are prefabricated finger-shaped splints of different sizes in the urgent care clinic already, but I doubt that it's common in nursing or caregiving circles. So the doctor found one to fit my middle finger, attached the new brace, and recommended that I be on modified duty. Unfortunately, I found out later, he failed to specify what I'm allowed and not allowed to do on the release form.
          Meanwhile, I'm in trouble with my supervisor. In 34 years of working, I'm charged for the first time ever with a no call/no show at my job because the supervisor was not properly notified that I would not be at work on Sunday night. I never got a definitive answer whether they covered my shift or not after the injury. Apparently I called the wrong people, the incorrect number and left a message with the incorrect voicemail. My supervisor said I should have persistently called her cell phone until she answered. I didn't do that because I didn't want to pester her after thinking that one voicemail at her office phone was enough. Not wanting to be labeled as pushy or a pest, I didn't make repeated calls and just waited for a response that never came. I even called the unit a few hours before my scheduled time to check if the supervisor left any word about covering my shift. There was none. Now I know better. Because I didn't show up for work, I left my co-workers inconvenienced because they were short one person for the shift with more than 30 residents to look after in addition to their housekeeping, dining room, and laundry duties. In retrospect, I should have just shown up, did the work as best as I could, or gone home if someone was there to cover me. Let's just charge the miscommunication a result of the long 4th of July weekend.
          In any normal industry, when an occupational injury happens, the point person or department is Human Resources who coordinates with the supervisor, but in this job, things are different as I'm painfully learning now.
          I'm supposed to wear the finger splint for two months which is the amount of time needed for the tendon to reattach and heal. An initial follow up with the doctor is scheduled for July 14th. I'll be returning to work on the p.m. shift on July 10th and we will have to see what I'm be able to do without being too useless to my co-workers.

Public comments below, private comments: E-mail Me!

P.M. Shift Duties and Responsibilities on the Memory Care Neighborhood

Selfie with Moxie :)
This cat has learned to open the door of her owner's suite. The first time she did this in the middle of the night, I thought it was a ghost. She jumps and turns the door handle, opens the door, and wanders around the TV room, dining room, and other resident's rooms. She has been eyeing the main door and trying to escape the neighborhood.

I've been working at this assisted living community for slightly over a month now and a few weeks ago I posted my duties and responsibilities for the overnight shift. This delayed post tells you about what caregivers do on the afternoon/evening shift. Although I'm starting to connect the names with the faces of the residents, I still have to find a better way to mesh or coordinate my duties with the other 3 care managers. Since I only work with them once a week, I'm finding it a little challenging to do that. They have to remind me what I have to do next like when I'm supposed to watch the residents in the TV room who are in risk for falls due to age and balance problems. I also sometimes miss what time I'm supposed to go on my lunch break. At times, I find myself doing what I'm not supposed to do like which type of laundry goes in which bin. Minor mistakes which may not necessarily imperil the residents, but mistakes just the same. I'm constantly learning as I go and I haven't minded being told what to do because my co-workers know much better than I do. Thanks for the help folks.

Here is the list:

*Get report and assignments, pick up walkie talkie, pager, and keys, then locate your residents.

*One care manager as assigned to monitor residents in Living Room at all times.

*Laundry and bath/showers as assigned. Also check dryer for clothes and table linens.

*Note 1: Don't mix soiled sheets, bath towels, clothes (i.e. pooped or peed on) with regular laundry which goes in a separate bin. Placemats and napkins also go in a separate container.

*Note 2: Do not wash female resident's hair during shower to retain the body done in the beauty parlor.

*Before 3 p.m. - pick up hydration supplies + 4 pitchers from 1st floor kitchen, fill with sugarless juice (1 with sugar for breakfast), pick up snacks for Social Activity. Bring up to the Memory Care neighborhood and the separate rear area where residents need more care.

*Offer hydration - i.e. watermelon, fruit cocktail, drinks, etc.

*Check on residents then move clothes from washer to dryer.

*Set up tables in Dining Room in preparation for dinner at 4:30 p.m. : Napkin in middle, 2 forks on left side, spoon, knife, and soup spoon on right side/ 2 glasses: 1 big and 1 small, fill big glass with water.

*Dinner: Inform residents of dinner time and usher them to the dining room/ Give them choice of soup or salad/Present main course choices of 2 hot dishes and 1 cold dish and serve/Present 2 choices for dessert/Serve on left side and pick up on right side of what's being served.

*One care manager fills bowls and plates, one tosses the salad, two serve the residents.

*Start clearing used plates and utensils as soon as the residents finish using them, bring to the sink for rinsing and place in automatic dishwasher. Clear tables with everything else after the meal and launder placemats and napkins. Sweep floor.

*Medications after dinner by medication technician / Lunch break as assigned by lead care manager.

*Check on residents / Continue laundry as assigned, wash, fold, and return to proper owners and hang in closets.

*Prepare residents for bed at approximately 7 p.m. Open up beds, close curtains, set out pajamas, nightgown, pull ups or wrap arounds (diapers). Assist with continence care, mouth care, remind to use bathroom. Needed products are inside locked cabinet. Return inside after use and lock cabinet again. Make sure bed wedge, body pillows, pillow between legs, portable rails are in place.

*Obtain hearing aids, remove battery, take dentures and lock them in resident's cabinet (some need to be kept in office).

*Place resident's dirty clothes in laundry bag behind bathroom door/Empty wastebaskets and replace plastic liners.

*Make sure cabinets in rooms are locked after providing night care.

*Pick up trash and do clean up in common areas and green door bathrooms. Take trash to outdoor dumpster.

*Check on residents (pull ups and wraparounds) to make sure they are clean and dry before shift ends.

*Monitor sundowners for safety and wandering.

Public comments below, private comments: E-mail Me!

The Fantasy and Reality of Assisted Living

          

This movie portrays residents in assisted living accurately.

          First, let me say that this is not a criticism of the company I work for. Rather, they are mere observations of things I didn't expect to see.
          Remember how I was gushing about getting this job after experiencing a 2 hour preview (http://aboutlifeandrunning.blogspot.com/2014/05/an-easter-present-or-bust.html)? Well, there were certain things I wasn't shown during that preview. Can one call it a bait and switch? Having finished 3 shifts of orientation (or shadowing as they call it) and a couple of weeks being given my own assignments while working the evening and overnight shifts, the reality of what really goes on in assisted living as opposed to what's presented and advertised in public and what I learned through the online "university", is setting in. And the difference is glaring. No, not in the care of residents. That remains top notch as far as I can see. After all, their families are paying an inordinate amount of money for that care. The ideal and model of the company is highly admirable and every day my perception is that the caregivers strive to achieve that ideal despite the compensation not being proportionate to the amount of work they do. I guess that's the kind of salary you should expect when just about anybody can walk off the street, come in, apply, and be hired as long as you are able to verbalize or show compassion for frail senior citizens.

          Some of the things I learned during computer orientation: Beer and wine can be served to the residents just like home. The culture of the company and their approach to compassionate care for seniors. A lot of the lessons touched on dementia because they have a dedicated "neighborhood" for those residents. We are not supposed to say a resident is incontinent but use a more positive "needs continence care". And some residents who need help feeding, normally called "feeders" in a hospital or nursing home, should be called 'residents who need assistance in feeding". All part of the aim to preserve dignity because regardless of their condition, they are still individuals with the same wants and needs as shown by Maslow's hierarchy of needs, even though they may not be able to verbalize them anymore. The computer orientation emphasized that regardless of what department you work for and/or what kind of care you are providing, everything goes back to the Principles of Service, and that all team members are caregivers.

          After seeing what was portrayed on the computer, I was excited to get started in this new job and apprehensive at the same time because I was the NKOTB (new kid on the block). After just a couple of days, I realized that I would have to deconstruct my previous training and learned reactions in psych units, because the approach in taking care of residents is much different from what I've been doing for the past 3 decades. Different techniques are required to redirect behaviors that in psych units would normally warrant psychotropic medications. For example, both sundowners syndrome, agitation, and echolalia were dealt with medications in psych units. And in psych, there has not been too much family involvement, while in assisted living, the designated caregiver is in direct communications thus having more interactions with the families who are very involved with their loved ones.

          During the 2 hour preview with a lead caregiver, and before accepting the job offer, this is what I observed with the residents I followed, which is the FANTASY part: they were all able to bear weight on their legs and stand up, needed little direction to change their clothes, were able to brush their teeth and comb their hair when given a toothbrush and comb, were able to walk to the dining room for breakfast, and still had some mental orientation left (to time, place, and person). That created a false impression that all residents were like this, fairly easy to take care of, and probably didn't need too much supervision. Another thing they didn't show was a separate "neighborhood"  at the end of one hallway that had a smaller number of residents with much worse mental and physical deterioration. They are what we call in hospitals as requiring total care. And this is where REALITY starts. I didn't find this out until I started my orientation on the overnight shift. I was surprised to see Hoyer lifts, hospital beds without side rails, cushions on the floor beside the beds in case a resident falls off, and lots and lots of continence care and feeding. I found out about the contractures and decubitus ulcers later. When I started "shadowing" or unit orientation, what I saw during the preview suddenly looked different even in the main dementia (it's called memory care) neighborhood. No, not the behaviors of persons with dementia, I expected that, but rather how much more physical care they required. This included assisting them with showers, continence care, clothes changes, ambulation, protection from falling off beds by using wedges and body pillows, use of chux (bed pads), and diapers (we have to call them briefs, pull ups, or wraparounds) and doing laundry 24 hours a day. The evening shift also served dinner, cleaned up, and did dishes. Another thing that was unexpected was the extraordinary amount of housekeeping especially on the overnight shift. After doing continence checks at the start of the shift, we had to give the dining/kitchen area a thorough cleaning - disinfect tables and chairs, clean fridge inside and outside, set tables for breakfast, wash clothes, kitchen linen, and aprons, pick up the trash in all areas, and prepare coffee for the next day. I already touched on those in this blog entry: http://aboutlifeandrunning.blogspot.com/2014/05/my-new-duties-responsibilities-in.html . I have a similar list for the evening shift which I have to update and have not yet posted. I found out from another caregiver ad on the internet that this is called the Universal Worker Model. So in short, the work is very, very physical, and because I move a lot when I'm on shift, I actually am losing weight. Might I add that the work is almost non-stop for 7.5 hours other than a lunch break and two 10 minute short breaks? Having finished all my orientation, I had to deal with reality - having my own residents to take care of. And despite one evening shift and two overnight shifts of orientation, I still felt unprepared to work independently. The lessened flexibility of my brain as I get older may partially have something to do with that.

          The difficulty I'm currently having while I'm new is this: since the residents don't wear wrist I.D. bands, I'm finding it hard to connect the name with the face, the type of care he or she needs, and how the residents prefer to be helped since what may work for one may not work for another. Or even what worked yesterday for a certain resident, may not work again today or maybe even a few minutes later. I look at the assignment sheet, add my own notes based on what I ask the other caregivers, or read the Individualized Service Plan (treatment plan). Another difficulty I'm having is locating the belongings of a resident in his or her room - where is the underwear, the blouse, the nightgown, the toothbrush, denture cup, continence care products, etc.? So I'm fumbling that too and it takes me longer than the regular staff to do it. Heck, I can barely find my own stuff at home much less doing it for 8 to 14 residents whom I don't know yet!

          As time goes on and if I can adjust my brain, then I believe I'm going to like it there. I'm just getting unnecessarily anxious due to the fear of failure. I have to give myself a chance to do the job, maybe fail in some aspects as long it doesn't harm the residents, then learn from them.  I hope my co-workers will be patient and understanding because they may have gone through a similar experience when they were just starting out. I too can do this eventually and hopefully sooner than later! To my co-workers, please don't hesitate to ask me if I already did this or that, or tell me what else needs to be done if you notice I haven't done it. That way, I can learn from you. Because even though I tried to take copious notes about what to do and how to do it, what I interpreted as what you said may differ to what you meant. So please bear with me and thank you in advance.

          Which leads me to the questions: why are there so many caregiver agencies? Are more seniors preferring to stay at home and just have a companion (basically an hourly paid housekeeper)? Is it a very lucrative business? Is home care the new nursing home? Or maybe these businesses have been there all along and I was just not aware of them? Perhaps it's just a cheaper version of a CHHA (certified home health aide) without the certification so they can be paid lesser.

Other random thoughts on this topic:

·         *They call shift report a handover and it's only between 2 lead care managers (CM). Other than the lead CM's who work 8 hour shifts, the rest work 7.5 hours. Which begs me to question why management is giving people a hard time when they clock out more than 5 minutes after their shifts? After all, they don't get paid overtime until it's over 8 hours for the shift.

·        * Are the unsuspecting workers being given the old bait and switch based on the glaring difference between the preview and the reality? What's the difference between an RCFE (residential care for the elderly)and a SNF (skilled nursing facilty/nursing home)? Perhaps it's the ability to pay exorbitant fees out of pocket for rent and caregivers vs. paying with personal assets and governmental assistance for nurses and nurse's aides. But you get excellent care given by underpaid caregivers.

·         *The fantasy and the harsh reality - I truly admire and have absolute respect for people who do this for a living, me excluded because I'm still learning and have to achieve even an iota of their skills. I'm afraid my co-workers are going to say "he's not good at this job, he did a bait and switch on us too based on his resume". And by the way, a similar job in the Philippines, you might be called a maid or house servant. Maybe 8 months of unemployment has made me soft.

·         *If there is one thing I'm getting out of this job, it's that I'm learning to smile more, being more compassionate with residents because that would be me in a few years, and more appreciative of what the caregivers do.

·        * The residents of assisted living and I (well, mostly me) were singing along while watching The Sound of Music before dinner one afternoon, and despite their dementia, they were enjoying it. Too bad I had to leave the TV room to set the tables in the dining room. That movie is shown several times a week by the way because they like it so much.The interactions with the residents I enjoy, the showers and diaper changes, not so much.

·         *When we were signing our hire papers, we were reminded by human resources that stealing is a basis for termination. I asked her if that included stealing someone's heart (more specifically, the resident's hearts). She said I can steal those as much as I want.

·        * Maybe, just maybe, if euthanasia is an option when I get to the stage where some of the residents are in, that's a decision that could be made. In short, when I get to that condition, please off me if that's my wish.

·         *The work is hard but the food looks and tastes great, and we are allowed to eat with the residents at their table. Although there is so much wasted because the leftovers are just thrown away.

·         *On my birthday, 6 of the 7 residents I was taking care of at the area behind closed doors gave me special presents when my night shift ended, but it was not of the pleasant kind, and came in all shapes, sizes, and textures. The first initial of this present is a B, and the second initial is an M. Yes, it was a BIG MESS!

·         *And yes, I do love the pets where I work (^.^)

Public comments below, private comments: E-mail Me!