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.

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!

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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.

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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.

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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.

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My New Duties & Responsibilities in Assisted Living

Example of Assisted Living Dining Room

Sunrise NOC Shift Duties (first orientation with: Bertha, Paula, & Alicia)

*Upon arrival, check for area assignment (1 or 2), pick up walkie-talkie, pager, keys, maroon apron.

*First rounds (Q hour for fall risk, Q2 on others), diaper and Chux underpad checks, change as needed. Products in resident's locked cabinet. Encourage others to use bathroom. Check bathroom floor for wet areas. Place dirty clothes in laundry bag and wash if scheduled after providing care. After washing clothes - fold, put away by hanging in closets and drawers (socks and undies).

*For residents who have them, check portable bed rail, body pillows, bed wedges, cushioned floor mats, and reposition as needed.

*Chores (must be done by 0530): clean up dining room area - using chemical spray and small towels, wipe down tables, chairs, baseboards, countertops, window sills.

*Clean kitchen cabinets. Clear dishwasher of dishes and place in cabinets. Fill sugar caddies with sweetener choices and 3 crackers.

*Set table for breakfast: placemat, pyramid napkin, big and small glasses, 2 forks, 2 spoons, 1 knife, coffee cup, flowers.

*Check on residents then return to chores - Wash and clean coffee pots, thermos, yellow pitchers. Also clean salt and pepper shakers.

*Steam table trays - drain, spray and wipe, fill large bowls with water and rinse. Open bottom cabinet & turn orange lever to the right to close drain. Fill each steamer with 2 bowls of water. Disinfect around steam table.

Clean and replace tray items (***what tray items?). Oh, the brown tray at right edge of kitchen countertop, LOL!

*Prepare coffeemakers, fill pitchers with water for hydration (watch out for the cat drinking from the pitchers).

*Set out tongs, slotted spoon, slotted scoop, small yellow bowls on 2 placemats on right side of steam table. *Set yellow plates in steam table trays. Place bags of brown sugar and raisins on the side.

*Fridge - clean thoroughly, check dates on food, write dates on stickers, dispose food or send to kitchen after 3 day expiration. Leave 1 pitcher of juice in fridge and send the rest to kitchen. Clean microwave oven.

*Refill syrup caddy. Rinse trash can lid. Set out 2 pitchers of water beside steamers and bring 1 each to living room and corner of dining room with a glass later.

*Popcorn machine clean up - use wet paper towels. Unplug/remove popper bowl. Wipe inside machine, bottom, disassemble bottom tray and wipe those areas, wipe outside. Wash bowl in sink, keep cord dry. *Reassemble bottom tray and popper bowl.

*Straighten up dining area & put away items like CD's, etc. Clean & remove clutter from snoezelen, bathtique, TV room (organize movies) & restrooms. Put away community towels and other linen in bathtique. Straighten life skills station making sure all items are in place.

*Check on residents. Sign off ISP's. Take collected trash downstairs at 0530 (leave inside if no security, to dumpster if escorted).

*Check residents with wander guards & make sure they have them. Write in maintenance log if anything needs repair. Report to lead care manager any unusual issues. Last resident check at approximately 0430.

*Make coffee for residents and pour in thermos, replace coffee filters and put in new coffee for day shift.

*Clean laundry room, floors, and wipe down all equipment. Clean kitty litter and sweep the area. Replenish cat food, water, & litter. Sweep patio and empty trash can. Clean, sweep, and organize casemanager's office and take out trash.

*Miscellaneous: Edna's place - most are total care, some Q2 hour repositioning, hospital beds (lower after giving care), cushioned floor mats. Washer - open cabinet for bleach/detergent, press right button then left button. Respond to pager as needed. Make sure all linens & and 5 each of green & maroon aprons are clean and ready for next day & wash as needed.

Wow, a lot of the housekeeping I hardly even do during spring cleaning! Now I only have to learn which resident is which and what care they need, and with 1 evening shift and 2 overnight shifts of orientation, I haven't quite caught up yet. This new job has caused some anxiety due to its unfamiliarity, so it's going to be quite an adventure and I hope my new co-workers will be patient with me and give me a chance to learn.

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