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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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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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 (^.^)

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