On the other side of long-term care
It is often said that you cannot teach an old dog new tricks, but that is not totally true. You can teach an old dog new tricks; it's just extremely difficult. In the case of this old dog, it took a near-death experience.
Here I am in my 40th year of long-term care. That is an eternity when you spend it in a field that has had so many changes. Earlier this year, I was looking forward to a comfortable time, having recently stepped down from the CEO position of a regional group of homes that I had helped to found many years ago. The next generation was doing a good job of running the company, and I was hidden away in one of the campuses as an executive director. I was back doing what I loved: running a nursing home, and interacting with the elders.
On April 15, my world changed. I was involved in a motorcycle collision. I was flown to a regional hospital. After surgery and some observation, I volunteered to transfer to one of our company's nursing homes, where I was for a month. I had never dreamed of being a resident in a nursing home, at least at this age, but here I was.
With little to do but observe, I had the greatest educational experience of my career. I saw with my eyes, heard with my ears, and felt with my heart the low level of compassion the care staff was experiencing. All the hopes and dreams of making life better that filled them when they first started had been slowly sucked from them. They were running on empty and I was very much a part of the problem.
Before I proceed further, let me publicly profess that I am deeply grieved by the callous manner I have treated the caregivers in our organization. Although I have never knowingly hurt any staff member, I have been neglectful of many as an individual and as a person. All my training and the volumes of regulations have helped to create this inappropriate conduct. With one eye on the bottom line and the other on the regulating bodies, I never saw what was occurring in front of my nose.
Our people, the backbone of each organization, our caregivers, are hurting. The stress of holding to tightly tailored PPD numbers, conflicts with co-workers, family members, and the occasional spouse, coupled with a career that forces you to have relationships that end in death, can suck the air from anyone's compassion balloon. When you mix in the stress of being a parent, spouse, family financier, chauffeur, and referee, you can end up with a person who is bankrupt of compassion.
The thing that is most disturbing to me is how we have accepted this in the profession as “Just the way things are.” We say that this attitude on everyone's part is simply a part of our business — it's nothing personal. But I believe it does not have to be this way. When we open our eyes to this practice of devouring our own limited resources we begin to see it. What happens when a caregiver begins to lose their compassion and then their performance slips? Our traditional response is to have a discussion with them about their performance, reminding them how important they are to our elder's lives. When that doesn't correct the problem, and it rarely does, we give them a second, sterner warning (a written warning in many cases). Finally, exasperated with their poor showing, we are forced to terminate them only to begin the process over and hope we achieve a better result.
We see this every day when we see employees hiding in a room, having attendance problems, leaving an elder in a mess, talking over the elders' head, and taking too frequent breaks. We label them a bad employee and place them on the “do not rehire” list when they resign, or we terminate them. Did we ever see this caregiver, once filled with hopes and dreams of what they might do for these aging individuals, as a person in need of a compassion refilling? For the first time I was able to see employees in this new light.
When we have epiphanies like these we may ask, ‘What can we do about it?' The answer is we can begin by caring and letting employees know that we do that we care about them. We can spend as much time preventing the problem of compassion bankruptcy, as we do in fixing the results. We still try to find good applicants, interview them, process them, train them and direct them. But we also can look them in the eye everyday and see the person that is there. We can ask them how things are doing and actually take the time to hear what they have to say. When they have a problem, whether it is work-related or not, we can make an effort to give them the support and caring we ask that they give our elders.
Here are some suggestions of various ways we have attempted to support and care about our most precious asset:
- Nourishment station in the staff lounge. We offer various fruits, crackers, bagels, ice cream, Popsicles, etc.
- Wider variety of scheduling options to permit an improved mesh of personal life with work
- A monthly dish day where we provide the main course and the caregivers bring their favorite side dish or desert. (The kitchen staff does not prepare the main course: remember they are a part of the caregiver team.)
- Surprise gifts, including door prizes and other giveaways at in-house in-services
- Administration and department supervisors are encouraged to take an employee out to eat, along with a caregiver's family member. We cover the meals and the time it takes them for a leisurely visit.
- We send birthday cards to the caregiver's house.
- Training supervisors to look for signs of compassion fatigue and then supporting them as they assist their staff.
The most important thing we have tried to do is let each care partner know that we truly care about him or her. We are attempting to celebrate their joys and support employees in their sorrows, praise them for what we had just taken for granted, and understand when they are struggling. It's not our goal to be their closest friend, but we can be a support and inflate their balloon of compassion when it starts to shrink.
Forty years of doing something wrong can make change a little difficult, but this is now the earliest I can begin to make the change. I have begun making rounds with an entirely different objective.
As one who contributed far more than my share to the draining of this compassion, I have done a 180-degree turn. If I am to ever be remembered by the long-term care industry, I pray that it will be for helping to put compassion back in our caregivers, not the financially successful company I have helped to build.