Taking vacations when residents can't do the same
Eleanor Feldman Barbera, Ph.D.
Like many, I'm taking some vacation time during the month of August. It got me thinking about the ways workers interact with residents when they take time off from their jobs. It's more important than you might first think.
I know some staff members whose residents are so attached to them and become so anxious at the thought of them being away, the staff members don't tell them they're going. This seems to me like passing the buck to the covering coworkers who have to deal with the anxiety of the residents plus their feelings of betrayal that they weren't informed in advance.
Other staff members don't seem to think that residents will be missing them, so they don't prepare them for their absence. As their psychologist, I know that residents acutely miss their regular staff members and really appreciate knowing in advance that they'll be gone. When you're not there – especially if you're a CNA – it's a generally bad time for your residents unless there's been some consideration of the personalities of the residents and covering staff members.
In my training as a psychologist, we spent a lot of time talking about leave-taking, vacation coverage, and termination of therapy. The gist of it is preparing patients for the vacation in advance, talking about who will be there in the therapist's absence, and ways patients can cope on their own.
I think that's a good model to follow in most cases in LTC. It's respectful to let the residents know you'll be away and to tell them who's covering or who might be good to ask for help while you're gone.
I once treated a very attached, emotionally fragile resident whom I knew would be panicky about my two-week absence, which we discussed at length prior to my departure. Before I left, I gave her a sheet of paper on which I'd written down the dates I'd be away, the names of staff members she could talk to if she needed help, and healthy activities she could engage in such as journaling or talking to a friend. At the top of the paper I wrote in big letters, “I will return on September 14th.” When she saw that, she laughed with relief.
The resident told me she looked at the paper frequently during my absence and it calmed her when she was feeling anxious. It served as a “transitional object.” Like a soft blanket for a child, it was something she could hold onto that reminded her of me and reassured her of my return.
Staff members could write their schedules on the calendars of very anxious and attached residents, or ask a few coworkers to check in with them during the vacation period.
Early in my LTC career, I felt kind of bad going on vacation when my patients were confined to the nursing home. I wished they could take a break from their illnesses. I had a lot of young patients with serious health problems and they were vocal about the unfairness of the situation.
We discussed this unfairness as part of the general life inequity of being sick at a young age. We talked about things they could do in the nursing home that could make it seem at least a little like a vacation week for them — attending more activities, making a plan to get off-campus, giving up arguing with the staff for a week.
One man in his thirties had been an avid hiker before his multiple sclerosis made backpacking impossible. When I met him, he was limited to his bed or his geri-recliner. In his therapy sessions we'd sometimes use guided imagery to go on imaginary hikes, passing by streams, “hearing” the leaves crackle underfoot, smelling the scents of the woods.
When I told him I was going on a trip to Italy, he said he'd always wanted to go camping out West and deeply regretted that it was never going to happen. I suggested he use the guided imagery techniques to go on an imaginary camping trip while I was away. I felt awful, though, that I was going on a dream vacation while he was stuck in his body.
I returned two weeks later and found him very chipper. Not only had he gone on his own dream vacation, but as long as he was imagining things, he'd decided to go to a high-end camping goods store and “buy” every type of gear he'd ever wanted!
These days when I go on vacation, I don't feel guilty. I tell residents that I need to “recharge my batteries.” They understand that.
Eleanor Feldman Barbera, PhD, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.