Guest Columns

Life or death

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Jean Wendland Porter
Jean Wendland Porter

As healthcare workers, especially as healthcare workers in long-term care, we don't have jobs that most people can identify with. Those who have jobs that are 9-5:00, with nights and weekends off, can't quite understand our stressors nor our responsibilities.

The man who works in software development punches out at the end of the day and his problems wait until he punches back in. The woman who works at the department store takes her lunch on schedule, has alternate weekends off, and forgets her work issues until she returns on Monday. The truck driver drives cross country for 10 hours, then rests for 10 hours and resumes his trek, with nothing changed and no surprises.

Our responsibilities are different. They are literally life and death. We have the weight of human lives in our hands. When we ignore the pleas of our clients (and their families), we are losing our humanity and the reason we took our jobs in the first place. Consider:

  • The nursing assistant who takes the call light away from the geriatric patient because the patient rings too often is robbing the patient of her choices and her power. Being under-staffed is not an excuse.
  • The subacute unit is un-manned for 30 min because all the nursing assistants are on break at the same time.
  • The daughter who is ranting to the Director of Nursing because her mother didn't get her insulin and got a meal receives the “she's just crazy” treatment. But she's right. She's advocating for her mother.
  • The therapist who says “You're not getting better and your insurance is going to deny any further services” may not have appealed to the insurance company for more care because it's too much trouble (it's a lot of trouble.)
    In my experience, the appeal to the insurance company will get the patient more time and more care. That therapist has doomed the patient to going home too soon and that patient will likely fail at home.
  • The kitchen manager who doesn't allow the Muslim client the option to get pork off his menu is failing that person's spiritual health and welfare by making him conform to a norm that is not his. That client is unlikely to get better because he's not getting enough calories to sustain his therapy program.
  • The patient who has a doctor's appointment refuses to go because he hasn't had a shower in two weeks. The shower log says he has. The aromatic evidence shows otherwise, and he misses his appointment at the wound clinic.
  • The nurse who is reluctant to send the congestive heart failture patient to the hospital because she's been told that readmissions are frowned upon decides to keep him and give him more Lasix. His legs continue to swell and his lungs fill up. By the time he gets to the ER it's too late.

When we place our administrative directives, stars, paper compliance, and staffing concerns over the health and welfare of human beings, we are under-serving and over-looking our clients. None of us got into this arena because we're selfish and unfeeling, but over the years we may have become immune to the altruism we had at the beginning. 

We need to get back where we started. I always tell my staff and co-workers that we need to do the right thing. Doing the right thing for the client and his family must always trump Star Ratings, and doing exactly the right thing may get you more of those coveted stars.


Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD is the Regional Director of Therapy Operations at Diversified Health Partners in Ohio.


Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.

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