Driving back from taking daughter to work gives me time to think, to plan and to consider.
Today's thoughts, inspired by a comment in a conversation with my daughter, is about how we develop stereotypes, nurture them and even develop them and what can and should be done to reduce and eventually eliminate their negative effects on ourselves and those around us.
Using time like this for positive mental exercise, while remembering driving is also a mental exercise, I often get inspiration for these blog entries.
While not still immediately immersed daily in the challenges of Lewy Body Dementia, the effects of 24/7 care giving for Mom and/ or my husband, I carry with me concerns for those who do and those who are.
It's not a life experience easily walked away from; as with many others, it has affects and effects.
It's in the giving, we receive. It's in the sharing we become.
Stereotypes. Ageism is at the top of my list. Followed by physical and mental "limitations" and then by those that have been or are in the process of being "debunked", like sexism.
A Stereotype is more than accepting there may be some limitations within a category, it's an overall, general and broadly applied total or massive negativism about someone or something.
Ageism is a stereotype focused at more than just growing older. We've "embraced" varying levels of Ageism from birth through death for generations.
Pick up old books, philosophies of "raising" children, for example. Spare the rod and spoil the child. Children should be seen and not heard. Children don't need education as young as the age of 5 -- or earlier-- were the vocal outcries of those against the founding of Kindergartens and Early Childhood Education.
Compare and contrast that to a presentation I attended a couple of weeks ago from a man who was "dedicated" to a specific Not For Profit seeking funds for providing early education to all levels of society.
This speaker's choice was to present (undocumented and unsubstantiated, I might add) figures and statements about how learning that's not obtained in the very early years can never be reclaimed.
Too broad for me. I saw a "stereotype" in the making.
Far too much known about those who have overcome, those who have shown great promise at later ages/stages of life for me to support his viewpoint. But it was to "serve a purpose".
We must be careful in our efforts to resolve the challenges of society we do not enable another stereotype to be created.
Stereotypes become a part of our culture and often create more problems needing resolution.
Debunking.
One voice and then many. Reading. Sharing. Joining together. Expanding the reach and the effect.
Blogging. Net Resources. Accurate presentation and open availability of information.
Effective communication rising above the roar of the fears and the prejudices. A concentrated effort to bring to light and out of darkness where people, ideas and possibilities fade and pass away.
Ageism isn't about growing older, it's about how we choose to perceive individuals -- each person who we have the privilege of encountering, working beside, meeting and sharing the small amount of time we receive wherein we create our lifetime.
Tuesday, September 29, 2015
Friday, September 25, 2015
Timeless Circle of Life & Love
Some girls want and get very special proposals and many let their "intendeds" know what they expect from that day forward.
Magazines and books call that many things including positive assertiveness and clarifying expectations. I wonder ...
Our relationship, our marriage, had a natural ability to communicate and a love for one another that was genuine, selfless and supportive.
Oh, we had some bumps along the way, but the underlying respect and care for and about one another, of our individual families and of the family we were forming, was the guiding light, the strength and the support of our marriage.
We shopped together for my ring. A local, small, neighborhood jeweler.
Ironically, the store had been robbed just a week or so before and their selection was very limited. The owner said he'd be bringing in more once he received the insurance settlement but there was this one ring, a solitaire in a marquis cut that caught my eye and I knew it was perfect, just like our plans for a life together.
Yes, I was that typical "newly engaged" young woman with dreams and hopes anticipating so much and never considering anything but positive years ahead.
And we found a ring for him, too.
At the time, wedding bands with diamonds in them for men were a little "forward thinking" but it, too, was one that "remained" and caught my eye.
Three stones across a band, a complete circle.
We often teased one another about how the stones represented each child we brought into this world through our love for one another.
A symbol and a remembrance.
In "my ring", the diamond was paired with a wedding band that was designed to fit around the style of the stone. Some friends believed this was "bad luck" and said the wedding band should always be one continuous circle.
Looking back, even when we chose to redesign the ring and purchased a different wedding band, one that was a continuous circle and had side stones added to the solitaire and changed from the white gold (popular at the time we were married) to yellow gold, our life's luck didn't really change -- we still had challenges and loses, great opportunities and wonderful memories.
With his passing, I kept wearing this special gift he gave me so many years before.
Sometimes I wondered what others thought about my choice but then I remembered how insignificant their voices were as some speculated (even within hearing of immediate family members) about how long I'd "really" be a "widow".
As time passed, I occasionally removed the two rings but I felt naked without any ring on my left hand.
I tried a black stone ring and placed it on my third finger left hand. It wasn't a real stone but the design was very traditional and I felt reflected the simplicity and "mourning" feeling I had. However, when the "metal" began to wear and left behind a residue of green, I thought this was not the way to transition and went back to the rings I knew and loved.
Recently, I've found another ring. Think it's one my daughter picked up when she was much younger.
The stone is purple, amethyst if it were real, which it isn't. It even has two "diamonds"-- clear, white glass, I'm sure, on the sides.
My daughter loved the color purple and I'm sure that's why this ring. Was it for a Mother's Day or birthday? I can't remember now. I know she didn't have much money of her own when she was young so treasure how she used some of it, no matter what the amount, to give me this gift of her love.
I've placed it on my third finger left hand. Just can't get used to putting any rings on my right hand without something on my left. I feel naked. I feel "lost".
It's a personal choice, I know. So then why do I wonder what to do, what to wear, IF I should wear and WHAT I should wear?
I've seen some "widows" wearing their rings as though nothing has changed, on their left hands as they did when there was truly a couple represented.
I've seen some "widows" wearing their rings on their right hands and suppose that's one transition to consider. I love my rings, still.
Then, there's the switching of the "engagement" ring to the right hand or to the third finger on the left hand.
I find rings on the right hand a slight inconvenience. Even though we're somewhat leaving behind the old custom of shaking hands, even in business, I've had fingers crushed by men (and a few women) and felt the pain of edges pushed into skin and bone.
Day to day, it really doesn't matter. Love isn't in tangible objects, it's what we have inside and give to others.
Love Is Eternal. Love can go on. Love is to be shared.
I will continue to move forward, treasuring the past, looking forward to the future, above all measuring life by the treasures of time given, taken and made .... together.
Magazines and books call that many things including positive assertiveness and clarifying expectations. I wonder ...
Our relationship, our marriage, had a natural ability to communicate and a love for one another that was genuine, selfless and supportive.
Oh, we had some bumps along the way, but the underlying respect and care for and about one another, of our individual families and of the family we were forming, was the guiding light, the strength and the support of our marriage.
We shopped together for my ring. A local, small, neighborhood jeweler.
Ironically, the store had been robbed just a week or so before and their selection was very limited. The owner said he'd be bringing in more once he received the insurance settlement but there was this one ring, a solitaire in a marquis cut that caught my eye and I knew it was perfect, just like our plans for a life together.
Yes, I was that typical "newly engaged" young woman with dreams and hopes anticipating so much and never considering anything but positive years ahead.
And we found a ring for him, too.
At the time, wedding bands with diamonds in them for men were a little "forward thinking" but it, too, was one that "remained" and caught my eye.
Three stones across a band, a complete circle.
We often teased one another about how the stones represented each child we brought into this world through our love for one another.
A symbol and a remembrance.
In "my ring", the diamond was paired with a wedding band that was designed to fit around the style of the stone. Some friends believed this was "bad luck" and said the wedding band should always be one continuous circle.
Looking back, even when we chose to redesign the ring and purchased a different wedding band, one that was a continuous circle and had side stones added to the solitaire and changed from the white gold (popular at the time we were married) to yellow gold, our life's luck didn't really change -- we still had challenges and loses, great opportunities and wonderful memories.
With his passing, I kept wearing this special gift he gave me so many years before.
Sometimes I wondered what others thought about my choice but then I remembered how insignificant their voices were as some speculated (even within hearing of immediate family members) about how long I'd "really" be a "widow".
As time passed, I occasionally removed the two rings but I felt naked without any ring on my left hand.
I tried a black stone ring and placed it on my third finger left hand. It wasn't a real stone but the design was very traditional and I felt reflected the simplicity and "mourning" feeling I had. However, when the "metal" began to wear and left behind a residue of green, I thought this was not the way to transition and went back to the rings I knew and loved.
Recently, I've found another ring. Think it's one my daughter picked up when she was much younger.
The stone is purple, amethyst if it were real, which it isn't. It even has two "diamonds"-- clear, white glass, I'm sure, on the sides.
My daughter loved the color purple and I'm sure that's why this ring. Was it for a Mother's Day or birthday? I can't remember now. I know she didn't have much money of her own when she was young so treasure how she used some of it, no matter what the amount, to give me this gift of her love.
I've placed it on my third finger left hand. Just can't get used to putting any rings on my right hand without something on my left. I feel naked. I feel "lost".
It's a personal choice, I know. So then why do I wonder what to do, what to wear, IF I should wear and WHAT I should wear?
I've seen some "widows" wearing their rings as though nothing has changed, on their left hands as they did when there was truly a couple represented.
I've seen some "widows" wearing their rings on their right hands and suppose that's one transition to consider. I love my rings, still.
Then, there's the switching of the "engagement" ring to the right hand or to the third finger on the left hand.
I find rings on the right hand a slight inconvenience. Even though we're somewhat leaving behind the old custom of shaking hands, even in business, I've had fingers crushed by men (and a few women) and felt the pain of edges pushed into skin and bone.
Day to day, it really doesn't matter. Love isn't in tangible objects, it's what we have inside and give to others.
Love Is Eternal. Love can go on. Love is to be shared.
I will continue to move forward, treasuring the past, looking forward to the future, above all measuring life by the treasures of time given, taken and made .... together.
Friday, September 18, 2015
Let's Talk About Our Own End of Time
Written several months ago. I found this subject a little too challenging to include in the blog. Now, from a different perspective, I believe it's time to "talk about" this subject.
Perhaps I simply needed to be farther along the path of life after the two deaths, of husband and mother.
Perhaps I needed to feel more settled back in to a daily life that was more than survival and a level of concern for tomorrow I'd not experienced since I was very young.
Dying is personal.
Death is a solo experience often shared.
What is dying? When does it occur? When is life "not worth living" -- these were questions and choices on a recent family survey questionnaire three of our family members have received.
I admit, I left many questions blank. Why? Because I couldn't find within my self, within my knowledge bank, the "best" answer for who I am now and who I will be. And I had reason to be concerned because there were parts that were shared with family members, parts that might be "used" or "remembered" and what if, just WHAT IF, my feelings, my beliefs changed and no one paid attention to anything after this writing?
Daughter, one son and I agreed to participate in a family survey on communication about planning for "later life and death".
It has another title; it comes with credentials of a highly respected educational institution.
What it didn't come with was a warning label: "Caution, may be hazardous to parental health and family relationships."
Glad daughter and I have such great open and ongoing communication. We could talk in depth and at great length; something I'm still not able to do with my son although we have had a few more "in depth" conversations as time passes.
Interesting to see that even though son and I and daughter all went through two recent deaths in family, husband/father and mother/grandmother, there are questions on son's part about what I "want to do" about various parts of living/dying.
All we went through together and he says he hasn't a clue about what I want for myself. Even daughter, who's been by my side constantly says she's also not sure especially since seeing my comments on the survey.
That's interesting and from my point of view, perfectly understandable.
Life isn't black or white and surveys that only allow for specific answers don't provide enough information to those who will be making decisions on behalf of the person needing those decisions made.
For that matter, however, I see these "questions" as important for all ages of life as we never know what accident can happen, what major illness might be in our future or we might even be living with that's dormant or not discovered but won't take us into those "Golden Years".
LET'S TALK ABOUT DEATH AND DYING. LET'S TALK ABOUT BEING SICK AND NOT BEING ABLE TO COMMUNICATE OUR WISHES.
It's not a subject we willingly approach or that anyone "wants" to talk about.
Some organizations have published books or provided guidance on websites but there's still that challenge to get past the normal human condition of not wanting to talk about a subject, like death, because in our society, death is still one of those "forbidden" topics.
We talk more about taxes and various sexual practices than we do about end of life decisions and choices.
I think one of the most challenging parts of this discussion is where we are currently in life, what our personal experiences have been and what our "family customs" are regarding initiating conversations or planning.
It simply hasn't been that long since we were "closeted" in our discussions on sex and even on the natural changes our bodies go through as we mature as young men and women.
Death may be the final frontier. It's the most uncertain. The most complex. After all, we're still legally defining and redefining when death actually occurs and States vary in their actual medical determination of when death occurs -- ceasing of heart activity, brain activity, etc.
Perhaps if we begin to examine choices in life and care?
That's talking about when we will be dependent --semi to totally. That's challenging because we are placed in positions when we have to "entrust" to others something we've given up along the way of becoming Adults -- control over our lives, over our daily lives and our bodies.
Perhaps if we are given life choices that are more individually centered, more positive and supportive and less shelving, less demeaning, less negating -- as is found in many Long Term Care Facilities and even among families, unfortunately.
Let's begin a conversation.
That's how we started as a society to be more "open" and accepting.
Let's begin to listen.
Opening our minds and our hearts to accept what the person feels comfortable talking about, planning and finding ways to ensure changes are accommodated so that nothing is written in stone, it's written in love.
Perhaps I simply needed to be farther along the path of life after the two deaths, of husband and mother.
Perhaps I needed to feel more settled back in to a daily life that was more than survival and a level of concern for tomorrow I'd not experienced since I was very young.
Dying is personal.
Death is a solo experience often shared.
What is dying? When does it occur? When is life "not worth living" -- these were questions and choices on a recent family survey questionnaire three of our family members have received.
I admit, I left many questions blank. Why? Because I couldn't find within my self, within my knowledge bank, the "best" answer for who I am now and who I will be. And I had reason to be concerned because there were parts that were shared with family members, parts that might be "used" or "remembered" and what if, just WHAT IF, my feelings, my beliefs changed and no one paid attention to anything after this writing?
Daughter, one son and I agreed to participate in a family survey on communication about planning for "later life and death".
It has another title; it comes with credentials of a highly respected educational institution.
What it didn't come with was a warning label: "Caution, may be hazardous to parental health and family relationships."
Glad daughter and I have such great open and ongoing communication. We could talk in depth and at great length; something I'm still not able to do with my son although we have had a few more "in depth" conversations as time passes.
Interesting to see that even though son and I and daughter all went through two recent deaths in family, husband/father and mother/grandmother, there are questions on son's part about what I "want to do" about various parts of living/dying.
All we went through together and he says he hasn't a clue about what I want for myself. Even daughter, who's been by my side constantly says she's also not sure especially since seeing my comments on the survey.
That's interesting and from my point of view, perfectly understandable.
Life isn't black or white and surveys that only allow for specific answers don't provide enough information to those who will be making decisions on behalf of the person needing those decisions made.
For that matter, however, I see these "questions" as important for all ages of life as we never know what accident can happen, what major illness might be in our future or we might even be living with that's dormant or not discovered but won't take us into those "Golden Years".
LET'S TALK ABOUT DEATH AND DYING. LET'S TALK ABOUT BEING SICK AND NOT BEING ABLE TO COMMUNICATE OUR WISHES.
It's not a subject we willingly approach or that anyone "wants" to talk about.
Some organizations have published books or provided guidance on websites but there's still that challenge to get past the normal human condition of not wanting to talk about a subject, like death, because in our society, death is still one of those "forbidden" topics.
We talk more about taxes and various sexual practices than we do about end of life decisions and choices.
I think one of the most challenging parts of this discussion is where we are currently in life, what our personal experiences have been and what our "family customs" are regarding initiating conversations or planning.
It simply hasn't been that long since we were "closeted" in our discussions on sex and even on the natural changes our bodies go through as we mature as young men and women.
Death may be the final frontier. It's the most uncertain. The most complex. After all, we're still legally defining and redefining when death actually occurs and States vary in their actual medical determination of when death occurs -- ceasing of heart activity, brain activity, etc.
Perhaps if we begin to examine choices in life and care?
That's talking about when we will be dependent --semi to totally. That's challenging because we are placed in positions when we have to "entrust" to others something we've given up along the way of becoming Adults -- control over our lives, over our daily lives and our bodies.
Perhaps if we are given life choices that are more individually centered, more positive and supportive and less shelving, less demeaning, less negating -- as is found in many Long Term Care Facilities and even among families, unfortunately.
Let's begin a conversation.
That's how we started as a society to be more "open" and accepting.
Let's begin to listen.
Opening our minds and our hearts to accept what the person feels comfortable talking about, planning and finding ways to ensure changes are accommodated so that nothing is written in stone, it's written in love.
Tuesday, September 15, 2015
Autumn: Change and Wonder
I've always enjoyed Autumn. Spring is so welcome with it's amazing rebirth of beauty as trees regain their leaves and flowers begin their regrowth heralding the beauty that's to come. Summer and Winter often bring challenges of endurance and even survival with their climbing and diving temperatures.
Autumn heralded and still brings new beginnings.
Marriage and moving to a new city, a new way of life. Babies born during the later months of Summer beginning to sleep through the night and beginning to take on their own individual personalities. And Autumn began our most difficult journey in life through a year and more of changing seasons and life changing experiences.
Today, a wedding invitation arrived from a relatively "new" acquaintance we've made, daughter and I, since my husband/her father's passing. She'd also lost her husband to a lingering illness/medical condition.
We were married in October; just a few days before the date of this celebration of life and love. The groom belongs to the same Service Organization my husband belonged to. Interesting and ironic how life includes so many similarities and brings opportunities so similar, so familiar.
A new beginning. Autumn brings opportunity once again.
Winter will follow. We used to welcome the season. We enjoyed winter sports.The sons both played ice hockey and we all loved to ski. We were fortunate; we had many great family experiences. As when my husband passed, I'm so grateful we didn't "wait" for a particular time in life but took advantage of opportunities that came our way and celebrated our life together, our family, our love for one another.
We also escaped sometimes to warmer places and enjoyed the respite into the sun filled areas. Those were times of shared joy and family fun, too. We were indeed fortunate, in those days.
Last night at an event, I sat beside a young woman who just began working at a travel business where I've returned part time to "try my wings" and fly alone into the future. It was a challenging return; a time heralded by concern and feelings of longing for the past, the time before..
She told me about other jobs and an experience she recently took advantage of; a life opportunity, one that could have been negative and turned it into a memorable positive.
She traveled around the Far East into several different countries with a friend for four months. That's a very long period of time for most people and few get this opening in life's journey -- usually the very young and sometimes those who've traveled the road of life far longer.
I applaud her personal courage to make this decision and take this journey.
I know nothing about her family's reaction or their relationship but I see her choice to "seize the day" as an action she will take into her future, into her growing older and into her becoming "old" as a significant part of her foundation, her being and what she can contribute to life in general.
Good for her; good for you if you have, make or take opportunities to grow, to become and to pass on to others.
Now she moves into Autumn bringing with her this life experience; it will travel with her and influence her choices and decisions as everything we do always does.
I'm so grateful I can share those joys in life I know are so important. It's a difficult journey "seizing the day" after such tremendous losses of close family members.
Will Autumn be a time of change and wonder for you?
Autumn heralded and still brings new beginnings.
Marriage and moving to a new city, a new way of life. Babies born during the later months of Summer beginning to sleep through the night and beginning to take on their own individual personalities. And Autumn began our most difficult journey in life through a year and more of changing seasons and life changing experiences.
Today, a wedding invitation arrived from a relatively "new" acquaintance we've made, daughter and I, since my husband/her father's passing. She'd also lost her husband to a lingering illness/medical condition.
We were married in October; just a few days before the date of this celebration of life and love. The groom belongs to the same Service Organization my husband belonged to. Interesting and ironic how life includes so many similarities and brings opportunities so similar, so familiar.
A new beginning. Autumn brings opportunity once again.
Winter will follow. We used to welcome the season. We enjoyed winter sports.The sons both played ice hockey and we all loved to ski. We were fortunate; we had many great family experiences. As when my husband passed, I'm so grateful we didn't "wait" for a particular time in life but took advantage of opportunities that came our way and celebrated our life together, our family, our love for one another.
We also escaped sometimes to warmer places and enjoyed the respite into the sun filled areas. Those were times of shared joy and family fun, too. We were indeed fortunate, in those days.
Last night at an event, I sat beside a young woman who just began working at a travel business where I've returned part time to "try my wings" and fly alone into the future. It was a challenging return; a time heralded by concern and feelings of longing for the past, the time before..
She told me about other jobs and an experience she recently took advantage of; a life opportunity, one that could have been negative and turned it into a memorable positive.
She traveled around the Far East into several different countries with a friend for four months. That's a very long period of time for most people and few get this opening in life's journey -- usually the very young and sometimes those who've traveled the road of life far longer.
I applaud her personal courage to make this decision and take this journey.
I know nothing about her family's reaction or their relationship but I see her choice to "seize the day" as an action she will take into her future, into her growing older and into her becoming "old" as a significant part of her foundation, her being and what she can contribute to life in general.
Good for her; good for you if you have, make or take opportunities to grow, to become and to pass on to others.
Now she moves into Autumn bringing with her this life experience; it will travel with her and influence her choices and decisions as everything we do always does.
I'm so grateful I can share those joys in life I know are so important. It's a difficult journey "seizing the day" after such tremendous losses of close family members.
Will Autumn be a time of change and wonder for you?
Saturday, September 12, 2015
Medicaid: Being At The Mercy Of The System
Before the experience with Mom, I
looked at receiving Medicaid as a Senior as the last resort but a “safety net” when
absolutely necessary.
Now, I realize once on Medicaid, as a Senior, your
life is truly at the mercy of those who administer the program: facilities,
State agencies and departments. And, unfortunately, as many who have the services at younger
ages will tell you, it’s degrading, dehumanizing and often provides far less than you’re told
when you agree to entering the process.
With generations in their 90’s and
beyond, 80’s and even 60’s through 70’s who went through financial downturns of
decades, wars and confrontations, and even economic times and lack of ability
of programs and plans, our society faces continuing challenges maintaining
quality of life and independent abilities as most States and the Federal
Government state they advocate and support.
The Answer: Effective use of current
State laws, rules and regulations AND the powers that be, the regulating
authorities, realize the importance of not only advocating and promoting but of
regulating through enforcement of specific corrections that mean the most to
facilities – loss of income, loss of new residents.
Transparency:
an online list of all facilities by State joining together the many State
Authorities under one “banner” with EVERY SINGLE REPORT GENERATED available to
click through – AND NOT JUST THE SUMMATION OF FINDINGS.
Quick and
Clear Reference: A checklist of
complaints by area, number of people/times reported and outcomes.
LET’S LIST STATISTICS CLEARLY AND ACCURATELY AS PART OF THE MANDATE FOR TRANSPARENCY AND OPEN REPORTING.:
‘
Deaths by
facility, by month, male/female, age at time of death, number of years spent in
that facility; total number of years spent in facilities by type
Number of
cases of pneumonia per facility by month; male/female
Number of
falls by person and reasons provided for falls in record of facility
Number of
cuts, bruises, abrasions or any other skin compromise per month per facility
We keep hearing how falls and infections are rampant in the elderly but we don't hear the details of the sources of these challenges.
We keep hearing how falls and infections are rampant in the elderly but we don't hear the details of the sources of these challenges.
Let’s see
an accounting by the State Departments of Health, those who oversee the
nation’s welfare in long term care facilities in a format and easily accessible
with updates at least on a yearly basis if not on a quarterly.
We’re in
the computer age. Colllecting data is easier. Mandate facilites report by
computer, don’t just say you’ll take paper. If they’re not using computers for
their work, how can we believe these businesses are well managed and well run?
Computer entries can be tracked far easier than adjustments to “written”
reports. Move Forward, DHSS!
Wednesday, September 9, 2015
CNA's Are The Workhorse of Skilled Nursing Facilities
In Missouri, most of the "training" of Nurses Aides is done "on the job" with some classroom required but more "in the field" at the Long Term Care Facility and under the supervision of the facility.
Aides are the "backbone" of Skilled Nursing Facilities/Nursing Homes. They're responsible for the majority of the extensive physical workload of patient care.
Their jobs are physically, mentally and emotionally challenging and yet they're usually the lowest compensated level of care giving.
Who would want this job? Everyday they face the challenges of answering to everyone and being sent to do jobs no one else wants to do.
Aides operate the Hoyer Lift, they are assigned to feed residents, they clear the rooms of food trays, take residents to the bathroom and wipe them if necessary, clean them up when they have an accident (food or other), give showers/bathe, make beds/change bedding, assist residents from wheelchairs into chairs/beds, wake up and assist residents in getting up in the morning, move wheelchair patients who cannot move themselves to on floor dining and more.
Their training is primarily "in house" with some classroom instruction. They go to facilities that have "partnered" with specific training facilities for Certified Aides. From these ranks facilities often add to their staff. Yet many are not paid for this training or minimally paid while still paying for the "privilege" of learning this "trade".
Who trains these Aides? The Nurse on duty? Another Nurse's Aide? One who received their "certification"?
As with any other training, the level of ability depends on the accuracy of the training and the ability of the instructor. And, it depends on the ability of the individual.
Mom had some great CNA's and she had some very poor CNA's.
The challenge as I saw it was the training for use of medical equipment like the HOYER lifts was minimal. There were two kinds, for one the individual had to be capable of standing and of holding on while the unit raised their body from a sitting to a standing position or vice versa.
With Dementia, individuals often "forget" they need to hold on or fear falling and let go.
With Dementia, the introduction of this "new" equipment for which the individual has no previous experience is as frightening as introducing a swing or bicycle to a young child for the first time. Some form of cooperation from the individual is needed to ensure the person doesn't fall -- balance, upper body and or lower body strength.
Usually one person is sent to "move" the resident as the facility believes it's a simple task.
That's not always the case, especially with someone who has varying abilities due to Dementia or even to the use of medications which can affect balance and/or perception.
We took a picture of Mom having a Hoyer lift used and almost falling by slipping down because she could not hold on sufficiently. The CNA tried to use a Gait Belt to control this and that meant Mom was even more "pulled apart" and in more than one direction causing her to have even more challenges.
Facilities should be required to have two person assists with each use of the HOYER equipment whether it's the one where the resident stands or sits.
Looking back and watching today, we still see safety issues in LTC's and believe the causes for falls is more than a resident's inabilities -- it's due to the lack of adequate caregiving.
Mom lived with us through many medical challenges including operations and a hip "nailing" and an escar on her foot the wound specialist was convinced would mean she'd lose her leg at least to the knee.
Didn't happen.
Took a great deal of patience and endurance on our part; a working together to ensure Dr's orders were followed even when Mom complained and initially rejected procedures but Mom came through these situations without the myriad of falls, injuries and infections.
Why? We believe it was because we provided a high level of caregiving.
People were amazed at Mom's advanced age when she passed and while she lived. Yes, it was genetic, a good quality of life in her later years but it was also because there was a direct involvement and interest in her as an individual and ensuring a high quality of life.
At the level of residential care Mom had to go to, this just wasn't offered. Mom did receive excellent care from a few, but not for long and not when they weren't there. There are many more like my Mom; placed in facilities where standards are low, turnover is high and outside resourcing of services provides many who simply don't care because tomorrow or in a few days, they'll be somewhere else and it's "just a job".
To those who do care, we applaud you. Your job is difficult, often unrewarding for the most part and unrewarding.
Thank you to those who are CNA's making a positive difference and truly caring about our Seniors.
Who trains these Aides? The Nurse on duty? Another Nurse's Aide? One who received their "certification"?
As with any other training, the level of ability depends on the accuracy of the training and the ability of the instructor. And, it depends on the ability of the individual.
Mom had some great CNA's and she had some very poor CNA's.
The challenge as I saw it was the training for use of medical equipment like the HOYER lifts was minimal. There were two kinds, for one the individual had to be capable of standing and of holding on while the unit raised their body from a sitting to a standing position or vice versa.
With Dementia, individuals often "forget" they need to hold on or fear falling and let go.
With Dementia, the introduction of this "new" equipment for which the individual has no previous experience is as frightening as introducing a swing or bicycle to a young child for the first time. Some form of cooperation from the individual is needed to ensure the person doesn't fall -- balance, upper body and or lower body strength.
Usually one person is sent to "move" the resident as the facility believes it's a simple task.
That's not always the case, especially with someone who has varying abilities due to Dementia or even to the use of medications which can affect balance and/or perception.
We took a picture of Mom having a Hoyer lift used and almost falling by slipping down because she could not hold on sufficiently. The CNA tried to use a Gait Belt to control this and that meant Mom was even more "pulled apart" and in more than one direction causing her to have even more challenges.
Facilities should be required to have two person assists with each use of the HOYER equipment whether it's the one where the resident stands or sits.
Looking back and watching today, we still see safety issues in LTC's and believe the causes for falls is more than a resident's inabilities -- it's due to the lack of adequate caregiving.
Mom lived with us through many medical challenges including operations and a hip "nailing" and an escar on her foot the wound specialist was convinced would mean she'd lose her leg at least to the knee.
Didn't happen.
Took a great deal of patience and endurance on our part; a working together to ensure Dr's orders were followed even when Mom complained and initially rejected procedures but Mom came through these situations without the myriad of falls, injuries and infections.
Why? We believe it was because we provided a high level of caregiving.
People were amazed at Mom's advanced age when she passed and while she lived. Yes, it was genetic, a good quality of life in her later years but it was also because there was a direct involvement and interest in her as an individual and ensuring a high quality of life.
At the level of residential care Mom had to go to, this just wasn't offered. Mom did receive excellent care from a few, but not for long and not when they weren't there. There are many more like my Mom; placed in facilities where standards are low, turnover is high and outside resourcing of services provides many who simply don't care because tomorrow or in a few days, they'll be somewhere else and it's "just a job".
To those who do care, we applaud you. Your job is difficult, often unrewarding for the most part and unrewarding.
Thank you to those who are CNA's making a positive difference and truly caring about our Seniors.
Sunday, September 6, 2015
Senators Propose Investigation of LTC's "Star Ratings" by CMM -- Long Overdue
Two Senators have recently called for the federal government to investigate Centers for Medicare and Medicaid Services' Five-Star Quality Rating System.
I wrote about the Minimum Data Set, mandated to be used in all Long Term Care Facilities on a regular basis and reports sent to the DHSS and Medicare/Medicaid for its negativity and misapplication.
Want to read what I wrote on December 17, 2014 on the MDS: click here
This system of "Star Ratings" by the US Government CMM has been promoted as being a reliable way of determining the quality of care and safety in Long Term Care Facilities across the US when it is actually a compilation of information whose source varies and whose information is questionable as to accuracy and dependability.
The general public deserves to have websites provided by the Federal and State Governments that are accurate and complete, especially when human lives are involved.
Unfortunately, this Star System can be detrimental to the lives of Seniors and their families with its limited and biased information.
Click here to pull up the page on the web that details what's used/included in this "review".
You actually have to click through to Nursing Home Compare to get information on specific facilities. You can put in your zip code and it will pull up several to compare.
I did and reviewed my Mom's LTC where she lived and died. Ratings were far higher than I would have expected from the actual experiences of Neglect and Abuse reported several times by our family and others.
The Key Word here is "Average" as it is the basis of the report. Let's see if we can find a definition for this word as it applies to the three categories.
For this we need to go into another site. Here you'll find the following on page 6:
"For the above reasons, Five-Star quality ratings on the health inspection domain are based on the relative performance of facilities within a state. This approach helps control for variation among states. Facility ratings are determined using these criteria: • The top 10 percent (lowest 10 percent in terms of health inspection deficiency score) in each state receive a five-star rating. • The middle 70 percent of facilities receive a rating of two, three, or four stars, with an equal number (approximately 23.33 percent) in each rating category. • The bottom 20 percent receive a one-star rating."
IMPORTANT: The information that each State sets its own standards so a 1 star in one State can be a 2 star in another and vice versa.
Shouldn't a Long Term Care Facility in Georgia have the same basic requirements and therefore comparisons as an LTC in New York State?
What's not being openly discussed is the broad scope of legislation and the leaving to the States individually to set their own standards and parameters for care giving for our Seniors.
Then, on Page 10 you'll find Table 5 Staffing Points and Rating (updated February 2015)
a table of information that's best viewed as it doesn't copy well for insertion into this blog.
What's also upsetting is the "lumping together" of RN, LPN and Nurse's Aides as though they were equally qualified to care for residents.
In Mom's facility, there was only one RN on duty and that was only during the hours of 7 AM to 5 PM Monday through Friday, not on weekends, one or two LPN's per floor depending on the number of residents at the time and usually 2 to four CNA's depending on the total number of residents and not the actual abilities of the residents or needs. All totally in line with the State of Missouri "requirements".
WHO CHECKS TO ENSURE THE ASSESSMENTS DONE BY THE FACILITIES IS ACCURATE REGARDING THE PHYSICAL AND MENTAL NEEDS OF RESIDENTS?
If the facility administers their own tests, hires their own Doctors, requires (as Mom's did) only their facility's Hospice Care and doesn't allow any other "end of life care", please tell me how much weight we should give to the accuracy and positive intent of a facility?
These valuations were always greatly underestimated and trying to get a facility associated Dr to ensure the real level of personal assistance, mental capacity and capability were notated and recorded was never accomplished in all the time we spent there and all the reports we generated.
Most importantly when you read the report you'll notice it relies on the reports generated by the facility as to the ability level of its residents.
Sadly, those who write the reports often do not tell the truth; they do not adjust for changes and especially for lessening of abilities both mental and physical.
At Mom's facility, as I'm sure is true of many, they relied on Staff "Rounds" that were supposed to be held at the beginning of each new shift to VERBALLY inform the CNA's about the abilities and needs of the resident.
Can't say I ever really saw a CNA checking a record of a patient. There was a recording area for them to put down what services they provided but the errors had to be extensive as it was not portable but fixed to a wall and totally dependent on the provider to leave the room walk down the hall, pull up the specific resident and record services rendered and observations.
Imagine this scenerio: CNA is called to Room 1 for resident who needs to be transferred to commode. CNA takes advantage of time while resident sits to give assistance to another who needs help getting wheelchair out of a corner or some other logistics need; another light goes on and another and the CNA moves from room to room.
So, if the average person can only remember 10% of anything they're taught or specific procedures they've done, how accurate can this "report" be when the CNA finally gets around to recording their actions/activities with each resident?
THAT, SENATOR CASEY AND SENATOR WYDEN, is one of the many reasons why this Star Report is inaccurate and not worthy of the time and cost.
How about a website that provides A VOICE FOR THE PEOPLE? One where residents and families can record their concerns and their observations? That would be a better spending of Tax Dollars -- in my opinion.
The general public deserves unbiased information and full disclosure. Some states now provide itemized reporting of ALL violations found and reports made generating visits by the State Departments of Health and Human or Senior Services.
Senators, this is the format that needs to be followed:
TOTAL TRANSPARENCY WHERE HUMAN LIVES ARE INVOLVED.
A federal government website that uses the reports generated by the individual States differing standards and procedures for reporting quality of care IS NOT ACCURATE when it does not include the parameters of each specific State or at least a click through for each State so we can acess directly the parameters used to judge and measure Seniors.
You cannot compare apples to oranges.
A federal government website that relies on individual interpretation and administration of measurements like the MDS, Minimum Data Set, often administered by unqualified and underqualified individuals in settings not conducive to a "controlled study" which this test and others like it should be is not reliable and should not be used to determine the "quality" of care giving in any Long Term Care Facility in any of our fifty States.
I've personally seen the questions given to residents after waking them from a nap, at the dining table, after receiving medications, etc -- all factors never reported or divulged as influencing the outcomes of the MDS-- as mentioned in the above blog entry I wrote on December 17, 2014
The Problems:
This system uses reports generated by the State DHSS's who each have varying parameters they use to determine the specific categories covered:
There are only three areas used to determine the Five Star Quality Rating System.
Health Inspections done yearly at facilities Staffing QM's
How often is there a review of this "system"? When is it updated? Let me know if you can find the answer -- I'm still looking.
I wrote about the Minimum Data Set, mandated to be used in all Long Term Care Facilities on a regular basis and reports sent to the DHSS and Medicare/Medicaid for its negativity and misapplication.
Want to read what I wrote on December 17, 2014 on the MDS: click here
This system of "Star Ratings" by the US Government CMM has been promoted as being a reliable way of determining the quality of care and safety in Long Term Care Facilities across the US when it is actually a compilation of information whose source varies and whose information is questionable as to accuracy and dependability.
The general public deserves to have websites provided by the Federal and State Governments that are accurate and complete, especially when human lives are involved.
Unfortunately, this Star System can be detrimental to the lives of Seniors and their families with its limited and biased information.
Click here to pull up the page on the web that details what's used/included in this "review".
You actually have to click through to Nursing Home Compare to get information on specific facilities. You can put in your zip code and it will pull up several to compare.
I did and reviewed my Mom's LTC where she lived and died. Ratings were far higher than I would have expected from the actual experiences of Neglect and Abuse reported several times by our family and others.
The Key Word here is "Average" as it is the basis of the report. Let's see if we can find a definition for this word as it applies to the three categories.
For this we need to go into another site. Here you'll find the following on page 6:
"For the above reasons, Five-Star quality ratings on the health inspection domain are based on the relative performance of facilities within a state. This approach helps control for variation among states. Facility ratings are determined using these criteria: • The top 10 percent (lowest 10 percent in terms of health inspection deficiency score) in each state receive a five-star rating. • The middle 70 percent of facilities receive a rating of two, three, or four stars, with an equal number (approximately 23.33 percent) in each rating category. • The bottom 20 percent receive a one-star rating."
IMPORTANT: The information that each State sets its own standards so a 1 star in one State can be a 2 star in another and vice versa.
Shouldn't a Long Term Care Facility in Georgia have the same basic requirements and therefore comparisons as an LTC in New York State?
What's not being openly discussed is the broad scope of legislation and the leaving to the States individually to set their own standards and parameters for care giving for our Seniors.
Then, on Page 10 you'll find Table 5 Staffing Points and Rating (updated February 2015)
a table of information that's best viewed as it doesn't copy well for insertion into this blog.
What's also upsetting is the "lumping together" of RN, LPN and Nurse's Aides as though they were equally qualified to care for residents.
In Mom's facility, there was only one RN on duty and that was only during the hours of 7 AM to 5 PM Monday through Friday, not on weekends, one or two LPN's per floor depending on the number of residents at the time and usually 2 to four CNA's depending on the total number of residents and not the actual abilities of the residents or needs. All totally in line with the State of Missouri "requirements".
WHO CHECKS TO ENSURE THE ASSESSMENTS DONE BY THE FACILITIES IS ACCURATE REGARDING THE PHYSICAL AND MENTAL NEEDS OF RESIDENTS?
If the facility administers their own tests, hires their own Doctors, requires (as Mom's did) only their facility's Hospice Care and doesn't allow any other "end of life care", please tell me how much weight we should give to the accuracy and positive intent of a facility?
These valuations were always greatly underestimated and trying to get a facility associated Dr to ensure the real level of personal assistance, mental capacity and capability were notated and recorded was never accomplished in all the time we spent there and all the reports we generated.
Most importantly when you read the report you'll notice it relies on the reports generated by the facility as to the ability level of its residents.
Sadly, those who write the reports often do not tell the truth; they do not adjust for changes and especially for lessening of abilities both mental and physical.
At Mom's facility, as I'm sure is true of many, they relied on Staff "Rounds" that were supposed to be held at the beginning of each new shift to VERBALLY inform the CNA's about the abilities and needs of the resident.
Can't say I ever really saw a CNA checking a record of a patient. There was a recording area for them to put down what services they provided but the errors had to be extensive as it was not portable but fixed to a wall and totally dependent on the provider to leave the room walk down the hall, pull up the specific resident and record services rendered and observations.
Imagine this scenerio: CNA is called to Room 1 for resident who needs to be transferred to commode. CNA takes advantage of time while resident sits to give assistance to another who needs help getting wheelchair out of a corner or some other logistics need; another light goes on and another and the CNA moves from room to room.
So, if the average person can only remember 10% of anything they're taught or specific procedures they've done, how accurate can this "report" be when the CNA finally gets around to recording their actions/activities with each resident?
THAT, SENATOR CASEY AND SENATOR WYDEN, is one of the many reasons why this Star Report is inaccurate and not worthy of the time and cost.
How about a website that provides A VOICE FOR THE PEOPLE? One where residents and families can record their concerns and their observations? That would be a better spending of Tax Dollars -- in my opinion.
The general public deserves unbiased information and full disclosure. Some states now provide itemized reporting of ALL violations found and reports made generating visits by the State Departments of Health and Human or Senior Services.
Senators, this is the format that needs to be followed:
TOTAL TRANSPARENCY WHERE HUMAN LIVES ARE INVOLVED.
A federal government website that uses the reports generated by the individual States differing standards and procedures for reporting quality of care IS NOT ACCURATE when it does not include the parameters of each specific State or at least a click through for each State so we can acess directly the parameters used to judge and measure Seniors.
You cannot compare apples to oranges.
A federal government website that relies on individual interpretation and administration of measurements like the MDS, Minimum Data Set, often administered by unqualified and underqualified individuals in settings not conducive to a "controlled study" which this test and others like it should be is not reliable and should not be used to determine the "quality" of care giving in any Long Term Care Facility in any of our fifty States.
I've personally seen the questions given to residents after waking them from a nap, at the dining table, after receiving medications, etc -- all factors never reported or divulged as influencing the outcomes of the MDS-- as mentioned in the above blog entry I wrote on December 17, 2014
The Problems:
This system uses reports generated by the State DHSS's who each have varying parameters they use to determine the specific categories covered:
There are only three areas used to determine the Five Star Quality Rating System.
Health Inspections done yearly at facilities Staffing QM's
How often is there a review of this "system"? When is it updated? Let me know if you can find the answer -- I'm still looking.
My Comments:
Reference is made to the three most recent ANNUAL health inspections. What about the inspections generated by families and residents endangerment and negligence? They wouldn't be in this classification or examination according to the interpretation of this directive.
Reference is made to the three most recent ANNUAL health inspections. What about the inspections generated by families and residents endangerment and negligence? They wouldn't be in this classification or examination according to the interpretation of this directive.
Three most recent surveys health inspections -- done by the government agency, the DHSS.
Ever read one? I have and was appalled to see severe and life threatening events portrayed with moderate and not severe language. Anyone reading this report would "judge it" according to the language as is stated above and a really poor facility could get significantly higher marks.
As someone who is very against the use of the Minimum Data Set, I challenge the Senators to review this tool as it is used on patients with Dementia, especially Lewy Body Dementia.
According to medical experts on the Lewy Body Dementia Association website, you can't get an accurate "reading" and variances can be extreme from one hour to another as to what a resident will respond with patients who have LBD.
This "tool" shouldn't be used to measure the amount of care giving an individual needs as it is too variable in its results and not effective in the hands of the people who usually administer it at Long Term Care facilities.
The Star System needs to be changed to allow the accurate and total reporting of facilities reports generated each and every time the DHSS makes an inspection for whatever purpose and full transparency should be required.
Forget giving ratings, give exact information or links to websites mandated for each State to contain exact information gathered from reports made by Long Term Care facilities collected by the DHSS, Medicare and Medicaid.
Let the general public see how many of each category of caregiver is actually working on a daily basis; let us see all the details (except for the name of the exact resident) for any and all real or perceived violations and the outcomes including all fines and any other actions taken by exact date and amount.
Ever read one? I have and was appalled to see severe and life threatening events portrayed with moderate and not severe language. Anyone reading this report would "judge it" according to the language as is stated above and a really poor facility could get significantly higher marks.
As someone who is very against the use of the Minimum Data Set, I challenge the Senators to review this tool as it is used on patients with Dementia, especially Lewy Body Dementia.
According to medical experts on the Lewy Body Dementia Association website, you can't get an accurate "reading" and variances can be extreme from one hour to another as to what a resident will respond with patients who have LBD.
This "tool" shouldn't be used to measure the amount of care giving an individual needs as it is too variable in its results and not effective in the hands of the people who usually administer it at Long Term Care facilities.
The Star System needs to be changed to allow the accurate and total reporting of facilities reports generated each and every time the DHSS makes an inspection for whatever purpose and full transparency should be required.
Forget giving ratings, give exact information or links to websites mandated for each State to contain exact information gathered from reports made by Long Term Care facilities collected by the DHSS, Medicare and Medicaid.
Let the general public see how many of each category of caregiver is actually working on a daily basis; let us see all the details (except for the name of the exact resident) for any and all real or perceived violations and the outcomes including all fines and any other actions taken by exact date and amount.