In lieu of an abstract, here is a brief excerpt of the content:

  61 Chapter 4 “We Are Nothing” Empowering Staff All the affection, all the consoling, all the filling of emotional holes and the tidying up of frayed feelings are invisible to the owners, to the administration, and to the official state regulators who monitor us so closely. . . . I have never known of any aide being rewarded or recognized for being kind. —Tom Gass, Nobody’s Home: Candid Reflections of a Nursing Home Aide We know our residents. We know their wants and needs. We know pretty much what’s going on. We set up our own budget for activities. It’s not a control thing anymore. You can make decisions, and it’s all about what the residents want. —Sherry Smith, aide at Meadowlark Hills In the conference room at Crestview Nursing Home in Bethany, Missouri, a dozen or so staff members were given time out of their workday to talk with me about their jobs. Crestview had a far different feel from Meadowlark Hills. Originally the poor farm, Crestview remained a low-budget operation owned by the county. The conference room where we sat still had the track on the ceiling, demarcating where curtains once offered scant privacy in a four-person ward. But Crestview had risen from its once lowly state. At the time I visited, it was viewed as a national model for long-term care. One advocate described it as the “most liberating” nursing home she had ever visited. I asked the staff what made Crestview different from other nursing homes. 62 Old Age in a New Age “It’s not as institutionalized as the others,” said Cissy, a young aide whose mane of curly red hair was pulled back in a ponytail. “You get to have fun with the residents. You don’t get in trouble for sitting down and talking to a resident.” A licensed practical nurse spoke up, saying she drove forty miles a day to work there, even though several other nursing homes were closer to her home. She had tried working at one of them. “That was a job,” she said. “This is family. The other places didn’t follow our standards.” I asked them how they learned their approach to working at Crestview. At first, they thought I meant the basic training they received to do their job. Crestview, like other nursing homes, required aides to successfully complete a seventy-five-hour classroom course and a hundred hours on the floor to become certified. Aides were taught how to bathe, feed, and transfer (help move) residents. They learned to observe symptoms to see if residents were in pain or losing range of motion. They took residents on walks and collected urine specimens. “You learn all that,” said Charlie, an aide and staffing coordinator . “But then we add the fun to it.” This was the second time the word “fun” had come up, and I pointed out that “fun” is not a word that most people associate with nursing homes. In fact, I said, in many nursing homes I’ve heard people moaning or calling for help. “They’re scared. They want to make sure there’s someone there besides them,” Cissy explained. “So that means staff is not really interacting with them, so they think they’re the only person there. And if you don’t go in that room once in a while, they get scared. We’re in the room all the time.” “You’re not sitting around the nurse’s station,” I observed. They all burst out laughing. “You better not!” someone called out. “We’re here for them,” said Charlie. “It makes them feel needed and wanted.” “What we have is one big family,” said Tammy, the social worker. “These residents are more like our grandparents. Residents ask about the employees . When I had my baby, I got calls and cards. One lady even came to the hospital. They become a part of our lives. They ask about our kids.” Carla, another team leader, regretted the years she spent working in a factory, even though she earned more on the assembly line than she does at Crestview. “These residents give me far more than we give them,” she said. “It makes all your problems seem small. They make me feel very, very special. That’s worth more than high wages.” The joy and confidence these staff members expressed is all too rare in nursing homes. Staff turnover and a shortage of direct caregivers have created a crisis...

Share