It was the Friday between Christmas and New Year's Day. I was ready to head home to enjoy the weekend and the holiday. It was my last day at the Manor. Andrea was expected back next week from her maternity leave. It was a tearful farewell, as residents, families and staff all wished me well. Some held out hopes I would be retained but I didn't think there was a chance. If they didn't tell me by now, Friday afternoon, it's not happening, iIreasoned.
Mrs. Alfgren . asked to see me fifteen minutes before the end of the day. She met me in the Social Services office, and thanked me for all I did since Andrea was out. No problem, I said, expecting nothing more.
"Greg, you've done such a wonderful job that I want to offer you the position of Social Service Assistant. Andrea needs help. Sorry it took so long to let you know but I had to wait for the final answer from my bosses. What do you think?"
Of course I accepted, thanking her for everything.
So, for the next three years I worked with Andrea. I did basically what I had been doing while she was out. Only now I had the second or third floor- roughly 100 residents- ( we would rotate floors every six months so we both were familiar with the residents on every unit) and we split the first floor, which was the Medicare floor- another twenty or so people.
The first floor was where we got most of our admissions. More often than not they would stay long-term and be transferred to second or third, the long-term care units. But if someone needed rehabilitation in order to return home they would stay on first until they were ready to leave. So, most of our discharges occurred on first.
It turned out to be an excellent system and we worked well together. My documentation was especially strong, as I always remembered "if you don't write it down, you never did it." In fact, one of the usually stone-faced state inspectors commented after an exit interview that my notes were some of the best he had read in the state.
In all of our years together our department never got "gigged"- received a citation. It spoke volumes for our work, how we cared and what we accomplished.
I was there when the nursing home won the coveted E award ( for "excellence") from the company after another tremendous survey, The corporation threw us a big banquet at a local hall, along with bonuses for all.
I was also there for the not-so good times, when inevitably the surveys showed deficiencies in other departments that needed attention. We worked hard in the allotted time frame given by inspectors to clean up any penalties. But I can say, in my many years as a Social Worker, there was never an abuse charge by staff to a resident. Andrea and I stressed Residents Rights, and any kind of abuse- physical, verbal, mental- would not be tolerated. We had a tight staff, even among the aides, so it wasn't a problem back then.
There was pressure like in any job. Keeping the beds filled, especially on the Medicare floor, was a priority and a challende. The nursing home was a business and an empty bed meant no money coming in. When referrals dried up, usually from the hospital across the street, we would joke about needing to go out and "recruit" for residents ("If you're planning on taking a fall in the near future, I've got just the nursing home for you...").
Andrea and I were not only the Social Services department, we were Admissions too. So if we had a new case being transferred in that day, even without much notice, we were expected to drop everything else and focus on the admission. That meant getting papers signed by families or Power of Attorneys. Again, it was all about keeping those beds filled.
Nursing home Social Work was fast-paced, unexpected and challenging. You had to be good to cut it. The Manor wasn't the old, stereotypical hellhole of the past, a place where old folks were mistreated, neglected and abused. Our place was clean, odor-free, bright and cheerful. It was a place where people came to live. Those who stayed long-term were treated with respect and dignity. More and more people needed rehab to go back home and live with a visiting nurse stopping by or home health aides. It was part of my duties to arrange the help, as Discharge Planner.
If Andrea and I saw that things weren't up to snuff- not one is perfect- maybe an environmental problem or a call-bell not working, or breakfast was cold that morning- it was our duty to alert Mrs. Alfgren and make sure she followed up to resolve the issue.
I was proud of our facility while I was there with Andrea.
Families were as different as their loved ones who came to live at the Manor. Many were experiencing grief, guilt, feelings of being overwhelmed or extreme sadness. Family members cried at my desk, and I was there to comfort them, to show compassion and listen. I didn't always know what to say and sometimes it wasn't expected to say anything. Letting the families know I cared and understood their concerns and their feelings many times was enough.
Some families were angry, deflecting their anger to staff, even to Andrea and myself. Some could be very demanding with the nurses and aides, as they felt guilty of being unable to care for their loved one.
I remember one daughter calling me to locate her mother's bras- all fifteen of them lost in the laundry. Who wears fifteen bras? Espcially when you are 95? I did find some, working with the Laundry department, but as it turned out, the daughter was secretly taking bras home, then claiming they were lost in order for the nursing home to pay for brand new ones.
I usually let Andrea handle future bra problems. She was much more qualified in that department, and she agreed, laughing.
Many families called for help with buying adaptive clothing, arranging for dental or eye appointments or set up transportation to doctor's offices or visits home. Some merely called for guidance and support, especially new families unacquainted with nursing home life or having a loved one sick. Families helped families and I helped to put together a support group. We held regular Family Council meetings too, which we organized and conducted, another source of support.
The residents suffer the illneess and some may not even be aware of what's going on. Many had Dementia or Alzheimer's, some more confused than others. Some could recall events that happened years and years ago, as far back as when they were kids, yet could not tell me what the had for dinner last night. Or sometimes even their own name.
But it was the families who knew exactly what was going on. The families were the ones who struggled every day with visiting, watching loved ones decline in their care needs and memory. And it was the families who often heard the line 'I took care of you when you were a child- why can't you take me home?" It had to be a helpless feeling, wanting to take your loved one home, yet knowing that going home wasn't the right thing to do.
The residents needed the same comfort and support. Who wants to be in a nursing home? After years of working hard, raising families, family vacations, celebrating holidays together, all the good times and bad, who would ever imagine it would all end in a nursing home? Many vowed, making family members promise, never to place a loved one in such an "institution." Often residents suffered from depression or anxiety the aftermath of admission. Some were accepting of placement- others fought it, attempting to elope, or were combative to staff.
Those were the challenges we faced everyday. It wasn't easy for anyone- resident, family or staff.
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