Photo Source Rosmarie Voegtli | CC BY 2.0
Let me say at the outset that I do not regard myself as any kind of “expert” on the subject of nursing homes. I’ve done only scant tangential research, and other than what you’re about to read here, have never published anything on the subject. But that said, I like to think I have gleaned some practical knowledge.
Some years ago, I was a resident—a highly motivated, cogent, resourceful, and curious resident—for 79 days at a sprawling 200-bed facility in Southern California. After undergoing double knee surgery (don’t ask), and being confined full-time first to a bed, and then to a wheel chair, I had nothing better to do with my time than explore the place, spy on everyone, and enter my observations in a journal.
Two things aided in that enterprise. (1) Because so many residents were either elderly or severely disabled, the nurses and administrative staff had trained themselves to speak loudly, which allowed me to voyeuristically overhear more than my share of private conversations. And (2) because so many residents were unable or unwilling to converse, I stood out as the shining example of a “motor mouth.” Aristotle was correct. Man is a social animal. Accordingly, everyone was eager to talk to me
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There were three around-the-clock nursing shifts: 7:00 AM to 3:00 PM, 3:00 PM to 11:00 PM, and 11:00 PM to 7:00 AM. In ascending order of qualifications, the nursing staff consisted of CNAs (Certified Nursing Assistant), LVNs (Licensed Vocational Nurse), RNs (Registered Nurse), and Nurse Practitioners (there were two of them on staff).
I can’t speak for every nursing home in America, of course, but I’m going to go out on a limb and assume that the following advice pertains to most of them.
Simply put, if you can help it, DO NOT have a heart attack, stroke, or other medical emergency during the graveyard shift-change because, odds are, you won’t receive any immediate help. The nurses getting off their shift and the nurses coming on will be busy exchanging information or gossiping for 15-20 minutes, and will likely not notice your “request light.”
The reason day-shift or swing-shift nurses don’t engage in similar gab-fests at shift-change is simple. There are administrative staff people walking around during those periods. And sharp-eyed administrators definitely pay attention to stuff like that. It goes without saying that there were no bosses present at 11:00 PM.
One night I happened to still be awake at shift-change, and witnessed my roommate, Wayne, a very sick man, lose his balance while trying to use the handles of his wheelchair as a “walker” in order to visit the bathroom. He fell to the floor. To be accurate, he more or less “slid down” to the floor rather than fell on it. In any case, he was not injured.
But even uninjured, he didn’t have the strength to get up. He was stuck there. He called out to me and asked me to summon help, which I did. I instantly turned on my request light and waited. After waiting three or four long minutes, I lost patience and began shouting for assistance. My bed was on the other side of the room, the window side, furthest from the corridor door.
Even with me shouting, “Nurse!!” no one came for 17 minutes. I timed it. They were all gathered at the nurses’ station way at the end of the hall, chattering away. Ironically, the nurse who finally did enter the room and help Wayne to his feet wasn’t one of the graveyard people; she was a swing-shift CNA who was on her way out.
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Another thing unique to night-shift, as they prepared us for graveyard, was their generosity with sedatives, sleeping pills, and pain medication. Graveyard shift already had a “skeleton” crew—the absolute minimum of low-seniority people to handle what needed to be handled—and the last thing they wanted was for residents to be awake and making demands at 3:00 AM.
Not that the quality of the graveyard nurses was inferior, because it wasn’t. Despite what I noted about the gossiping at shift-change, the quality of the staff, low-seniority or not, was excellent. It’s just that, in the middle of the night, they really needed all of us to be asleep, so they began handing out the sleep meds at 9:00 PM. Pain meds were given whenever requested (and they served as a nice sedative), but sleeping pills were cut off at midnight.
Another thing: Almost everyone in the facility was constipated. Any nurse will tell you that when you are prescribed a myriad of medications, you tend to become constipated, particularly when you are bed-ridden, without exercise, and living on an unfamiliar hospital diet.
As a consequence, even though the place was clean and hygienic, there was a faint, not entirely unpleasant, odor permeating the facility. I pestered one of the nurses until she told me that the smells were emanating from the large portable laundry bins stored in the corridors. It was the telltale odor of stool softener.
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One of the night nurses gave me some good advice. She urged me to keep my fingernails and toenails clipped and filed down. “Your skin will get dry in a place like this,” she said, “and you don’t want to scratch your skin and open a wound that could become infected.” In my condition I couldn’t reach my toenails, so they kept them clipped for me.
Based on everything I saw, heard, or had reported to me from Dr. White, it was close to impossible for a resident to be neglected in the manner depicted in those sordid TV movies we’ve all seen. There are simply too many things working against it. Besides having emergency 800-numbers plastered on the walls of all the rooms and corridors, reps from county and state agencies were constantly snooping around making sure nobody was “warehoused.”
Even those residents who were deemed unresponsive or functionally comatose got the “full treatment.” Based on my spying activity, every person in the facility, no matter their condition, was fed, bathed, turned in bed, and, whenever possible, wheeled out to the courtyard to get some air. Those who could make it to physical therapy were taken there, and those who couldn’t make it had the world’s tiniest barbells brought to their bed, and were put through their paces by a physical therapist.
The same for recreation. The activity center offered music, sing-alongs, crafts, word searches, movies, etc. Even though the facility did its best to liven things up, that whole “rec room” scene was too weird for me. Witnessing stroke victims and palsied elderly people who couldn’t sit up straight in their wheelchairs singing “She’ll Be Comin’ ‘Round the Mountain When She Comes” was heartbreaking.
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Based on what they shared with me, the main complaint of the CNAs was having fussy and confused residents insist to their families that they weren’t being adequately treated—weren’t being given an extra blanket when requested, weren’t being fed enough, weren’t having their sheets changed regularly. They complained to me because they knew I was interested, and knew I was aware of what was really going on.
Even my roommate, Ralph (who followed Wayne, who died of lung cancer), whined to his sons that his requests were being ignored. Ralph was a great roommate. We spent hours reminiscing about our early lives in Southern California, and I lent him my electric razor. But Ralph also had a flair for the melodramatic, and could be a bit of a pain in the ass.
To their credit, his sons were skeptical enough to ask me to confirm their dad’s complaints, and to my credit, I was forthcoming enough to set them straight. Oddly, when Ralph heard me contradict virtually everything he had told them (they never failed to bring us extra blankets, and we were given snacks whenever we asked, no matter the hour), instead of taking offense or arguing, he just lay there, nodded his head, and smiled knowingly.
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Women nurses outnumbered the men, 10 to 1, but because everyone knew I preferred a male nurse, I was always assigned Fernando, a day-shift CNA. Fernando’s two main beefs with the place were that his bosses constantly criticized the nursing crew for issuing residents too many terry cloth towels (laundry costs), and that he was always being asked by women nurses to help lift people out of bed.
As he rightly noted, he was paid no more than the women nurses, so why should he be expected to do the lifting simply because he was stronger. If they needed more male nurses, let them hire some. I agreed with him. In truth, I think Fernando was just venting, looking for a sympathetic ear, because I never once saw him refuse to help lift somebody. He was a great guy. We swapped life stories, and I let him read parts of my journal.
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Three days before I was to leave, the resident who lived directly across the hall from me died. Besides being a recovery facility, this place also served as a hospice. Many of the residents were never going to leave. Fernando was on shift, and the young woman CNA who had been assigned to the man’s room was understandably shaken up.
Unlike Fernando, who had earlier told me that he’d seen many terminal residents die at the facility, this young nurse had never had a patient die. The man’s family had already been notified and were on their way, but the CNA wanted to know what she should do in the meantime.
Fernando told her to wipe clean the man’s nightstand, and then carefully clean and arrange the personal effects he kept there—comb, eyeglasses, etc. Other than that and some general tidying up, he instructed her to do nothing. I heard her ask this question: “Should I pull the sheet over his head?” Fernando answered politely but firmly. “Of course not,” he said. “This is a convalescent hospital, not the morgue.”
And then, three days later, I left. After 79 days and a total of four knee surgeries, I was wheeled out of the facility into the loving arms of my wife Marilyn. My time there had been as much of an ordeal for her as it was for me. Once home, I stayed in wheelchair a couple weeks, then progressed to a walker, then a cane, and then nothing. No one had to remind me that I was one of the lucky ones.
