I began my relationship with the elderly in nursing homes when I was 15 years old.  My first summer job was as an “aide” in the local home in my small community in Nova Scotia. A nursing aide job was just about the only summer employment available for a teenage girl in our village. Absolutely no training or prior experience was required; all training was offered on the job by fellow aides and the nursing supervisor (remember, this was in the late 1960s). The job didn’t pay well, but it was better than the allowance I received from my parents.  The biggest perk was that an aide was required to wear a white uniform dress, white pantyhose and white shoes.  It was fun to get new clothes and to feel official, grown up and important, at least for the first hour or so on the job.

It was very hard work.  Shifts were eight hours with one meal break.  Nurses or LPNs (Licensed Practical Nurses) dispensed the medications, but the aides did everything else, usually working in efficient teams to visit a long list of patients during each shift. I was on my feet 3-4 hours at a time in the early morning, moving from room to room with my cart of clean linens, basin, soap and cream and helping to bath, toilet, and dress the patients. While one aide would move the patient onto his or her side, the other would wash the back, bottom and limbs and prepare fresh sheets.  Then we would roll the patient to the other side to straighten out the linen and wash the front side of the body.  Some patients had bedsores, and the treatment for these was primitive and painful.  During and after morning rounds, breakfast would be delivered and sometimes we would feed patients.  Because there was no dining room in the home, patients ate in their rooms or hallways, and those who were mobile were dressed and placed in wheel or stationary chairs.  In the afternoon, all of this happened in reverse. Once rounds were completed we aides (some of us very young), would be required to update and sign each patient’s chart making observations about his or her physical and mental condition.

I enjoyed working alongside some of my fellow aides, and some supervisors I admired, but there were others with whom I dreaded being paired, not because they were shirkers—we all worked hard—but because of their attitude toward and treatment of the patients.  Some aides were physically gentle and emotionally solicitous. Others were rough, abrupt and, well, the euphemism would be “disrespectful.”  Most of the aides were older and had been doing this work for a long time.  Some were hardened to the suffering they had observed.  Others were perennially tender.

From my recent experience of nursing homes in the northeastern United States, not a great deal has changed in 50 years.  Yes, all aides are now required to have some degree of formal training and there are unions to advocate for them.  More government and other oversight is exercised; rating systems provide information on the quality of care; a variety of ancillary services and programs are offered; and formal care plans are required.  But the patient’s experience is similar to those who were under my care in the late 1960s.  The work is still physically exhausting and often extremely unpleasant for the aides; and the daily routine is nearly identical in most of the dozen or so nursing homes that I have encountered over the last 25 years.  Of course, there is one huge difference.  The cost for this care has increased exponentially.

Enormous challenges exist on all sides:  for individual caregivers and for eldercare institutions, for families who place their loved ones in nursing homes, for the patients themselves, and not least of all for the health insurers who cover the costs for this care.  It’s a complex, interdependent, often inefficient, and, in many instances, inhumane system.  And it is permeated by issues of respect and disrespect.  I’m not a professional, and there are many who have analyzed and advocated for improvements in the system.  It’s not good enough yet.

Upcoming posts on this topic:

  • The Nursing Home Staff
  • Food and Feeding
  • Personal Care, Clothing and Incontinence
  • Rehabilitation and Long-term Care
  • Advocacy and Families
  • Dementia
  • Home Care and Hospice

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