Planting Ourselves Again in the Universe

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Uprooted
(photo by Moriah Freeman)

” We must get back into relation, vivid and nourishing relation to the cosmos and the universe….For the truth is, we are perishing for lack of fulfillment of our greater needs, we are cut off from the great sources of our inward nourishment and renewal, sources which flow eternally in the universe. Vitally, the human race is dying.  It is like a great uprooted tree, with its roots in the air.  We must plant ourselves again in the universe.”

          ~D.H. Lawrence, 1931, in “A propos of Lady Chatterly’s Lover”

    Stress, Equanimity and a Sense of Humor

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    Why would an Executive Assistant’s job be stressful?  Isn’t it just a matter of typing most of the day and doing routine tasks like making appointments and booking flights and hotels?  Don’t EA’s have it easy compared to the executive – less pressure, fewer decisions to make?  They just do as they are told, right?

    Wrong!  Imagine this. Your boss’ calendar is already full of vitally important meetings when you receive a call from the CEO’s office that an urgent two-hour meeting will be scheduled for sometime the following day. You must clear that day on your principal’s calendar and hold it open until further notice. She is at an off-site (the latest lingo for a planning day away from the office with her team) and unplugged from all technology, so you can’t consult with her to determine who to reschedule when and who to cancel.  So, as an experienced, knowledgeable, intuitive EA you set to work rearranging everything.  This change will affect perhaps an entire month of meetings.  Each person (or their EA) must be emailed or called, and the contacts must be made in priority order.  You will have to wait for responses before contacting the next individual or group.

    All the plans for your own workday must be put on hold while you tackle this unexpected rescheduling project.  You will call into play your knowledge of your boss’s preferences and priorities.  You must also be sensitive to the needs and feelings of those you are canceling or rescheduling.  You must have developed an excellent working relationship with their EAs.  You are required to accomplish this project quickly and efficiently while being constantly interrupted by others.  You are trusted to keep your cool; have confidence in yourself and your relationship with your boss; smooth ruffled feathers; and diplomatically explain the reason for this change.  You may even have to cancel travel plans at the last minute and keep track of the financial implications of doing so. And, in the midst of this, you must remain calm and cheerful, juggling multiple balls with faultless skill and perfect equanimity.

    By the end of the day, you have made significant progress, but you are stressed and exhausted.  You realize that, unknowingly, you have been holding your breath all day. Just before the workday ends, you receive a call from the CEO’s office that plans have changed and the crucial meeting will be delayed until the following week.  Do you cry? Do you scream? Do you throw your mouse at the wall?  No.  You sigh, shake your head and pack up to leave the office.  This is no surprise, this has happened multiple times before.  You’ll deal with it tomorrow.  Perhaps you’ll stay on an hour or two to catch up on the work you had planned for the day just passed:  pay some bills, reimburse some travel expenses, proofread a report, get a head start on arranging an upcoming trip.  Perhaps you’ll walk down the hall to chat with a fellow EA about the day, and you’ll laugh together to release some of the tension. After all, the day was relatively typical.  It could have been worse.

    I’m tempted to leave it at this and to draw some conclusions now about respect and the qualities of equanimity and humor exhibited by a top-notch EA, but I feel compelled to tell an even more stressful story –  the responsibility of being in-between.

    An angry employee calls to say he needs to see your boss immediately.  Your principal has widely disseminated an “open door” policy.  She wants to welcome and listen to others in the organization.  But you know the situation with this employee, and you know your boss has already discussed the employee’s concerns with him several times.  There are plans in the works to address these issues, but they are not fully developed.  Today your boss has blocked off a couple of hours to work on a critical report and has said she doesn’t want to be interrupted.  All of this is running through your mind as the employee demands an immediate meeting and says he’ll be arriving in five minutes, despite your protests.

    You calculate that your boss will welcome an interruption from you in this case and you quietly enter her office telling her the employee will arrive any minute, and she should stay closeted in the room until further notice; you will handle the situation.  She gives you a grateful look, there is complete understanding between you. You close the door and return to your desk.

    A few moments later the employee arrives, red-faced and shouting.  You speak softly and offer a relaxed demeanor, trying to mirror the kind of behavior you would like him to exhibit.  You explain that your boss is not available at the moment, but you are aware she is working on the problems the employee is worried about. She will be in touch as soon as plans have been developed. You ask the employee to sit down and explain his concerns further while you take notes.  You want him to know he is being heard and taken seriously.  As he talks he calms down, and you gently communicate that you are in the middle of a project but that as soon as you can, you will inform your boss about the conversation that has just occurred.  You stand up, the listening session is over, and he departs.  You prepare a brief email to your boss, low priority, to communicate any new information or nuances you have just gained.  She will read it when she has finished the report, or she’ll check with you on the way out to her next meeting.  She has complete confidence that you have handled the situation appropriately and may say thank you or may just accept your talents as an intermediary with silent gratefulness.

    You sigh, take some deep breaths – another uncomfortable situation diffused – and go back to your project.  But later you notice how tired you are, how tight your shoulders.  A slight headache hovers around your temples.  Perhaps tonight you will go to the gym, listen to your favorite soothing music during your commute, or enjoy a delicious dinner cooked by your understanding spouse.

    I have watched many talented EA’s keep their composure during extremely stressful incidents.  They relate delicate situations that they have handled quietly, to prevent them escalating, or to save their boss time, effort and stress.  They understand that their role is sometimes to smooth troubled waters and always to remain flexible, changing projects on a dime in response to the needs of their boss and others.  They feel the stress these situations create, but, for the most part, they don’t show it.  They welcome interruptions with a smile and stay late to finish tasks that have been pushed aside during business hours.  They do their best to maintain a sense of humor about themselves and those they serve.  Sometimes these efforts at equanimity fray slightly and take a physical toll, but they try to maintain a life balance that keeps them healthy and productive.

    None of this differs from the lives of countless workers at all levels in all jobs and professions.  I write about it because I admire the EAs with whom I have shared such stresses. I respect their backstage brilliance, strength, and dedication. We may commiserate in private, but in public, we strive to be models of calm professionalism. If you have such an Executive Assistant, she/he is worth her/his weight in gold.

     

     

     

     

     

    Behind the Scenes: Respecting those who serve you

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    [I am breaking into my series on “Executive Assistants and Respect” to post an article on another group of service people – wait staff in dining establishments; a topic that is now of great interest to me.]

    Almost three years after my retirement from Harvard, my work life took an unexpected turn.  I began waiting tables in the dining room of the retirement community where I live.

    Our dining room is chronically short staffed for a variety of entirely understandable reasons.  The work is physically hard, and the pay is relatively low.  We offer staff a generous yearly bonus but no tips.  For these reasons, the job attracts mostly young people – high school and college students for whom this may be their first work experience.  We feel very grateful for them and for the more mature wait staff who have been serving steadily and faithfully for many years.  However, the lives of teenagers and those in their early twenties are constantly changing, and their studies must take priority, so they often need to move on to other important things.  The staff turns over rapidly and hiring and training new staff takes a great deal of time, effort, and patience.  The head of dining services and the dining room manager are always between a rock and a hard place.  They want to offer the residents the highest quality service – an excellent dining experience – but they find that difficult to do with a shortage of wait staff.

    When the head of dining services described this situation at a resident meeting this past fall, I immediately wondered if I, at the age of 65, could do anything to help solve the dilemma.  I was completely aware of my time constraints and physical limitations, but I spoke with the dining services director anyway, offering my assistance in any form that might work for both of us.

    A month later I started waiting tables on Tuesday and Thursday evenings.  The other residents and the kitchen and wait staff are very supportive and patient, and after two months of learning the ropes, I am beginning to relax and enjoy the work.

    I have learned more than I could have imagined about what goes on behind the scenes in the kitchen and what wait staff do.  My respect for those who do this work has grown enormously.

    Shifts for wait staff during the evening meal are four hours long.  On very busy days or days when the dining room is short-staffed, they can stretch to four and a half or even five hours.  Some staff work two shifts a day, a full eight-hour workday.

    For the first hour, the staff members prepare for the meal.  Wait staff check tables to make sure the settings are complete, prepare condiments, make the coffee, fill water pitchers, set up the service stations, prepare fruit cups, cut and plate desserts, restock the ice cream freezer and make sure dressing and beverage dispensers are full.  They prepare the order slips for the tables they have been assigned and make a note of the starch and vegetables being offered and special appetizers and desserts for the day. They also prepare trays for room service, deliver them and, if there is any time left, fold napkins. Ten minutes before the meal begins, the chefs brief the waitstaff on the menu, and there is an opportunity for reminders and questions.  If short staffed, and table service is not feasible, the wait staff help to set up a buffet.

    Once the meal begins, wait staff are in constant motion for two full hours. On most evenings the waiter is assigned three to five tables of various seating capacity.  The timed arrival of diners makes it possible for one wait person to serve as many as 16 people during the meal.  They offer beverages, take orders, deliver appetizers, entrees, desserts, coffee and tea, clear tables between courses, and reset tables when guests have departed.  There is no separate “bussing” staff, so wait people do it all.

    Once the meal is over, around 7:00 or 7:30, wait staff are assigned “closing” tasks.  Covering unused salads, desserts, and condiments, restocking supplies and linens, washing the coffeemaker and pots, wiping trays and carts, picking up room service trays, and disassembling the buffet table.

    The dining services director and dining room manager supervise the entire four-hour shift and pitch in when necessary to make sure service is smooth and timely.  It is, indeed, a well-oiled machine and teamwork at its very best.  Staff members look out for one another and help when they see a need.  They do this with good humor, respect, and appreciation for everyone’s contribution.  Current staff welcome new members with open arms.  He or she will make everyone’s work easier.  All are open to learning from and encouraging one another.

    Even more “behind the scenes” are the chefs and their assistants.  The kitchen is busy and well organized.  The chefs are proud of the food they prepare and serve, and they help the wait staff to provide the best service.

    While all of this is specific to the dining room in my retirement community, it provides a window into restaurant and foodservice venues everywhere.  Our residents and dining room clientele are appreciative and respectful of the staff who serve them, but I wonder how many know what goes on behind the scenes to deliver the meals they enjoy daily.

    So, the next time you are dining out at a restaurant or frequenting our dining room and service seems a little slow, or a wait person forgets an item you have requested, or you are facing yet another buffet on a night when staff is short, please remember that the folks who are serving respect you. They are doing their best and are worthy of your respect too.

     

     

     

     

    Respecting those who serve you – through the lens of the Executive Assistant

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    This series has now been published as a book entitled I’ve Got Your Back: Respecting the Irreplaceable Executive Assistant.  You can find it on Amazon.com at Amazon.com: I’ve Got Your Back! : Respecting the Irreplaceable Executive Assistant eBook: Freeman, Moriah, Spencer, Sarah Faith : Kindle Store

    Motorcyclists and Respect

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    [Photo Credit: Pixabay Free Downloads]

    Many years ago, when I lived in a suburb of Boston, I called the local police in the middle of the night because neighbors were partying with blaring music and loud shouting.  I said to the officer who answered that I wanted to report a “disturbance of the peace.”  “A what?” he asked.  “A lot of noise,” I translated.  This story has been told at my expense in many circles to illustrate the old-fashioned “turns of phrase” I sometimes use.  (Just as an aside, I have also been teased mercilessly because I once said, “so-and-so had a baby out of wedlock.”)

    This post is about motorcycle noise, so, in a manner of speaking, it’s about disturbing the peace.

    Let me say up front that I love motorcycles.  A highly polished black and silver Harley Davidson is a thing of beauty.  Riding with an experienced cyclist can feel exciting and freeing.  So, I’m not prejudiced against motorcycles or cyclists.  I know a couple who have taken cross-country motorcycle trips as seniors and I admire their sense of adventure, their courage, and their style!

    Loud motorcycle noise, however, is definitely a “disturbance of the peace” in my book.  When I lived in Massachusetts one of my greatest joys was sitting on our screened porch on a warm summer evening with a glass of wine and a book, or engaging in quiet conversation there with friends.  I was livid when our peace and our conversation would be interrupted by the deafening roar of a motorcyclist racing up a nearby street, revving his engine to the maximum.  Often, as I was falling asleep at around ten p.m., I was incensed to be awakened by the same cacophony – inconvenient for me, but even more so for the neighboring parents of small children whose interrupted sleep would make them cranky the next morning.

    Early on, shortly after we built the porch, I called the town police to report the disruptive motorcycle noise.  They indicated little interest but said they would “look into it.”  The noise continued, multiple times daily.  Next, I dropped in at the police station and expressed my concern.  The duty officer behind the glass wall said that it would be impossible for the police to catch such a cyclist in the act of making the noise because by the time they arrived on the scene he would have sped on his way.  I suggested that just parking a cruiser in the vicinity for half an hour on a summer’s evening would enable them to catch the culprit.  They suggested I call the next time the disturbance occurred.  I gave up and the roar of engines continued.

    Several years later, after my retirement, I finally had the time to think about a more effective approach to the problem of excessive engine noise in my neighborhood.  I asked the candidates running for town council to suggest solutions (hinting that the one who provided a successful result might get my vote.) Their answers ranged from presenting the issue at a town council meeting to organizing a petition with my neighbors.  I chose, instead, to write to the town’s police chief.  He responded, after some delay, by saying that he would raise it at his next staff meeting to see if his duty officers could suggest solutions.  He did not report back to me the results of this consultation and the noise continued.  Finally, I moved away before having the opportunity to approach the town council or to organize my neighbors.

    What is the point of this story-telling?

    I am presumptuous to speculate on the reasons why cyclists loudly rev their engines, but I will do so anyway.  Is it the thrill of accelerating quickly?  I wouldn’t want to put brakes on the thrilling activities of others, but it seems that a muffler might mitigate the consequences for those nearby. Is it selective defiance of the restraints of society?  Which of society’s restraints would the cyclist want to be enforced for his or her own comfort and peace? Is it a deliberate attempt to ruin his or her hearing?  Or is it simply a “f— you” attitude?

    Whatever the explanation, at its roots, loud motorcycle noise demonstrates lack of respect for those nearby – a lack of interest in or care for how the cyclist’s behavior affects those in the vicinity.

    This post completes my “pet peeves” series:  disrespectful bicyclists, dog owners, and motorcycle noise perpetrators.  Respect arises from, among other things, thoughtful reflection on how my behavior may affect the lives of others – it’s the good old “golden rule” principle.  Do I want to be endangered, limited or even just interrupted by others?  Does exercising my so-called rights or liberties harm or inconvenience my neighbors?  These are “old-fashioned” questions like the phrase “disturbance of the peace,” but perhaps it’s time to revive them.

    Dog Ownership and Respect

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    A year ago, I adopted a dog from a shelter called “Save a Dog” in Sudbury, Massachusetts.  I had longed to own a dog for many years but had always felt it would not be fair to the dog since I worked long hours, far from home and could not give it the company, exercise and care it would need.  A year and a half after I retired, I decided it was time for the great dog-parent experiment.  Admittedly, I was not as prepared as I should have been, having no clear idea how much time, energy, patience and money it would involve.  When I fell in love with the first puppy I met, I didn’t listen to advice about looking for an older, lower-energy dog “at my age.”

    However, a year later and much water under the bridge (as well as many nights of wanting to tear out my hair in frustration), I now have a beautiful, happy, and relatively well behaved 18-month-old Paperanian (Papillon/Pomeranian mix), named Digby.  I have learned not only a great deal about dogs in the last year, but also about dog ownership and dog owners.

    One of the saddest lessons I’ve learned is how unwelcome dogs are in most public places. Signs abound in stores, hospitals, malls, hotels, tourist sites, restaurants (of course), parks, campuses and even on wooded trails. I had no idea that a well-behaved dog and a responsible owner would find so many barriers to enjoying ordinary daily life together.  Occasionally I would see a water bowl outside a store and I would think, “Oh, this place must be dog friendly!”  Yes, but outside only.

    I can, of course, understand why dogs (except for service animals) are not allowed in restaurants, and hospitals. I’m guessing that issues of allergies, hygiene and fear cause these bans.  But I find it harder to understand why dogs are not allowed in outdoor venues, hotels, malls, or large stores.

    However, as I looked around more carefully in my neighborhood, populated by quite a few dogs, I began to understand why dogs have, in large part, been banished to their own homes and yards and to dog parks.  I walked the neighborhood with my pup, pockets stuffed with “dog waste” bags, and noticed that the streets and sidewalks were defiled everywhere with the excrement of other people’s pets.  I jokingly put words in my dog’s mouth: “Mom, why do you pick up my poop all the time when other moms don’t do so.  I must be pretty special.”  On our walks through the woods the waste would be even more pronounced in spite of abundant signs pleading with dog owners to pick up after their pets.

    I also saw signs saying, “Dogs allowed on leash only,” and my heart would sing.  However, no sooner had Digby and I entered the permitted area than an off-leash dog would dash up to us, followed at a distance by its unconcerned owner.  Digby, who is smaller than many dogs, would cower behind me and I would cower behind a tough but false cheerfulness about the situation.

    “Jumping up” is another problem in public places. Yes, it’s difficult to teach your dog not to jump on strangers or friends, but it can be done.  Though Digby is not perfect, he’s a lot better than he was as a younger pup.  It’s taken a lot of persistence with him, and a lot of educating of those who want to greet him, to get him to the stage where he will squirm with excitement at someone’s feet, sit upon command most of the time, and wait for his new friend to bend over and slowly and gently scratch him under the chin.

    So, what is the point of all this storytelling?  Sadly, I believe the disrespectful behavior of many owners causes dogs to be unwelcome in so many settings.  If more owners would pick up after their pets, keep them leashed when required, and teach them how to behave in public, dogs would be better integrated into our society.  Wherever I go, people stare in awe at service animals (the legitimate ones) who are so calm, well mannered, and expert at their trained tasks.   No one expects such model behavior from a pet, but certain minimal behavioral norms are the entrance key to more “allowed” places for dogs.  “Pick up” means pick up; “on leash” means on leash; no jumping on people, no barking incessantly.  Again, it comes down to respecting the rules – there is a reason for them – and respecting the needs of others.

    I am thrilled when a public place, like our new bank in Maine, allows us to bring our dog inside while we do business.  I’m going to be extremely careful that he is as well behaved as he can be, politely greets the staff and other customers who want to meet him, and is not a contributing factor for a “no dogs allowed” sign on the front door in the future.

     

     

     

    Bicyclists and Respect

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    For many years, as I commuted from my home in a Boston suburb to Harvard University, I frequently vowed that when I retired I would write a “Letter to the Editor” expressing my frustration with the bicyclists I encountered daily on my route through Cambridge.  Their apparently superior attitude and their disrespectful actions annoyed me intensely. I did not write the letter, but as I now reflect on respect I believe this blog would be an appropriate place to voice my pet peeves.

    I know several people who bike to work who are extremely cautious about safety – they wear helmets, use reflective gear, and obey all the rules of the road.  When I complain to them about disrespectful bicyclists, they agree completely. I don’t know the cyclists personally who cause my frustration, but from observing their actions I imagine their attitude to be: “I’m better than you are.  I’m getting daily exercise while you sit immobile in a gas guzzling car, your emissions damaging the atmosphere (causing climate change).  The rules of the road don’t apply to me. Safety is your responsibility.  I have no responsibility to anyone for my biking behavior.”

    Sound a bit presumptuous and judgmental?  Well, here’s what has led me to these assumptions.

    I’m driving along Mass Ave in Cambridge in morning traffic.  I pull up to a stop light, noticing in my right rear-view mirror that a bicyclist is approaching me from behind.  I have my right turn signal on, but I am still nervous that the cyclist will shoot out into the intersection when the light turns green and I begin to turn.   However, instead, the cyclist whizzes by on my right, nearly scraping my car, and speeds through the intersection paying no attention whatsoever to the red light.  I fume!

    Or, I’m driving down Sherman street at 6 p.m. The cyclist in front of me is not wearing a helmet.  Sherman Street is very narrow, so when she wants to jump the line of traffic she swerves onto the side walk.  Drivers, including me, are very careful to stay at a safe distance behind her.  I worry about her erratic behavior. Suddenly, as we approach the stoplight at the bottom of the street, she shoots out to the left of the line of cars, passes them all, glides through the stoplight and weaves into a street on her right.  I think, “She’s an accident just waiting to happen; one that could possibly ruin her life and that of the driver who hits her unintentionally.”

    Boston instituted the “Hubway” bike share program about 10 years before I retired.  1,600 bikes are available at 180 stations across Boston, Brookline, Cambridge and Somerville. The program promotes attractive motives for using its bicycles to get around town: “Save time; save money; have fun; get exercise and go green.”  Several pricing options make it convenient to use the bikes:  $8 a day; $20 a month; $99 annually. One joins, gets a ride code or key and selects a bike at any nearby station.  Sounds like a great idea, right?

    I cringed when I first heard about the program and when the distinctive Hubway bikes started appearing in traffic.  For the most part Hubway riders do not wear helmets (though I have heard that some stations do make them available.) Many are inexperienced – tourists in town looking for an “up close and personal” tour of the city; professionals seeking a quick way to get across town for a meeting; someone running an errand on his lunch break.  Were they more experienced riders, they would probably have their own bicycles and helmets.  I applaud Hubway for its environmental and exercise mission, but I believe if we are going to encourage more people to bike and therefore fewer people to drive, we need to ensure that the riders are well trained in the biking rules-of-the-road and in safety precautions.  Why, for instance, is study, practice, testing and licensing required for motorists and motorcyclists, but not for bicyclists?

    By the way, I should mention that I would have loved to bike to work at Harvard, but for the last 15 years I lived 20 miles away.  Commuter rail was not an option because of parking and work schedule issues.  When I lived in a nearer suburb of Boston, I took the commuter rail daily, and on weekends, rode my bike, of course, while wearing a helmet.  Once when I was on a bike trip from Cambridge to Newton, a parked driver opened her car door in front of me and I slammed into it, falling to the pavement, hitting my head, and scrapping my hands and knee.  Thank goodness for the helmet!

    If a cyclist is injured or killed by a car, regardless of who is at fault, the motorist will most likely be viewed as the aggressor (even in her own eyes), since she is considered in a position of power and is therefore more responsible for her actions. The bicyclist is more physically vulnerable, surrounded only by air, while the motorist has the protection of heavy plastic or steel, glass and airbags. But motorists are vulnerable too. I recently read a New Yorker article describing how a driver’s life can be irreversibly damaged by unintentionally causing another’s injury or death.

    Safety for drivers and bikers alike is ultimately about respect – respect for the law, respect for safety precautions, and respect for those who are travelling differently from you to the important places and events in their lives.  I’ve seen many “Share the Road” signs in Massachusetts.  Now that I am living in Maine, I frequently see “Bicycles May Use Full Lane” or “3-Feet to Pass” signs.  The following blog article provides an excellent summary of ways cyclists and drivers can share the road safely: https://www.bikelaw.com/2017/04/a-guide-for-drivers-and-bicyclists-to-properly-share-the-road/

    As I close this post, I recall the many avid but careful and law-abiding cyclists I have known:  a man who cycles to work daily even in the winter, using the appropriate safety gear and bicycle; riders who wait patiently behind cars in traffic until lights change; those who signal correctly when making turns; those with excellent lighting on their bikes and their persons; the mother who bikes to school each day with her children, teaching them safety and respect along the way.  I also recall the cautious drivers who wait for cyclists to pass on their right before making turns; those parked motorists who look behind before opening their doors; those who follow at a safe distance when a cyclist is using the full lane; and those who yield to oncoming traffic, slowly and carefully passing bicyclists.  Thank you all for fostering respect on the roads!

    The Wrap on Nursing Homes, Care for the Elderly and Respect

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    I have not posted for a while because I’ve been in the middle of my own transition into the “eldercare” world and have been occupied with the many detailed tasks it involves. In a months’ time, my partner and I will move to an independent living community in Maine.  It is the first step away from our lives as single-family home owners in a town near Boston, and toward life in a retirement community.  We’re making this move in our mid 60’s and early 70’s because we want to do so while we still have the physical strength and mental fortitude to carry it off.  Our observations of other aging couples have taught us that we don’t want to leave this move too late and therefore, by default, shift the burden of making and carrying out such decisions to our loved ones.

    Ideally, we would be moving to a CCRC. Continuing care retirement communities (CCRCs) have accommodations for independent living, assisted living, and nursing home care, offering residents a “continuum of care.”  A CCRC would ensure that the transition from one level of care to the next, as necessary, would be relatively smooth.  However, our financial situation does not make this option possible.  So, we will take this first step, and hope for the best (that we will have acceptable and feasible choices open to us) as we age and our health and strength decline.

    I want to wrap up my “exposé” on nursing homes, eldercare and respect by touching briefly on four topics:

    • Rehabilitation, Respite and Long-term Care
    • Advocacy
    • Home Care and Hospice
    • The Top One Percent

    Respite, Rehabilitation and Long-term Care

    Not everyone is aware that most nursing homes offer at least three different kinds of care:

    • Respite – a brief stay of a week to several weeks offered to a patient so that his or her primary caregiver, usually a family member, can have a respite from caregiving responsibilities. The patient plans to return home though there is always the possibility that a respite stay may turn into long-term care.  For reference see: http://www.aplaceformom.com/respite-care
    • Rehabilitation – a transitional stay in a nursing home for patients who have been discharged from a hospital and need physical and/or occupational therapy before they are able to return home. The duration is usually relatively short.
    • Long-term care – a “permanent” stay, when the patient is not expected to recover enough to return home, and will need ongoing nursing care.

    Different durations of nursing home stays are funded differently.  Often respite care is privately funded, rehabilitation is funded by Medicare, and long-term care, especially for those without private resources, is funded through Medicaid.

    In most nursing homes, different types of patients share the same rooms, floors and common spaces.  This can present problems, particularly for those receiving respite or rehabilitation services.  Some fear that if they do not maintain their current daily living skill level or achieve the goals set for rehabilitation, they may end up becoming long-term care patients.  Because they are distributed throughout the nursing homes’ population, they do not interact regularly with others who share their skill level and a sort of lethargy and hopelessness may set in.  For long-term care residents, who see respite and rehab patients come and go frequently, continuity and stability are sacrificed, and confusion can contribute to mental decline. I can’t imagine a solution for these problems without an enormous infusion of funding, and that is inconceivable in the present political and social climate.

    Advocacy

    It goes without saying that a nursing home patient who has an active, attentive, external advocate will receive a much better level of service than one who doesn’t.  If a friend or family member visits on a frequent, though preferably unpredictable, basis, and interacts with the nursing staff concerning the quality of care the patient is receiving, the quality will improve.  It is essential that the advocate attend care planning meetings on a regular basis, and respectfully speak up about concerns

    This is not an easy role to play.  Firstly, most families would prefer to care for their elderly relatives at home and they may feel guilty about being unable to do so.  Often all adults in the household work full-time and can’t afford to quit jobs and stay at home with a parent who requires care or supervision. Sometimes the layout of the home makes it impossible for a disabled person to live there without expensive accommodations. Once the decision is made to place a parent in a nursing home, it is often difficult to find one near work or home.  Transportation may be a barrier.  The “out-of-sight-out-of-mind” syndrome also comes into play.  As time passes, it is easy slip into a less frequent visit pattern. Sometimes it is difficult to visit mom and see her in soiled clothing, staring vacantly into space, losing weight, and perhaps angry with her children for having placed her in a nursing home.

    It is very important to rise above all these obstacles and emotions and be disciplined about visiting and advocating.  It is the only way your loved one will receive acceptable care.  I speak from experience.  I was a guardian for a developmentally disabled, mentally ill woman who lived in a variety of nursing homes for the last 10 years of her life.  Also, my mother in law spent her final two years in nursing home care.  I drove hundreds of miles and spent countless hours in visits, meetings and phone conversations.  I moved my disabled friend twice because neglect threatened her life.  I played the advocate role, as arduous and uncomfortable as it was at times, because I believed that they both deserved care that reflected respect for their dignity as human beings.

    Homecare and Hospice

    Homecare – See http://nextstepincare.org/uploads/File/Guides/Home_Care/Guide/Home_Care.pdf

    Hospice – “Formally speaking, hospice care is that which can be provided to patients with a life expectancy of six months or less. Rather than seeking a cure, hospice care aims to make their remaining time…as comfortable and as meaningful as possible. This may mean pain relief and nursing care, but also includes emotional support and help with everyday tasks…the needs of family, friends, and caregivers are also taken into account.” Center for Hospice Care, Southeast Connecticut

    My experience with homecare and hospice is limited.  My friend Dorothy signed up for both shortly before her death.  The intake process was time-consuming and complicated, the scheduling and set up for care slow, and from Dorothy’s end, confusing and disorganized. The in-home caregivers were invariably kind and well-meaning, but they did not always have a nuanced understanding of the problems and needs of the elderly and dying, and they did not relieve the burden on Dorothy’s family very much.  Coordinators responsible for handling applications and adhering to government funding regulations juggle competing priorities and needs, accounting for delays that can be very frustrating for family caregivers.  I believe that the quality of both homecare and hospice varies dramatically from one region or location to another, regardless of income level.  My sister, who enrolled with homecare and hospice in Nova Scotia when my father was dying, experienced some of the same problems as Dorothy’s family in Massachusetts.  In our family’s case, however, the counseling and emotional support available to us during my father’s death was superb.

    Despite these caveats homecare is, for many, a step forward in eldercare, enabling them to live somewhat independently in familiar surroundings, to have a measure of control over their lives, and, thus, to preserve their dignity. For those who wish to die at home, hospice is a welcome alternative to a hospital.

    The Top One Percent

    On a cloudy day in early April I went to visit a friend in a CCRC in a wealthy suburb of Boston.  My friend was in the “skilled nursing facility” on the premises – the name commonly used for newer, “upscale” nursing homes affiliated with CCRCs.  While I waited for his daughter to join us for the visit I decided to take a cursory tour of the other eldercare options on the premises.  Besides independent homes, the community also included several large independent living apartment complexes with a “clubhouse” for central services like meals and programs, as well as an assisted living complex.  I merely stepped into the lobbies of the apartment clubhouse and the assisted living building.  It was like stepping into another world.  A resort atmosphere prevailed in both.  Dining rooms were “high-end” restaurants with cafés or bars nearby. The fixtures and furniture were luxurious. The receptionist was professional and welcoming.  The residents all looked healthy, fit, active and happy – from a cursory glance.

    The skilled nursing facility where my friend was undergoing rehabilitation after a hospital stay was also extremely well appointed.  Granted, the facility had just opened, so everything was new and fresh.  The staff-to-patient ratio appeared high.  The staff we encountered were respectful and professional.  My friend, though obviously ill and tired, was alert, dressed cleanly and appropriately in his own clothes, and oriented to his surroundings.  His private room was spacious and attractively decorated.  The art was of surprisingly good quality.  We went from his room into a quiet and well-furnished lobby where we had a conversation that I will remember forever, as my friend died a few months later.

    I came away from that visit – that cursory glance – wishing that every nursing home were just like this one.  I do not know how my friend paid for his stay at the skilled nursing facility.  It’s quite possible it was covered by Medicare, but though a gentle, kind, and humble man, my friend was wealthy.  His family had the resources, influence and “know-how” to get the very best care for him.  Would that you and I – indeed everyone – could get the same kind of care for those we love, and for ourselves.

     

     

    Nursing Homes:  The Proposed Budget’s Medicaid Cuts

    Posted on by respectful.com

    On Tuesday morning, I awoke to an email announcement from the Democratic Senatorial Campaign Committee that the budget President Trump proposes calls for $800 billion in Medicaid cuts. In other news reporting I’ve read that the actual Medicaid cuts will total more than $1.4 trillion.  Both numbers are, for me, incalculably large.  I can only vaguely imagine what such cuts will mean for the biggest category of recipients of Medicaid funding – the nursing homes I have been writing about for several months.

    Many of us will find it difficult to see how these proposed Medicaid cuts would affect our lives.  We are not among the wealthiest One Percent, nor are we living below the so-called poverty level.  We are not yet very elderly, or poor or disabled. In the moment, we feel somewhat secure.  We have our modest retirement savings, our mortgage-free home, and (if we have been really careful) a small amount of long-term care insurance.  Our health insurance benefits are covered by Medicare and a supplement program that we purchase at what we consider a reasonable price through our former employer, or perhaps through AARP (American Association of Retired Persons).  Though we are part of the dwindling middle class, we should be safe, at least for the time being.  Cuts in Medicaid won’t affect us, right?

    Consider this true story – one that is close to home for me as it describes what happened to my mother and father-in-law, Ruth and Roger, at the end of their lives.

    Roger was an aircraft engineer for most of his career.  He worked for well-known aircraft companies and enjoyed a middle class income. He and Ruth, a homemaker, had two children, Christopher and Susan.  When Roger retired they moved to a lovely Maine town, purchased a small “Cape” house and remodeled it themselves, surrounding it with a beautiful yard where Ruth cultivated her gardening skills.  They had a quiet life, participating in community gatherings, volunteer activities and the church. Roger continued to work part time well into his eighties repairing screens at a nearby hardware store.  It gave them a little extra income to supplement his pension and their Social Security.  They did not live extravagantly, seldom traveled, economized on everything, and saved their money. They had, perhaps, 20 years of comfortable retirement before dementia set in for Ruth and Roger’s health began to decline rapidly.

    When their daughter and son stepped in to make decisions for their healthcare, Roger was in a rehab facility after a long hospitalization and Ruth was placed in respite care since it was unsafe for her to continue living alone in their home.  Christopher and his wife were already caring for his wife’s mother in their own home and Susan was working full time and owned a house with several flights of stairs.  Neither had the ability to bring Ruth and Roger home to live with them.  Roger died soon after Ruth was permanently placed in “residential care” at a privately funded eldercare facility.  Chris and Susan sold the parents’ home, netting about $250,000 in profits.  These resources, plus Ruth’s and Roger’s modest savings, were dedicated to covering the cost of Ruth’s care.  The facility offered good nursing; the atmosphere was compassionate and respectful; and Ruth ultimately settled in and felt comfortable and at home.

    Within little more than two years the resources from the sale of Ruth’s and Roger’s home as well as their savings were exhausted.  The facility notified Chris and Susan that Ruth must be moved elsewhere immediately.  Susan and I began a long and tortuous search for a nursing home placement near our home in Massachusetts, while Chris undertook the gargantuan feat of completing the extensive paperwork to document her qualification for Medicaid funding.  Ruth was 90 years old and destitute.  She had no income other than her meager Social Security check.

    It took many months to find a nursing home that would admit her.  Barriers to admission included: her lack of private funding; her residence outside Massachusetts; the unusual circumstance of transferring her from a nursing facility rather than a hospital; and finally, the possibility that she was too high functioning to qualify for nursing home care.  I remember arguing with many admissions directors that while Ruth may be able to complete most ADL (Activities of Daily Living) tasks in her “residential” placement, the moment this victim of dementia moved from a familiar setting to a new one these skills would deteriorate rapidly and she would immediately qualify for nursing care.  Finally, an admissions officer offered us an opening.  Ruth’s Medicaid funding was approved, and we moved her to a nursing facility near us where we could visit her several times a week, advocate for her care and offer her family support, though, by then, she hardly knew who we were.  My predictions had been accurate, the move from one facility to another in her delicate mental state caused her great emotional distress and her ADL skills went downhill drastically.

    I don’t know what we would have done had it not been for Medicaid, and for the nursing home that was willing to accept her as a Medicaid patient without any private funds. Ruth lived another two years, steadily declining, receiving the kind of mediocre care I have described in previous articles, despite our active advocacy and intervention.

    This story had a far better outcome than we can expect in the future for similar “middle class” families if the President’s budget cuts to Medicaid are adopted and the Affordable Care Act is dismantled. Will there be nursing homes to care for our parents or for us at the end of our lives?  With their funding drastically cut, how many will go out of business, leaving only privately funded facilities for the wealthiest?  Will we regard the social safety net of Medicaid with such indifference, or even scorn, when it is no longer there to catch us as we fall from our precarious middle class tight rope?

    Nursing Homes: Clothing and Incontinence

    Posted on by respectful.com

    Some problems seem absolutely intractable.  Two such closely related problems in nursing homes are incontinence and care of patient clothing.

    Appearance is, for many of us, closely associated with our sense of personal dignity.  Some control over how we look and what we wear seems vital to maintaining a sense of identity, of personhood, particularly in American culture.  Situations in which people are forced to wear clothing they have not chosen (e.g., prisons, hospitals) make them feel objectified and de-humanized.

    My mother-in-law was a fastidious person.  Over the years, as she aged, she cultivated a tailored, simple, neat and soft style in her dress, both at home and in public.  She had few clothes, but they were of moderately good quality, always clean and well pressed.  Her attire expressed her identity and her sense of self-worth.  Before she died at the age of 92 she spent two years in a nursing home.  I believe that part of her rapid deterioration there was due to her inability to take pride in or have control over her appearance.

    While patients are encouraged to bring and wear their personal clothing (each piece labeled with their name) to the nursing facility, this attempt to make them feel more “at home” breaks down very quickly.  Nursing home laundries are notorious for losing or destroying clothing, partly due to the pervasive problem of patient incontinence.

    For various reasons, many nursing home patients are incontinent.  Those who do not suffer from lack of control physically, may do so psychologically.  Some have lost sensation and are unable to determine when they need to eliminate. Many are completely dependent upon nursing assistants (NAs) to help them with toileting. Since the NAs are burdened with heavy patient care loads, the patient may have to wait for very long periods of time between trips to the bathroom.  After numerous frustrating attempts to maintain continence, many simply give up, relinquish this relic of their dignity and succumb to incontinence.  At the end of the day, or perhaps several times during the day, patients’ soiled clothing is removed and tossed in a laundry hamper, where it may sit for hours or even days before being collected for laundering.  No matter how hot the water, how strong the detergent, the odor never really washes out.  Inevitably, clothing breaks down quickly and the patient’s wardrobe becomes gradually smaller. [An aside: some families, like mine, frustrated with inadequate clothing care in the nursing home, resolve to collect their loved one’s soiled clothing several times a week and launder it at home.  Smaller, less powerful washers and dryers are even less effective in removing offending odors and many families give up after just a few attempts.]

    Dwindling patient wardrobes are also due to lack of care in returning clothing to the proper rooms.  When I visited my mother-in-law, she was often dressed in ill-fitting clothing that was not her own.  A peek into her closet would show that perhaps half of the items there had someone else’s name on them, and many of her favorite pieces had disappeared permanently.  The clothing was poorly hung or stuffed, unfolded, in drawers.  Though I have been able to understand the nature of many operational problems in nursing homes, I have not been able to figure out why clearly labeled clothing does not make it into the correct patient’s closet.  I speculate that lack of care or concern, low job performance standards, and a failure to understand the importance of appearance for one’s physical and psychological well-being might be some causes of the problem.  There is so much work to do in a nursing home. Caring for the appearance of a patient may be quite low on the priority scale.

    Is the problem really intractable?  With a different mindset – one of honoring dignity and expressing respect – would it be possible to recognize the importance of answering call bells quickly, taking patients promptly to the bathroom, soaking soiled laundry immediately, hanging clean clothing neatly on appropriate hangers, folding items carefully, reading name tags and returning clothes to their owners. Would it be possible, with such a mindset,  to dress patients in their own clothing, comb their hair, and wheel them out into their world as their best and most respectable selves?