When it hits home

They say, “Practice makes perfect.”

As a nurse, it’s my job to connect with older adults and their families. I read and hear their stories all day. I've been trained to "speak doctor" and understand the weight of the conversation down to the numbers. My professional career is all about aging – the good, the bad, and the ugly. 

Nothing could have prepared me for being a caregiver. 

I’ve written before about my grandfather and the day both our lives changed. At the end of the story though, our lives did go back to normal--a new normal. Physically, he rebounded. Time in an assisted living with daily physical therapy brought back most of his strength. We were all looking forward to having him back home when...

I walked into my grandmother’s hospital room. She was there after she fell backwards onto the concrete sidewalk while fixing the garden. As I leaned over to give her a hug, she yelled, “Don't you touch me! I saw you kissing that other man. What are you going to tell John!?”

Her hallucinations only increased as she sat in an empty room speaking with her "visitors".  I'd walk in quietly, not to interrupt, and shortly after get blamed for "scaring away friends". As she slept, my eyes would darn between her heart monitor, to her, to the number on the IV pump, back to her. The two roles inside me, all nurse yet all granddaughter, drove both into over drive.    

I fought to catch my breath and hold back the tears, all the while trying to keep a smile on face for Grandma. Why wasn’t I prepared for this? I knew what to expect. I knew how to handle this. Yet the thousands of stories, the countless talks with the doctors, and all my research and training, could have never prepared me for the emotions of actually being a caregiver.

Today,  I applaud you caregivers as a nurse and I empathize with you as a caregiver. Our journey may differ greatly, but now when I look into the eyes of another caregiver to teach them about their "new normal", I allow them to look into my eyes. With just a glance, those who have been there, know. The dreaded call, the late night in the emergency room, the torture of waiting for that result or that doctor, that shred of hope that still holds on.

Fellow caregivers and healthcare workers, I'd like to invite you personally to join me Monday nights on twitter. I'll be hosting a TweetChat at #Nurseup at 4pm PST or 7pm EST. Topics will center around caregiving and available resources.

Our first meeting, Monday November 18th, will cover challenges of being a caregiver and helpful resources. I would like to partner with you to bring to light the true role of a caregiver and put the best resources into the right hands.

Looking forward to meeting you and hearing your story. 

Nursing Home vs Assisted Living

Recently, PBS came out with a chilling report that looking deeper into the Assisted Living cooperation Emeritus and found horrific cases of wrongful placement of seniors within it's facilities that lead to tragic endings. It's well worth your time to watch the 53 minute report, here.

It's an impasse that leads to big decisions and uncomfortable conversations, and yet so many families are struck with the fact that they can no longer care for their mom, dad, or loved one. 

Lots of emotions surround this topic; namely guilt. 

I've been there. 

Usually people turn to group homes of some kind. “That’s everyone’s first thought,” said Lisa Gwyther, the veteran social worker who directs the Duke Family Support Program in Durham, N.C. “Everyone says, ‘My mom doesn’t belong in a nursing home,’ so they think assisted living, regardless of her medical needs or prognosis.”

But assisted living is not for everyone, either. Ms. Gwyther and Dr. Hawes are now speaking out to give guidance on which older people are likely to do well at such facilities and which will need the greater supervision and higher staff ratios that nursing home can offer.

“Nursing homes have gotten a bad rap,” Ms. Gwyther said. There are good ones, and there are seniors who need them.

For instance, “anyone with moderate to severe cognitive impairment and problem behaviors like resisting care or becoming alarmed if someone tries to help them shower generally belongs in either a dementia unit with well-trained staff or in a nursing home,” Dr. Hawes said. In assisted living, “there’s not enough staff to help.”

This also goes for seniors with complicated medical conditions that require frequent monitoring. Assisted living doesn’t provide much health care, so residents risk becoming what Ms. Gwyther calls “frequent fliers — they’re going in and out of hospitals for conditions that could perhaps be treated in a nursing home.” This not only increases costs for the family, but also increases the change of their loved on being  exposed to the harmful bugs (various contagious illnesses, antibiotic resistant bacteria, etc.) within the hospital. 

Assisted living can pose a problem for seniors with incontinence as well. Although most assisted living facility will accept someone who’s incontinent, what they mean is 'as long as they can change their own briefs'. Dr. Hawes cautions against assisted living,  "(If) what you mean is, ‘She needs help getting changed four times a day and needs the sheets changed every other day.’” Housekeeping staff in assisted living typically change linens weekly.

Furthermore, federal regulation provides greater protection for nursing home residents. State regulations govern assisted living but they vary widely. 

Nevertheless, assisted living can work well for people with mild cognitive problems, who particularly cherish privacy, and who are sociable and alert. They usually offer interactive programs that create an environment for socializing and the creation of new hobbies. 

I urge you, for the sake of your loved one, regardless of their location (including home) don't ignore the warning signs. If you notice that they smell of urine or feces, if they're becoming increasingly (and unusually  anxious or lethargic for a length of time, or simply just not themselves; speak up.

It won't hurt to ask questions. It certainly won't hurt to get a second opinion. If anything, it may even prolong their life or save it.     

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Share this report and increase the awareness of the differences between assisted living and nursing homes. This post is not intended to discourage or encourage one or the other. It's purpose is to simply inform, so your loved ones don't become like one of the grim stories from the PBS report. 

To your wellness, 
Leah Korkis, BSN, RN

My Story

Looking back it's feels only weeks ago when I sat in the nursing lounge clutching my phone. My eyes filled with tears as I fought to keep them from spilling over. My entire body shivered with unexplained chills and my chest and belly filled with utter dread. My breath refused to let go.

In an instant, I was completely overwhelmed with fear and ineptness.

The day before, my life was pretty normal. It was 2010 and I was happy to be a nurse working on my dream unit; Neurology. I gladly took care of individuals after their back surgery, stroke, aneurism clipping, or tumor debulking. This particular shift was no different, until the point when I received a call at four in the morning that would redefine my normal.

On the other end of the phone, my Grandma was in an Emergency Room three hours north with my Grandpa. Her voice quivered as she tried to explain what had happened through her fear of what might happen to my Grandpa. They had been there for two hours and she wanted me to speak with the doctors because she didn't understand my Grandpa's diagnosis. 

It soon became clear that my Grandpa was having a stroke. As I spoke to the doctor, he asked if my Grandpa was taking the medication his doctor had prescribed for cholesterol and to thin his blood. Among his questions were medical history, social history, family history; he finally asked "Don't you visit them pretty often"?  

The worst part about it all, being three hours away I felt powerless. And as I looked out the window at the first blizzard of the season, I knew that I wasn't going to be getting to my Grandpa's side any time soon. 

My Grandpa

For the remainder of my shift, I cared for the patients under my care as though they were my Grandpa or my Grandma and I vowed to do so for the remainder of my nursing career. On the day that the roads were clear enough, I made the drive up to my Grandparents and asked to move in with them as their “roommate”, to which they agreed. Thankfully, after a few months my Grandpa was back on his old routine as well.

I’ve always been proud to be a nurse, and now I can say I’m a proud caregiver.