CNAs: Vital Partners in Caring

Certified Nursing Aides, or CNAs, play vital roles in caring for our elderly and disabled. CNAs, (sometimes called Home Health Aids) provide such services as bathing, dressing, house-keeping, and supervision for those that cannot do those tasks independently.  An estimated 2 million CNAs perform these vital tasks, meeting the daily needs of many Americans.* I can recall numerous times when I felt awed by the work these ladies (89% of CNAs are women) accomplish on a daily basis.  One instance stands out prominently in my mind.  I was at at the bedside of a woman when she took her last breath.  She was living in an assisted living community, and only myself and the CNA were present at her death.  After notifying the nurse and family that the death had occurred, I remember feeling helpless and at a loss as to what to do next.  The CNA didn't, though.  She promptly filled up a small tub with warm, soapy water and began cleansing the deceased woman's body, preparing her for her family to see her.  She washed her whole body, even applied body powder and a new gown, and fixed her hair before her family arrived to say good-bye.  I was amazed by the CNA's swift action and compassion.  I knew that she did not have to do this.  She could have chosen to move on to her next patient, and yet she seemed to not even think twice about what needed to be done.  The family was moved by the peaceful beauty they found when they saw their loved one, and I am forever in awe of the work of CNAs.  

That story is only one of many that I can recall of a CNA going above and beyond for her patients.  I have consistently witnessed CNAs bring patients into their hearts and care for them like family.  It was not unusual to hear of a CNA buying sweets or Cokes for her patients or picking up some fast food for a housebound patient with a craving.  I have known CNAs to go by their patients' houses off the clock just to check in.  These extraordinary efforts are even more amazing when I consider the compensation most CNAs receive. Recently, I stumbled upon PHI PolicyWorks after reading an article in the New York Times.  PHI Policy Works, a non-profit policy group that represents the interest of direct-care workers (CNAs and HHAs) in the US, publishes some interesting statistics on the working condition of CNAs.   The average wage for a CNA ranges from $9-$12/hour. Disappointingly, 28% of CNAs have no health insurance; this is compared to 18% of the total US workforce. The higher uninsured rates among CNAs may be caused by their part-time work status: 48% of CNAs are employed part-time or full-time part of the year.  In the Metro Atlanta area, it seems to be a common and acceptable practice to hire CNAs prn (as needed) and then assign them to 30-40 hours of work a week.  This arrangement gives the employee enough work to get a consistent paycheck and the employer a break from paying for benefits (e.g., health insurance, paid time-off, sick leave, retirement plans, etc.).  It also allows for the employer to not guarantee a certain amount of work or pay.  If the census of a healthcare organization declines, the employer can just assign the prn staff less hours and save money.  That being said, I have no data or stats on this local phenomenon, and I contend that it may be less common than I have experienced.  

Figuring out how to care for our elderly and disabled citizens while keeping it affordable for consumers and profitable for business is no small task.  I am, however, bothered by the apparent inequities in the working conditions of CNAs.  Their work is hard and so necessary, yet their compensation does not reflect this.  Recently, President Obama announced a new rule that will give CNAs working as in-home care workers the same minimum wage and overtime protections afforded to other workers under the Fair Labor Standards Act.  This group of workers has been excluded since 1974.  This new rule is being hotly debated now, and businesses are claiming the potential unintended consequences of higher costs for consumers and job losses for employees make this new rule faulty.  Perhaps it does, but when 46% of CNAs live in households that rely on public benefits, it seems as if there is something faulty with the current system.

Book recommendations:

Barbara Ehrenreich's Nickel and Dimed 
    Barabara Ehrenreich writes about the world of the working poor by going undercover and doing the work they do.  One of her undercover gigs is as a nursing home aide.  This expose reveals the demanding and often undignified world of low-wage work.

Lauren Kessler's Dancing with Rose
    Laruen Kessler also wrote a book after doing some undercover work as an aide at an assisted living community for folks living with dementia.  Her story was supposed to be about the residents/patients, but she revealed just as much about the people caring for them.  I highly recommend this book to anyone that wants to learn more about the world of institutional care.

Click here to learn more about CNA requirements in Georgia.

*PHI Policyworks stated, "In 2008, over 3 million direct-care workers were employed
in the three occupations: Nursing Aides, Orderlies and Attendants (1,470,000);
Home Health Aides (922,000); and Personal Care Aides (817,000)."

Marriage and Dementia: A reflection

Recently, I met with a couple in the their late 60s.  The husband has been living with dementia for about seven years, and he is now living in an assisted living facility that specializes in memory care. The wife is living at home and still piecing together her own life.  I was struck and saddened by the cruelty of this disease.  Perhaps the wife still seems familiar to the man, but I am not sure he still knows her or even himself.  Their marriage looks nothing like what we think of as a marriage.  The partners sleep in separate beds, in separate areas of town.  She handles all of their finances, house maintenance, and family matters; he spends his days walking the halls of the assisted living community. 

When I first met this man, he was a tall, strong man; within two years, he has lost about 60 pounds and has a stooped posture.  His appetite is good, he sleeps regularly, and his moods are stable--this is about the best we can hope for.  In reality, his situation is as good as it gets.  The aids at his assisted living facility know him and keep him clean and well-groomed.  The psychiatrist's nurse practitioner is able to see him there and manage his medications, keeping his mood stable and is agitation abated.  So, this is what the disease gives us, a new set of expectations for a good life, a new reality. 

Sometimes I feel there is nothing I can say to the wife.  How can I address the magnitude of this kind of grief and long-term stress?  I try to accompany her along this journey, validating her feelings, encouraging her to take care of herself, and troubleshooting issues that arise.  I am glad they have money to pay for his care and enough left over for her to go see her family and take trips.  She has so much life ahead of her, and it seemed as if he would be with her along the way.  This disease stole those dreams, and I often find myself dumbstruck by that kind of cruelty.  My heart ached for them, and I feared ever having to face the shadow this disease could create of someone I love.

Why "Turn Left at the Purple Mailbox" for the title?

Working with older adults (and I mean 80 year-olds and older) never ceases to entertain me.  Oftentimes as I am setting up an appointment to visit my families, they will give me directions to their house (despite my assurance that Google can get me there); and those directions will include some random landmark. That is where "turn left at the purple mailbox" originated. 

I consider myself blessed to get to walk alongside families as they navigate the elder care maze. I get to hear amazing stories of surviving the Holocaust, living through the depression, being a test-pilot for the Air Force, and raising families.  I wouldn't trade those stories for a new BMW; they have enriched my life and taught me invaluable lessons.  I hope I have given to those families at least a fraction of what they have given me.