Nursing Homes: Managers, CNA’s (Certified Nursing Assistants), Residents

Sometimes I read research that has fairly predictable results. But the fact that the results were discovered through research validates them more. Consider these words: nursing homes, managers, CNA’s, residents, satisfaction. There is a general thread that connects them in a nursing home setting.

It’s common knowledge that managers generally set the tone at the workplace. Having been a school principal, I know that to be true. This research focused on the role managers play in creating a person-centered workplace. In order to develop this kind of workplace, managers must interact with staff in ways that will encourage their satisfaction, loyalty, and commitment. When this is done successfully, residents benefit.

In this 2007 research study explained in the “Journal of the American Medical Directors Association,” CNA’s and residents’ families from 156 nursing facilities completed surveys to measure their satisfaction, loyalty, and commitment. I already knew CNA’s would have plenty to say on this, because these are popular topics when I talk to them at nursing homes I visit as a hospice volunteer. The survey responses were analyzed.

What was the conclusion of the research? You’re probably way ahead of me. The conclusion was that the work setting that managers establish greatly impacts the lives of the CNA’s. Caring managers who produce a person-centered workplace can inspire workers to become excellent caregivers who enhance the lives of patients. This principle is so simple and so important. It’s a shame it’s not practiced in all workplaces.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Hospice Care and Pain Management

As a hospice volunteer in urban nursing homes, I have seen dying patients in little or no pain. When cure was no longer the focus, the dying process, with its naturally evolving symptoms, was facilitated in a manner that brought beauty to their personal letting go. Death came with perfect closure to life.

But I have also witnessed patients in pain. In a study reported in a 2006 “Journal of Pain Symptom Management,” severe pain was reported at least once by 20.3% of 156,887 hospice patients, although overall pain was mild. A 2006 report in “The Gerontologist” states the obvious regarding pain management in nursing homes: “Care is dependent upon the context in which it is provided.”

I have concluded from my own observations and readings that the certainty of hospice care providing a pain-free, end-of-life experience is increased significantly when several safeguards are in place:

1) Appropriate pain medication and management procedures must be prescribed by a doctor with expertise in this area. Really listening to feedback of patients regarding their pain is crucial. Patients need others to advocate for them when their pain is under treated.

2) Medical personnel must be knowledgeable in how to implement appropriate pain management procedures that the doctor prescribes. This includes informing CNA’s (nurse assistants) of their roles related to the hospice philosophy and pain management. Like any other important procedure, pain management requires ongoing monitoring and adjustment, particularly when staff attendance and schedules are irregular.

3) Attitudes of everyone, including doctors, regarding how pain is being treated must be explored honestly. Staff education on transitioning from a total focus on cure to one of non-curative quality of life must also be addressed. In addition, some families need help in understanding that chronic severe pain is not a necessary part of dying. Ultimately, everyone involved in hospice care must be committed to pain-free death journeys.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Nursing Home Reminiscence Groups: Video

For some, they were the good old days. For others, they were just the old days. Either way, they are who we are today, and we can’t seem to get rid of them completely. Everywhere we go, we push them around in mental shopping carts. Sometimes we think we’ve lost a few items permanently. Then they turn up when we least expect them. They are our memories. Lately, they are becoming topics for group sharing in facilities where seniors congregate.

Reminiscence groups, which are a form of therapy, are sessions with seniors sharing memories. They aren’t quite the same as lounge-talking get-togethers, however, because conversations are guided by a trained facilitator such as a social worker. This person presents topics and helpful comments when they are needed.

The purpose of reminiscence group sessions is to trigger brain responses through nostalgia and socializing. This is similar to the way bingo and socializing might give the mind a workout. Reminiscence also helps seniors analyze their lives by reviewing where they were, where they are, and how they want to respond to those reflections. Hospice patients often benefit from life-review forms of closure.

In our pressured world of multitasking and fast living, how fulfilling it sounds to meet with a group and talk to them about our memories. How supportive it must feel to open our hearts while listening to theirs.

If you’d like to sit back and enjoy a visual-musical portrait of one nursing home resident’s life, I invite you to reminisce, along with this video (3:48 mins.) titled “Look at Me.”

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Hospice: AIDS Drug Too Late Again

Years ago, before I became a certified hospice volunteer, I found myself in the unexpected position of giving ongoing assistance to two men with AIDS. I was a hospice volunteer then and didn’t know it. The first man died. The second man, who was diagnosed with AIDS a year later, had the great fortune of living with AIDS during the same time that protease inhibitor drugs revolutionized treatment of the disease. The multi-drug "cocktail" changed AIDS from being an automatic death sentence to a chronic, but manageable, disease. The number of AIDS-related deaths decreased. Unfortunately, the prevalence of AIDS continued to increase. Infected people were living longer. New cases continued to develop, with particularly high rates among African Americans.

I thought the new drugs would be successful in helping everyone who had AIDS. But a January 2, 2007 news article by James Ricci titled “AIDS drug offers hope, but too late for one man” in the “Los Angeles Times” reports otherwise. Warren Ratcliffe and Mark McClelland are two men among an estimated 40,000 Americans whose illness could not be controlled by modern drugs. They'd developed resistance to them. Their only hope was to stall the virus by receiving “salvage therapy” to stay alive until a new drug was discovered that could help them.

That amazing new drug, an integrase inhibitor, was finally discovered in 2006. While it came in time to save McClelland, it came too late for Ratcliffe, who died at age 59 of AIDS-related cancer. Once again, a man and many others, died before they could benefit from a new drug discovery. So far, McClelland seems to be responding well to the drug. Dr. Steven Deeks, a UC San Francisco salvage therapy authority, hopes that during 2007, other surviving salvage therapy patients will develop immune systems that can rebuild themselves.
Note: See comments section to view AIDS videos.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog