V is for Vigilance

V   Vigilance

I’ve mentioned a few times before the staff in my mother’s memory care unit. But I haven’t yet given them all the credit they deserve. Certified nursing assistants have an incredibly stressful job, yet they handle it with so much aplomb. Their caring, compassion, and genuine love for their charges is both comforting and inspiring to us who have loved ones under their care.

When caring for someone with dementia, you absolutely have to be on your toes all the time. I found it exhausting when I was my mother’s primary caregiver. Making sure she used her walker when she got up and not just a cane. Rushing around to her side of the table to help her get up and balanced on the walker. She would put a light under a kettle on the stove to make coffee without putting water in it first. She would try to carry the cup on the seat of her walker and end up spilling it. She would put garbage and dirty dishes in her walker basket and wheel them all around the house or leave them there for days. We were constantly looking for her glasses, her dentures, her hearing aids, even her shoes.

Even when I visit her now, there are things I have to watch for. We bring her coffee, and I need to make sure she holds the cup straight so she doesn’t spill it on herself. Guide her hand so that she places it securely back on the tabletop. Keep her neighbor at the dinner table, who has quick reflexes, from grabbing her drink or her cutlery. Try to get her to use her napkin instead of her sweater to wipe her mouth.

All this is the reason I have so much respect and admiration for the CNAs. Multiply all these tasks by more than twenty residents, multiply by all the minutes in all the hours in their shifts, and increase the severity of tasks by the severity of the person’s incapacitation, and you may get some idea of the stress factor of their work.

Vigilance is a constant. There are usually four or five CNAs on the unit on any shift; each one is responsible every day for a rotating list of residents. Nevertheless, when they’re in the common areas, they have to keep an eye (sometimes those eyes in the backs of their heads) on everyone. If someone who’s a fall risk is struggling to get up from a chair, whoever is closest needs to rush over to help them. Another resident may be trying to get out of the locked unit door. Another one may start to shout at a fellow resident. People need to be helped to the bathroom. One person may have just poured her juice all over the tablecloth. Someone doesn’t like dinner and wants something else. A couple more need to be fed. Someone is shouting that she wants to go to bed instead of eating dinner; another keeps getting up from the table, refusing to eat.

The CNAs need to know where everyone is at all times. If a resident’s daughter took her out for dinner, that must be written down. If a few of them went to hear a concert in the main assisted living unit, they have to know who they are and when they’ll be back. At least one CNA must be in the common area at every moment. Among all these duties, they somehow have to find time to clean up, to do laundry, to play games with the residents, to accommodate requests from residents and residents’ family members.  And to keep cheerful and pleasant demeanors all the time, which they do, because they genuinely love all the residents. They know them, and they treat them all as individuals. They know what they like and don’t like. They joke with them, dance with them, sing with them. One of them recently said to me, “It’s hard work, but it’s good work.”

I bless them all. I could never do it, but for those who can, it must be so fulfilling, knowing you’re giving security and warmth and care to people who have done so much in their lives, made so many contributions, and who just can’t any more. My friend’s father had dementia and cancer and lived in a memory unit. After he died, she and her brother donated what was left of his money to the Alzheimer’s Association in the name of all the staff members in her father’s unit. I think that’s such a lovely way to honor them. I don’t know if I will have the resources to do something like that, but I’m glad she did. They deserve such a tribute, these people who work so hard for and care so much about the people we care about.