Thursday, April 26, 2012

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.


  1. You need to be a very special person to do that type of work. Well done to all carers.

  2. I believe that those who have those jobs are called to them for a reason. Because they carry the extra measure of patience and care that the rest of us don't have. The team at your mom's place sounds extraordinary. How nice that you have lifted them up in this post Elaine.

  3. CNAs definitely are the workhorses of the medical world! It really does take an amazing person.
    I'm sorry that you have to go through this with your mother. I know how hard it is to watch someone you love struggle through such a devastating disease. It is refreshing to hear you speak about the ordeal with such a heart of appreciation and grace.

  4. Elaine,, I read your posts religiously as I do feel we're both in some kind of grieving. We seem both to be, have been, close to our mothers, and I do very much appreciate your comments on my posts about my own mom. Having my mother lose her license this week frankly at the moment is more devastating to me. She's relieved to have the whole testing thing over. But as much as I didn't want to be the one to take the keys away, I wasn't prepared for her to actually have to hand in her license -- to surrender it. And be issued just some kind of ID thing now that shes doesn't have a driver's license for ID. My father had alzhiemers for years, and stopped driving early on. But it wasn't dramatic. my mother just did the driving; he never lost his actual license. He still had that as part of his identity. My mother too had an accident and that's what lead to all this. But as she missed the fiirst two mandatory road tests, her license was merely suspended. I wish we could have kept it that way.

  5. It's so kind of you to recognize the hard work of those who have grouped together to do what no one person can do, keep your mom safe.
    It's an endless and often thankless job and I hope they know how much you appreciate them. ♥

  6. I love that you recognize and appreciate those who provide consistent, competent care for your mother. My daughter-in-law was a CNA and is now an RN. She's strong, kind, and compassionate--exactly what's needed to be wonderful at what she does.