The Wild Thing With Wrinkles

For a couple of years, I did MDSs (Minimum Data Set assessments in nursing homes/SNFs- mine were used to determine Medicare reimbursement rates and care plans for SNF-skilled nursing facility- patients who were generally there for rehab and then to return home; some did end up staying permanently) in a facility that was in a town with a couple of ‘sister’ facilities within the same corporation.  We were ‘separate but friendly’. They were still competition, but part of the same overall corporate bottom line.  One of those facilities had been going through a period where the DON (Director of Nurses) was the only RN in the building… ever. So she never had a day off, and was always on call. This went on for several months (I would have bailed, God bless her). One weekend, she had asked her administrator if one of us at the facility where I worked could take call for the weekend for her- meaning if there were problems requiring RN intervention- or at least notification- someone else would do it. She needed a break.  Because of health issues and medications, I didn’t take call at the facility where I worked  (and the need to do the MDSs 5 days/week; the deadlines didn’t allow for days off following having to work the floor if staff calling in sick needed someone to cover their shift), I agreed to take call. I felt bad for their DON, and could respect the need for some time off.  I didn’t know the staff or residents over there, but knew if I ran into something strange, I could notify my administrator who could contact their administrator.   I’d be on-call from 3 p.m. Friday through 7 a.m. Monday. I held my breath and went home.

At 5 p.m. on Friday, I got a call. Two hours in… this wasn’t good.  One of the nurses was upset that one of the male residents wanted to have a ‘conjugal visit’ with one of the female residents.  OK.  And the problem was???  She didn’t think they could do that. I asked if they were both cognitively intact, and had the physician statement saying they could act on their own rights. Yep. They both did.  In that case, they were aware of their actions, and were able to make those decisions. (Had one or both of them been cognitively impaired/demented, then that is a totally different situation… no diddling in the nursing home).  She double checked my answer- I told her that it was their home…they had the right to get busy as long as they both were capable of acting on their own rights.

The nurse was still uneasy about the whole thing. She asked about the roommate. I told her she needed to find a way to keep the roommate busy, and discretely ask her to allow her roommate some private time, or find a room where the two horny ones could have some privacy.  She needed to put a sign on the door that asked everybody to knock before entering (and wait for an answer !), and not act like anything was going on that required some sort of national security clearance. They were having sex, not discussing Pentagon secrets  (though in this day and time, those lines are blurry).  The nurse was still not comfortable with the whole thing.

She told me that the horny female resident was a double amputee (legs). I wasn’t sure how that mattered given what they were wanting to do. *scratching head*  I asked her what her concern was… the response: “She doesn’t have LEGS!”.  Last I knew, legs weren’t mandatory for doing the wild thing.  I told her to have the CNAs (certified nursing assistants) help the lady into bed, make sure she was safe, and leave.  Finally, I told her that if anybody had any problem with this come Monday, tell them I’d given the OK since both residents were able to make their own decisions, and that it was their home.  They had the right to intimate relationships… legs or not. I’d heard our social workers and consultants discuss various ‘rights’ many times. I was comfortable with my decision.  Let ’em have at it.

During this whole conversation I was thinking ‘it’s 5 p.m. on Friday, and I’ve got sixty-two more hours to go….’.   I was doomed. But, the rest of the weekend was eerily quiet. NO calls from the nursing home.  I hadn’t heard of any disasters on the news involving a Hill Country nursing home, and my administrator hadn’t called me  with any concerns from their administrator.  I had wondered during that phone call on Friday if they were yanking my chain to see how I’d respond, but sometime later, I think I remember hearing that the two residents involved in doing the wild thing were, in fact, a ‘couple’.

That next Monday, back at the nursing home where I worked, I was asked how being on call had gone, and told them about the wild sex questions. They all laughed.  It was funny, but more importantly, the residents weren’t stopped from being able to make decisions in an environment where nearly everything was decided for them.  The alert, cognitively intact residents of any facility can’t be ‘banned’ from living their lives as they so choose. If they are safe, it’s not up to me- and if they’re not safe, and can act on their own rights, I have to do what I can to make things safe for them.  I don’t have to agree with their decisions (no matter what they are- sex or otherwise), but I’m not permitted to impose my ‘rules’ if they are more restrictive (or permissive) than what the state guidelines permit. Nursing home residents have rights. The facility is their only home; it’s not like they can take off to the Holiday Inn for a few hours.  I found it rather sweet that those two had found each other in an institutionalized setting, and actually wanted some ‘privacy’.  And, their DON got some time off. 🙂

Dementia Wins By A Landslide !

I worked in various nursing homes during the years I worked as an RN, starting in 1985.  I worked as a ‘floor’ nurse, charge nurse, supervisor, and administrative (desk) nurse.  Nursing homes really are quite delightful places to work, and while nursing home nurses are often looked down upon by hospital nurses (I’ve done that kind of nursing too), the skill set required is extensive.  They have to have a bit of knowledge about all medical specialties (except obstetrics, though one gentleman did scream that he was giving birth to a calf in an emergent situation…my guess is that most people in a 3-4 block area knew of his distress; his doc felt that Haldol was a good ‘post-partum’ drug… I don’t like Haldol for the elderly; it was designed for schizophrenics- but it did quiet him down).  There are the medical issues that put people in nursing homes to begin with, and then there are those folks with dementia who can be so totally heartbreaking to watch…or a source of some humor. If we didn’t chuckle, we’d weep.  The following are from some decades ago… some of the rules were a bit ‘different’ back then, though nobody ever did anything to make the situation worse.

One woman I remember was very distinguished in her outward appearance. She was always ‘put together’ in how she dressed and in her appropriate greetings of people she met in the halls, but had no clue about hygiene or changing her clothes regularly.  Usually the certified nursing assistants (CNAs) could get almost every resident into the shower without too much hassle, but this lady was persistent in her refusal.  Nursing home residents have the right to be sloppy…when they are coherent enough to know the risk/benefit of their decisions.  When a green cloud follows them, and people fall like dominoes in their wake, something has to be done.  That’s when the administrative nurses have to jump in and figure something out.

The first thing to do was notify the family and get their permission to bathe Mrs. Cloud, even if she refused. They were the legal guardians since she couldn’t make decisions, so that wasn’t hard- they were thankful we were looking out for her (they were also out of town, so couldn’t be ‘hands-on’). The next thing to do was to figure out a plan.  The assistant director of nurses (ADON) and I were the ones who somehow got blessed with this task assignment, and thought we had a pretty good idea of how to get the job done. We got Mrs. Cloud into her private room, and carried on some generic, though tangential conversations as we got her overcoat off, and then talked about getting her clothes washed (that was usually less threatening than actually talking about showers up front).  OY.  We got the coat. We were doing pretty well with the dress, but getting down to her slip, and undies, we noticed that she had about 4 pairs of caked-on pantyhose. Each of those pantyhose required getting Mrs. Cloud back on her bed, ‘scootching’ the hose down, and then removing them…. x 4. Between each ‘scootch’, she’d bolt up and try to run off, so we’d have to get her seated again, then lying back on the bed so we could continue ‘scootching’.   The ADON and I were sweating by the time that was over.  The slip, bra, and undies were a piece of cake after the pantyhose circus.

So, we get Mrs. Cloud into her shower- after all, if we’re going to clean her clothes, why not get a nice warm shower (sounded like a good line)… she wasn’t happy, but went for it. We had the towels and washcloths ready. But…. oops. I forgot the body wash.  The  poor ADON was left wrangling Mrs. Cloud in the shower as I sped out of the room to find body wash.  I found what we needed, and we finished the shower from hell with no casualties.  A few minutes later, I saw Mrs. Cloud in the hallway, all fresh and sans cloud-o-funk, and she greeted me as if she’d never seen me before- very polite with a superficial smile. She remembered nothing. Crickets.

I also worked ‘the floor’ at night for a while.  One night, another confused little lady was wandering in a sort of frenzy, and was visibly tired. She had a sleeping pill ordered, so I offered her one. She wouldn’t take it.  I opened up the capsule, and mixed it with a tablespoon of orange juice in a one ounce plastic ‘shot glass’ medicine cup. I offered her a little nightcap, and she was so happy to take it.  I had poured some plain orange juice to get rid of any funky taste in her mouth, and she looked at me- dead serious- and said “Oh, Honey- I can only have one”.  She traipsed off to bed and finally got some sleep.

Another night, I was doing my routine work on the 11-7 shift, and one of the CNAs comes flying up the hallway off  one of the ‘pods’ (a grouping of rooms), calling my name as if she’d just witnessed Jack the Ripper field dressing a dozen deer in the back room.   I immediately went racing down to meet her, and follow her to the room in ‘distress’.  I stopped cold when I saw the elderly gentleman (also confused as all get out) sitting completely naked, bolt upright in his bed, grinning from ear to ear with his sheets and blankets all over the place. He was ‘splashing’ the gel from his gel mattress (as much as someone can splash something with the consistency of applesauce).  He had managed to puncture the mattress (used to protect skin), and had that gunk all over the place. It was hysterical.  I didn’t want to laugh at him, but it was hard to maintain anybody’s dignity at that moment. He was having a ball !  We got him cleaned up, and my only comment to the CNA was the need to differentiate between something that is life-threatening and something that is an inconvenience, but essentially harmless.  We didn’t need blood curdling screams in the middle of the night for a little  gunk on the floor (well, OK, it was a lot of gunk).

We also had a  hoarder.  The facility towels and washcloths, junk- didn’t matter. And she was possessive.  Anybody who went to clear out the stuff for laundry to rewash had to have someone else ‘stand lookout’, or the poor ‘lone’ retriever would be yelled at for a good 3-5 mintues, until the hoarder forgot why she was mad. One afternoon, one of the activity aides found a family of mice (mama and babies….LOTS of babies) living in a leftover popcorn bag (from movie and popcorn day), and a cake in a plastic bakery container that was so old that nobody could figure out the original flavor and/or color.

One of my favorite little ladies was superficially appropriate, but 2-3 minutes into a conversation there was no doubt that some bulbs were dimming. She was generally cheerful, and had a buddy she hung out with. She also was not fond of showers or combing her hair (think Einstein plugged in to a household outlet), but would let me check her skin weekly (per required protocols everyone got weekly skin checks- head to toe). The CNAs and I got into a routine of doing the skin checks in the shower room, and since I needed to see ALL of her skin, she’d agree for the CNAs to ‘hold’ her clothing…funny how the shower would get turned on, and she’d get nice and clean- she was always very agreeable once she felt the warm water. One day before getting showered, she walked past one of the mirrors, and saw herself. She literally gasped loudly and stepped back from her own reflection… she looked at me and asked about a hairbrush.  At least she still knew it was her own reflection- some lost that.

Nursing homes get bad reputations, but there are so many nice ones. I had the chance to work at two that I really liked, each for about 2.5 years.  The residents become like extended family, and some of their families also became part of the daily routine.  I’ve worked with CNAs who have been at the same facility for over 30 years…when offered promotions, they refused, not wanting to leave ‘their’ people. ❤  I’m incredibly thankful for the coworkers and residents I met when I was working at those facilities. 🙂