Another stage in life's journey

I have been accepted back at the Hospital I previously worked in, but on the Casual Pool only. It has been a test of my faith, as my budget is falling short each week, if I do not get any work. I need at least three days a week and have no plans to retire for many years yet. I pray daily and trust God to look after my needs. If I didn't, I would stress out and that would not be healthy. So far He has met my needs, as I have been called in for some shifts, in a different ward every time. 

My experience of being back at the hospital has been very enjoyable. I have been warmly welcomed by past and new colleagues and have rediscovered just how much I love inpatient care. It has been great to reconnect with my vocation that began when I left school at sixteen years old. Working on 'Pool' has been great reconnecting with an overview of how the different wards run in the Hospital. 

I can call in and visit Mother either before or after work, as the Residential Home she lives in is near the Hospital. Mother is very proud I am back at work. She has settled into her placement and is adjusting, sadly resigned that this is her lot now. She still remembers to ask for me if she is upset about something, and this has happened a few times. My fears for Residential Care have not been relieved though...it triggers the past.

As I look back on the days I was training as a RN, (late 1960's), I remember there being a Hospital scandal that exposed abuse of the elderly that were cared for in the geriatric wards in Public Hospitals. In those days untrained 'Aids' were used. As a result of the abuse found, the Government brought in Registered Community Nurse' training, as they decided the ignorance of the Aids lead to the abuse. After some years, the two year course was shortened and the name changed to 'Enrolled Nurse' training, which can now be bridged through more training to become a RN. 

I fear history is repeating itself, as 'Aids' (now called 'Carers') working in the Aged Care Residential Homes, show the same lack of knowledge and common sense as a result of ignorance. They 'don't know what they don't know' which shows in decision making that leads to deterioration or neglect of a medical aspect that the Registered Nurse hasn't been informed about. To me, if a person has complex medical issues, as the elderly often do, very basic nursing training should be provided to staff just to the stage of 'awareness' the problem is not always what it seems. 

Example 1: A client with a medical history of heart failure and the carer dressing her discovers that the client's bras suddenly don't fit. The carer's answer was to avoid putting her bra on, and not inform the Registered Nurse, as it wasn't identified as an issue. The Registered Nurse was  unaware until the poor client was suddenly in a panic because she couldn't breath, literally drowning with heart failure. With some basic understanding, the carer would have recognized the bra was not the issue, but the underlying cause needed assessing. Swelling from fluid retention from the heart failure was more likely as people do not gain weight (fat) overnight! If informed, the Registered Nurse could have avoided the distress to the client by assessing her and having her water tablet increased among other things.

Example 2: It is not normal to accept and ignore a semi-conscious wet naked client after bathing her! The warm water dilated the client's blood vessels and her circulating perfusion was compromised as a result of an underlying condition. I found this event happening as the Carers happily chatted while they emptied the bath etc. The client was last on their list of priorities and tasks at that moment. The Carer needs to protect the vulnerable client by informing the RN on duty. How is she to know if not informed.

The Carer's don't seem to understand enough about basics to communicate and be safe. Basic principles of hygiene and positioning for a bed-bath, dignity and empathy training for example. I believe lack of training  is costing the health System with Hospital admissions and extra expense in dealing with conditions that could be avoided. The sort that hit the newspapers now. I have found that if the abnormal is repeated enough, it is 'normalized' even though it is out of ignorance, It is Abuse, the vulnerable are not protected and standards are lowered! No wonder child abuse and neglect is rampant, as the elderly are devalued. Where are we to learn empathy, if not identifying and caring for the more vulnerable in society.

History repeats itself as new managers, with no memory or experience of the past keep reinventing the wheel, but chucking the baby out with the bath water as they don't recognize the difference when deciding what to cut back. So much money can be wasted long-term in the process!

I guess every generation of experienced workers go through these stages of observation. It would be great if the wisdom and experience of elders were included in planning, and not discounted via 'ageism' and the ignorance of those in power! Treat others how you would want to be treated. Honor our vulnerable elderly.

A Load too Heavy to Bear?

I have been responsible for caring for Mother since she came to live with me. It became more difficult when she lost the ability to walk. I needed to turn her 3 hourly as she was unable to turn otherwise and was very high-risk for pressure sores, which have been successfully avoided to date. Mother is in good health apart from her deteriorating memory, movement and heart conditions. She has made 90 yrs old! But not without a cost; to my health; I'm sorry to say the journey has taken a deviation I did not want to or had envisaged happening... I was walking by faith, trusting in God after-all! 

Mother, as I have spoken about in previous detail, had become very heavy to manage over the 4 plus years I have looked after her. The effect on my health, apart from exhaustion had been swollen joints from the strain of turning her overnight. Then I began to get rigors, with temperatures 40.2 degrees C. The Government NASC and carer support agency were excellent in providing a second person to take my place to wash, dress and get Mother up daily, and again to return her to bed at night, temporarily. I still had to drag myself out off bed to cook and provide her meals, and also to turn her overnight despite how ill I felt. I eventually came right after a week of misery. It really knocked me psychologically and emotionally as I began to wonder if I could last the distance, fearing failure in my hopes to care for her till the end. 

Mother also had began 'sun-downing' which may be explained as possibly a combination of poor brain perfusion and tiredness, along with time perception becoming so slow it became disorientating for her. From about 3:30 pm onward Mother would become restless and agitated, but not knowing why. Whether she was in bed or up in her chair didn't seem to make any difference. Company, distractions, reassurance and cuddles didn't make any difference. I felt I was failing in my mission of keeping her happy and content. Some days she seemed to look at me as 'the enemy' which I believe symbolized an outlet for her grief at not being able "to do things",  or be independent as she desired. She began to hate the hoist and what it represented gave her more reason to grieve. She did not believe any explanation as her memory was not able to verify the fact she could no-longer walk. It was heart breaking, and to become the brunt of her grief was emotionally very hard to bear. I pressed into God, prayed and resolved to carry on. The family isolation only served to make it a more heavier burden and so isolating. Weekly visits from a dear friend was like a breath of fresh air; my only social contact on a regular basis. Mother and I had become 'prisoners-at-home'.

About a month later, while my dear friend was overseas, I found my jaw extremely painful with an abscess. It happened a week before Mother was booked into Respite relief, which I was hanging out for. I had planned it to co-inside with a time I had committed to supporting my best friend in treatment for a brain tumor. What a dilemma! Suddenly my needs were conflicting with Mothers. An X-ray confirmed an abscess in a root-canal that had been done incompletely way back in 2011! (The fill had stopped short of the end of one root, which was where the abscess formed). The easy answer would have been to have the tooth pulled, but I needed my teeth, so chose to have the root canal re-done after a period of antibiotics. I worried I couldn't afford the dental bill. I rang around family to inform of my and Mother's happenings. The outcome was that they considered my looking after Mother was affecting my health, so I was encouraged to put Mother into Respite a week earlier (Govt. NASC emergency respite relief) and to consider having her assessed while in, for permanent placement. "There was no guarantee of a placement if I didn't leave her there, as bed availability was in demand", I was told by the authorities. Everything happened so fast and I was in no condition to resist. They thought they were helping me, but it only opened a can of worms as far as the implications for me went. I felt circumstances took everything out of my hands.

Suddenly I was faced with

•  dealing with Mother, preparing her clothes, labeling all etc for suddenly going into permanent care, 
• dealing with sorting out all her financial affairs regarding funding application and financial assessment for this, which involved a thorough assessment of where her money had gone from historical assets.
• dealing with the multiple agencies and equipment suppliers currently involved, 
• preparing for the changes financially for me , with the carer-support funding stopping
• dealing with the need to re-enter the work-force as soon as possible, and the stress of this
• dealing with 40 minutes of drilling at the dentist,weekly for three weeks until my abscess was cleared and tooth root re-filled,
• Supporting my friend, which was very important to me
• feeling emotionally, mentally and physically drained concerning Mother.
• feeling a failure that I had abandoned Mother and let her down in my promise to look after her till death.
• feeling the family isolation more acutely and worse than ever.

Since Mother has been in Residential care, the grief has been intense. She wants or expects to come home every time she sees me. She feels abandoned and doesn't remember explanations. She told me she "doesn't feel like she belongs to anyone anymore". I just want to gather her up and bring her home.  The financial stress continues. Although told I am accepted back into the casual work-force, I have been waiting three weeks for the CEO to sign the contract! Why the delay when the Hospital is short-staffed? Mean-time I have been living on fruit and veg from my garden and lost 5 kg in weight. I have since turned 65 yrs old -  retirement age in NZ and feel robbed of preparation time, while life on hold to look after Mother, now am feeling discarded. The worst part is being alone at home. The first time I have lived alone since leaving home. The cost on relationships has been the greatest,  contrary to my belief of encouraging multi-generational family interactions as being valuable and most precious experiences for all ages.  What is my purpose now I ask?