Families: Why the Battle?

One of the issues CNA’s deal with on a daily basis is interactions with resident families. Like it or not, they are the most important part of our residents’ lives. I think an admission to a nursing home is not only a shock to the person, but to their family as well.

Families deal with many feelings when they decide to place their loved one into a nursing home: guilt, helplessness, financial worries. They hear the stories about abuse and neglect. They fear these things will happen to their loved ones. Usually families have little experience with how long term care facilities work- the daily pulse and beat. The nursing home becomes HOME to the resident and the second home to many of their families.

CNA’s on the other hand work in nursing homes for a living. We punch in, do our shift and go home. We love most of our residents and do the very best we can with what we have. Often, we work short of staff and this is heartbreaking for many of us. Few of us remember our first days in this work…the shock and dismay we felt at the lack of time to do really good work. We went home feeling guilty and a little shamed of the care we gave. Soon enough, we each realize this is how it is and we also know it could be much worse than it is. I think we become immune to that SHOCK effect.

Families go through the same thing. Some come to know how nursing homes operate. Some don’t bother to learn and others just don’t care. They expect the world to halt to their demands and they could care less about who ends up being neglected because of their demands. They tend to put the heat on management with complaints and needless accusations; and they have expectations that are really not in tune with the typical model most nursing homes follow.

At the message board for this site, a discussion was initiated about this very subject. We got hot handed, a little, because I believe aides can have a huge impact on the families perceptions of who we are and why we do things the way we do.

This one is for the families of nursing home residents
You know who you are, you are the one who likes to show up a few minutes after your family member was looked after but has had an accident and then claim they had been that way for hours. You think you know our jobs, but never had a hour of medical training. You think I am your servant but I serve only god and country. My boss is the nurse, hunt her down with your bitches.

I have a real nice question for you, here it is in little words that I know you can understand:

If you think that you can do a better job then why the f—k don’t you?

Now be honest.

Understand this:

1. I am a CNA, not whipping boy or girl.
2. I am worthy of respect and you will respect me.
3. If you do not do #2 I will talk real bad about you to my co-workers about much of a moron you are.
4. Again, I am a CNA. I take of more patients that just your family member, so if you want extra special care and attention given to Sally or Fred or Ann then you going have to shell out for a private sitter.
5. O if you think I got an attitude, well think no more and now you should know.

The familes are the single worse thing about this job. Nursing homes should have stricter visiting hours.

This is an extreme view, held by more than I would care to know of. I could not work with people who hold this opinion and I can see how negative the work environment could get, surrounded by aides who are seething to the brim with these feelings. Yet I understand where Kevin is coming from…I have had days where I just wanted to toss the towel in literally at a spouse of a resident- who was caught up in the middle of this battle. The demands of one family can have a very negative effect on the other residents we are assigned to care for.

This presents a problem for us. Management always applies grease to the squeakiest wheels, and this bandaid approach never truly heals the wound- instead it makes it worse. I do place blame on management for allowing this to happen. It is up to them to deal with the nitty gritty demands and expectations that truly do take away hours of care from other residents. Dealing with these people might mean telling them how things really are. It might mean letting the families know their petty concerns over missing laundry equate to another resident getting their medications late. It might mean holding a meeting and explaining to these families that they are disruptive and detrimental to overall morale of both staff and residents.

What can a CNA do when caught up in the middle of the family/facility battle?

My best tips:
Smile!

Apologize. It may not be your fault but it is your responsability as an employee.

NEVER say that you are shorthanded!!!! It maybe true but families and patient don’t want to hear it. (I know I don’t want to here it from the bank teller when I have stood in line for 10min.)

If it is something you can’t mend as a CNA then get the RN involved- use your chain of command. Get the risk manager involved if it comes to that.

That about sums it up, nicely. Try to be upbeat and positive, and at the same time acknowledge the families concerns. If there is ever a time to pass the buck, now would be the time.

Hopefully management can do some things to make this issue better for all:
*Before someone is admitted, a good educational session about the workings of the nursing home should take place. Families should always know and understand the aides are responsible for MANY residents, not just one. Timeframes should be disclosed- it should be well known that 20 to 30 minutes is the normal expected amount of time an aide can spend with each resident.

*The family could be asked to come in and watch part of a shift. To see how things work; to learn about how nursing care and treatments; to see the food and meals and laundry service. This is a good time for families to be introduced to the dept. heads

*Get this book, several copies of it…and lend it out to families:
The Eldercare Handbook: Difficult Choices, Compassionate Solutions

*And this book:
Living Well in a Nursing Home: Everything You and Your Folks Need to Know

It wouldn’t hurt to have everyone read these books to be honest- nurses, aides, laundry staff…