Is Abe Simpson really so hard to work with?
November 27, 2010 6:49 AM   Subscribe

What is it really like to work in a nursing home / aged care facility? I sometimes think about working there or volunteering some time, but everybody says it's the most depressing thing in the world. Experiences please?
posted by KLF to Work & Money (15 answers total) 9 users marked this as a favorite
I worked briefly for a nursing home earlier this year.

Experiences are going to vary based on the quality of the facility. I was lucky to work for one of the better ones. It had a grimness that would be a shock if you're unaccustomed to being around older folk, especially the dementia ward. I thought I would find it depressing to work there but I didn't. Mainly it made me fully aware of my own mortality, the fragility of our bodies, and the impermanence of our youth. I think you would have to have a real selfless patience to work there. Some of the residents will be rude or insulting or just difficult, and the administration (at my facility at least) will want you to take it all with a smile on your face. It's not somewhere I wanted to work at for very long, but I thought it was a rewarding experience.
posted by Shesthefastest at 7:04 AM on November 27, 2010 [7 favorites]

I worked at nursing homes all through college as a nurse's aide, primarily in the highest level of care (i.e. people in comas and in the last stages of dementia--the truly dying). I did not find it to be primarily depressing, though it was of course often sad to deal with abandoned people and their varying horrible dementias and various bodily breakdowns. I was ready to be done in four years, mostly because it was very hard work for very little pay (look at who ends up being nurse's aides in our society, and you'll see it's only a bare step above fast food). However, I still count it as one of my most important self-chosen life lessons. I learned about death and what happens to our bodies as we age. I saw that though some people were miserable, some people were rather plucky in the face of death. At a young age, I learned that I could be both compassionate and without fear while caring for a person as they literally died before my eyes. It is definitely good training for a bodhisattva. (I am not saying that I am one, but rather that it is a good pathway.)

However, many nursing homes are seriously understaffed, and there is no way in hell you can answer everyone's needs. The place will smell like pee sometimes, and vomit sometimes, and other smells you cannot quite understand. People will say things to you that you have no way of knowing what to do with. There is nothing more heartbreaking than having someone grasp at your arm and beg you to kill them. Seriously, this will happen. How you are able to handle that sort of thing will determine whether or not it is an untenable place to be.

There is a vast difference between volunteering and working, however. Volunteers are by necessity going to be working with the most active and alert people. You will not be faced with cleaning poop and helping to treat bedsores.

It's time to quit when you stop being compassionate. It's unfortunate that so many workers in those places don't have that choice.
posted by RedEmma at 7:29 AM on November 27, 2010 [4 favorites]

I volunteered for 6 years at a nursing home while I was in junior high and high school. There are some things that are depressing, no doubt. But I met so many wonderful people there who were put in to the facility and basically forgotten by their families. A lot of the residents genuinely appreciated having a visitor and really looked forward to the weekly visits. It was always sad when I would make my way to a specific room and upon arrival, find it empty. It gave me perspective, because it seems like most people try to ignore the fact that they will one day be an old person.

I learned patience. Patience in dealing with Alzheimer's patients, listening to long stories from residents, in dealing with overworked nurses. The residents aren't really viewed as people by most, and I remember this when I am out and some old fart is counting pennies at the cash register or complaining about something. I think the experience as a volunteer reminds me to step back and remember that they are people, they have feelings, and that for many it is hard to wake up and be constantly reminded of all of the friends and family that are gone. Actually, it helps me to be patient with all kinds of people. Reminds me that we are all on the same playing field.

As RedEmma mentioned, volunteers don't clean up poop or treat bedsores. I did visit the bedridden and very sick. Overall, the experience was completely rewarding.
posted by bolognius maximus at 7:32 AM on November 27, 2010 [2 favorites]

you would have to have a real selfless patience


It seems like caring for the elderly and the rest of the world have completely different scales for things like patience and compassion. My 94 year old dad was pretty sick his last two years and we got very close to his caregivers - they became part of the family, including pall bearers at the funeral. They were almost a different breed of person from most folks I know. There is a calm, pardon the expression, zen-like serenity to their approach to the job.

I also have family in New York that own and operate a very large nursing home that can't give quite that level of intimate, personal care because of the sheer size of the institution and the bureaucracy involved in keeping the doors open. However, even there, nurses are expected to have that serenity. It's not a matter of having a thick/thin skin, there ia no "having a bad day" for you while at work. Some nurses will burn out, sometimes after short periods, sometimes with surprisingly long histories of doing good work (one recently just didn't come in to work - she just woke up one day and decided she had nursed her last day after almost 20 years).
posted by victors at 7:44 AM on November 27, 2010

i've worked in a few nursing homes. how depressing they are often depends on how good or bad the actual home is. some of the lower cost nursing homes can get pretty bad--including roaches and poor general care. the nicer ones are actually pretty upbeat--especially if the staff and residents are pretty comfortable.

most important then what you find is what you're there to do. a lot of times the things that you might have to do are unpleasant--especially if you're a nurse's aide--for everyone involved. if you go in with the mindset that you're going to make people better off, and concentrate on that then you can actually make a lot of people happy. those unpleasant things are actually often pretty simple, and they make people feel a lot better. giving someone a bath is a lot more pleasant for all those involved if you have the attitude of making your patient more comfortable then just doing it because you're supposed to.

it really depends on the home itself. one place i worked at was really nice, but it was for people who had money. one of my duties there was to rearrange the art reprints on the walls so the residents thought they were getting new pictures.

on the other hand, seeing roaches flee when you turn on a light can be kinda bad. and once i came across 3 residents sucking down bong hits in their room. that was kind of funny.
posted by lester at 8:49 AM on November 27, 2010

I worked in an assisted living facility for about a year. It can be hard in ways you don't anticipate.

I was hired two hours after I applied and began training that same day. "Training" lasted 2 days and was conducted by people with no actual qualifications; to work as a caregiver in that state and in that type of facility required no more education or training than a GED.

I dealt with a lot of poop. Poop and vomit. Sometimes I'd be in the middle of cleaning someone up and they'd start to poop again, and I'd have to try to catch it in my (gloved) hands to prevent an even bigger mess.

I'd have to give showers to men and women, and sometimes shave the men. One man would tell me stories about WWII while I shaved him; one story was about how his best friend exploded right next to him (while walking through a dense forest area, a tree branch pulled the pin on a grenade he had disabled the safety features on and hung on the front of his coat for "easy access").

One night a woman with dementia who had been having anal sex with another resident had her rectum prolapse afterward when she had a bowel movement. The man had been pretending to be her dead husband to have relations with her; her family was unable to convince her he was not her husband and eventually moved her from the facility.

On Halloween I found a woman wandering the halls covered in blood. She had torn an earring out of her ear and was on blood thinners, so it never clotted. One side of her upper body was completely soaked, but she hadn't noticed and was smiling a huge grin as she wandered about.

An old man that I took to and from dinner in a wheelchair each day died and willed to me a small sailboat statue (he had been in the Navy).

I learned that several of my co-workers were on meth. I was told one worker there had been convicted of sex crimes against elderly patients he had worked with at a different facility, but no one had bothered to check before hiring him.

One of my favorite residents started dying. His children came and stayed with him for a week. It was extremely painful, and he was given doses of liquid morphine to ease the pain; he was mostly delirious when he wasn't screaming. His adult children, decades older than I was at the time, begged me in tears to give him an overdose of morphine.

One man spit in my face because I didn't put enough ice in his water. A lady with Hep C tried to bleed on me.

It was difficult work that paid 25 cents above minimum wage, no benefits. I would not recommend it to anyone.
posted by Menthol at 8:56 AM on November 27, 2010 [2 favorites]

Interesting timing on this question, I just had a lengthy conversation with a nurse's aide (she was taking blood from my 86-year-old Dad who, sadly, is currently in the CICU) this morning. She's been a nurse's aide for 27 years and she'd spent 14 of those years working in nursing homes and special care facilities for dementia patients. "That had to have been depressing," I commented, remembering the facility my mother-in-law was in for a year. (Very nice place, wonderful staff, but the patients just broke my heart.) "No, I loved it," she replied. Maybe she had something of a Mother Theresa complex, because she mentioned that she felt like she "was doing good" by spending time with and caring for people whose families had seemingly forgotten them. The only reason she finally quit was because of the very poor pay. She's paid more now working in a large hospital, but she said she doesn't really have the same sense of "helping" patients as much as she did before.

I still say that if I ruled the world, nurses and hospital aides - the ones who clean the bedpans and the patient's bottoms, etc - would have salaries on par with those of executives at Fortune 500 companies. And the folks who care for the elderly would be paid a premium but only if they were properly credentialed and had sufficient training relative to caring for dementia patients. I'd love to think that such a system would eliminate the "tie-him-to-a-chair-and-leave-him-until-mealtime" climate that unfortunately exists in some places.
posted by Oriole Adams at 12:03 PM on November 27, 2010 [2 favorites]

I'm in the UK, YMMV, worked in a couple of residential homes when I was a student and overall had positive experiences.

First impressions: The smell (s) got to me for about two weeks - I would even feel like I could smell it at home. Then I stopped noticing it at all. Also, my previous job had been at a supermarket and it was such a revelation to work somewhere that people said "thank you" when you did something for them. I went about with a smile on my face for that alone.

There was, indeed, a lot of poo; there were old, naked people to bathe; the tinkle of tea cups; skin ulcers that smelled bad; snowy white hair to brush; regular smiles and hand holding and gratitude; left over food to clear up; people to feed; stories to listen to; surprisingly intimate places to put cream onto or medication into; heavy work moving people on their beds or in and out of chairs; fresh laundry to fold; dirty laundry to pick up; and late at night everyone asleep and just the dishwasher whirring away in the kitchen as you finally sit down to a cup of tea.

In other words, it's a world absolutely full of sensory stimulation of just about every type. That can be quite overwhelming if you've previously just worked in an office or retail or just about anything else. But very soon it becomes completely normal.

I think places really vary and you will tell very quickly what kind of place you're in, just by observing the staff. I regret that I was too young and inexperienced to stand up to members of staff when I thought they were cutting corners or being mean to residents (treating them like children, not giving them the choices they deserved to have over their lives; being rude about them in the staff room). But I like that I spent a spell when I was a young person where the lives of the very elderly were around me every day. I hope it'll stand me in good stead when, if, I reach that stage myself.

I still remember all the long-term residents, the ones who were there every time I came back from University - Ernie, Foffa, May, Eva, Hilda, Dorothy, Rose and Mabel. They'll all be long gone now, but I like that I remember them, and can see their faces as clearly as if I'd just finished a shift, even though it was 15 years ago.

tl;dr It's a unique experience, I can imagine it's not for some people, but don't avoid it because other people tell you it's depressing. If you're interested, the only way to find out is to try it.
posted by penguin pie at 12:04 PM on November 27, 2010 [4 favorites]

I worked as a nurse aid in several different nursing homes in Ohio for about 4 years when I was a teenager and during my first couple summers home from college. It was a very formative experience, one that I learned a lot about myself and others through. I'm glad that I did it, but I can also solidly say that I never want to do that kind of work again.

As a nurse aid, I was responsible for everything from helping residents move, shower, eat, and yes, cleaning up diapers and bedpans. If you're one for some good old fashioned poop talk, I could tell you horror stories involving massive diaper blow-outs, poo winding up in places it certainly SHOULDN'T be, and a woman who once took a 10lb poop (we weighed it!).

The funny thing is though, the gross parts of working as a nurse aid were far from the worst part of the job. You just put yourself in this mental space that it's just a job, and someone has to do it, and you hardly bat an eye when you're scrubbing diarrhea off the wall. It's a part of life, and I certainly hope that there's someone to do it for me when I reach that age.

One of the hardest parts of the job was living with death on a daily basis. The first time I watched a person die, I was 17 years old. I was the only person working my wing that night (more on under-staffing later), which made it even more difficult. Thankfully a kind veteran nurse came to my aid and cleaned the body and helped me finish the shift. (Yes, the body releases all waste upon death) Cleaning the body was always pretty difficult, but again, it's a matter of putting you mind into a certain space and just doing what needs to be done. The hardest part was watching residents slowly slip away over a matter of days, weeks and months. You learned what death looked like, what it smelled like (bitter and sour), and even what it sounded like. When a person dies, often the body will continue to move and vocalize after death - that is pretty creepy.

However, there were also some really great moments that made the job worth it. Everyone has their favorite residents, you find the ones you click with and sit and listen to their stories. One of my favorites was Doc, a gentle old WWII medic. He would whittle things and tell me stories for hours. I still have one of his carvings.

I also really enjoyed working the dementia ward. There were some genuinely funny moments there, as well as some heart-warming and heart-breaking moments of clarity. My favorites were the folks who were what we called "Pleasantly confused" - like the old lady who told me to put her down as a reference the day I came in and filled out my application. We remained fast friends ever since.

By and far, the worst thing about the job - in ALL of the 4 nursing homes I worked in - was my co-workers. All of these facilities were grossly under-staffed, with 2 aids servicing 20+ residents on a good night. There seemed to be two types of people who became nursing aids - the people who chose it as a profession, and the people who fell into the job because they couldn't get anything better. The people who had chosen that career path were always the best. They were gentle, kind, smart, understanding, and not planning on leaving any time soon so they were invested. The people who fell into the job were the worst type. They'd come in hung over, do drugs on the job, skip work without calling off, be mean and abusive to the residents and rush their work. I'm telling you, they were the kind of people you shouldn't trust to walk your dog, let alone care for your grandmother.

I could tell you a lot more, specific stories and anecdotes if that's what you're looking for, but this is just a general summary from what I remember. The people who do this kind of work, and do it properly, are good people and should be commended. It tough but rewarding work, and I still owe a debt of gratitude to the few fine nurses and aids that I had the privilege of working with.
posted by bloody_bonnie at 12:46 PM on November 27, 2010 [4 favorites]

Experiences of elder care depend a lot on what role you play in the facility. It looks like you're in Australia. My experiences are in the US, where things may be very different.

If you are asking about how depressing it is, I think that you must be referring to seeing dramatic loss of function and death. I think many people who work in medical fields end up changing the way that they see aging.

It's not uncommon to hear people say, "I'd rather be dead than suffer x" but it turns out when people are actually debilitated, they manage to deal with it pretty well. So seeing people in various states of (dys)function isn't really depressing if you can make a slight philosophical leap-- if you can see that debility isn't misery.

Death is similar. People's attitudes towards death change as they age. Mostly, people near the end of their lives are ready for death. It's not so sad for people to pass on, when it's time, when everyone is prepared for it.

There are exceptions to the above. Elder care usually involves some care of people with advanced Alzheimers, which is sort of a special case, but I don't think it's necessarily depressing. Most nursing homes also have some younger people, and some people who aren't verbal at all, even in the absence of Alzheimers. I think people who are unprepared can be depressed at first, but that usually resolves.

But I think that working in a nursing home as an aide is extremely depressing, if not because of the patients. It's depressing because it's extremely demanding work, that pays very little, and there is no real hope of promotion without further education. Actual interactions with patients are very limited by time demands.

In the US, if one is going to work as a nursing aide, one needs a little education (~3 months) and the only employers that will hire inexperienced nursing aides are nursing homes. That means that somebody that wants to work as a nursing aide has to spend some time in nursing home, like it or not. Working as an aide in a nursing home as a springboard to something else would be trying, but doable. But I don't know how anybody can do it for long periods of time.
posted by nathan v at 12:51 PM on November 27, 2010 [1 favorite]

I think it sounds like a nightmare but I had a cousin who worked in one as an aid for years and loved it. She said she loved having ridiculous conversations with her people, and she always had great stories. She really seemed to feel she had found her place in the world.
posted by BoscosMom at 1:52 PM on November 27, 2010

Just another suggestion besides paid or volunteer work for the home itself--I spent about 2 years working as a personal care assistant hired by the family of a nursing home patient. They lived at a distance and couldn't come by often, so they paid me to visit and read to her and purchase diapers and such. At first, I was hired to come late in the evening and help her fall asleep. She was afraid to die alone and was having insomnia as a result. Later, I came more often and earlier in the day to read the paper to her, talk about baseball, buy milkshakes, etc., but I also found myself being an advocate for her care and making sure the staff was coming to clean her promptly after accidents (see abovementioned poop stories) and record medical events as they were supposed to.

At first, it was just a job, and one I felt sort of strange about since I was hired through a friend of a friend and didn't meet any family members for months. But then I realized that even though this woman had some money (I was paid through a trust she had set up), she didn't have many friends left, and her various family seemed to be just waiting for her to die. They talked more about that money than anything else on the rare times they visited her, wondering if her will was in order and such. She got so mad at that that she gave me a $5/hour raise and decided that I should ask a friend of mine to come in on the days I couldn't. She said she'd just as rather that we had a bit of that money than those "vultures," so even though I called her financial adviser and told him he didn't need to change my pay rate, he said that's what she wanted, so it went through.

She was at a relatively nice home, but even that one was understaffed much of the time. She wasn't a favorite among the staff because she actually advocated for herself and wasn't very passive--she thought she knew what kind of care she should be getting for what she was paying and thought the nurses should have worked a bit faster (which was true for some of the nurses, but it's hard to keep a fast work pace if you are motivated by pay and the pay is bad). Some of the staff was gruff and always asked her why she hadn't gotten to the bathroom on time, which embarrassed her. Others were compassionate. Only rarely were any of them cheerful.

I think the best staff remembered that the residents' lives were very circumscribed, with limited choices about activities, food, meal times, medicine, or even what to wear if someone had to help them dress. Any time they could give a resident a meaningful choice about their own care (spending an extra minute to find out what they might like to wear, allowing them to take two desserts or skip the cooked carrots, asking whether they wanted the blinds open, not trying to force someone to go to a sing-along, etc.), they allowed that resident to keep a bit of the humanity denied them by their living conditions and reinforced their personhood. Yes, it's easier to get through an already hectic day if you can keep everyone in line and not spend time asking about individual preferences, but it's those little things that can keep people more content and help them feel more cared for.
posted by BlooPen at 2:32 PM on November 27, 2010 [2 favorites]

Running nursing homes is sort of my family's business. My grandfather ran them, my uncle ran them - my Dad's been running nursing homes since he was 24 (30+ years). My father's side of the family has a sort of lofty penchant for sacrificing one's self in the name of duty. Working in a nursing home, as any of these men would tell you, is fulfilling and miserable. You are put in a climate of constant death, a climate that reminds you every second of the day of the suck that is getting really old, losing your mind, being relegated to a sort of prisoner status because you can't control your shitting. I say this only because you do have to, especially if you want to make a significant time commitment to working or volunteering in one, have this sort of mentality - because whether you think it will or not, working in a nursing home will drain you. It will. My father has had an obligatory subscription to AARP since he was in his 20's. The man is a sage.

I will tell you a story about one of the summer's I worked in the kitchen of one of the home's my father directed. I was a junior in high school at the time, I needed the summer job, and my dad got me one working in the cafeteria. I'd get there at about 5 a.m., clock in, and check the death chart. So, everyone in the nursing home has a meal card that lists their allergies, special needs, food and drink preferences. Each day these cards are used to set-up personalized meals for everyone. Each morning, I had to check the chart to see who died in the night and pull their meal card. This fucked with me. The meal cards were so personal. Sometimes I knew the resident well, if they'd been there awhile, sometimes I didn't know them really at all - but you pull their card and it says, you know, 'Dolores likes orange juice in the morning and chocolate milk for lunch...' And this constant contact with the pedantic, pragmatic elements of dying, it wears on you.

I spoon fed people a lot. Spoon fed them meat that had been blended into a liquid and thin mixed with Thick-It to give it a jell-o like consistency. I cleaned up a lot of vomit, piss and shit. I listened to a lot of complaining and incoherent nonsense.

I also made some great friends with the more cognizant residents, heard hundreds of fantastic stories, played old waltzes on the piano during lunch and watched residents smile in recognition, sat and watched the birds with folks who had nothing left to do but watch the birds.

The thing is, someone has to do this work - so if you're thinking about doing it, know what to expect, but also know the great service you'd be doing. In other parts of the world, families and towns take care of their elders. In America, we have grown accustomed to sending them away - and so it's up to people like you to stand up and be the surrogate children for these people during their final years or months or days. It is a difficult but noble thing to do.
posted by Lutoslawski at 5:06 PM on November 27, 2010 [1 favorite]

It depends what type of work you're talking about. You mention volunteering, so if you mean playing cards or bringing pets to hang out with the residents, that would probably be pretty fun. But if you're talking about working as a nurse or nurse's aide, that's very different.

My first job out of nursing school was at a nursing home, and it was a pretty typical one--poorly managed, understaffed, and populated with some very unfortunate souls. Some nurses take nursing home jobs because they're perceived to be "easier", and indeed, some of the nurses there did nothing other than pop pills and sit at the nurse's station. But on the subacute floor, where I worked, there were lots of treatments, wounds, IVs, etc. to attend to, so it was extremely busy and physical. I got burned out very quickly due to an enormous patient load, which is quite common in nursing homes. I just didn't feel I had enough time or support to provide safe care, especially since I was a new grad and not entirely confident yet.

I need to give a special shout-out here to CNAs/PCAs/nursing assistants by any other name who work in nursing homes: these people are among the hardest working and least rewarded in the world. Nursing is hard, but the aides are generally the ones emptying the bed pans, doing the feeding and bathing, and getting the brunt of the patients' bad moods, all while making next to no money and getting no respect. The good ones deserve endless accolades.

If you've got the balls, it can be incredibly rewarding and you can make such a difference in the lives of people who have literally no one else in the world. It can be depressing, but it's all in how you choose to look at it. For me, the most depressing part was the suckiness of the way the place was managed, not the actual patient care. I still think about specific patients sometimes, wondering if they're still alive and hoping that there are some great staff still there caring for them.
posted by tetralix at 5:12 PM on November 27, 2010

You have to find a good nursing home. In high school I was taking a vocational course to get my CMA. They put me in a nursing home where all they did was get people up and dressed and then left them in their wheelchairs in the hallway. I lasted 3 days before I broke down crying and asked my teacher to get me moved out of there. All I could think was that these people used to have meaningful lives and now are treated with no dignity at all.

The work is hard. In addition to all the unglamorous bodily fluids, there is a lot of lifting and sweating.

But when we as a class volunteered to sing Christmas carols there, good God, did I love that... it was the best thing in the world.
posted by IndigoRain at 7:04 PM on November 27, 2010

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