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How? Who? Why? - Questions of Care, The Thin Edge of Dignity

Caregiving - Hands
Boffeli, Seth
How? Who? Why? - Questions of Care, by Dick Weinman, The Thin Edge of Dignity

I stand with my back toward her, my pants tugging my ankles. I bend over, and grasp the cold metal handicap bar. She wields the toilet paper, extends her arm, and wipes. I should be glad. I can’t do for myself. Toileting me is one of the Activities of Daily Living (ADL) and one of the reasons I pay $5000+ each month for my residency at an Assisted Living Facility (ALF.)

Sure, I’m irked by the high price of living in this ALF, but that’s not all that irritates me: I’m bothered by the lack of concern of some caregivers. I wish they would put more feeling into their job. I don’t mean they should hum It’s a Beautiful World while lovingly caressing my behind as they wipe – that probably wouldn’t get anything clean, anyway. But a caregiver could respond to my call for help with sincerity, and mean it when she says, “How may I help you,” which is the standard question a caregiver must ask as she enters a room to answer a call for assistance. (And grammatically incorrect: using “how” implies action and ability to help – “can” is the correct word. “May” implies permission and there’s no need of “how.” The caregivers have been told wrong – or is it, “wrongly?”)

I want the caregiver to approach me as a person, not as room 108. (When I ring for help, that number appears on the screen of her iPod.) I’d be grateful if she related to me with “dignity and compassion” - the words that ALFs publish to market themselves. I’d appreciate it if she’d not just mechanically help me, but show some understanding of what I can’t do for myself – why I called; why I’m a resident here.“Know who I am,” I silently urge, “I’m not just the next call light to answer.”

I quietly fume at caregivers who do their work perfunctorily, disinterestedly, and nonchalantly – caregivers who don’t care, or, as one of those who do care said of one of her colleagues, “she doesn’t give a rat’s butt.”

But, I’m fortunate that many of the caregivers employed by my ALF have their hearts in their work. They care.



What is a Caregiver?

It’s a name. It’s a category of employee, identifying one who helps elders needing assistance. In the many kinds of Long-Term-Care institutions that house society’s elders, the caregiver is indispensable. She’s the “ground soldier” in the battle to keep people’s lives livable.

Her assistance covers a wide range of degrees of intimacy between herself and a resident. The most intimate is touching, such as occurs during toileting and showering. Less is applying lotion to arms and legs following a shower. Slightly less intimate is dressing and undressing. The range of activities extends from cutting nails, shaving, brushing hair, inserting hearing aids, and q-tipping ears.

Then there are the needs caused by violent bodily eruptions: cleaning up after accidental vomiting or incontinent explosive diarrhea.

That might make it hard for a caregiver to answer a friend who asks, “what did you do today at work?”

There are other less personal types of care - less dealing with bodily fluids, functions, and cavities : I need help to open my mail, insert a letter into an envelope, write the address, and lick the seal.

I’ve given you a glimpse of what’s done for me and other elders who can’t do for themselves.


Who can do it? Who should do it?

In many parts of the country, care givers are middle age women-of-color, whose job supports a family. It’s a low paying job: think minimum wage.

Some of my caregivers are women who fit this description, single or divorced mothers, who depend on the pittance caregivers receive to support their families, pay their bills, live their lives – pay for soccer team for their kids, swimming lessons, volleyball camp, and all that defines family life in today’s middle class society. These caregivers care at home. They know how to care here - and they do.

Usually, they have a second job.

In my facility, located in a college town, many caregivers are twenty-something white college students. Some would-be caregivers need a part time job to offset the high cost of college; they need work that fits easily into a school term’s course schedule. Students who plan to apply to nursing school want health care experience; some students try to show a multi-dimensional persona on job applications; some need community service for course credit; some sororities require members to volunteer.

Hopefully, some applicants actually want to help others.


 Who decides who is to be a caregiver?

In the modest size ALF in which I live, the Human Resource decision is made by two people. First is the Director of Health Management, a nurse. But, the ultimate judge of the motivation and character of the applicant is the ALF Administrator. S/he decides. I think this process creates the problem.

Other caregivers aren’t consulted. They should be. If the applicant is hired, she will be a colleague of the current caregivers, maybe even share a shift. Morale and team work must be forged between caregivers if they’re adequately to give care to a resident.

We residents are not consulted either; we, who are here to have the remaining years of our lives made tolerable and comfortable, have no say in who makes it so. Shouldn’t a resident be part of the screening process? Or a resident’s family member who placed the mother or father in the facility, and most likely pays for the service.

In industry, employee groups have input in management hiring. In universities, students are represented on search committees. Why not a selective few of us, who may have an ass wiped by the future caregiver?

Finally, let Myers-Briggs and IPIP-NEO, or similar personality, attitudinal, self perception tests help choose who should be a caregiver.



In the mid-1970s, Oregonian, Dr. Keren Brown Wilson, conceived the idea of a non-institutional facility that would provide “health, housing, and hospitality” for elders. She was prompted by her mother’s impersonal, institutionalized care in nursing homes. An ALF was to be the antidote to the traditional venues for Long Term Care, and was dedicated to “person-centered” care. Over the years ALFs haven’t always so committed, enough so that Dr. Wilson withdrew her support for the ALF franchise.

Today, “person-centered” is once again the rallying cry of governmental and non-profit organizations advocating for dignified livability for society’s older citizens.

Therein is the need for caring caregivers.


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