By Stu Johnson
http://stream.publicbroadcasting.net/production/mp3/wkms/local-wkms-957130.mp3
Richmond, Ky – Hiring the right people has long been a problem at Kentucky's nursing homes. Low pay, hard hours and heartbreaking work complicates the job of finding and keeping competent employees. In addition, they also need caregivers capable of compassion. Kentucky Public Radio's Stu Johnson takes a look at the profiles of two such women.
In most workplaces, death is a rare sight. But, at Lexington's Homestead Nursing Home, it's a common occurrence. When she arrived at work earlier this year, Annette Dence learned one of the residents had passed away over night. As activities director, Dence went to work comforting the deceased woman's roommate.
"I was concerned about her roommate because she and her roommate were very close and we had had a special day yesterday we sang and we prayed and she actually had said that she would not be here long. So my concern was to take care of her roommate and see if she was ok and that's how my day started," said Dence.
Dence remembers visiting her grandmother in a nursing home, and it was an unpleasant experience. She didn't feel her grandmother received proper care. That's when Dence decided to spend her life advocating for the residents of nursing homes.
Joni Gosser says a similar experience brought her into the nursing home business. Gosser directs operations for Louden and Company, which operates five nursing homes and two assisted living facilities. In Gosser's case, it was her grandfather sick with cancer.
"He rang the bell a lot and the orderly came in to him and said What can I do for you now?' and my grandfather just said I'd just like a kind word, just a kind word .and that stuck with me like glue and I, like Annette, you know, I vowed that no matter what kind of a mood I'm in when these residents see me it's Hello, how are you, and I have a smile," said Gosser.
For three decades, Joni Gosser and Annette Dence have worked in long term care. The two women got their start at Homestead where Gosser says they bonded immediately.
Gosser says nursing home residents are people who make us laugh, cry, and, at times, can be exasperating. Dence says they should be much more than customers.
"It can't be employee-resident. After a while, it's family and that's what we are is family and when they're hurting, we're hurting. When something is going on with them, we know something is going on with them," added Dence.
Over the past thirty years, the practice of providing proper care has changed. Three decades ago, Gosser says it was not uncommon to find residents with dimentia strapped into wheelchairs, which were then tied to hand rails. Keeping a patient clean was also a problem.
"Back 30 years ago, we had no incontinence product. You knew somebody was wet when you saw urine and therefore skin issues were a problem. Odor in the facilities was a problem plus think about what it did to the residents' dignity," explained Gosser.
Gosser says advances in medications and cleaning products have made a significant difference in the nursing home care. Plus a nursing home has evolved into a place where a patient receives more than medical attention.
"I think over the 30 years the biggest thing we can say is we've gone from a total medical model of just treating the disease to a more social model of treating the person," added Gosser.
On a Friday afternoon, Elvis impersonator Bill Kelly performs for a room full of residents at Homestead. Annette cheers as three elderly women move to the music.
"83-87-81, that's 80 girls yeah! Woo woo clap clap,"
For most of her 28 years at Homestead, Dence has organized activities for residents. She has taken them even patients who cannot walk or talk well to movies, to horse races, to restaurants, and bowling.
"I had a plastic bowling ball with bowling pins and for a resident to look at me and say I'm not a child you're right, you are not a child plus I don't enjoy picking up those bowling pins every time somebody rolls them down so we started going to a real bowling alley," said Dence.
Such activities are vital in a well-run nursing home.
Sherry Culp directs the Nursing Home Ombudsman Agency of the Bluegrass. Its volunteers inspect nursing homes in 17 Kentucky counties watching out for the well being of about five thousand residents. Culp says those residents want compassionate caregivers.
"They rate that above care in some instances rather than you being a extremely skilled nurse aide caring for this condition. They might prefer that you be friendly and treat them like family," said Culp.
As this story began, Homestead Activities Director Annette Dence was coping with the death of a resident. That morning, Dence spoke with the woman's family.
"She sang all day yesterday. We sang gospel songs and set by her bedside. She ate a hundred percent of her meals. She ate her fluids. Things she hadn't been doing for days and they're concerned and you don't know how much that made that family feel. It made them feel good to know that their mother's last hours was a positive thing and not a negative thing," said Dence.
When asked if it's been difficult to work at a place where suffering is part of the environment, Dence said you just deal with it. She says you try to put yourself in the residents' shoes, realizing there is more to do.