Working at my Nursing Home used to be an Exercise of Hope - Now it's feeling Increasingly Hopeless due to COVID

Sure we could always get paid more, work at a more leisurely pace, or whatever - but the worst part is the "moral distress." To me it feels like we're not helping them, we're at best warehousing them.

Photo by Mulyadi on Unsplash

If you want to get a handle on where “burnout” in the nursing home industry is coming from, you often get a lot of different answers. They’re underpaid, they’re overworked, they are afraid because of COVID, they are being asked to do much more than ever because of COVID, etc etc etc. Not that any of these things are necessarily wrong, but often I feel like the people who write these articles - even when they are really doing their level best to capture what’s been going on in long-term care over the last two years, just don’t get what it’s really like to work with these people.

(In doing some brief research for this article, I found this article in NPR, which actually wasn’t half bad).

I touched on the subject in my story about my fictionalized patient “Mandy” last week:

When I first started working at my current facility 10+ years ago, I had a sense that hey - living in a nursing home may suck for a variety of reasons, obviously 90%+ of the people there don’t want to be there, but we can, as nursing home workers, make it tolerable for a bunch of them - and possibly even make some of their lives better. I truly believed that!

These days? My residents can’t leave, visitations have been significantly restricted and controlled, volunteers and volunteer-led activities are largely absent, paid companion services are gone (and this is just for starters)…. and everything, daily living is and remains largely subservient to COVID mitigation and control… so now, I go to work every day with a sense of ongoing loss and anguish about what’s been done at my workplace and to my residents - it sucks.

Prior to COVID

All nursing homes have been under some degree of stress long before COVID. We are an un-sexy part of the medical field. We’re quite aware that you have to be somewhat “different” to want to work in our field, and we’re all quite aware to varying degrees we care for people that certain segments of society just want to tuck away from view and ignore (to be fair, we’re also saviors for any number of families who have reached the end of their collective ropes when it comes to exhausting home-care options). Either way, we’re the forgotten corner of the medical system.

But my nursing home? Like I’ve mentioned before, we used to be a relative oasis amongst nursing homes.

We have more resources than most - an active staff of true recreation therapists, a large community of volunteers that, prior to COVID, you practically couldn’t keep out of our building! Residents frequently taking advantage of day passes to visit their homes, and would often get to go out to a restaurant or to a coffee shop or a movie with staff for frequent outings.

Physicians on-site at our facility every day, five days a week. A behavioral specialist on-site to see patients for therapy, consult with staff on behavior management planning, etc.

We truly did make it a home, or as best as we could anyways.

Post COVID

I’ve been really trying.

Initially, in the first few weeks of COVID, as my nursing home shut down, as we stopped the in-site church services, as we halted outings, as we stopped day passes - I was telling myself “this is temporary. Once everyone is vaccinated they’ll reopen again, they’ll start giving our residents freedoms back.”

Then the weeks stretched into months. Now it’s been literally years, and going on three.

My nursing home residents - my patients - they have no advocates anymore.

The world seems satisfied that they are locked away, sealed off from COVID, but also sealed off from the community, from the trappings of civilization, from anything that exists outside of the nursing home’s four walls.

For sure - when you’re you’re living out in the world, maybe you’re middle aged or younger, and you just want to make sure that you do whatever it takes to prevent catching the virus, because you just don’t want to gamble with your life (or with “long COVID”) - sure, go ahead - mask up.

Mask everywhere.

Wear an N95 every waking hour of your day. Never leave your house. It’s your choice! And while I personally believe that the latest bugaboo, that of the threat of “long COVID” is more massively overhyped scaremongering nonsense - if you’re worried about that, you go ahead and wear a moonsuit outside of your home. Or inside it. Whatever.

Photo by Kyle Cleveland on Unsplash

But my residents DON’T HAVE THAT CHOICE.

Moreover, I will bet your bottom dollar that the overwhelming majority of my 80-plus-year-olds who will never be discharged from my nursing home, they just don’t care about the possibility of “long COVID” - they would much rather chance it and see their children’s faces again, to get a kiss from their great-grandkids.

To perhaps just visit their home, one more time on a day pass.

Their time is running out. They’re being kept alive, but for our own purposes. Not for theirs. No one asked them. My residents just exist, we keep their bodies alive to make ourselves feel better because we’re “protecting the vulnerable.”

It’s sickening. So many of you should be utterly ashamed of yourselves. I saw this the other day and I wanted to punch my phone:

GeroDoc @doc_gero

There’s something about this exchange that almost perfectly typifies how simultaneously absurd, tragic, and angering these last 2+ years have been. I’ll let you all figure out what that is

I’m firmly convinced that while the absurd, absolutely absurd toddler masking bullshit in NYC, the school shutdowns, the learning loss - while that was a scandal, what is really the worst is what’s happening in my nursing home and nursing homes across the country.

While we pat ourselves on the back for keeping them sealed away from the vicissitudes of COVID, their spirits decompose, and the remaining time they have ticks away.