Efficiency

Every job has its own way of measuring success and every business has key benchmarks that ensure they actually make some money. After years of working for a non-profit where my monthly salary was "discovered" I'm still working on reaching the major benchmark in the therapy world: efficiency. Medicare, or some other health insurance, pays for all the therapy my patients receive and they reimburse the company I work for according to the amount of time I spend with patients within a certain target range that varies from patient to patient. Ideally all of the therapists end the week at 70-80% efficiency. In other words, we spend 80% of our working time with patients and 20% doing other things: documentation, talking with staff or family, or just getting from one room to the next. In March I was pretty consistently in the 70-80% range so I was feeling good about myself. But then...

Three weeks ago I was moved to the nursing home in Spencer. In many ways it has been a good move. It takes me longer to get there (but gives me the opportunity to catch up on my favorite podcasts), but I'm working with a lot more people who intend to go home and will actually get there. That means there are more things to work on besides making sure they can get dressed and to the bathroom on their own. I've enjoyed the change and the challenge. However, my efficiency has taken a major hit. Instead of having one new patient every couple of weeks, I have 3-5. Today I saw one new person and spent 29 minutes with her. (I bought a watch with a timer on it so it is easy to keep track -- when I remember to push the start button upon entering the room.) It took me at least that long to write up the Plan of Care which includes the goals of what the person needs/wants to be able to do to go home. So about the best I can do with a first visit is 50%. Add in two discharge summaries which can take about as long, an updated plan of care, and finishing two Plans of Care from last week that I had only done the bare minimum on before leaving on Friday, and I was once again below 60% for the day. It will get better since I am getting lots of practice in filling out the paperwork. And maybe I'll get better at tuning out the distractions of the cartoons the resident down the hall likes to watch, co-workers talking to residents or each other, or other staff coming in with the latest update. And for the time being, my supervisor has my back with those higher up in the company. But soon, I will no longer be able to say that I'm doing discharge summaries on people that I only saw once or twice so I have to read all the notes before I can say anything coherent about how far they have come. Until then, I'll keep plugging away even as I take the time to poke my head into a room to see what the resident needs. Today all the woman wanted was for her table to be pulled over close enough to her bed so she could reach her water.

What will you be singing?

One day I observed a hospice worker sitting in the dining room with one of the residents of the nursing home. As I walked by a couple of different times I heard snippets of prayer and the quiet singing of a hymn. The resident gave only slight indications that she was aware of what was being said. A couple of weeks later, this same resident was sitting in her wheelchair near the nurses station where she often sits in the afternoon. Her eyes were closed but as I walked by she tilted her head back and began to sing, On a hill far away, stood an old rugged cross... 

As I continued on with my day I wondered what song I would be singing. What songs will people sing to my generation when music is the only thing that lifts some of the fog of dementia? It used to be that every church sang more or less the same songs. That is no longer the case. When I was looking for a church in Minneapolis I remember several Sunday mornings when I didn't know a single song that was sung. In time I grew to know (and love) the repertoire of the church I was a part of. The music was primarily from the 21st century and the lyrics were filled with solid truth providing encouragement to my soul as they ran through my head throughout the week. Some of the songs we sang were written by church members and were an expression of our corporate life with God. But I have not sung most of those songs since I moved. 

Last weekend I was in Minneapolis, visiting my church family there. We sang one hymn and its words spoke right to my heart, bringing tears to my eyes and they rang in my mind throughout the week. 

How firm a foundation, you saints of the Lord,

Is laid for your faith in His excellent Word!

What more can He say than to you He hath said,

You, who unto Jesus for refuge have fled?

"Fear not, I am with your, O be not dismayed,

For I am your God and will still give you aid;

I’ll strengthen and help you, and cause you to stand

Upheld by My righteous, omnipotent hand."

"When through the deep waters I call you to go,

The rivers of sorrow shall not overflow;

For I will be with you, your troubles to bless,

And sanctify to you your deepest distress."

"When through fiery trials your pathways shall lie,

My grace, all sufficient, shall be you supply;

The flame shall not hurt you; I only design

Your dross to consume, and your gold to refine."

"The soul that on Jesus has leaned for repose,

I will not, I will not desert to its foes;

That soul, though all hell should endeavor to shake,

I’ll never, no never, no never forsake."

My experience of working in a nursing home has given me another reason why the good old hymns should continue to be sung along with new songs. They give us a common vocabulary, a common experience across local expressions of all denominations and all generations. And that is important, not only for the current elder saints, but for all future generations.

I chose this YouTube version of How Firm A Foundation simply because it is the sound of God's people singing the truth of God's promises. (I tried to embed it below, but in my preview it isn't showing up.)