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.)

The guest room is open

I've never had a guest room before. Since I moved in it's been used as a storage space, an office, and a place to iron. In the back of my mind I wanted to get a bed so I could actually have overnight guests but that meant getting rid of the boxes. My original good intention of emptying one box per day lasted about a week. Thankfully the February mattress sales coincided having my first overnight guests on the calendar. Deadlines help since I've always worked better under pressure. I bought a bed and my parents come over to let the delivery men in while I was at work. They even made the bed, hung a couple of pictures, and put the lamp together. I was in business.

Last weekend four friends from Minneapolis (one now living in South Dakota) gathered at my place to celebrate a birthday. I scrambled a bit on Friday evening doing the cooking prep and Saturday I finished up the last minute cleaning. Thanks to their being a bit later than expected I was actually sitting down to read a book when they arrived. We had a wonderful time together with much laughter and good food. The apartment seemed quiet when they left.

A salesman joked that I probably didn't want a real comfortable mattress so guests didn't overstay their welcome. Two people have declared it as very comfortable (at least for one night). So come visit and see if it passes the test for several nights in a row.

Playoff basketball

Last Friday night I decided to attend the girl's high school playoff basketball game between Okoboji and Hartley-Melvin-Sanborn. I went with the intention of cheering for Okoboji. After all, I live in Okoboji and work in Milford (where the actual school is). By the time I arrived the Okoboji side of the gym was full so I found a spot among the HMS fans. After a few minutes of watching as I munched on the obligatory popcorn, I couldn't help but pull for HMS. They were a senior dominated team that passed the ball well and had some sweet assists. They also played hard on defense. Those two things make basketball a team sport and a beautiful game. Okoboji has only 2 seniors but a couple of key players who had a soft shooting touch both inside and out. They played some tough defense as well and hit their free throws at the end to hold off the HMS come back and win by 7 after being up by 16. As a reward for winning, Okoboji got to play Unity Christian, the undefeated #1 team in the state whose average margin of victory has been 36 points a game. Okoboji turned out to be pretty average and was defeated by 38 points.

High school basketball has plenty of travel calls, turnovers, and missed shots. But it also has fans who make the cheerleaders irrelevant and no TV time-outs or instant replay to interrupt the flow of the game. I'll be watching/following the state tournament next week to see how the Northwest Iowa teams do. One of my co-workers also refs high school basketball so our morning conversation has often included the latest results. Our patients listen in and we've learned that some of them have been listening to the games on the radio. As we (therapists and patients) follow the area teams next week we'll try to remember that we are there to do some therapy. I can only imagine what it will be like when March Madness rolls around.

Drag Races

On my daily drive to work I drive between East Lake and West Lake. I've observed the skating "rink" shoveled out on West Lake with no one enjoying it when I go by around 8:30. This week the old car was parked on West Lake where it will sit until it falls through the ice. You can bet on when it will fall through the ice after which first responder divers will use it for practice before it is pulled out of the lake to dry out until next winter. Last Wednesday I noticed snow being removed over a long stretch on East Lake. The next day flags were being placed in the ice at regular intervals to form lanes. Friday one of my co-workers noticed a Zamboni out on the ice. At least six of us were in the therapy room discussing the question of the day, "What is going on?" Google didn't even have the answer. Another co-worker walked through the room giving the name of the person to call. The next thing we knew, one of our patients was on his phone. After a short conversation he reported, "snowmobile races."

Saturday I was scheduled to take Elizabeth, my niece, and Vicky, my sister-in-law from Dallas on an outing. Elizabeth wasn't feeling well so Vicky and I set out for the Lakes. The day was warm (40˚) and sunny so it was a great day to stand on the ice and watch the vintage snowmobiles drag race for 200 yards/meters down the ice. Vicky and I watched for almost 2 hours as all her senses were filled with northern culture: the sound of revving engines and burst down the ice (I was wishing I had brought some ear plugs), the smell of diesel being burned by old engines, the feel of the cold ice under our feet, the sight of children playing and being able to identify the winner from 120 yards or more away.... Vicky was actually quite good at picking the winner, even when it was close. The start made all the difference in the world as there was only a couple of come-from-behind victories. I never did figure out where the start signal came from or how they actually decided the ultimate winner in each category since the same snowmobiles raced against each other numerous times in what was announced to be the "final." We left a couple of hours after we had arrived feeling revived by the stark contrast from our individual daily routines even though we had little feeling left in our feet.

This isn't the way life should be

Every work day I walk the halls of a nursing home. I see lift chairs, call lights, chair alarms, wheel chairs, walkers, naps at all times of the day, and smiles. I hear confusion, frustration, incomprehensible babbling, the same story 100 times, cries for help, and laughter. I sense despair, resignation, loneliness, and deep love between spouses who have been married for over 50 years. For all the kindness shown, the good care given, the love demonstrated, the longer I'm there the more I want to rebel. This isn't the way life should be. No story should end this way.

Today is John's birthday, his 4th since he died 3 years ago. Some would say that he died doing what he loved -- farming, that he had a good life. And he did. We don't know what heaven is like but I can imagine Grandma baking him a chocolate cake with 44 candles and Aunt Suzanne organizing the party. Whatever his day was like today, it was great. But for the rest of us, even as we remember the twinkle in his eye, the welcome sight of his red pickup, the jokes he played, his faithfulness and love, we grieve. This isn't the way life should be.

Today Mom started chemo treatments. Two years ago she had endometrial cancer of the uterus. If you have to have cancer, that's a great place to have it since it's all contained in a sack that can be easily removed. According to the doctor, there was a 2% chance that it would reoccur. Just 3 short weeks ago, an x-ray discovered a nodule. Numerous tests later, the verdict came back that it is the same cancer and it is observable in two places. The doctor is confident that the cancer can be beaten but the the weapon is chemo which is short for all-the-side-effects-that-come-from-poisoning-yourself-for-18-weeks. Whatever the long range outcome, this isn't the way life should be.

I could broaden the scope to the lives of others I know, to the daily news, but for now there is plenty in my daily life that brings out a mixture of sadness and revolt. This isn't the way life should be. This isn't the way life was meant to be. This isn't the same world God looked at as he declared, "It is very good."

This morning I read,

All flesh is grass... the grass withers, the flower fades, 

but the word of the Lord endures forever. 

A couple of pages over it says,

...those who war against you shall be as nothing at all. 

For I, the Lord your God hold your right hand; 

it is I who say to you, "Fear not, I am the one who helps you." 

Two chapters further is a favorite of our friend, Mary Pat, 

Fear not, for I have redeemed you; I have called you by name, you are mine. 

When you pass through the waters, I will be with you; 

and through the rivers, they shall not overwhelm you; 

when you walk through the fire you shall not be burned,

and the flame shall not consume you. 

For I am the Lord your God, the Holy One of Israel, your Savior. 

Paul prays that we would know the hope that God has called us to. My favorite definition of hope is a confident expectation of good. And the good God promises is to make all things new. He doesn't come to fix things. He will remake it all. 

Then I saw a new heaven and a new earth, 

for the first heaven and the first earth had passed away...

Behold the dwelling place of God is with man. 

He will dwell with them, and they will be his people, 

and God himself will be with them as their God. 

He will wipe away every tear from their eyes, and death shall be no more, 

neither shall there be mourning, nor crying, nor pain anymore, 

for the former things have passed away.

We are not yet at the end of the story. It's more like the end of the first section of the first book in a trilogy. I need to remember there is so much more yet to come.

Odds and ends

I started working on a more substantive post, but am too tired and too distracted by football to do it justice so that will have to wait for another day. In the meantime here are a few odds and ends from the past few weeks.

For the first time in my life, I'm hearing my name and people aren't talking too/about me at all. There are several women named "Alice" in both nursing homes where I work. And even when I know staff a few rooms down aren't talking to me, my instinct is still to turn my head. I explained this to a man named Dave and he said he usually doesn't pay attention when he hears his name because most likely he is not the one being referred to. Maybe I'll eventually get used to it.

This week I was trying to get a gentleman to stand up and walk 20-30 feet. His response, "Why would I do that? I'm over 90 years old." I wondered what that had to do with anything but he seems perfectly content to let others do everything for him. I am trying to learn to motivate people to work a little in order to be as independent as possible. That motivating can be difficult, especially when some dementia is involved.

I've been "sick" in the last month more often than I've been in the previous 4 years. I only missed 2 days of work, but there has been quite a few days I've felt like I've been fighting something and by mid-afternoon I've been ready for a nap. It seems that most days, by the time I make supper I don't have much energy for anything else. Thankfully, I haven't gotten really sick, but hopefully I'm not assisting in passing around the stomach bug or influenza between the different residents I come into contact with. I wash my hands more times a day than I can count.

I actually got my laundry done this weekend without leaving a Kleenex in a pocket. That makes a big difference when the primary items are black scrubs.