Tuesday, May 08, 2012

A Question for You All

A couple friends of mine called me today, extremely upset. It's a bit of a complicated story so I'll try to simplify it in the explanation. They know an older fellow who, over the course of the last few years, lost his job, alienated everyone who knew him, frightened children and small dogs. He squandered his money and was about to be made homeless. They stepped in, only as concerned bystanders really, and helped him get organized - out of his house and into what they called 'foster care' ... which sounds on description like a group home for elderly people. Throughout the weekend, as they helped out, he was alternately thankful and mean. They weren't close to him so his attitude annoyed them more than hurt them but they were determined to help him get moved out of his apartment (from which he was about to be evicted for non payment of rent) and into some kind of care. I don't really know much more about the circumstances.

The reason they called me was because they were upset at how 'uncaring' the 'care providers' were. Oh, they were nice to the fellow moving in but they were horrid to the others living there. Shouting at them. Disregarding their requests. Dismissing their needs. They had the sense that the fellow they were helping was only getting decent treatment because they were there. As they left they didn't know how to feel. They were relieved that he hadn't been put on the street. They were grateful that he had a place to stay. But they simply knew that his life had gone from bad to worse. "How can people be like that?" they asked me.

I don't know.

Everyone makes excuses about people being underpaid (that's true) and overworked (that's true too) but even with all that, I don't really understand. How we act is, I think, always a choice. Our behaviour isn't affected as much by our circumstances as it is by the moment by moment decisions we make. Ultimately I am responsible for what I say and what I do - because I said it and because I did it. So the excuses don't really make sense to me. Punishing people who have no power to affect change seems simply mean.

But something they said struck me, "We'd all better think about demanding better care because we may all be headed for care."

And that's true.

However, I wonder if we should be demanding better care because people get hurt in care - because people are demeaned in care, because people experience humiliation by care providers. Isn't that reason enough? If our motivation is only 'me' then I won't care about things that don't affect 'me'.

But that aside they asked me what they should do.

They thought that writing a letter or calling the administrator to report what they saw and heard might end up in the old fellow getting bullied because of their action. They didn't want him to suffer because they'd made a complaint.

I gave them one piece of advice, I'll put that in the comment section after I hear from you all. What do you think they should do or should have done ...? I'm curious because I realized that they were immobilized by a sense of helplessness - which isn't, by far, the same as apathy.

So over to you ...


Anonymous said...

Tough Question Dave...

At first I would explore why the carers in this place acted not nice to the other people they had to care for.

Is it exhaustion? Was it a bad day? Did they have the right resources? Were they people they cared for extremly stressful?

After all we are just human (and sometimes just because I feel very sad and angry I have to take everything I have together to not act mean) and cargivers who are not cared okay for themselves make no good caregivers.

Then try to talk to the people directly. If this fails try to talkd to the organization.

Oh and I forgot one thing: Try to see the unique human being in every person. Cared for or cargiver. We may not be councelors but knowing that there is a human and not a number to talk to is essentiell.

Does this make a little sense?

I am waiting for Daves idea/solution!!!!


Louna said...

Julia, I disagree. People may have bad days and bad working conditions, they may work with people who are "hard to work with", but that doesn't allow them to be abusive. Especially since that was not one carer yelling once at one person, but most or all carers yelling repeatedly throughout the week-end at most clients.

So what should these people do? They could try contacting the management anonymously, explaining that they are afraid giving their name might endanger their acquaintance, but I doubt that would have much of an influence. They could look for organizations working against abuse of elderly people in their country; I'm not an expert, but these things must exist. They could visit the foster care more often, and try to meet the relatives or friends of the other clients. If they talk about the situation with them, perhaps they could lodge a complaint together. That would not only make the complaint stronger, but it would also expose the clients less. I am not suggesting involving the clients directly, except perhaps as intermediaries to make contact with their relatives or friends; I'd be too worried about them. I hope these suggestions are helpful, and I'd love to hear your opinion, Dave.

Anonymous said...

What a tough position for these kind people to be in. Some times the outcome is better, but not the best.

I guess it depends how involved they want to be. True - if it is truly an abusive situation - stirring the pot can make it worse for the end user. But if it is just a bad day - perhaps talking to the caregivers about it may make them more aware of how they are coming across. You can get stuck some times.

Visiting the fellow a few times will let the people know he has outside contacts, plus allow the visitor to observe behaviours on a different day. Surprise visit? Then if the "bad" behaviour continues perhaps approach the caregivers by saying that they noticed they seem to be having some problems with _____ (whatever observed). It must be difficult dealing with that. Do you have resources to help you with ______?

Often a little sympathy and acknowledgement goes a long ways. If they say that there isn't enough staff, or whatever, perhaps the visitor could say that that must be hard. As a interested person they are going to write a letter and let the administration know.

That way you are almost "getting permission", not condemning directly, and letting the caregivers know that you have seen undesirable behavior - all in a move forward positive way.

Should they be abusive - NO. It is tiring caring for people - and if all the personalities are like the gentleman taken in - you can imagine how the day to day must be.

Just some of my thoughts.

Susan Ludwig Goharriz said...

Many care-providers assume this type of job because they are bullies. They are not only employed in care-providing, but also in teaching. They are attracted to positions in which they feel a sense of authority and entitlement. Bullying needs to be addressed no matter who is doing it!

Betty said...

Visit as often as possible, unexpected at unexpected times.

I would complain to management,maybe look into getting an advocate involved. (this is a risk,but if no one ever says anything about these people, they will think their behavior is okay and it will never change for the better)

John R. said...

Of course, not knowing the exact situation and details, this is hard to comment with complete certainty. However, I would advise the people who contacted you that they remove the man from the "home". (Is he still alive?) If so, find another alternative. They should do an immediate report to whichever authority monitors this "home" in order to rescue the other people who live there. Second, bullying, disrespect and psychological abuse is considered either illegal, against regulatory rules and/or punishable via sanctions, fines or other corrective action plans...this particular "home" should be disbanded and the man in their care, of mention in this post, deserves a safe and respectful environment regardless of HIS attitude and behavior. Services for people who need them must be safe.

Sher said...

I will never understand how staff can demean, belittle, yell and make demands of people.....in their own homes! I run across this every day in our agency. Staff, who are paid to support people who need support, think it's perfectly fine to yell, punish, mock people in their own homes. No one comes into my home and does that to me, let alone someone who's paid to be there! My theory, and maybe I'm jaded, is that people who require support are considered just a little less human than the rest of us and therefore are the targets of the frustrations that could never be released on the fully human. It angers me to no end that staff who are supposed to be there to advocate for people supported are the biggest offenders. Where did we go off the tracks? Where did it become OK to treat anyone like this, let alone vulnerable people? I disagree with that exhaustion, a bad day, stressful people is an adequate excuse. My theory is that if you can't leave your issues in the parking lot, you need to not come to work that day. Take a sick day, take a leave, but DO NOT come to work and accept a pay cheque to abuse and do harm! You have no right!

I think the friends of this person should make some general inquiries starting with the person in charge on the floor. Make their concerns known...."We've noticed that there is a fair bit of shouting, not listening to people, etc., going on. Is that a regular thing or has something happened that we don't know about?". That way, you've identified the problem and started at the source. Then they can go further when the problem continues and go to management, knowing that the front line people are aware of the concerns. I also think that there should be some way to involve the people supported so that they can speak for themselves....if it's safe.

It's a terrible thing to witness the bullying of people who often can't stand up for themselves. It certainly highlights the blackness in the hearts of those doing the bullying. It's even more terrible to witness it and walk away.

Tamara said...

I'd email you and ask what to do. :-) Just kidding ...

My mom's in a nursing home - has alzheimer's. We go frequently. I've never seen anyone mistreated - not even the ones doing "bad" stuff are talked to in a mean way. It's not about how much money you make; it's probably more about training and who you are as a person.

If I saw something like this with people who are caring for my mom, I'd tell them that it wasn't acceptable. Depending upon the situation, I might tell them loudly or I might pull them aside. It would have to be a judgement call.

If the abuse seemed to permeate the facility, I would report it to whatever agency governs it. And I'd report it again and again until it stopped.

If it seemed more isolated, I would feel more comfortable reporting it directly to the administrators of the facility.

I would also visit often and at different times. Talk to as many people as I could - other family members, the people who live there. Figure out exactly how serious the situation is so I could give good information to the authorities. And, like someone else said, band together to stand up against the abusers.

Maybe I'm overthinking it, but I don't think there's a simple solution. You have to keep at it until it's fixed - or move him to another facility (after you've checked it out more thoroughly.)

Anonymous said...

I was delighted to see in the first comment posted, from Julia, 'Try to see the unique human being in every person. Cared for or cargiver'. I don’t know how it is elsewhere but in the uk there have been lots of programmes on tv ‘exposing’ abusive care with hidden cameras, and also programmes showing the strain and pain of families who are carers at home.
Caring is hard, hard work. It’s heavy and it’s often messy and it hurts. We do it because we love people. When it becomes beyond our capacity to keep the people we care about close, in our care, we delegate caring to others. I think we have to take responsibility at this point, and not ‘expect’ there to be caring carers. People do care work for money to keep their families, or sometimes because they get something special from being a carer- their wings unfold, or maybe they are tripping on it in a bad way. They don’t do it because they love the individuals they care for.
I think an answer to the dilemma, possibly an idealised one that’s just to think about and not to replicate, is on the Archers on the BBC where Peggy has befriended and used her community connections to support Ilana and her family, Ilana is a carer at the nursing home where Peggy’s husband Jack lives. Jack has advanced Alzheimers and moved to the care home when it wasn’t working for anyone with him living with Peggy any more.
Ilana certainly started out as a ‘good’ carer. Now Ilana is part of Peggy’s network, we could call it family of choice, and Jack is part of Ilana’s family.
Maybe the message here, is, love is the answer. The love you have for the person in the care home has to extend to the people of the care home, the others who live and work there. Tough love, that speaks up and acts when people mess up. That says when things are wrong. That appreciates when things are right. That treasures the humanity and individuality of each person.

Bubbles said...

As someone who assisted an elderly aunt with a brain injury to a retirement home this past year... in my experience, if the person doesn't have money... as apparently this gentleman doesn't, then youre in a position of requiring a subsidized spot, which in some communities are few and far between. Typically, the places that still have subsidized spots available wouldn't neccessarily be your first choice, thats why they have beds available! It's a frustrating system... even though there are support agencies... it is often left to family and friends to advocate and do most of the work. Fortunately the staff have been kind and professional, at times however, they don't tolerate my aunts extreme behaviours in the best manner and I believe in their lack of training and skills set her off. What options do we have outside of complaining to the director? Not many... Doesn't help that my aunts behaviour contributes and is challenging to deal with... I think being through the process has left us feeling so beat down that we don't have much oomph left in us to battle... I however have no issue pointing out to staff directly when I feel their contributing to the problem and when they need to be more tolerant of my aunt.... I guess if their behaviour was abusive I would report them to the city/county that funds their subsidies and then leave it in their hands to follow up....

Colleen said...

Dear Dave:

I think that bullying is not acceptable ever. If they treat these people like this in front of witnesses, how do they treat them when they think no one is looking? The fact that people are afraid of repercussions if they report is very telling - these are bullies who are targeting very vulnerable people.

I think that this man is in terrible danger. Isolation will make the danger more acute. He needs his friends to make a commitment to his safety by visiting him regularly. If they cannot do this then they need to recruit others who will.

Further I think that they need to document what they witnessed and take it to someone in authority within that organization. I think that they need to demand a response by a certain date or they will go to the police. In fact what they witnessed sounds like verbal and psychological abuse to me and in Ontario, when someone witnesses abuse to a vulnerable person in care, they are supposed to go directly to the police.

I do not accept that these are overworked overstressed support workers. They know the lines they have crossed. They need to be accountable for crossing those lines. They will not be held accountable until someone takes action. If not the men who called you then who?

I will look forward to your answer

Karry said...

I have seen this at the agency I work for. I have approached the staff and asked them if they need a break, and also assisted with the person who needs care. I have also gone to a supervisor. However, it's entirely different if you are not employed there.... It's still important to say something, but whether to address the staff person, their supervisor, or some outside advocacy group would depend on my feelings....

Anonymous said...

Sometimes people are not aware of how they sound to others. This is an issue that should be brought to the attention of the administration, who would be able to better train the staff in tone, volume, rate, etc. when speaking. If, after that, there is not some change in care giving, there should be a system in place that allows folks to anonymously report abusive situations involving seniors; that outside organization would be able to do their own visits and investigation to determine the appropriate action to best serve the needs of the individuals receiving services.

Taking out your frustrations about job conditions,or life in general, on others is never okay. Whether family or paid care giver, no one ever has the right to make someone in his/her care feel small just to feel a sense of power and control.


Anonymous said...

First and foremost, such behaviour must never be minimized. There's a big difference between staff being a little less patient than we might hope and a culture of abusiveness that allows multiple staff to yell at, bully and ignore multiple people they are entrusted to care for. The fact that this went on in front of these people is just evidence that the staff see nothing wrong with their actions.

Folks in care are not all going to be sweet and compliant. In fact, when dealing with elderly people who may be dealing with dementia, for instance, the nature of their diagnosis may mean they are much more inclinded to be suspicious, accusatory and resistant to care. The people who work with them, however, are obligated by law and common decency, to refrain from abusive behaviour, at the very least.

In my opinion, speaking to individual staff in a "home" that has a pervasive culture of abuse, is a waste of time. The problem is not one person having a bad day...it's a team of staff who feel it is acceptable to treat people with disrepect and worse, even in the presence of an outside observer. I think going to the very top of the organizing would be the place to start. If that yeilds no result, the funding body would be my next stop.

In case you think I'm staff bashing, I AM staff! The truth is, some of us are abusive and have a vested interest in asserting power and control and some of us, I hope most of us, are genuinely intersted in providing the best possible support and care for all those we serve, regardless of the challenges they may face or present.

Faery said...

Hi Dave,

Over here in the UK we have had a couple of high profile abuse cases come to light.

The first was Winterbourne View, a residential home for people with learning disabilities. A member of staff witnessed horrific abuse and made several complaints to both his managers and to the CQC (who are supposed to inspect care homes) but they were ignored. He eventually took his complaint to the BBC. BBC sent a Panorama journalist to work there undercover wearing concealed recording equipment. The footage was then featured in a programme, the home has been closed down and the abusers arrested and are facing prison.

More recently a lady thought that her elderly mother was being abused in an old people's care home. She set up a camera hidden in an alarm clock and recorded the abuse. This footage was also featured on a BBC Panaorama programme.

I'm not suggesting that this couple set up hidden cameras (although it's an idea!) but I do think that if complaints to the management and to whatever governing body is in charge of inspecting this place are ignored, the next step is to contact the press.

Abuse like this is never acceptabl, however tired, over worked or underpaid you might be. You should never take this out on other people, especially not the vulnerable people you are supposed to be caring for.

I really hope that this situation reaches a happy conclusion. I look forward to hearing an update on this.

Liz Miller said...

I would call the licensing folks and report it, asking them to keep your name out of it.

Ettina said...

I'd see if they can talk to the loved ones of the other residents - eg if they see others visiting while they're visiting - and ask if they've noticed the problem. If so, maybe a bunch of them could get together and complain as a group. That way, it'll be hard to single out any one person, and many people complaining will carry more weight.

Other thoughts are to consult the media or the police, or both. (Is the behavior they're witnessing against the law?)

Anonymous said...

I find it very worrying that the staff was so used to this kind of behavior, that they act that way even when they had witnesses. I'm looking forward to hearing your ideas, Dave.


Rosemary said...

I too was thinking that if the staff acted this way when there were visitors, how much worst might they be acting when no outsiders are there. Also, since the staff didn't seem to mind bullying and not acting in a caring matter in front of the visitors, perhaps (heaven forbid) they think they are behaving properly.
I think their conduct has to be reported . The staff and those in charge may need some workshops and training.

Dave Hingsburger said...

I am in a hotel with very, very, slow internet. Please forgive me, I'm going to respond tomorrow afternoon when I get home. I don't like not following through on a promise. But, then, I'm enjoying the discussion. This took me twenty minutes to type in ... I timed it.

Jen Nealon said...

I think this might be something for them to look into, considering inspections are unannounced...the home need never know that someone has 'reported' them, thereby protecting residents against any unsavory repercussions.

I feel that regardless of how stressed or underpaid/overworked the workers might be, there is no excuse for taking those problems out on other people. We are professionals, and part of that title comes with the expectation that you are aware of your limitations and can step back when you are unable to provide the care your are there to give.
It's a very tricky situation, however, because while this must be addressed, it's difficult to do so without unintentionally causing more difficulty for the lives of those receiving support.
I hope your friends can find a solution that holds potentially abusive caregivers accountable, without endangering the health and safety of those in the home.

Anonymous said...

It might not be possible to move the gentleman (although I suspect that may be the best outcome from what is described) however one of my concerns is that families tend to just "hand over" their relative to care agencies. We get busy, jobs, family, it is hard to visit, particularly if our relative is declining in some way.

Just because someone is in a care home doesnt mean we stop being carers, the role might have changed but we are still important. We need to visit, visit and keep visiting, get involved with the staff and the unit. Get to know other families who visit, get involved in the fund raising activities.

One of the units I visited was trying to set up a residents families group - only 2 people turned up.

Other units were unwelcoming and smelt of urine.

The unit I wanted had a waiting list, there were people milling about, cakes, tea, coffee available to everyone. Decorations up and staff smiling and talking with relatives visiting and caring for them as well.

I think abuse happens when there is no one there to see it. Staff morale is important but it is never an excuse for abuse.

Dave Hingsburger said...

Hey Y'all, you did very well. I found this hard because of several reasons, mostly because these people were't part of the elderly guy's circle, they just were bystanders who helped out. They didn't have a past relationship with him and didn't want a future relationship with him. They worried about him in an abstract way. I don't mean to portray them in an unkind light, I thought that what they did was an amazing act of community - in a world where people watch without assisting when someone gets assaulted - someone intervening and putting themselves out. They gave up an entire weekend and helped him deal with all his stuff. After gentle questioning I found out that they didn't want to begin a lot of visits with him - they were strangers. The options were few, I thought. I asked them to, and they did, contact an advocacy agency for the elderly and explained their concerns. Someone was assigned and went out the next day. The fellow now has an advocate assigned to him. I think that is astonishing in and of itself. That's all good. Really good. My advice was simple, "a fifteen mintue visit takes up less time than an hour of worry" they were already spending time worrying about him. If, right now, you don't want to visit for him, visit for your own reasons. Knowing he has people coming, knowing he isn't alone in the world, changes staff behaviour - it does! It doesn't have to be daily. They don't have to do it together. But they can give him now, what they'd want then. If they continue to see what they saw, take notes, jot times, dates and behaviour and then take action.
Is it the best advice ... no ... I think many of you did better. What was interesting in reading through the advice was how forbidding and intimidating systems are - even to those who will for good.

(my honest fear is that my advice may make them regret they helped in the first place)

Baba Yaga said...

Why? Power, fear, power, ignorance, power...

The relationship between circumstances and 'choices' is tricky. On the side of choice, you tend to find that in organisations gone bad, where the organisation seems really to create abuse and bullying, there's always the odd person in whom respect is so central that he just doesn't get sucked in. (Those people usually leave for healthier organisations.) & sadists have always gravitated to the back wards, where no-one cares to investigate too closely.

But circumstances shape one's choices, too. The premisses on which one bases those choices, the power one feels one has to choose, the kind of choices one can imagine or defaults to under pressure, one's tolerance for wrongness and one's ability to remember that there can be rightness. Some of us have very limited imaginations.

Most people, the ordinarily decent ones who seem generally to manage respect and kindness, don't seem to come naturally to true respect, to regarding others as fully human, no matter what: they (we) tend to regard others as fully human, up to a certain point of stress, exasperation, incomprehension, power imbalance. Most people, the ordinarily decent ones who don't positively enjoy the abuse of power, certainly aren't deeply aware of power relationships; and I believe anyone can be blindsided by an unperceived power relationship, betrayed by unawareness into trespassing and assuming the trespass to be right.

The ordinarily decent can be derailed by a moment of misperceiving the power relationships, or of task-focus or clock-focus instead of person-focus, or by a system which represents relationships so wrongly that there's no healthy basis for them except by flouting the system altogether. A good few alleged 'care' organisations are so structured.

... I still wonder whether the very empathic, civilised and unhierarchical psychiatric nurse who nonetheless physically chased me (with two of the office staff to assist), out of the building, ignoring my blind terror, looks back in horror at that appalling lapse, or has rationalised it away. & whether he has any notion what kind of lapse it was.

Had he been working for an organisation where respect truly was central, the clock-focus and fear of my terrified divergence from the expected would probably never have got so out of control. But under pressure, he lapsed into the understandings of the system in which he worked which (in a disguised way) was based on control.

I like your advice that "a fifteen minute visit takes up less time than an hour of worry". It's perspective. I'd be inclined to use visits to take notes, to be passed on to whatever supervisory body exists: that way, it's not just one person protected, but all.