In theory, practice is like theory.

But in practice, it sure as heck isn't. Yesterday was my first day of clinic, at a real, live, longterm care facility. I am on evening shift, 1-9pm. The nighttime NAC instructor, not Betty, was our supervisor, even though she'd already supervised the day shift from 6:30 am to 2pm, since it should've been a third person entirely, Amita. Amita was stuck with car trouble a 2.5 hour busride away, so she didn't make it.

I'd come to think from Hazel's descriptions of her experience working as a NAC that I'd see a bunch of overworked NACs who couldn't possibly take as much time to practice humane care as is ideal, since they had too much to do, given a too-large resident-to-NAC ratio possibly made worse by the current economic climate and the budget cuts that have happened everywhere as a result. Instead, I saw NACs who should've been overworked, given the too-large resident-to-NAC ratio, but who weren't, because they did the minimum and took frequent and long breaks. It's frustrating for us as students, because we are each paired with a NAC, whom we are supposed to shadow and help, but the NACs keep disappearing--we'll look down the hall and see the other 4 students on our floor, and no NACs are to be found.

This has good and bad aspects. The bad are that care is performed peremptorily, minimally, and with almost no conversation or human interaction. I have seen the NAC I shadow--I'll call him Joe--joke around with a few residents, but mostly he comes in their rooms, quickly changes their briefs, wipes them, changes their clothes, and they are put in bed with no explanation or gentleness. Joe is effective, fast, safe, and self-assured, but he does not talk to or with them.

The good side of this is that, when and if I manage to get a job in a facility like this one, simply by working the hours I'm paid to work, there _is_ room and time for me to care for residents in the ways Betty has taught us. As Joe was putting one resident to bed, he was brusquely moving her limbs about and tucking pillows under here and there (essential to preventing pressure sores), and I reached down to pull the gown he'd put over her front further down her legs, so it would cover more of her and not be wrinkled. She thanked me--and before that she'd only replied in monosyllables to direct questions.

I had conversations with a few residents this afternoon and evening, and they seemed mildly surprised, and appreciative. One resident, who I'd assumed from a series of repetitive sounds she'd made yesterday must be quite absent mentally, told me she was 95, and asked about the bruise on my thumbnail. Another told me he can read again after his Parkinson's medication (L-Dopa) since it has helped him control his fidgetiness, and that he likes good fiction. _The Razor's Edge_ was his favorite novel for years, he said. He's only reading pulp fiction currently, because that's what he finds on the shelves at the facility. He hopes to move from this facility into an assisted-living facility, since his symptoms have abated significantly with his medication and he is again mobile.

Joe has brushed no one's teeth so far that I've seen. If I went two days without brushing my teeth, I'd start to feel not human. Amita, who has rented a car, suggested in our debriefing today that we touch the spot on our neck that makes us stupid, and ask our shadowees, wide-eyed, "So, I know that different places have different ways of doing things, but when do you do P.M. care here? 'Cuz I have to check off tooth-brushing on this list I have from my instructor..."

As for the briefs, all the residents I've seen so far that don't walk to the restroom by themselves wear them, which is distressing. It possibly has more to do with the trouble it is for caregivers to assist with toileting than full incontinence.

I realize I am being harsh on minimum-wage workers, many of whom are immigrants trying to make it here. Maybe they started off kind and gave up. They are kind to each other, and to me. Nonetheless, I find at clinic, as has been the case for me everywhere else, time flies as long as I'm busy, and crawls if I'm not. So today, during a few of the crawling times, I asked residents if they are comfortable and may I adjust their pillows, or if we might make beds while residents are dining... and Joe tells me "Don't worry, it's no problem." He clearly thinks I'm the type that works too hard, in a bad way, since it makes trouble for others, but I'm not there to take 30-minute breaks every two hours (we're in a somewhat far-flung part of the city--I wonder where he and the other NACs go!). Does time not crawl for Joe when he is idle? Hmmm.

A final thought: without giving up a minute of their ample break time, the NACs and LPNs on the floor I've been on could at least use proper terminology for the sake of preserving residents' dignity and self-respect. We are supposed to say briefs or Attends and clothing protectors, NOT diapers and bibs. :/