This job, caring for grandparents around the clock, paid $7.25 an hour — above minimum wage, the hiring manager boasted, which at the time in Texas was set at $5.15. This really was a great job, the other aides told me. It was steady work that came with a lunch break and health insurance for your kids, things that were lost on me. I was an anomaly in that job: a teenager, in college, white.
The facility was broken into seven distinct hallways, with two aides assigned to each for their shifts. Each hall housed 15 or 20 residents, making each aide responsible for eight to 10 residents. There were no firm state or federal regulations on what the resident-aide ratio should be (and still aren’t), but 10-to-1 is considered easy street in most facilities. To be clear, this is still a terrible ratio. Imagine having to wake, bathe, dress, and hand-feed 10 elderly patients who need total assistance: buttoning shirts, brushing dentures, changing bedsheets for those who will have inevitably soiled the bed in the night. Imagine having to complete it all in an hour or less. It’s an impossible task. Which is why dentures don’t get brushed, baths don’t get offered, nightgowns are worn at the breakfast table. Now double it to 20 patients; this is what you have in many facilities across the country.
Hall One was for rehab patients, those who had suffered strokes or broken bones and were simply there until they could regain strength and rejoin the world (if they were lucky) or move to another wing (if they were less so). Hall Two was reserved for patients with dementia and Alzheimer’s. They were mostly ambulatory, which was great for those residents who liked to wander and terrible for the aides who had to keep track of them and everyone else. Halls Three and Four had a mean reputation, old folks who bit and scratched. One resident in that hall was a literal shit-flinger, known to keep her hands hidden until an aide was close enough to smear. Many of the Black residents were placed on these halls, creating a racist chicken-or-egg situation where the care was poor because the residents were difficult and the residents were difficult because the care was poor. Hall Five was a tale of two extremes — people who either needed a ton of help or none at all. Any aide was happy to get that assignment, though, because the extremes averaged out to something sustainable. Hall Six was for the bedridden.
It was a toss-up whether Hall Three, Four, or Six was the worst assignment for aides — it depended on whether you felt like taking insults or blowing your back out. But Hall Seven was the hall everyone wanted: elderly people who were mostly lucid, mostly independent, who just needed a little help and some company. Hall Seven was heaven. And because I was young, too small to lift alone, and white, I got assigned to Hall Seven every time. (...)
The entire elder care system operates on a mantra of out of sight, out of mind. Medical residencies feature little to no geriatric training; the profession experiences an annual turnover rate of 60 percent. A 2021 study found that turnover in nursing care facilities skyrocketed during the COVID-19 pandemic, with the average annual rate in 2020 at a shocking 128 percent. In other words, if you apply for a job at a nursing home, you can pretty well count on getting hired. For someone with little access to education living on the edge of poverty, this fact is a godsend. Yet, caveats lurk. There are countless reports of understaffing in nursing homes, underfunding, limited regulations where it matters (staff pay, patient ratio) and reels of red tape where it doesn’t (hours of required paperwork that detail how many ounces of water the resident drank, but not how they cry at night for their children). And while you may be trained on how to wipe from front to back, there’s no training to prepare you for the psychic toll of watching your people suffer until they die.
It was a toss-up whether Hall Three, Four, or Six was the worst assignment for aides — it depended on whether you felt like taking insults or blowing your back out. But Hall Seven was the hall everyone wanted: elderly people who were mostly lucid, mostly independent, who just needed a little help and some company. Hall Seven was heaven. And because I was young, too small to lift alone, and white, I got assigned to Hall Seven every time. (...)
The entire elder care system operates on a mantra of out of sight, out of mind. Medical residencies feature little to no geriatric training; the profession experiences an annual turnover rate of 60 percent. A 2021 study found that turnover in nursing care facilities skyrocketed during the COVID-19 pandemic, with the average annual rate in 2020 at a shocking 128 percent. In other words, if you apply for a job at a nursing home, you can pretty well count on getting hired. For someone with little access to education living on the edge of poverty, this fact is a godsend. Yet, caveats lurk. There are countless reports of understaffing in nursing homes, underfunding, limited regulations where it matters (staff pay, patient ratio) and reels of red tape where it doesn’t (hours of required paperwork that detail how many ounces of water the resident drank, but not how they cry at night for their children). And while you may be trained on how to wipe from front to back, there’s no training to prepare you for the psychic toll of watching your people suffer until they die.
There are plenty of reasons to see nursing homes as sad, neglectful places, and I’m sorry to say that my experience working in one did not change this perception. But I can also say that the perception has less to do with staffing, funding, and regulations (or lack thereof) and much more to do with our country’s fear of death, its rejection of vulnerability, and its subsequent inability to see the inherent dignity in people — especially in their vulnerable moments.
Dying is a vulnerable act. There’s rarely the serenity we see in deathbed scenes. Instead, the pragmatic, much of which we view as shameful: the slow loss of function, the bowels loosed in bed, the sweat stench, the tonguing mouth, the hallucinatory terror, the whimpers, the rattle. You spent all this time learning how not to trip over your own feet and here you are now — older than anyone else in the room and forced to use a stroller, swaddled in diapers. You revert to a time when your mother held you, only your mother is gone. Your children (if you remember them) don’t visit, and why is that?
Shame stems from a fear of disconnection. We live in a culture that increasingly connects old age with disconnection rather than dignity. Our friends pass on, our families visit less and less, we spend more time alone, helpless to arrest the breakdown of our own bodies. It’s no wonder the elderly — and those who care for the elderly — are steeped in a hot tea of shame. And because shame repels, it is no wonder our policies and priorities for eldercare are so lax as to be nearly criminal. Out of sight. Out of mind. (...)
One of my favorite tasks at the nursing home was supervising the 4 p.m. smoke break. Many of the residents were lifetime smokers and no nursing facility was going to curb that habit, so after breakfast and before dinner we’d wheel everyone to a small, glassed-in room off the corner of the dining hall. It stunk like only a room solely used by smokers could stink. Staff hated covering smoke time because of it. But it was also 15 minutes in which all you had to do was light cigarettes and make sure nobody burned themselves. I volunteered every time.
Dying is a vulnerable act. There’s rarely the serenity we see in deathbed scenes. Instead, the pragmatic, much of which we view as shameful: the slow loss of function, the bowels loosed in bed, the sweat stench, the tonguing mouth, the hallucinatory terror, the whimpers, the rattle. You spent all this time learning how not to trip over your own feet and here you are now — older than anyone else in the room and forced to use a stroller, swaddled in diapers. You revert to a time when your mother held you, only your mother is gone. Your children (if you remember them) don’t visit, and why is that?
Shame stems from a fear of disconnection. We live in a culture that increasingly connects old age with disconnection rather than dignity. Our friends pass on, our families visit less and less, we spend more time alone, helpless to arrest the breakdown of our own bodies. It’s no wonder the elderly — and those who care for the elderly — are steeped in a hot tea of shame. And because shame repels, it is no wonder our policies and priorities for eldercare are so lax as to be nearly criminal. Out of sight. Out of mind. (...)
One of my favorite tasks at the nursing home was supervising the 4 p.m. smoke break. Many of the residents were lifetime smokers and no nursing facility was going to curb that habit, so after breakfast and before dinner we’d wheel everyone to a small, glassed-in room off the corner of the dining hall. It stunk like only a room solely used by smokers could stink. Staff hated covering smoke time because of it. But it was also 15 minutes in which all you had to do was light cigarettes and make sure nobody burned themselves. I volunteered every time.
by Lisa Bubert, Longreads | Read more:
Image: Peter Rubin. Photos by SolStock and Kenneth Faulkner/Getty Images.
[ed. My mom went through this, and it's my worst nightmare. Our politicians and medical community are less than worthless when it comes to helping/allowing people to die with dignity. See also: Emergency Room Notebook, 1977 (Lucia Berlin).]
