You know it must be morning

You know it must be morning because a stranger in scrubs comes into your room with a wheeled toilet-looking chair and turns on the light. It's still dark outside. They usually don't wake you until after the sun comes up. What's wrong with this person?

The stranger approaches your bed and says something you can barely hear. You don't even bother to respond. You've been here long enough for all of them to know you don't hear as well as you used to. Your hearing aid is in the drawer next to the bed. The good ones know to give it to you before they try to talk in a normal voice.

This one looks as if she has escaped from the sanctuary for the terminally patient, standing there in ill-fitting yellow scrubs with huge, glaring, brightly colored flowers all over them. She repeats her statement just a bit louder. "Morning, Martha," you hear, "I mere to tape you to getta sour."

Ah. They have sent in a nutcase to torment you. You finally figure it out - you have died in your sleep, and this is hell.

"Go 'way."

The girl brings the wheeled toilet-looking chair up to your bed and lets down the bed rail. "I mug it chew up, Martha."

What? Is she threatening to bite you? No, she's threatening to get you out of bed all ready. For crying out loud. "Why? I don't want to get up." What is wrong with this person? It's not morning yet. If you had your teeth in, you'd bite her.

The girl, ignoring your protests, puts one arm under your knees and the other under your shoulders and counts to three, and then suddenly you are spinning and screaming and maybe even falling, and then you are sitting on the edge of the bed, hanging on for dear life and panting like a dog. It feels as though you are sliding off of the edge. Your legs don't support you any more, and neither does your tummy. Why has she put you in this terrible position with no back support? "Lord help us!" you gasp, but your protests are ignored.

"There now, that wasn't so bad," the girl says just as loudly right into your ear as she wraps something binding around your waist. Well, that's her opinion, you think. In your opinion, it was quite bad indeed. What the hell is she doing to your waist? It's really uncomfortable.

"I mug it chew into the sour hair."

Chew into the sour hair? What the hell is this twit trying to tell you? Why can't she just talk like a normal person? Think of what rhymes... oh, yes. That thing sitting over there is the shower chair.

Shower chair! She's going to put you in the shower chair. She's going to give you a shower. Great. It's still dark out. You don't want a shower. You want to sleep. What is wrong with this person?

"…gay bell to lit you. Sis gonna fee ya bit tie."

Thank God you have learned to translate gibberish, or you'd never understand what this kid is muttering.
You figure out the thing around your waste is the gate belt, a narrow strap of strong fabric the aides use to assist in lifting people. It's just awful. That thing cuts you in half, or at least it feels like it!

"No! You're no' s'posed t'use zat on me. Go Look. 'Sin my shart." It's so hard to talk without your teeth. You know you aren't enunciating well. You just can't without your teeth, and your mouth is dry, too. You guess if she expects you to understand her, this girl ought to at least try to understand you.

She doesn't.

She tightens the horrible strap around your waist like a misplaced noose, seemingly oblivious to your protests. Working her fingers under it, she begins speaking again, "One, two, THREE!" and you realize this waif, who you outweigh, is going to lift you by herself! You grab her arms.

"Hey, don' do dat!" you shout as she hefts you like a sack of fruit. "You can'treat me like dis."
She's speaking again. You can't hear well enough to understand the words, but the tone sounds terribly condescending, and strained at the same time. She is probably trying to reassure you. It isn't working.

You decide to speak more slowly in the hope that she will listen better.

"I'm not an animal," you remind her as you cling to her arms, "I'm ninety one years old." Your bones are fragile. If she drops you...

and then she sets you down on that shower chair. It is as uncomfortable as it looks. It feels as if you are going to fall through it onto the floor, butt first. The girl continues to chatter witlessly at you as she proceeds to remove the flimsy excuse for a night gown the other girls dressed you in last night. Now, in addition to being half asleep, irritated, nervous, and upset, you are naked and cold.

You bark at the young idiot, "I'm freezin'!" and she puts a very thin blanket over you, tucking it in under your arms. She pulls you foreword and wraps the blanket around your back. It hangs over the edges of the chair. You can feel it overlapping against the back of your butt, though it doesn't feel like much coverage. The draft from below takes away all sense of being covered.

You ask for your teeth. Displaying the ignorance of the young and healthy, the idiot reminds you that you are going to the sour (shower), not bed fat (breakfast), as if the only thing teeth are good for is chewing your food. She doesn't care a thing about your dignity.

While you sit there squirming uncomfortably on the shower chair, she puts a pillow case over your feet, then without asking, roots around in your dresser to find your soap and shampoo. You have to remind her to get your powder. Good God, was she going to dress you without it? Your skin would rub itself raw in an hour. She digs in the drawer again, and pulls out the bottle. She puts your toiletries, along with two towels and washcloths, in a bowl in your lap.

This is when you realize that you are going to be wheeled down the hallway to the shower room in this getup.

"Is this thing closed in the back? I feel a draft."

You are patiently assured that you have full coverage. It doesn't feel like it, but that is probably because of the hole in the bottom of the chair. What the heck kind of stupid chair is this, anyway? Whose idea was this? Whoever it is, that person should be shot.

Without warning, the girl pushes the back of the chair, wheeling you forward. You let go of the bowl and grab the arms of the chair to keep from falling out. She continues until your feet are almost up against the door. She leans over you, pushes it open, and wheels you out into the hallway. In the hall, another resident is being wheeled back to his room.

Dear God, there's some poor guy who gets this treatment even earlier? You hear his protest as you move down the hall. "Uuuuuuunnnnnnghhhhh." From this, you realize why they get him up so early. If he can't tell them how he feels about it, then he's not complaining, is he? Then, you remember that you're naked under that blanket, being wheeled down the hallway next to a man who is also naked under his blanket. Horrified, you turn your face away from him.

The twit wheels you right up to another door. Then, she has to back up because this one opens out into the hall, just like it does every other time it is approached.

Idiot! But she doesn't see you shaking your head.

She parks you in the middle of a small, tiled room with a drain in the middle and a shower on the wall. It has one of those nice attachments with a hose so the shower head can be operated by hand. Those are wonderful when you're using it on yourself, and you can direct the warm water over your back when you get cold, and keep it out of your eyes. They're not so great when someone else is doing it. You can operate the shower yourself, if the aid would just turn your chair so that you could face the handles and give you the shower head. Instead, she has your back to everything.

You sit there for a few moments in silence, then you hear the sound of something being placed under your chair. A moment later, there is the sensation of hot water hitting your skin.

"OW!" You give the twit an indignant look. "Hot!"

She adjusts the temperature. The water is now uncomfortably warm, but you're afraid if you ask her to adjust it again, you'll get a cold shower. You endure the heat as she runs the water over your shoulders, down your back and chest, and over your arms so that your whole body is wet. The air on your wet skin makes you feel cold, which makes the water feel even hotter.

Now, she hangs up the shower head and you sit there wet, cold, and shivering. Yay.
You hear her say, "Tipper Ed bat."
Huh?

In the moment it takes you to understand what she's asking you to do, she decides to prompt you by putting the edge of the palm of her hand on your forehead, near the hairline, and applying a bit of pressure.

"OW!" Does she not realize that you're old? What kind of an idiot puts pressure on an old person's neck? You push her hand away.

"Now Martha, let's not get combative, ok?" This time she speaks well enough to be understood.

Combative. The label sends shivers up your spine. If the aide decides you're being combative, she'll call in one of the male orderlies to hold you down while she finishes your shower. You glance at the call button on the wall. Unnoticed moments ago, it takes on a menacing appearance.

"You're hurting me," you point out, speaking slowly and struggling for clarity. "Don't push on my head. And you're not speaking clearly. I can't hear you enough to do what you say. And I can wash myself if you just give me the handle."

The aide is standing with her arms crossed, looking at you. You sigh, and tip your head back, as she apparently intended. She washes your hair with rough movements.

She picks up your arm by the wrist instead of asking you to raise your hand. With the other hand, she scrubs your armpits vigorously, as if you were a sweaty teen instead of an old woman. You hardly even wear deodorant any more. The experience is repeated on the other side, and then the girl unceremoniously lifts each breast and scrubs under those as if the skin there represented a second set of armpits. You feel pushed around and dehumanized as she scrubs you like a thanksgiving turkey instead of treating you as a live woman. The indignity is further visited upon your nether regions as this girl you don't even know soaps you underneath with a washcloth, which she wrings out after, and tosses across the room, out the door, and into a laundry hamper. This whole time, she hasn't rinsed your hair. You can feel the suds working their way down your forehead, and you have to close your eyes to avoid getting soap in them.

There is a sharpness to her voice now, but at least she's loud enough for you to hear, "Ok, Martha, I need you to tip your head back for me again."

Your neck feels sore, but you tip your head back anyway. The hot water cascades over your forehead, running back through your hair and over your eyes. You hope she doesn't get it in your nose. The last thing you need is water up your nose. You'll have a sinus infection by tomorrow.

You lift your head so that the water won't go up your nose, and she rinses the back of your head. The water feels burning hot on your skin as she runs it down your back and over your body, once again manually lifting your arms and your breasts as though you can't do anything for yourself. Then, she sticks the shower head under the chair and sprays your butt and your sensitive parts with hot water. You can't help yourself this time.

"OOOOWWWW!"

You grab both arms of the chair and lift yourself up in discomfort. It rolls a little because the aide forgot to apply the break. She yells at you.

"Martha, don't! You can't get up. You'll fall!"

You reply, "I'm not getting up, you nit-wit! You're burning me!"

"Now, Martha, it just feels hot because your skin is wet. It's not even red. You're fine." And with that, she totally dismisses your discomfort and irritation. It doesn't matter to her. Why should it? She can't feel it.

She grabs the object from under your chair. You see that it's a bucket. Why the hell would she put a bucket under your chair?

She steps into the little bathroom attached to the shower and dumps the contents of the bucket down the toilet. You hear something solid fall with the water, and you realize that while she was showering you, you must have moved your bowels. You're not normally incontinent, as long as you get regular trips to the toilet. This must have happened because she didn't take you to the toilet before dragging you in here and dousing you. Still, you're embarrassed. And cold. Why hasn't she wrapped you back up again?

The aide notices you shivering, and pats you down with one of the towels. She uses the other one to wrap over your thin, short hair. Then, she wraps you up in the same blanket and pillow case as before, and wheels you back out into the hallway, where it's much chillier than you remember. A gasp of surprise escapes you. Worse, she rushes back to your room so fast there's a breeze on you. You tense up, trying to keep warm.

The twit has the same problem outside your door as she did outside the shower door. What are they teaching these kids in school now? Act before you think? Sheesh.

Finally, you're back in your room. There's a split second of relief before you remember that she has to lift you again. Fortunately, this time there's another aide there. She is just finishing helping your roommate get dressed. She offers to help lift you back on the bed. When your aide says, "No, I can do it," the other aide reminds her that you are a two person lift. "Look," she says. "It's in her chart."

Again, you can't help it. "Toll you!" you crow.

It's much easier this time. The two girls lift you together, one on each side, onto the bed, still under the blanket. Then, one supports your shoulders as the other lifts your legs onto the mattress. Your aide thanks the other girl, who says, "You're welcome! Any time. Call me when you're ready to get her into her chair." Then she leaves. You know she won't be back.

You realize... oh, dear God. Now this twit is going to dress me. It's going to be quite a day.

* * * * * * * * * *

I worked with that twit (and the helpful girl) for six months at a crappy, poorly run home in a small town. When I talked to the head nurse about the bad aide's poor treatment of the residents, I was told to mind my own business. There were a lot of other concerns with the home. Management didn't make sure we were properly staffed, and we were often illegally shorthanded. Care was neglected, and residents suffered. I contacted management, and got no assistance with the problem. The same occurred with corporate.

Eventually, after trying the company's chain of command, I went to the Ombudsman for the Elderly. The state took over the home. I was retaliated against, but the job didn't pay enough to fight for, and I was able to get another within days. The state straightened out that particular site, but for every facility, there's at least one twit, and there's at least one Martha.

Martha isn't the memory of a real person. She's a conglomeration of memories of different residents. Her health problems (hearing difficulty, weak legs, sensitivity to heat and cold, false teeth, and not so flexible muscles) are pretty normal with the aging process in most people. They're also not well understood by the young. It's tough for a twenty year old to understand that a woman's teeth can be a key to her dignity, that simply nudging the forehead can give an elderly person whiplash, and that it's not just volume, but enunciation, and even the tone and timbre of your voice that determine whether a person hears and understands what you've said. It's too easy for people in health care, in the rush of trying to squeeze too many tasks into one shift, to forget about the needs and the humanity of the patient.

It's important to remember that aging doesn't eliminate human rights, human experiences, human perceptions, and human emotion. The elderly are not lifeless shells that can be treated without deference to their personhood. They deserve the same consideration as those of us who are still able to fully stick up for ourselves.

One way to help in achieving this is the use of home health care. By changing the setting and style of care-giving, the health industry can also change the perception of the patient. In her own home with her own family, Martha is not just patient number 3 of 14. She is seen as someone's wife, mother, sister, or grandmother, and maybe as several or even all of these. Even without other family present, in her own home, Martha's story will be told by her decor, her possessions. Her home will reflect her style.

In addition, the home health care system is not as hectic and fast paced as the nursing home system. Laws in my state say one aide can care for 14 people simultaneously. Under a system like that, an aide gets little time with each patient, and none of them receive the full focus of her care.
In a home health care setting, the aide gets a smaller number of patients to care for, and is at each patient's house for a set time frame.

At a nursing home, assigned tasks are the focus of the job. The patient is almost like a product. In a home health care setting, the patient (or the family) is the client. There is a whole different relationship there. If the client is not satisfied with her care, she can ask for a different aide. She does not have to put up with the lack of care and dignity. She has a choice.

Increasing the home health care system, and reducing the size and scope of the residential nursing home care system, would allow for a more focused effort to monitor and manage the bedside manner of nursing home personnel, to improve the rate of prevention of abuse and neglect in nursing care facilities.

Beyond the human aspect, home health care is also a money-saver. Martha can live on her own or with her family. She can eat with at home, and sleep in her own bed. She may only need an aide for a few hours a day, maybe even only a few days a week, depending on the level of her family's participation in her care.

Choosing home health care over residential nursing care could reduce spending thousands of dollars into spending hundreds. At the same time, the industry also creates jobs, as elderly folks who have a tough time at home, but who just aren't ready to give up their independence, hire home health aides to visit their homes a few times a week to help with tasks that have become too much of a challenge, like bathroom cleaning, or to act as a "spotter" during self-care processes that become dangerous with age, like showering.

... just some things to remember when you read or hear about officials in your state either considering or taking action to allow Medicare coverage for home health care.