What I Learned in a Nursing Home: It’s All About Relationships

Alice Li during her stay in a nursing home

I’m a third-year medical student at Mount Sinai School of Medicine. Last summer, I spent two weeks in a nursing home in Maine as part of the Learning by Living Project, where medical students are admitted to nursing homes as residents to gain insight into how it feels to be an elder in a nursing home. The observations that follow are taken from the journal I kept while I was there.

It is really amazing how much the CNAs know about the people they take care of. They are what make the medical system tick. They bring up names and stories and what the residents did that endeared them to the CNAs. They know what each resident’s preferences are. Those they really love become family, and when the resident dies, they shed tears. That is the kind of relationship that I hope I will have one day with my patients.

Yes, sometimes they are spit upon, peed upon, hated upon, but other times they are loved, appreciated, and always needed. They all have favorites. Some even have favorite floors – for many, the dementia floor, it seems.

They have helped me to see that dementia isn’t so scary. It isn’t the great unknown that lots of people are making it out to be. It is just about making a conversation with someone who isn’t really coherent. It can be downright entertaining. It may be tragic for the family, who knew the person before the dementia, but parts and pieces are still there, since memory is only part of what made up the person. Yes, there are those who have forgotten everything and needs to be fed, washed, toileted, etc, but majority of them are just quirky.

There is a lot of death and dying, and it is heartbreaking. A resident died in a CNA’s arms because the family couldn’t deal with it. I really hope that CNAs will receive formal coping with death themselves. They talked about how it is not possible to not get close to residents. They know it, too, when they start to get close to residents. They tell themselves it is just work, but when you see someone every day and you laugh, you cry, you care for them, they just become family.

I just chatted for about 2 hours with the CNAs of this floor about the best and the worst part of their jobs. Here’s what some of them said.

Best:

•   The relationships and families you build here
•   The people working with you when everyone is working together

Worst:

•   The insufficient teamwork
•   A lack of formal team training for small and big things
•   Lack of support for new CNAs
•   Complete chaos and disconnect between what the patient is like on the charts and what they are like in person between here and the hospital, in terms of their needs, temperament, compliance, etc.

I think about all the talk about how doctors need to be compassionate. Maybe what doctors really need to do is live here and observe the relationships between people, whether they are the care giver or the receiver.

I think the most incredible fact that I’ve learned here is that people are people. I can’t say much about learned helplessness here because I don’t think I see it here. Instead, I see people treating people. And they aren’t doctors, just friends.

Alice Li