5. Unraveling the Threads of Trauma, Grief, Compassion Fatigue and Burnout in Elder Care

Join Dr. Lorie Hood (affectionately called Dr. Lorie by her fans) in the inaugural episode of The Traumatic States of America. She will set the foundation, boundaries, and rules for what she envisions will become a microcosm of our society. A group of both non-likeminded and likeminded people who are able to communicate through civil discourse to begin to heal the collective trauma we have all suffered.

Transcript

spk_0:   0:00
And now stay tuned for another episode of the traumatic states of America. Welcome to the traumatic states of America. Our main goal is to begin to heal some of the trouble we have suffered both individually and collectively. I am your host, Dr Lori Hood. And I will be talking with people from all walks of life who has suffered trauma in its myriad forms. Military veterans, attorneys, first responders, football players, stay at home moms and many more. We will hear how trauma has not only affected them, but their families and communities as we take an in depth look at what science has to offer and what can be done to prevent, mitigate and help recover from trauma way. Welcome to the trend of states of America. And today we have John again with us. Welcome, Jonah.

spk_1:   1:10
No.

spk_0:   1:11
Nice to have you here, So let me introduce you. Um, you have over 40 years of experience in the long term care facility profession, and you're a trained nurse. You currently work is a physical therapist assistant. And you started in high school at what, 16.

spk_1:   1:32
Yeah, yeah, yeah. It was a way to get out of high uh, class.

spk_0:   1:36
We went to

spk_1:   1:37
a allied health course in college

spk_0:   1:40
with

spk_1:   1:40
every hour in the morning.

spk_0:   1:42
So that's how you got started?

spk_1:   1:44
Yeah. At the back in the day when it was just a nurse is a We weren't certified back then. And then there was a really good this. Let's go hide the college and be a nurse. And here I am.

spk_0:   1:57
Nice. 40 years later. Yeah. Sam, um, can you tell me how you've seen the industry change?

spk_1:   2:05
Oh, my God. Um, I remember back in the day before, insurance was such a big deal. Uh, if people were going out of town, they take their grandmother, their mom, to the hospital to be watched for, you know, forever longer. If Mom's needed a break, they just went to the hospital for a week or so, you

spk_0:   2:29
know,

spk_1:   2:29
and then they can't know. And then it was in the mid eighties, where we started with the classifications series and the course Now I can't remember what it's called, but the different things, like came for pneumonia, fractured hip or something. They started Billingham Different way Billingham and charging and paying for him differently through Medicare and such things with insurance, and then we've just moved on. Up to now they are talking about is the person goes in for a knee replacement surgery. The government will give the doctor who is doing the surgery off a chunk of money, and then it's up to him to disperse from their whether you know, whether it's physical therapy, going into rehab, to do some follow up and get stronger and everything that, uh, they get him in and out really quick. I mean, people used to have babies, and they be in there for several days, and now they can walk out 24 hours later.

spk_0:   3:38
Right? Right, So So the so The way that things are coated and build to the insurance company and that the shifted how insurance, um are the way insurance has evolved in our country has it sounds like put a lot of stress on not only, um, patients with their families. Is that okay?

spk_1:   3:59
I mean, it is really stressful and, you know, conditions like a stroke or something. Many cares that, um I think it's 100 days.

spk_0:   4:09
I heard

spk_1:   4:11
what they call Medicare A, which is 100% paid your 1st 100 days. And then after that, you flip to Medicare, be and then you get a certain chunk of money. Eyes. It's like, last I heard it was like $3500 and you have to split it between the three, um, therapies speech. There be occupational therapy and physical therapy,

spk_0:   4:35
okay. And stroke recovery can last for a really long time, right?

spk_1:   4:40
Correct.

spk_0:   4:40
OK, so So give me an idea of how long you know someone comes in with a stroke and they've got 100 days paid 100%. How long does the normal average stroke victim take to recover fully

spk_1:   4:57
It just all the pins. I'm actually doing a seat community education course online, uh, for stroke certification. And, um, you know, it just depends on the patient. A younger person may not take very long, and but an older person say they they have, um, a Feige, which means they can't talk, or they might have global aphasia, which means they don't understand anything you're saying. So when they talk to you may get, you know, word jumbles. Okay, so you're trying to explain, but they can say they can walk really good So speech has to go in there and work with, um, or you make it somebody that's got hamming praecis, which is one side, uh, is paralysed, and you're having to work with balance and sitting, being able to set yourself up out of bed, been able to sit on the side of the bed, being able to stand up. And in the meantime, you know, they may have, uh, that plasticity. You know, where you see the arm pull up and stuff like that.

spk_0:   6:05
Okay,

spk_1:   6:05
so you have to try to work with that, and then you then they have difficulty swallowing.

spk_0:   6:11
Oh, Mom. And,

spk_1:   6:13
um, you know, they are silent Asperger's, which means when they swallow, go down into their long

spk_0:   6:18
Oh, my goodness. Even I'm feeling overwhelmed a little bit here. So I am thinking about, um, that that after 100 days you send my parent or my aunt or elderly person I love home to me with very limited amount of, um, Medicare coverage, I suppose. And it's up to me then to to take care of all this stuff.

spk_1:   6:46
Um, uh, generally, they try to get some home health coming in

spk_0:   6:50
right and

spk_1:   6:51
home help may show up a couple of times a week, whatever they did deem necessary. And, um, you know, Yeah, when they come out of the hospital, the the idea is, if they're doing really good, we sent him to an acute rehab, which is focuses on nothing but that, and they get three hours of therapy a day. And all of that is to get a photo where they are functionally able to get themselves out of bed and functionally able to go home. Right? And, you know, we try to set the families up. At that point in time, you can have home health come out and you may get a physical therapist or, you know, occupational speech. Whatever their highest need is. Like I said, you you have a certain cap. And at that point in time, they have to write a letter to Medicare. Teoh, um act or more mining.

spk_0:   7:51
Okay, so it so I So I'm confident so, as a trauma ologists, I'm like seeing stress and, you know, potential trauma here. Um and so there are also people who don't have a family,

spk_1:   8:03
right?

spk_0:   8:04
And so what happens to them if the If the money runs out for lack of better words.

spk_1:   8:10
Uh, they usually stay at the nursing home at the, you know, long term care facility and a certain point time if they have care. Workers, caseworkers that, um, monitor this their usual. Usually a social worker there in the facility, and they handle that kind of stuff. And at mid point that they'll start trying to get him over to Medicaid,

spk_0:   8:35
you

spk_1:   8:36
know, to help pay for that. And then they just stay there at the at the facility.

spk_0:   8:42
My gosh, how sad, you know, and, um yeah, Okay. So, wow, I'm feeling really sad right now. Um, yeah, it is. Yeah. So kind of This is what this podcast is really about Is trying to sort of explore, um, the experience of populations who are sort of silent. One of my podcast guest said that hurt the population. She works with his invisible, and I feel like this population is as well. I want to shift a little bit. So what I but I would like to focus on is your experience or the experience of people who are are dedicated to helping. Um, you know, our elderly. So you know, I'm just hearing about it, and I'm I do feel sad. And my thought Is that us? Someone who has worked closely with another human being? Um, you know, you you urine, urine, close contact. You're rooting for them. You're you're hoping to get better. You're giving them your skills and your education in your experience and your expertise and to watch the system for lack of better words. Um, sort of Let them down. What is that like for you?

spk_1:   9:55
Frustrating, very frustrating. And you you try to go to bat for them as much as you can. But unfortunately, once they have used up their therapy, um, they're not allowed to come in and use the gym and stuff until they reach a point where, um, maybe they're not transferring as well. They're not walking as well. Are they following a couple of times with triggers? Something for them to come back to therapy. And that's how we get them back.

spk_0:   10:26
It's a reactive system then. So basically, the system past two, um, have something has to have happened to the individual to prove to the system that they need ongoing therapy. Correct on,

spk_1:   10:42
uh, the Nice thing is A to the facilities. They also have what they call a restorative dinner. So once we get them, um, ready to be just getting close to be discharged from therapy, we write up a little program and we give it to restorative medicine. It's up to them to do these X certain exercises with them. Um, walking, whatever is necessary is what we call a maintenance program. Uh, those were good for somebody like with Parkinson's. You know what Parker says? It's a degenerative disease, right? And so, um, you try to keep them. If you discharge him, you know that they're going to come back because it's degenerative. So if you can, Medicare also does pay for a maintenance program. So where they come in and try to do, you know, a couple of maybe once or twice a week? Yeah, it's outpatient therapy to keep them strengthened. If they're in a facility, they may be seen to three times by the restorative nurse to try to maintain their strength. Their functional mobility reduce all risk.

spk_0:   11:56
Right? Right. Okay, so So I kind of got us back off track again, But tell me about your experience. So have you ever sort of hit the wall?

spk_1:   12:08
You're yes. Sometimes. Because when they come in, you know, your you're getting somebody that fairly fracture their hips and they have to come in for rehab to be able to go home because they have stairs, they gotta climb. They they're living a two story house and their bedrooms up there. And so these people there used to be very independent, and maybe they're a little bit grouchy. Or maybe they have dementia and you're trying to get them being able to go home, and sometimes they're resistant.

spk_0:   12:45
So you may be asking them to do things they don't really want to do

spk_1:   12:48
here

spk_0:   12:48
in the moment and in their frame of mind. So

spk_1:   12:51
right, you know, and you may go down and say, OK, time for therapy. And they're like, I don't want to Well, I'm sorry, but that's why you're here. You know, you run into that, and

spk_0:   13:06
there's a concept I want to put out there to the audience because I think it's really, really important. And I know that it it, um well, I think it was first studied on nurses, so that would you know, you would qualify for that. But, um, it's called compassion fatigue. And, you know, for those of you who are listening, I'm sure you know what this is, right, Jonah? Yeah, yeah, yeah. So for our listeners who don't know what it is, compassion, fatigue is a condition characterized by emotional and physical exhaustion leading to diminished ability to empathize or feel compassion For others, it's often described as the negative cost of caring. So compassion fatigue is something that sort of runs sort of dovetails with the work I dio, um, and the way I sort of like to think about it is someone who has to care for others to such an extent that they're not able to care for themselves. So it's It makes sense that you know, people in your profession. Jonah, um, nurses, um, psychotherapists, sometimes coaches those of us who ran to help doctors, emergency responders, those of us here in the helping fields. That's our job. And we usually choose that job because we're pretty good at it. But there comes a time when the amount going out, the amount of caring that you're doing does not get balanced by enough coming in either you don't have a partner or a friend or someone that can sort of feel you back up. Or you may have kids at home or you may have something else that needs your care animals. So I mean, I think this is a really important concept, and I think it has to do with this podcast because I think there's not a huge line between compassion, fatigue and extreme stress and into trauma potential trauma. So if you could, do you have any stories that you could share with us about either yourself or someone else who maybe with somebody else and maybe you could describe what it was like toe watch someone sort of lose their ability to care because they had given way too much and they weren't getting anything back in their life?

spk_1:   15:14
Well, yeah, um, there have been time, even when, uh, I was working. And sometimes they they're short handed or something like that and or you get attached to a certain patient and you're really invested in working with them and working with them and you walk them even though you're doing the best and the nurses air doing the best, you begin to watch them declining, and it's really sad. And then you go home and there's really no one to chat with. And and you go back to any CIA day after day and then and you see not just them but others come in and at a certain point time you wake up in the morning and you like, I don't want to do this no more. I can't delay there in bed and cry because you got to go to work and you know what you're gonna walk into,

spk_0:   16:09
right? So what do you do with that or what happened? What have you tried that? You know whether it's worked or not. What have you tried?

spk_1:   16:17
Sometimes I just have toe, uh, I have to go for long rise in my car with the radio wand, listening to my favorite music with, you know, knob turn firmly to the right. I've learned about meditation. Um, sometimes call, um, one of my friends. And just like, you know, here I am. I'm gonna event be prepared, and that's what you do. And that you a little bit more. It cleans, cleaned it out. So you're able to go back and do it again. You see it a lot of times in families that, as you said, like with patients that go home and they're caring for their family all the time in the morning from wife has to go to work, you know, and the husband have to go to work. And when they come home, they have to handle the family member, and it they just never get a break from anything. And then and sometimes as the patient begins to slip, they don't see it because they're right there on it. And then, um, if you happen to notice, somebody has gone through something like that. Suggest to them, you know? Hey, let's bring a home health person in here so you can get a break. There's respite care where you can send them somewhere so the family can take, like, a of couple weeks or so whatever they need to get it back together. Sometimes

spk_0:   17:47
it is hard and and you know, that's why so I've sort of identified through this conversation with you there. You know, several places where people are just sort of given more than they could handle. So the patient clearly, um, the family of the patient. And then I would also think that those who are members of the family, like Children or dogs or cats or pets or extended family. If if the primary caregivers of that elderly patient when the patient comes home are giving everything to the to the family member who needs it most, probably then others suffer as well because they're not getting much and and so it's sort of like a ripple effect. But then I also can see where you and your co workers are under extreme stress. And while it seems like you have the ability to in the knowledge to reach out and you know what works for, you know, not term for lead, for me to the right, um, you know, you know what works for you, and probably the 40 years experience has helped you figure that out. But, you know, I would think that young people coming into the system as it is now you described in the beginning the podcast, how it's changed over time. Um, they're probably not prepared for all this,

spk_1:   19:08
Frank. And and I see that was young nurses that come in, they're fresh out of school, and they're all excited. Yeah, we're gonna save the world, and they get stressed out by the the load, the weight of what's going on. And so, um, I tried to tell him, Hey, you know, take a deep breath. Yes, nothing bad is gonna happen. And when you get done, figure out a way that when you walk out the door, the facility, you leave it at the facility, you've got to learn to make boundaries between where you're working and when you're home, because you can't take work at home. And consequently, you can take home to work.

spk_0:   19:51
That's beautiful.

spk_1:   19:51
That's a real line you have to learn to do. And, um, you know, cultivate activities outside of work that is brings you pleasure and helps you relax and wind down whether it's hiking, biking, swimming, you know, going to the y in C a to do number classes, you know?

spk_0:   20:12
Yeah, it really doesn't matter. Some sort of outlet. Yes, some sort of outlet, right? Yes,

spk_1:   20:17
you will get you. And then you may have a favorite person that, um, passes away, and that's hard. And then you got to come back the next aid.

spk_0:   20:29
Um I and look at an empty bed or somebody else in that bed? Yeah, I just I'm envisioning it. There's just so many cues and triggers and things that I can you know, after talking to you, I can see. So I just I just want to commend you for from someone who does the psychologist side of this, You know, the fact that you brought up boundaries and that you leave, you leave, work it work and go home and find, you know, that's that's so beautiful and that you're teaching young nurses those those skills because it's super important. And I think it's becoming more important, you know, with Kobe 19. And what's going on today. Um, you know, you guys were placed in a really scary spot, but, you know, you're still care workers, and, um, you know, it's it's

spk_1:   21:16
grew up to go

spk_0:   21:17
still. Gotta go. Right. Okay. Well, Jonah, thank you so much. Um, this was really enlightening to me. I think I'm gonna have to go for a walk just to kind of shake. Wow, You're

spk_1:   21:30
most welcome. Your very well. Nice chatting with

spk_0:   21:33
you. That was John again. A woman who has devoted over 30 years of her life to caring for the elderly in our society. I wasn't quite sure what she would share with us when I asked her to come on the show, and it took me a little while to digest everything that she told us I had to sit down and be still just to grapple with what seemed like strands or tentacles that came from one event. The decision to place an elderly loved one in a facility in addition to all the things that Miss Gan explained, like how insurance has changed over three decades and the cap on its benefits, the stress on family members, nurses and other facility therapists. There are so many other things that creates dress and the potential for trauma. One of the things in the research literature that I feel is particularly important with regard to the decision to place an elderly loved one into a long care facility or even a Reaper rehabilitation facility is the idea that we don't just grieve someone after they die. We grieve the loss of a life as we knew it. That and guilt, even if there's no real decision to be made even if those who love an elderly person know that the very best care that can get us within a facility. My guess is most people feel really guilty about having to make that choice. I could go on and on until you describe how I see these threads or tentacles crapping around one another until they become an indistinguishable ball of stressors. And I don't know about you, but I'm going to be thinking about this for a long time to come. And maybe if you come across someone who has loved when an elderly facility, you might just ask them how they're doing. Thank you for listening to the traumatic states of America. If you would like to learn more about Dr Lori Hood, go to Laurie Hood. Ph d dot com The Traumatic States of America podcast is produced and engineered by Band Olive Productions at their studio in Washington, D. C.