Since April 2020, Dorothy “Dot” Holder, age 93, has resided in a small assisted living facility in Charleston, South Carolina, two blocks from the home of her son Robert Holder, who visits every day. “My mom has dementia,” Holder says. “She has no memory; it’s shot.”
The facility has 22 residents, and even the director helps with day-to-day care. As a result, the director can answer any questions about how his mom is faring, Holder says.
But for the previous three years, Dorothy lived in an assisted living facility with hundreds of residents, two hours away in Columbia, her hometown. It wasn’t always easy for Holder to find out if his mom slept through the night or was participating in activities.
“The director of nursing didn’t have an intimate knowledge of my mom’s care because they just have too many other things to do,” Holder says. “So, the only way to get reliable information was talking with the certified nursing assistants.”
He cultivated a relationship with one particular CNA who had taken a shine to his mom. “And then I was able to get the straight story.”
“The nursing assistants and the activity professionals are the most important people for families to have a great relationship with” in long-term care facilities, says Jennifer L. FitzPatrick, a licensed clinical social worker in Chester, Maryland, and a gerontology instructor at Johns Hopkins University. “The direct-care staff truly understand your loved one’s moods, idiosyncrasies, likes and dislikes and what is going to make them feel better when they are having a bad day.”
Ask appropriate questions
The activities staff organizes games and other activities. Resident assistants and certified nursing assistants help loved ones with activities of daily living (ADLs), such as eating, toothbrushing, bathing, using the toilet, dressing and moving around. But they cannot answer all of a family’s questions.
“Resident assistants and CNAs are not in charge of the medications, [medical] procedures and treatments that a resident is receiving, so it is important to remember that there may be some questions that need to be directed to the charge nurse,” says Pamela Truscott, senior manager of clinical and regulatory services at the American Health Care Association/National Center for Assisted Living, an industry membership organization. “However, if a family member wants to know how the resident is eating, sleeping or doing with their activities of daily living, the resident assistant and CNAs are a great resource.”
That kind of communication depends on families taking the time to build relationships with staff, experts say.
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Treat caregivers with respect
Establish a rapport with the CNAs and other assistants, and ask their opinions on issues of care, advises Sherry Perry, who has been a CNA for 34 years and is the chair of the board of directors at the National Association of Health Care Assistants, which advocates for CNAs and other caregivers. Perry notes that it is a big responsibility to care for vulnerable older adults. “We see them in a way that nobody else sees them … we’re providing the most intimate care ever.
“Talk to them and treat them like a human being, like someone with expertise, because a lot of times CNAs don’t get treated like that,” continues Perry, who lives in Lebanon, Tennessee. “We get treated like we’re undereducated, like we don’t know anything. And that’s not true at all.”
Families also need to understand that direct-care staff are responsible for many residents at once.
Ask — don’t assume — whether they can speak to you at that moment, Perry emphasizes. “Nursing homes are not one-on-one care. For example, today I have 13 patients,” she says. “So, it’s basically triage, and if someone is going to fall, for instance, I’ve got to get to them first. Just give me a few minutes and I’ll be happy to talk.”
“A really valuable way to communicate is to be able to thank staff for something they’ve done, something specific,” says Catherine Ray, a geriatric care manager in the St. Louis metro area. That may require asking your loved one for examples, she adds.
And don’t be shy about praising an assistant to higher-ups. “Sending a letter to the person’s boss and copying that individual or calling the corporate office to say what a great job they’re doing means so much,” says FitzPatrick, author of the book Cruising Through Caregiving.
Sometimes, check with management
Ask managers about bringing gifts or paying tips, experts recommend. Many will prefer that families do not single out individual staff members.
“If family members want to bring a gift, it would be best to bring something that can be shared by the entire facility, such as a box of cookies, individual bags of popcorn or a fruit basket,” Truscott says.
Families should be particularly careful about friending staff on social media or calling or texting their cellphones.
Rebecca Harris lives in Brooklyn, New York, and, during summers, in northern Michigan. Her 81-year-old mother, Madelyn Harris, who has Alzheimer’s disease, lives in a skilled nursing facility in Fayetteville, Arkansas. Harris gets to visit about once every five weeks. Communicating with staff she has befriended on those visits is critical to her ability to manage her mother’s care, Harris says.
“I want to know if she’s been sleeping, how she’s feeling, does she seem happy,” Harris says. And so she has friended some direct-care staff members on Facebook. “They have lives and children, and so social media allows me to get to know them.”
But Harris is careful to speak about her mom only through direct messaging so that those conversations are private.
Even so, FitzPatrick advises families not to use social media to communicate with staff. “It can muddy the relationship,” she says.“What if a staff member posts something [on Facebook] and you don’t comment on it, and then they get angry or have hurt feelings. A better approach may be to ask the administration to arrange for you to talk to one of the direct-care workers once a week by Skype.”
The last thing a family would want is to get an employee in trouble for violating rules against using social media or personal cellphones to communicate with family members, FitzPatrick says.