Being a Caregiver, Not Just Giving Care: Dorie Haley's Story

Dorie Haley has worked in the healthcare field for twenty years, and has experienced just about every job from CNA scheduling to laundry. However, in her heart and above all things, she is a caregiver. Her long history and varied experience give her a great deal of perspective on the nature of the work, the relationships that form between client and caregiver and between coworkers. Dorie brings 100% of that perspective and experience into the supervisory position she now holds at a group home. Her knowledge combined with her role as an advocate makes her an asset to the work community of which she is a part.

A Long History

I became a CNA in 1980. When I first started, it actually paid better to work as the evening cook in the kitchen at a local nursing home, so I worked in the kitchen and filled in on the floor when they needed me. Then I took the med tech course in 1990 and started at another nursing home. We were working short-handed all the time. I can remember there was one point when I passed meds for an hour and a half as fast as I could and then was responsible for four residents. During the med pass, when people needed to go to the bathroom I'd take the time to assist them. I couldn't say "no" if I were already in the room, could I?

After awhile I traded in med teching for the nursing staff scheduling position. This was around the time supplemental staffing agencies started popping up everywhere. They would provide us with staff, but we had to pay more for it. We were paying $23 an hour for CNAs even though they were only making $12/hour. We were paying $40 an hour when we needed an R.N. A lot of good CNAs left to work for the agencies; I can't blame them for wanting to make $12 an hour instead of $8. It was getting very expensive to fill shifts. Then we got a new Director of Nursing. She took over the scheduling and I became the ward secretary. I made sure the residents' charts contained everything they were supposed to have, so that when the State came in, everything was in order. I also covered for the receptionist and for purchasing when vacations were taken. I even worked in the laundry for a couple of weeks when they were short-handed.

One of the best times I had working at the nursing home was when we created the Alzheimer's Unit. Their staff was specially trained because there are so many things to learn about Alzheimer's and dementia. I remember the black-colored toilet seats in the unit. We had learned in our training that to these patients, shades and contrasts -- like spots on the floor -- appear as holes. Therefore, it was a struggle to get them to sit on the toilet because they believed we were trying to push them into a hole. When the color of the toilet seats was changed, these behaviors stopped. That was my favorite unit because everything was accepted. If someone was wearing someone else's clothes, we didn't mind. Eventually, we just put those clothes back in the laundry. We didn't say to people, "This is not 1942, you're not 17 years old, and you don't have to report to your mother where you are." Whatever year the resident was in, that was where we were, too. It made things so much easier.

Right now my dad is in a similar unit at the Veterans Home. They do a good job there. It's clean and they all get their own room. It's a large unit, but it's designed in a manner that enables the residents to do a lot of walking. The hallways loop around so there are no dead ends. Each side of the unit has a dining room and a fenced in courtyard so that if anyone goes outside, they won't get lost.

It's hard because my Dad has Parkinson's. He started to develop the dementia that goes along with Parkinson's and Mom could no longer take care of him. He would be up all night, sun downing. Once in a seven-day period Mom slept only 16 hours. She was having health problems associated with exhaustion. Dad was aware of what was going on to an extent, so he agreed to go to the Veterans Home. I don't know which is harder -- having your mind and not your body or your body and not your mind. I think Mom thought he'd be there only until she could get rested. She'd go home to sleep and be right back in the morning to get him washed, shaved and out to breakfast. When Mom took an out-of-state vacation, my family took turns going in and taking care of Dad. I found I missed the caretaking. I missed being hands on.

Being on the receiving end of the caretaker spectrum is difficult. I feel I need to make excuses for the CNAs. Mom will say, "They didn't shave Dad today. They didn't brush his teeth, and his bed wasn't made until after lunch." I would explain how they would have to prioritize. Sometimes it's shaving versus ambulation, oral hygiene versus toileting eight or ten residents every two hours, bed making versus passing nutritional supplements. On the other hand, though, Dad is there to be cared for. When he was able to take care of himself, he shaved every morning, washed before meals and always brushed his teeth. It's an issue of dignity.

Mom is a hairdresser. There is no room for excuses in that profession. What would happen if hairdressers prioritized? Would it be acceptable for them to leave your hair longer on one side than the other because they were busy? How about the excuse, "Sorry, I meant to get right back after I applied the highlighting solution." Would any of us accept that?

In this profession you have to have empathy and respect. There are those who are caregivers and those who are there just to give care. The caregivers are the people who are born with it. They know what you need before you ask for it. They fix your pillow because it doesn't look right. They think, "How would I want to be treated?" And then there are those who are there just to give care. They come in and go through the steps without having that natural empathy. There are people like that everywhere, no matter where you go.

A New Start

Now I am working in a group home for adults with mental retardation. The facility has four beds, and right now we have only two ladies. That's very different from what I was used to at the nursing home. At the nursing home I had so many people that I was trying to take care of: to toilet every two hours, make sure they ambulated, had eaten, their clothes and hair cared for appropriately, nails cut, etc., etc. The group home is more laid back. We go to the movies, shopping and out to eat. It's slower paced and a lot better.

I had spread myself very thin at my old job. I had been in the nursing home scene for more than twenty years and getting burnt out. I was ready for a change, even if it meant a huge cut in pay. Money isn't always everything. At first I was hired as relief staff and still worked at the nursing home two days a week. The regional manager knew me from the nursing home, and when there was a need for an assistant manager at one of the homes, he knew I had the skills for it. I've been supervising there for about a year and a half.

I think my medical background has helped me in my job now. One of our former clients was a sixty-year-old gentleman with Downs Syndrome. When his health began to fail and his level of care increased, we were able to keep him home because I could share with my staff the care he needed. They learned to give bed baths, how to transfer safely and how to feed someone with a swallowing disability.

Our staff was eager to learn how to keep him home with us, where he was well known and surrounded by people he knew. We were his family, and we didn't want him to go to a place where he might be one of eight residents getting care each day. We were one on one with him, even though it was more work for us. Our staff was proud that we could keep him home. Outsiders weren't so supportive. There were former employees who said we weren't qualified to take on that level of care, and he should be in a nursing home. I stuck up for my staff; they did a great job. And with his loved ones around him, he died in his own bed at home.

Being An Advocate

I don't know if I consider myself an advocate, but I always stick up for people when I think something is not right for them. I was actually fired from the nursing home for telling a new employee to speak up for herself. They called me a non-team player. I've always been an advocate for my clients, but it's since I joined PASA that I really feel like I'm trying to make things better for the staff that I work with.

I serve on the PASA Leadership Council. Once a month I meet with others from all over the state. We're advocating for direct care workers and we hook up with other organizations to get their support. We're just doing anything we can to make direct caregivers' lives better. We've put out surveys at different functions asking CNAs and direct caregivers what they believe needs to be changed to make their job better. Most of the trouble, we found, is that workers don't have health care and are not paid well. There were also many of those who claimed that even above that is the absence of respect and credit they deserve for all the work they do. We would like our supervisors to respectfully listen to what we have to say. My CNA instructor told us, "You are the eyes and the ears of the charge nurses. You need to be on your toes. You are better qualified to know what's normal for your resident because the charge nurse doesn't see them as often as you do." So what happens then when the charge nurse isn't listening to what we tell her?

I really do love my job, even though during the busy times I might say to myself, "Why do I do this?" I've just finished taking a tax preparation course. There's good money in that, but could I sit behind a desk all day and not be emotionally involved? I don't think so. I have a lot of responsibility at my current job -- with reports due, answering to the State for everything and keeping up with staff issues, but I don't mind. I feel invested.