I’ve been teaching people about aging and memory disorders for more than a decade now, almost two decades. I believe ongoing employee training is essential for a compassionate and competent workforce. Furthermore, especially given the variety of disciplines within healthcare, I recognize many learning styles; and as a trainer I need to accommodate everyone’s abilities to help them succeed.  I tell my students all the time, “If YOU can’t get an A, then I’ve failed.” I genuinely mean it.

So how did my colleague and student Hannah change my perspective?  She helped me see how insulting I had been.  Yes, it was unintentional, but knowing this one secret may make all the difference for you to transform care of older adults. Let me share the story:

I was raised by entrepreneurs and professionally developed under some excellent leaders. I’ve learned from some of the best in fields of aging, education, health and wellness, long term care, and management. I had been taught why employees don’t do what they are supposed to do, and I tried to adapt all of my presentations to ensure they knew WHAT, WHY and HOW to do it.  My why is directly connected to my grandparents, especially those with dementia, so it is part of my mission in life to make the world of senior healthcare better than we’d ever imagined it could be.

In 2016 a colleague approached me with a fabulous idea and invited me to partner with her. Along with some others, we developed the ECHO Dementia Summit and we eagerly awaited our first session. January 2017, we welcomed our inaugural class of students and together we started to explore what we could do to improve the world of dementia care – from our own perspectives and disciplines – from community care management to assisted living to interior design to long term care.  At that session I met Hannah, a certified nurse aide with more than 20 years experience. I told her she was absolutely the most expert in the room. I meant it then, and I still think so now.

As we started to explore our true “why” (a la’ Sinek), Hannah and I spoke about why she does a job that most people could barely stomach. With daily insults, personal care nightmares, unappreciative and demanding managers (except for whomever had the wisdom to send her to ECHO!), limited training, and only occasional smiles from clients or a thank you from the family member, how could she do this work for 20 years? Her answer was one I had heard many times before.

Hannah endures all of this to honor her mother.

Hannah’s mother was a single mother of 8 children (Hannah is the youngest). Her mother did this kind of work too.  In case you work in a different field, nurse aides withstand hours of being on their feet, stooped over people while changing urine and feces soaked undergarments. They have to protect themselves physically from resistance of confused people who don’t FEEL sick, and therefore cannot fathom why they would be in a “hospital” looking place. Nurse aides are taught to be task focused and to work quickly and efficiently – and then someone like me comes in and tells them “For culture change, focus less on tasks and more on the person.”  We tell them they need to develop a RELATIONSHIP with someone with whom they may have NOTHING in common, or maybe if they do, the only relationship they can understand is where the subservient “aide” tells the “customer” what to do and when to do it – and then we are surprised when they report ongoing “behaviors” of the clients. Nurse aides have to know which resident has a specialized diet, and how to make liquids “nectar thick.” To prevent dinner time arguments, they have to remember which prefers to sit near the TV and which will start singing, setting off a chorus of “SHUT UP” from the rest of the table. And someone like me comes in and says, “For excellence in customer service, you need to smile – let them see your smile,” and “Approach is everything.”

It’s not that what I was saying was wrong.  In fact, for good customer service, smiling, having a smile in your voice, and your approach does make a huge difference.  And it’s also imperative to develop a rapport with someone to provide excellent care. If the client does not trust the staff, the client will never feel safe and well. These sorts of issues are essential for quality of life.

What I did wrong was assume I understood Hannah’s why. I never really listened when someone told me they did this work because of their parents. I never understood what it means to do something to HONOR your mother or father.  MOST OF ALL I never realized that when I told them to do something a different way, I was telling them that what they were doing was wrong – and that for some people, the message I taught was that, until that moment when I enlightened them (indeed…), they were DISHONORING their mother or father.

Now I challenge you to consider how we can transform care of our frail elders, in home care, assisted living and nursing homes, without insulting staffs by telling our experienced teammates that they have been dishonoring their parents by doing it the way they were taught.  Maybe it’s just language/semantics? Maybe we need to re-conceptualize the entire “culture change” paradigm.  Enlighten me as Hannah has.  Thank you Hannah for teaching me how we can honor each other.

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