1:15pm July 28, 2012

I think I just discovered yet another reason for the mortality rates in nursing homes.

So I get most of my services from an agency that treats me well. And then there’s the VNA. They provide bathing and intimate care. The VNA does its best to resemble a nursing home without the walls and stuff. I know people who get all their services from there and it’s truly dismal.

So an LNA comes over today to do all the physical assistance they normally do. Mostly involving washing me and applying medications to my skin. It involves a lot of grabbing me and moving me around.

Most days, I interact with them. I say things. (Which, for me, involves typing on an iPad that’s seriously clumsy in that posture in bed.) I move my body more than is required of me. I visibly react to things they’re doing and saying. I pull away or squeal when they dig their fingernails into my vulva. I tell them when they haven’t dried me enough, or when they miss a spot. I pull away when they put things where they don’t belong. It doesn’t look like a lot at the time, but it’s interaction.

Today I feel sick. My chronic nausea and lack of appetite is flaring up for reasons unknown. I’m not throwing up, but I’m sluggish as all hell. And I feel gross all over. I’m not thinking clearly. Things are not good, and they look not good to anyone who is paying attention.

When the LNA went through her routine with me, I didn’t interact with her at all. My eyes stayed half closed the entire time. I let her lift and manipulate my limbs without interfering. I didn’t squeal or pull away when she put her fingernails in places fingernails where fingernails just shouldn’t go. I can still feel the pain from that. I didn’t alert her to wet areas she didn’t dry. I did the bare minimum of movement required of me.

Any staff person who normally works with me, from outside the VNA, would have noticed something very wrong immediately and asked me if I was okay, to make sure it wasn’t something serious. In my current physical state, the effort of replying would have bothered me, but I’d have understood why they had to find out. I’ve got several conditions bad enough to put me in the hospital. They have to make sure it’s not that, because I sure as hell won’t, not when all I feel like doing is going as inert as possible.

(My body is intent on proving my point. It just spent several minutes getting me to do absolutely nothing.)

But when the LNA was here it became clear she was relieved. Relieved because I am just one more body she has to contend with. And my feeling sick meant that she could just interact with me as another body she could clean.

(Insert another period of doing and thinking absolutely nothing for a few minutes instead of writing.)

This made it easier because I did not resist her moving me around. I did not give her any instructions. I did not tell her she did anything wrong. This made her physical interactions with me easier and more efficient.

(Insert another inert period.)

Nursing homes are organized more for the convenience of the employees than for the people who have to live there. So is the VNA.

Certain ways that people behave when sick with some kinds of conditions (including ones that are life threatening) are so much more convenient for staff, than actually having to interact with us as people. This way we behave is especially true of people with communication problems or severe cognitive or physical impairments, where lethargy may be the only outward sign of something fatal. And people among that group who are more likely to get ignored than others include both women and people of color.

I can totally see the less ethical staff in a nursing home welcoming the ease of taking care of people in all the routine ways, that comes with those kinds of illness. When someone’s too lethargic to interact much, they’re usually too lethargic to interfere with routine care in all the ways that healthier people need to do. And some staff would see that as a relief, not a danger signal.

And when danger signals get ignored, people die. I have needed hospitalization at times when I looked not a lot different from how I do today. I’ve become really really Inert as the only outward sign of things like having an organ fail on me. The first step in learning whether I’m in danger, is to ask me how I’m feeling. I may not always give the best answers – but it’s the first step of many, not the last.

(Insert semi-inert period.)

And yes. As far as I know, I’m okay. I need to keep a really close eye on this though, because things like this can change.

(Insert another inert period.)

The number of ways that places like that can put us in danger. It scares me and it pisses me off. Like our lives are less important than the convenience some people experience as they maneuver(*) our bodies around.

I had better go because my body wants to be inert. Or at least more inert than writing long(*) involved posts(*). So, yeah, stopping now. But this is a seriously fucked up situation that is life and death for people who are(*) in situations where most or all of their caregivers have this mentality.

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(*) Yet another inert period.

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