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machado: if staffing shortages and burnout mean people left sitting in diapers, we are in big trouble

people who are perfectly continent forced to use diapers. hours spent alone with no human contact. this is life on a palliative floor at a toronto hospital.

by lisa machado

jul 17 2023
read time 8 minute read
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we are failing people who need health care
are we really at that point where we we can’t allow patients dignity despite their vulnerability? getty
“who knows when they will come.”
i was checking in on a friend’s father who is in palliative care at a local hospital. when i got to his room, he was sitting in his wheelchair, legs pushed underneath the small table that he ate his meals at, looking out the window.
he said that in anticipation for my visit, a nurse had gotten him out of bed, but then mentioned that his dinner would be coming soon. he said he didn’t want to leave the room for the trip to the garden we had planned and risk missing his meal. so we sat, for around 45 minutes, trading stories about the weather and the news, when, with no dinner in sight, he said he needed to use his commode — a chair with a bowl in the centre that is used as a toilet for people with mobility issues.

he was wearing a diaper even though he was perfectly continent

that he was wearing incontinence underwear even though he is perfectly continent spoke volumes. you might say it was just another sad and depressing sign of the state of our health care system, that there are aren’t enough staff to help him out of his wheelchair to the commode several times a day. you could also call it a gross lapse in respect and the preservation of dignity.
i stepped out to ask the woman at the nurses’ station if we could have help getting my friend’s father to the commode. she looked up from the computer screen and nodded. not grumpily, exactly, but not pleasantly either. back in the room, my friend’s dad and i waited. and as a half-hour ticked by, then an hour, his knees were squeezed together tighter and tighte as things became more urgent.

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“i don’t like when they have to clean me. they probably don’t like it either,” he said, as i headed back out to the hallway to find someone to help. i caught the eye of another staff person. she was wearing a purple shirt with little pink cows on it, and had just tucked a clipboard underneath her arm so she could squirt hand sanitizer on her hands.
i asked again about the commode. a little more pleasant, she said she needed to get gloves and she’d meet me back in the room.
as i waited in the hallway for her, i had flashbacks of the years my own dad lived in long-term care, paralyzed by dementia. long before covid, the state of care was very much the same — my mom and i needing to ask repeatedly for help to move him from his bed to his wheelchair so we could take him outside to feel the sun on his face, for someone to check his temperature when we thought he might be sick, and waiting, sometimes an hour or more, to get help changing his incontinence underwear after he had had a bowel movement. nothing was more difficult than knowing that my dad was sitting in a soiled diaper, which would eventually cause a rash or sores, and i could do pretty much nothing about it.
sure, i could complain. my mother often had long discussions with the head of patient care. she also tried bringing snacks and gifts for staff, getting angry, and showering psws with compliments, but other than a few shiny surprising blips in care, it never felt like any of the residents were ever a priority. 
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back then, just like now, all of the families who had loved ones there reasoned these things away, as did the administration, putting the blame on not enough employees, too many residents, not enough funding, too much bureaucracy. families were left comforting themselves with the thought that things could be worse.
but they could also be so much better.
one afternoon, i visited when my dad was being showered — his once-a-week wash. i poked my head into the shower room to let the personal support worker know i was there and i saw him, naked and thin. unable to use his arms, he couldn’t wipe the water out of his eyes, or move the hair that was plastered to his forehead. he was sitting motionless on a plastic bath chair in a corner, his bony back curled over his knees as the psw silently sprayed him with water from a few feet away. i wondered if the spray hurt from that distance. from the air, i could tell the water wasn’t that warm and when she stopped to roughly rub soap on his back, he shivered slightly. i offered to help, but she shooed me out, saying she’d be done shortly.

if only we treated humans as gently as animals

as i waited outside anxiously, i felt nauseous. i remember thinking about the dog grooming place around the corner from my house, where the employees sing to anxious dogs as they are bathed; where the thermostat is turned up so they aren’t cold; and where every dog gets loving belly scritches, a fancy bandana and a treat when they are done. if only we treated our humans as well.

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i called my mom, talking it out, trying to come up with a way we could do his showers. the sad truth was that he was almost 200 pounds and completely immobile — we likely couldn’t move him safely ourselves. and besides, it was unclear whether or not we were allowed by the home’s regulations to take on that level of care. the wife of a man down the hall had overheard me talking and poked her head out of his room and said that it was better not to think about it too much.
after waiting for about a half-hour with my friend’s father, listening to his agitated breathing, i stepped out into the hallway again. the woman with the clipboard and purple shirt was at the end of hall, and i waved, getting ready to use my best friendly-yet-firm voice.

20 minutes is a long time to sit in pee

“are you free to help with the commode? or at least help get him changed?” i asked, crinkling my eyes so she could see that i was smiling underneath the mask i was wearing.
“we are very busy,” she said, taking a deep breath and walking quickly in the other direction. “give me 20.”
“20 is a long time to sit in pee,” i called out as she turned a corner.
just saying.
what a sad state we are in in terms of how we care for our people. not enough staff. not enough pay. long hours. burnout. i get it. but even with all of these pressures, can we not still be compassionate, empathetic and caring? could that nurse have taken a minute to let my friend’s dad know at least that he was on her mind and that she would be there soon? and sure, it wouldn’t have taken away the discomfort of holding a bowel movement, but it would have let him know that he hadn’t been forgotten and given him an idea of how long he would have to wait, which certainly would have helped with the anxiety he was feeling.

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instead, he lay with his eyes half-closed, brow furrowed, taking heavy breaths. after a moment, he said that 4:00 and onward was the worst time of day because it’s when the floor goes quiet and if you need something, you have to wait for a very long time. as he looked out the window, he commented on how nice it would be if someone just popped their head in to say, hello and ask how his day was.
“they wouldn’t have to do anything for me,” he said. “but it would make such a difference if i knew someone was here.”
ridiculous that we can’t deliver on such a simple request — acknowledging someone’s life, providing comfort, allowing these patients dignity despite their vulnerability — even if a few words is all you have time for. surely, we, simply as humans, are not too busy, understaffed or underfunded for this.

health care should be a commitment to keeping people out of harm’s way

besides, isn’t this part of the bargain? when courses are taken, degrees and diplomas framed, and job offers accepted, the deal is that you are signing up to take on one of the most important and challenging jobs in the world — to care for those who can’t care for themselves. you are committing to doing the best you can to keep people out of harm’s way, and to deliver care that is compassionate and empathetic. looking around the hospital that night, it was clear someone wasn’t holding up their end of the deal.

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and while comparing our health care system to for-profit businesses might seem unfair, what with the whole you-get-what-you-pay-for argument (and by the way, we do indeed pay for health care), it’s still worth considering for a moment that these so-called bargains and commitments also exist outside of hospitals and ltc, in arguably less critical arenas than keeping people alive, like internet service, cosmetics and even coffee.
in fact, just that morning, there was a line of about five people outside of a local starbucks. as i walked my dog past the line, a friend of mine called out from the front. she said that only one employee had showed up that morning, so things were slow. as we chatted, that one employee — looking frazzled and very stressed — came out and was handing out cookies and free mini-coffees as she apologized for the confusion. she mentioned to the guy behind us that it was supposed to be her day off after a string of days covering other people’s vacations. she also said that she was given the option of closing the store until someone else showed up, but felt badly about the people who had been waiting.

her words hung in the air as she stepped back inside the store to get more cookies and coffee: long hours, burnout, not enough staff, and yet, she still managed to treat customers courteously and respectfully. more than this, she made sure that they got what they had come for — she was holding up her end of the bargain. s he had made the choice to do what she could to meet the needs of the people waiting outside of her store.

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my dad, my friend’s father too, heck, all patients, deserve the same — attention, respect and someone doing the best they can. and if that’s too much to ask for, staffing issues, funding and burnout are the least of our worries when it comes to building a health-care system that works.
lisa machado is the executive producer of healthing.
 
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lisa machado
lisa machado

lisa machado began her journalism career as a financial reporter with investor's digest and then rogers media. after a few years editing and writing for a financial magazine, she tried her hand at custom publishing and then left to launch a canadian women's magazine with a colleague. after being diagnosed with a rare blood cancer, lisa founded the canadian cml network and shifted her focus to healthcare advocacy and education.

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