Stories in the Springfield Business Journal and State Journal-Register have described staff cuts at Memorial Hospital, and that the Valet Parking Program is closed. Memorial’s decision is wrong. There are three ways to make money; one is to bring income; another is to plug the leaks in the operation which drain income. Read this and you will arrive at the third way to make money. Think of a hospital like a swimming pool; adding water only works if it stays in the pool. Cutting Valet Parking is the equivalent of cutting 8 holes in the pool’s lining!
The Valet Parking Program produced material benefits which shield, the income-producing, aspects of the hospital’s operation. The State Journal- Register’s article included interviews with users of the valets who mentioned some of the issues described here. The following observations are the accumulation of my 17 years as a Medical Visit Companion through Senior Sidekicks. My work repeatedly took me through both Springfield hospitals. When valet parking was established, its founders may not have realized all the ways it would add value to Memorial. Now we will learn of these benefits by their absence.
Drain One: Traffic cop needed. Many people converging on a small area can cause traffic jams and delays. Add infirm patients to the mix, and safety concerns rise. This situation reminds me of navigating O’Hare airport. O’Hare has officers; Memorial didn’t need them because the valets coordinated ramp traffic. The hospital will need to hire off-duty officers: an added cost.
Drain Two: Missing point of contact. Valets performed that function for the entry area. They answered questions and gave directions: freeing other staff to do their jobs. Now, no one coordinates. The hospital will be forced to re-hire part of the former valets to monitor the area, another added cost. The valets knew who to call if a patient appeared to be in distress, a mishap, or a traffic accident. Who is in charge now? It’s another rehire cost.
Drain Three: Rising liability costs. Injury prevention became one of the defacto tasks of the valets. They made sure the brakes are actually set on the wheelchair before the patient is transferred. Valets watched for trailing clothing which could get caught in the wheelchair wheels. Simple things like these prevented tip-outs and injuries. Now we will see how many incidents were previously prevented! Valets also assisted when a driver appeared to be untutored or infirm. (Now, who will help a 6 ft, 250 lb, post-op, man that is being assisted into a car; by a 5 ft, senior woman?) I predict that Memorial will see a rise in the rate of additional injuries to patients and their families. More incidents push the liability insurance through the roof; another unnecessary, cost.
Drain Four: Loss of society causes loss of manageability. When the valets retrieved the cars, the family stayed with the patient. Patients can react to their procedures. I have observed some patients that seemed disoriented, looked exhausted, and sometimes shivered, even when the weather is warm. Occasionally, patients become agitated. Family knows the patient and how best to respond. Thus, a small situation didn’t become a big scene. Now these situations will drag other staff away to respond. The loss of valets forces the family away from the patient to hunt for the car.
Drain Five: Delays and congestion in the reception area. Valets reserved a certain area of the lot for their cars which cut the response time. No valets=need for a designated area. Thus, a family must trek through the lot for the car. Since everyone must trek, moving patients through the transport area will slow down. This will lead to delays in getting patients out and crowding in the patient waiting area. How does Memorial plan to keep patients at a safe distance from each other to prevent a rise in infection rates? How does a rise in infection rate affect to the Memorial’s licensure? Not all costs come in money form.
Drain Six - Part 1: Traffic jams due to delays. The family must leave their cars in the ramp to retrieve patients. A family might leave the car running, possibly with an open door. Families may not have set the parking brake even though there are two hills at either end of the ramp.
Drain Six - Part 2; Preventable Issues; A. An unset parking brake leads to a rolling, unmanned car. B. A passing car clips an open door. C. An item left on the seat (cell phone) goes missing. D. Cars with two open doors (second one opened for the patient) take more space; crowding and already crowded drive. Do any of these scenarios remind you of O’Hare? No valets = more traffic jams and more accidents. Hired officers will be needed because the valets, who prevented them, are gone.
Drain Seven: Accidents caused by family rying to avoid the parking ramp; Eventually, crowding and congestion will give rise the use of ramps or stairs by post-op patients; leading to incidents. Memorial’s front was never designed for frail patients to negotiate. The valets ensured that patients would leave the hospital quickly, and in cars. Now, some families might try to walk the (patient) to the parking lot! Another rise in liabilities=another rise in costs.
Drain Eight - Part 1: Missing wheelchairs and accidents; The scarier scenario would be the patient, in a hospital wheelchair, piloted on their maiden voyage by family! Who will stop that untrained family, or prevent them from taking hospital wheelchairs? How would some of the patients make it all the way to the car without a wheelchair?
Drain Eight - Part 2; How many times have you seen grocery store carts left beside the disability parking places? The whole Memorial lot becomes a defacto disability parking place. Like a grocery store, Memorial must hire staff to collect wheelchairs from the parking lot. Have you ever seen a homeless person who “adopted” a grocery cart? Does Memorial believe no one will “adopt” a lonely wheelchair from a parking lot? Add missing equipment to the other, above-listed costs incurred by removing the valets.
Keeping the valets would have been cheaper for Memorial. Now operations will cost more because the valets are gone. There are actually three ways to make money, bring income, plug income holes and avoid making short-sighted decisions. Memorial has made a short-sighted decision by removing the valets. Valets don’t cost as much as they pay.
What worries you about these cuts? Do you know someone who will have trouble getting care because they can’t access it? Do you have any ideas to solve this problem?
We want to hear from you. Contact Senior Sidekicks, on the following form. We’ll gather your responses. Your feedback will guide our next steps.
Has this happened to you? “I took groceries to my Mom. She wanted have coffee with me. I’ve tried to tell her I couldn’t, but she just doesn’t get it! I don’t know what to do”!
Caregiving is a demanding process and Covid-19 adds more demands. Caregivers still try to respond to their loved ones even under new circumstances. In the past, the caregiver could might take the elder shopping; not now. Shopping was an outing, a chance to socialize, and a chance for the caregiver to assess how the elder was doing. Now, we wear masks and are encouraged to shop as quickly: a-l-o-n-e. We only have a fleeting glance at our loved one on food drop-off. We can’t just pop in the house or care facility to check on things for ourselves. We must rely on reports from our loved one, the staff or (sometimes) the news. Imagine reading the news and learning your parent’s facility has a Covid-19 outbreak! Caregivers revealed they felt guilty before, it’s especially true now. Some guilt seems to be rooted in the feeling, “I can’t do anything!”
Yes, you can.
Caregivers used to worry about elders taking medicine properly or eating regularly; now worries include possible exposure, illness & death. To add to these concerns, seniors seem to want more from the caregivers. They ask caregivers to run more errands or ask for things not appropriate to their diet or welfare. An elder asked me to try to take money out of an ATM with his bank card!
Why are elders making more or different or even illegal requests? There are a couple reasons. First, caregivers make the distinction between the Covid-19 as the cause and the changes in our lives as the response. Sometimes, that distinction is not as clear to the elder. “They just don’t get it”; is a sign to caregivers that the senior hasn’t understood in the first place. Everybody has studied something that felt very different when actually experiencing it. Think of your first time behind the wheel of a car. No instruction manual prepared you for that feeling of your foot on the accelerator. Childbirth classes help, but they can’t communicate what it feels like to give birth to a child. After the experience, we “got it”. Making it real,related to the senior’s early experiences, helps them to “get it”.
Second, caregivers understand the impact of this pandemic process. So, instead of doing more errands, we need to take the time to help seniors grasp the process. We feel guilty because we can’t take them out, or can’t give them a hug. So, when they ask for more and more, we do it because it makes us feel better. Have you noticed that more errands just aren’t enough? That’s because errands don’t fill the senior’s real need: finding meaning and support. A conversation, in which you focus on their early experiences, such as quarantine, helps them feel the reality of current circumstances. Explanations don’t work as well as a trip down memory lane. Just making the effort to help them understand the experience will fill their need for direction and support from you. Your senior relies on you in ways they can’t express. When they feel like the world has gone crazy, they look to you. When you show effort to help them understand (not expertise) they become calmer and you’ll feel better too.
Third, just saying NO, puts limits into their lives and is another way to calm your senior. When times are uncertain, a clear guide creates a sense of stability. They sense that you are looking out for them and you are their leader through these times. Your firm guidance gives them clarity.
Then, you have more time and the emotional space to feel less guilty.
Caregivers need not do e-v-e-r-y-t-h-i-n-g; just the right things.
Fourth, a rule of thumb for elders with dementia is; the more dementia, the longer “emotional antennae”. Your seniors are highly attuned to your moods. They just can’t process the information the way they used to. Covid has shifted everyone’s life. Elders sense that you are struggling to adjust your lifestyle. Caregivers may not want to show these struggles. They feel guilty these the elders depend on their care. The elders already know. When you put words on your feelings, it’s like putting on an oven mitt; now you can handle hot stuff. Your words become the elder’s way to express their own feelings. Keep it simple but keep sharing. Remind them of any major adjustments they had to make in the past: WWII rationing, Great Depression job losses. Emphasize how they made it through hard times and the example they were to you. Thus, the caregiver becomes the mirror that reflects the senior back to their best self.
Finally, remind the elder this is only for now, it will not last forever. As the old song says: “Some day; s-o-m-e-d-a-y, we’ll be together (yes we will)!
A daughter commented that she had not been able to visit her parent because the facility was “locked down” to prevent the viral spread from Covid. She could only drop his snacks off at the door. She worried. No matter how many times she explained, she still couldn’t get him to understand.
Many elders and their adult children face this dilemma. All facilities are closed to visitation: even when the elder is dying! The more frail the elder, the less likely they can manage total separation. Seniors need tangible connections; touch, sight and hearing.
How do we keep in touch in an era of no-touch? Families often bring presents to these visits, yet; it’s the present of their presence that elders crave. So, how do we convey presence when we can’t be present?
KEEP IT TANGIBLE: E-cards are nice but a classic greeting card is tangible.Your loved one can hold it or look at it repeatedly. Tuck a greeting card into a bag of groceries or a bunch of flowers. The facility staff can point to it to remind them that you are keeping in touch.
MAIL CARDS: It helps support our postal service and your loved one. Getting mail is a big event in care facilities. It’s not how fancy the card, it’s how often you provide a reminder that you care.
TRY PRINTED PHOTOS: These are more tangible. Perhaps you got your loved one a cell phone and sent them pictures. That wasn’t their early experience. For decades, today’s elders only had the paper option. When you send a shiny paper photo it resonates. Photos used to require going to a studio, posing, and were made for special occasions. Photos were important. So printed photos carry an important message from you; “You are important to me”.
Children’s crayon drawings carry the unique, tangible message. They are especially important if the drawings are labeled with the child’s name, date, and something about the picture. That way, the staff can point out the picture later, when the elder says they think they’re forgotten.
WHAT’S THEIR FRAME OF MIND: We’ve all had a crash course about pandemics. Elders may not have paid as much attention to the news. Some have turned news off altogether. 98+% of today’s elders weren’t alive during that last pandemic in 1918. It isn’t part of their experience. They can’t relate to the scale of lock down necessary to contain a pan-demic. Some may have known families who were quarantined when they were children; but they are not familiar with a whole society in quarantine.
So what do you tell them about why you can’t be there? Start by asking them what they know about today’s news. If they have been following the news, use their level of information to determine what you share about your being away.
If they don’t seem to know; try a simpler explanation: you “have to be away for awhile”. You’ve taken vacations, trips and returned. This is just another time away. Promise only that you will return. Say that in a card as well as on the phone. Say it often. “ Someday, some way, we’ll be together”. That’s what the song says and that’s my prayer for all of us.
“‘This will be catastrophic’: Maine families face elder boom, worker shortage in preview of nation’s future,” from The Washington Post, could be a description of a dystopian movie: it’s not. This is the state of State of Maine, which is the harbinger of things to come for the rest of these 50 United States. We need to listen to this alarm.
We’re facing a demographic dilemma: not enough young people to fill all jobs, even those outside of elder care. We need them now! Where do we get them? We can’t hire them because they were never born! Thus, current workers remain on the job long after it’s safe or appropriate. Results include accumulated injuries to workers who keep doing injurious jobs. Even the field of healthcare can’t find enough workers or volunteers.
The State of Maine has learned that there is no one available to fill home care jobs. There is no one to fill care facility jobs either. Professional fields have the same problem; many of the number of nurses and doctors are now older and there are not enough of them it is and there’s no one to replace them.
Medicaid pays far less than other employers, drawing the few workers away from elder care. However, simply raising wages won’t help if there are not enough people to hire!
Maine is already experiencing the results, some facilities closed altogether. Others closed admissions for months due to too few staff. No vacancies in care facilities means families must place their loved ones wherever they can. A loved one far away means a l-o-n-g commute to visit. Younger, disabled people also get caught in this care-crunch. If no one is available, some adult children try to fill the gap. Those care gaps further pressure the few remaining working adult children.
Keep this number in mind:
*By 2030, 1 in 5 Americans will be over 60.
*The number of seniors will DOUBLE between 2015 and 2050.
*The senior population over 85 will TRIPLE in that same period.
**We will need 7.8 MILLION new people to fill these jobs. Since we didn’t give birth to them; where do we get them?
This isn’t as riveting as a news story as a fire, or a shooting, that’s the problem. The numbers of affected families are there, but they aren’t collected (aggregated). This problem is spread everywhere.
We’re in a presidential campaign yet no candidate is talking about this national problem. Why? This demographic dilemma is happening one family at a time: Your family is next.
As we approach the holidays, we consider visiting elderly relatives or arranging for them to visit us. While I cannot offer a guarantee of a pleasant visit, here are a few things to keep in mind to avoid some of the pitfalls
When families gathered on Thanksgiving day, some realized that their senior was not the same as last year. Families often respond by doing internet research. The internet is a good first step. However, some sites make outlandish claims. I saw one that offered a treatment that “cured Alzheimer’s”. There is no cure and some of these sites can offer dangerous suggestions.
Here are a few reputable sites that offer reliable information:
Alzheimer's Association. This site also has a page devoted to explaining the different types of dementia. It also lists other physical conditions or environmental conditions that can look like dementia.
American Society on Aging. It can feel encyclopedic in size. The society has done decades of research and offers reliable information. It’s a good second step.
AARP offers many programs and information for families as well as seniors. Each state has a chapter with offices in each area. Look up your state to find help in your area.
And Senior Sidekicks offers a course; Preparing to Parent Your Parent, to prepare families for the practical issues they will face as they become caregivers. Contact us about teaching this course in your church or at your job. Call (217) 787-5866 or email us for more information.
"A Senior Moment" is written by Ms. Sara Lieber, owner of Senior Sidekicks. Ms. Lieber has over 30 years of experience in senior care.