The last week has been an intense one with quite a ride,
literally with lots of bike rides. I am reflecting the
week and slowly writing my journals for the Community
course.
9 July 2007
Today I have met a 79-year young nice lady who speaks English very well. Her name is Mrs. A. She has had a stroke one and a half month ago and her left body has been paralyzed since then. When the Nursing Home director introduced her to me, she was exercising her wrists using a bike pedal machine. A middle-age physical therapist was helping a few other nursing home residents. The bike machines - those that users move pedals by arms not legs -- are placed on the corner of a square-shaped inner courtyard, with a glass ceiling all the way up to the second floor, surrounded by glass walls on all four sides. I can see what others are doing at the other side of the glass walls even people on the upstairs. The courtyard is filled with lovely plants, small tables and chairs. There are metal trellis, almost two-story tall, with climbing vines glittering with morning sunshine, which is rare one since it has been rainy and cloudy for the last couple of weeks. It is quiet and peaceful. It seems that the time has slowed down almost to stop, with the elderly residents enjoying their morning activities in a slow motion. This is a Nursing Home called Salem, meaning 'peace' in most Middle Eastern languages. It is a private nursing home in a municipality called Gentofte. The Deaconess Foundation administers and manages funding for Salem, together with Sister Sophie's nursing home in Frederiksberg. I am supposed to work with staff and residents in Salem for the next two days. I already like the atmosphere here very much.
The Deaconess Foundation (Diakonissestiftelsen in Danish) is 140-year old institution that has contributed in nursing education, medical care, and community health in Frederiksberg and beyond. The Danish Deaconess Foundation was established in 1863 on the initiative of Princess – and later Queen – Louise. The purpose was to provide Christian women with faith-based, compassionate nursing training. Deacons were later admitted. Today, the Deaconess Foundation provides care for children, the elderly, and the dying in particular, and offers community care services training. The nursing school I am privileged to be connected to for this summer belongs to the Deaconess Foundation. Gentofte is another municipality north of the Copenhagen city about 40 minutes on metro and S train. It is a charming and tranquil suburban town that is quite expensive to live even in Danish standard. Salem is an upscale private nursing home in Gentofte. It was built in 1963. Since the beginning, Salem has been built on the management and standard of the established Deaconess foundation. It was founded by a private donation from Johan V. Adolph who got the idea all the way into 1903, when he started a centre for convalescents on the place where Salem lies today. In 1963, it housed 44 residents.
There are still 45 elderly people living in Salem now. The building has been through an extensive renovation from 2003 to 2005 and the only unchanged structure might be the outside wall of the building. The inner structure contains four 'gardens' - 'Have' in Danish - that physically divide the nursing home residents. Their names are like Grete's garden, Mary's garden, etc. The four gardens are spread out in the two-story rectangular building with the inner courtyard at the center, with each garden holding 10 to 12 residents. Each garden has its own living room, kitchen, and dining room in the middle. The glass wall connects the kitchen and dining area to the inner courtyard from which the green plants and sunshine comfort the residents. The residents' rooms are located at the opposite sides of the central meeting place. About 10 times everyday the residents are transported from their rooms to dining room or living room, for meals, coffee or tea breaks, for watching movies, for song and dance, etc. The activity of moving the residents back and forth is intentional to help them wake up from their dementia, sleep, and boredom. There are three social and health care helpers ('social- og sundhedshjælper' in Danish, hereafter SHHs) assigned to each garden, performing daily routines of transporting residents, helping them wash themselves, taking care of their bathroom tasks, feeding them, and observing them for any changes in symptoms and behaviors. SHHs are the front-line caretakers for the community elderly care.
The three SHHs I met today have come from Thailand, Sri Lanka, and Nigeria. Another SHH, who came to help us from a neighboring garden, originally came from England. There are some older Danish SHHs in other gardens. The three SHHs helped me to get situated between residents on the lunch table. They have been very friendly, sincere, and honest to me. I have fed Mrs. M, an elderly female resident with Parkinson's disease. She could not move her body at all and only able to move her left arm to drink water in shaky motion. I am told she is able to speak English because she is half English and half Indian.
She has lived in India for quite some time. Her voice was harsh and sentence was short so I could barely understand what she was saying. She was also able to open her mouth just about half way and I had to chop up the food real small. She did not want any red meat so only chicken and fish were on her menu. Other residents’ meals were like that too. Each resident's food preference is strictly respected and there are even different choices of desserts for each resident. Diabetics get cakes with no sugar. SHHs work in three shifts, day (07:00 to 15:00), evening (15:00 to 23:00), and night (23:00 to 7:00), about eight hours each. I use the word 'about' since there seems to be flexibility in the time they can leave work. Most of the Salem residents have chronic diseases like Alzheimer's, Parkinson's, and paralysis after strokes. Also they are quite old, older than 80. I hear the oldest person is becoming 101 this year. A lady with big smile, who has worked as a nurse in the Frederiksberg hospital where I got my nurse uniform, is 94 years young. Another lady on her opposite side of the dining table is 96 and she still eats the whole meal by herself. Taking care of these ladies can be stressful sometimes, partly because of their physical and emotional dysfunction.
Two of the three SHHs commute from Sweden everyday because of the cheaper cost of living there. They say that the Danish nursing homes pay them more. But the guy from Nigeria, Mr. Y, expresses deep resentment about the Danish society. He is 26 and has a Sociology B.A. degree from a University in Norway. He came to Denmark with his family but he could not get a decent job using his major. Danish society demanded education from Danish educational institute. He blamed Danes not treating foreigners equally as themselves. He has been working SHH jobs in two nursing homes and was able to save some money though. He recently bought a car and apartment in Sweden. He says he does not have to pay much Danish tax if he only earns below the minimum taxable income per year, around 40,000 Kr. His girl friend drives his car because he does not have the driving license yet. He is going to take the license exam - driving test - tomorrow, which is his birthday. Later he would help me buy a used mobile phone in one of the poor neighborhoods in Copenhagen. Mr. Y and the SHH from England, Ms. E, had a discussion with me, after we transported all residents to their rooms for the afternoon nap. We had one hour before moving them back out for coffee and cakes. They explained the real working situation in Denmark. There is a serious worker shortage in Denmark. The turnover rates in the job like SHH are high. There was a strike and demonstration by SHHs a few days ago in Copenhagen asking for more workers. To be a worker like Mr. Y, one needs to pass Danish language exam and show fluency in communication in Danish. Many immigrants experience difficulties having command over the language, as well as being integrated into the society. Ms. E says another reason for nursing shortage is the low salary for nurses. The Danish government pays college students for their education and living. University students receive 6,000 Kr per month after tax and after tuition is paid. But the nurses’ salary compared to the minimum wage is quite low. The minimum wage is 98 Kr per hour, SHHs get 109 Kr./hr, and Social and Health care Assistants (SHAs) get about 118 Kr/hr. Nurses’ salary is not much higher than that right after their four-year education. A new nurse gets about 25,000 Kr/month and that is about 15,000 Kr/mo after 42-46% tax has been paid. SHAs need 18 months of training to assist nurses in nursing care. For Ms. E, even the SHH job at Salem is a bit stressful for her. Later in the afternoon before she gets off her shift, she tells me, waiting for the weekly staff meeting to be over, that she is going to announce her resignation to the nursing home director and move on to become a SHH for home health care. She can have more freedom and less stress and a bit more pay by doing the home health SHH. She says a guy from a home health agency called her this morning. She does not seem to be fond of the director or to be much concerned about the director’s own problem which she had discussed with me this morning. Ms. E does not think that the director is doing her job well.
I have been close to three residents today, Mrs. A, M, and V. Mrs. A’s room is very neat and clean. All rooms have wooden floor, height-adjustable wash sink and bed. Also motorized lift is installed from the ceiling to help transfer residents from wheel chair to their bed. I watched Mrs. A being ‘flown over’ to her bed by smooth operation by an SHH. She praises her SHH’s operation of the device. The SHH plays Mrs. A’s favorite CD softly. It is a jazz CD compiled by Mrs. A’s husband before he died of heart attack. Mrs. A showed me her husband’s pictures. Portraits of her two sons hang on the wall. She says she and her husband traveled all over the world including America. I can feel that she misses her husband so much.
Mrs. V’s room smells urine and I suspect she has some kind of bladder problem. She has serious Alzheimer’s disease to the level that when she stands up to go back to her room, she forgets what to do the next. The SHH has to keep remind her of her next move. Her emotionless face and lack of appetite worry me. But she thanks me when I move her to her bed. She does not need the motorized lift. Mrs. M had her cake in her room. I fed her a little while she was watching a TV cartoon.
The nursing home director Mrs. M has worked for the nursing home for a long time and about to retire in three years, according to Ms. E. Mrs. M gave me a brief introduction to Salem this morning. To be eligible to move to a nursing home like Salem, the community has to approve. Some residents do not have family to support them. All of the residents stay in nursing homes until they die. Each resident’s general physician and home health nurse play a big role in deciding if a person would need a nursing home care. Once that decision is made, the candidate is put on a 3-month waiting list to be placed in one of his or her three nursing home choices. Main principle is to place the elderly to a nursing home close to where they used to live. Applicants sign a contract about the financing of their nursing home care. Their pension fund is used up first. Also they pay certain amount by themselves. Then the rest of the cost is paid by the government though the municipal office. The fund is used to pay for the 55 employees’ salary, and the living and medical cost of residents. The cost of caring has increased recently and Salem spent 100,000 Kr more than the budget last month. Mrs. M is going to have staff meeting in the afternoon to discuss how to reduce the cost. Some of the residents went to a trip to Barcelona recently, Mrs. M said. I do not know if that is anything to do with the increased cost.
For me, I am a bit empty-handed because I have not been interacting with any nurse today. It is still not clear what nurses do in nursing homes. I asked Mrs. M to assign me a nurse tomorrow if it is possible. She says she would try.
Inner Courtyard of Salem Nursing Home, viewed from one of the 'garden'.
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