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Lisa Bubert | Longreads | November 30, 2022 | 11 minutes (3,072 words)

When I was 19, a nursing home hired me to work as an aide. There wasn’t much to the interview that I remember, other than I agreed to come to work on time and take the certification course the home provided. In this course, I learned how to lift a frail person out of bed, how to wipe them, how to bathe them if bed-bound; how easily their skin tears, and how to touch so as not to cause a bruise. The head nurse was a short man with a thick north Texas accent and a handlebar mustache who finished the training with the advice to “treat each resident like they’re your grandmama.” The course lasted two weeks and came with the stipulation that I stay for at least six months. Employee turnover was high.

This job, caring for grandparents around the clock, paid $7.25 an hour — above minimum wage, the hiring manager boasted, which at the time in Texas was set at $5.15. This really was a great job, the other aides told me. It was steady work that came with a lunch break and health insurance for your kids, things that were lost on me. I was an anomaly in that job: a teenager, in college, white. 

None of my friends understood why I wanted to work there. Young people are scared of old people, which is to say all people are scared of old people, which is to say all people are scared of death. Death hung over the place like a ghost, the hospital smell embedded daily in my clothes. All I can say is that I wanted a real job and I liked old people. I’d already seen my share of dead bodies, thanks to the slew of open-casket funerals that came with a childhood spent in an aging rural community. Also, the home was the only place that called back when I applied.

The facility was broken into seven distinct hallways, with two aides assigned to each for their shifts. Each hall housed 15 or 20 residents, making each aide responsible for eight to 10 residents. There were no firm state or federal regulations on what the resident-aide ratio should be (and still aren’t), but 10-to-1 is considered easy street in most facilities. To be clear, this is still a terrible ratio. Imagine having to wake, bathe, dress, and hand-feed 10 elderly patients who need total assistance: buttoning shirts, brushing dentures, changing bedsheets for those who will have inevitably soiled the bed in the night. Imagine having to complete it all in an hour or less. It’s an impossible task. Which is why dentures don’t get brushed, baths don’t get offered, nightgowns are worn at the breakfast table. Now double it to 20 patients; this is what you have in many facilities across the country. 

Hall One was for rehab patients, those who had suffered strokes or broken bones and were simply there until they could regain strength and rejoin the world (if they were lucky) or move to another wing (if they were less so). Hall Two was reserved for patients with dementia and Alzheimer’s. They were mostly ambulatory, which was great for those residents who liked to wander and terrible for the aides who had to keep track of them and everyone else. Halls Three and Four had a mean reputation, old folks who bit and scratched. One resident in that hall was a literal shit-flinger, known to keep her hands hidden until an aide was close enough to smear. Many of the Black residents were placed on these halls, creating a racist chicken-or-egg situation where the care was poor because the residents were difficult and the residents were difficult because the care was poor. Hall Five was a tale of two extremes — people who either needed a ton of help or none at all. Any aide was happy to get that assignment, though, because the extremes averaged out to something sustainable. Hall Six was for the bedridden. 

It was a toss-up whether Hall Three, Four, or Six was the worst assignment for aides — it depended on whether you felt like taking insults or blowing your back out. But Hall Seven was the hall everyone wanted: elderly people who were mostly lucid, mostly independent, who just needed a little help and some company. Hall Seven was heaven. And because I was young, too small to lift alone, and white, I got assigned to Hall Seven every time. 

I loved working Hall Seven because Hall Seven felt like home. I had grown up in the presence of old people, my grandparents some of my earliest caretakers. My father drove truck; my mother worked at the hospital by day, and had nursing school at night. She would dress me as I slept and shuffle me off to Granny K’s house at five in the morning, where my grandfather, Papa, was always awake and waiting, the local weather news segment on the TV glowing blue in the front window.

Granny K would make the meals, play with me, pick me up from school. We watched One Life to Live and General Hospital every summer day at 1 and 2 p.m. She was small and short, shrunken in her big, pink armchair. Papa was large, big-bellied, farted often, and smelled of peanuts and sweat. Granny K was sweet to me and harsh to everyone else; Papa was a teddy bear, grown soft in his old age. 

Papa died just a few years prior to my stint at the nursing home. The first sign of his illness was the loss of his round belly. He shrunk, then shrunk some more until he was confined to the hospital bed Granny K kept in the living room. Pancreatic cancer. We didn’t even try to fight. After he died, Granny K sank into a sullen, depressive loneliness I couldn’t understand, so I visited less and less until I moved to college and got work in the home that let me pretend everyone was my grandparent.

Shame stems from a fear of disconnection. We live in a culture that increasingly connects old age with disconnection rather than dignity.

There was the lady who covered herself in beaded necklaces and split her secret stash of chocolate with me as we watched game shows and talked about boys. There was the man who wore a daily uniform of plaid shirt, khaki shorts, and Reeboks. There was the teeny tiny woman who couldn’t remember shit moment to moment but still thought all of this was pretty funny anyway. I’d take her to dinner with the other ladies who couldn’t remember shit and we’d sit and laugh about god knows what. She had no teeth so everything had to be pureed. I remember feeding her from piles of color on the dinner tray — green for peas, yellow for potatoes, brown for meat. 

Some of the residents refused to leave their rooms for dinner and would have their meals brought to them on a meal cart. Some of them had to be fed or they wouldn’t eat. Most of them refused even that, hell-bent on starving themselves out of existence. Take the food yourself, they’d tell the aide. You weren’t supposed to take the food, management said. That would be wrong. But things moved so fast that lunch breaks could pass untaken, and on days like that this was the only chance for food. An untouched butter roll, stale French fries, cold steak fingers, unopened cartons of juice. The chart truthfully updated — resident refused meal — the food in an aide’s mouth. Some wrapped the food to take home to children. You would take the food too, you just would. 

The entire elder care system operates on a mantra of out of sight, out of mind. Medical residencies feature little to no geriatric training; the profession experiences an annual turnover rate of 60 percent. A 2021 study found that turnover in nursing care facilities skyrocketed during the COVID-19 pandemic, with the average annual rate in 2020 at a shocking 128 percent. In other words, if you apply for a job at a nursing home, you can pretty well count on getting hired. For someone with little access to education living on the edge of poverty, this fact is a godsend. Yet, caveats lurk. There are countless reports of understaffing in nursing homes, underfunding, limited regulations where it matters (staff pay, patient ratio) and reels of red tape where it doesn’t (hours of required paperwork that detail how many ounces of water the resident drank, but not how they cry at night for their children). And while you may be trained on how to wipe from front to back, there’s no training to prepare you for the psychic toll of watching your people suffer until they die. 

There are plenty of reasons to see nursing homes as sad, neglectful places, and I’m sorry to say that my experience working in one did not change this perception. But I can also say that the perception has less to do with staffing, funding, and regulations (or lack thereof) and much more to do with our country’s fear of death, its rejection of vulnerability, and its subsequent inability to see the inherent dignity in people — especially in their vulnerable moments.

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Dying is a vulnerable act. There’s rarely the serenity we see in deathbed scenes. Instead, the pragmatic, much of which we view as shameful: the slow loss of function, the bowels loosed in bed, the sweat stench, the tonguing mouth, the hallucinatory terror, the whimpers, the rattle. You spent all this time learning how not to trip over your own feet and here you are now — older than anyone else in the room and forced to use a stroller, swaddled in diapers. You revert to a time when your mother held you, only your mother is gone. Your children (if you remember them) don’t visit, and why is that? 

Shame stems from a fear of disconnection. We live in a culture that increasingly connects old age with disconnection rather than dignity. Our friends pass on, our families visit less and less, we spend more time alone, helpless to arrest the breakdown of our own bodies. It’s no wonder the elderly — and those who care for the elderly — are steeped in a hot tea of shame. And because shame repels, it is no wonder our policies and priorities for eldercare are so lax as to be nearly criminal. Out of sight. Out of mind.

Granny K and Papa were both het up about “not being put into a home.” Papa didn’t have to, on account of the cancer. But no cancer came to save Granny K. She just got older and older and lonelier and lonelier until she couldn’t care for herself and my parents couldn’t leave their jobs to do it for her like she’d done for Papa. She went into assisted living, very reluctantly — though not until after I started working in my own facility. And by then, I’d seen how the sausage was made. 

I visited Granny K at the facility every time I came home. Short, quiet visits in her room that smelled of cough drops and Kleenex. The hum of her oxygen tank. The humidifier on high, turning the air wet. She would never say much past lamenting how terrible it all was, how she just wanted to die and be done with it. My visits grew shorter and shorter and then I took to calling her on Sunday mornings where I would hear more about how terrible everything was and how death would be a welcome ending. I called my mother crying, who then called Granny K and told her she couldn’t tell me those things anymore. My conversations with Granny K dwindled and dwindled, both of us playing a morbid waiting game to see how long it would take to get what we both wanted. 

Christmas 2012, I sprung Granny K from her facility for family dinner. As we drove home, the sun was setting across the fields in a dazzling display of purple and pink and rustling prairie grass and open, open pasture with room to run as far as the eye would allow. Live oaks with massive curling limbs cast long shadows in the hazy light. It was, by far, one of the more beautiful sunsets I’d ever seen, in a place that’s no stranger to such spectacle. Granny K sat up straight in the passenger seat, her eyes fixed out the window, taking in every sight, committing it to memory, presence. I wanted to say something, but stayed quiet. The moment was hers. 

Granny K sat up straight in the passenger seat, her eyes fixed out the window, taking in every sight, committing it to memory, presence.

We had Christmas dinner. We opened presents. My father offered to take Granny K back and the four of us — my mother, father, brother, and me — all went out to the car to see her off. It was the first time it had been just the four of us in years. A memory flickered to the surface of us eating around the dinner table when I wasn’t yet in grade school, before my brother got his first job and my mother worked nights. We said our goodbyes, watched Granny K’s small head disappear in the window as the car drove off. I already knew when I watched her watch that sunset that this would be the last time. 

It was; she died a week later. Just before, my mother called me and placed the phone at Granny K’s ear. I said I was glad to know her, that I enjoyed our time together. I could hear a clicking, the soft rattle in response. That was our last moment. But I prefer to remember the sunset. 

I worked at the nursing home until the six months were up and then I left. I’d had enough of the hours, the lifting, the side eye from the other aides who knew I wouldn’t stay. I didn’t need the job like they did. I was just a college kid. I was playing grown-up. 

A decade later, though, my training came in handy. May 2020, the height of the pandemic; my other grandmother, Granny Nawara, lay dying in a hospital bed. My mother had tried to keep Granny Nawara in her own home to care for her there, knowing the moment she went into a nursing facility would be the moment we could no longer sit with her. But it grew to be too much. My mother was a veteran nurse at our rural hospital; when the administration heard about Granny Nawara, they transferred her to a room there. I took my chances and flew to Texas to be with my mother as we watched Granny Nawara’s last days. 

For three days, we sat together in that room — my mother knitting a lovey for a new baby, me burying my head in work, Granny Nawara lying in bed, just breathing. Mom and I would trade off. Mom would check Granny for bedsores, sop a watery sponge to her cracked lips. I would rest a damp towel to Granny’s forehead and she would open her eyes for just a moment, see me, and smile. Mom spent the nights at the hospital, unwilling to leave. I went home to sleep in my childhood bed. The last night I told Granny good night, she gripped my hand with more strength than she’d had in weeks, pulled it to her chin, and wouldn’t let go. She blew a kiss and I stood there, letting her hold me until it grew late and I had to pry my hand out of her grasp. She would still be with us the next morning; she would only die after her older brother said his goodbye. Granny Nawara did always like to get permission. 

The last night I told Granny good night, she gripped my hand with more strength than she’d had in weeks, pulled it to her chin, and wouldn’t let go.

I have a hard time writing about this, not because it’s a traumatic memory, but because I got to do something so many others couldn’t in this pandemic. I sat with my grandmother as she died. And there is no act of love greater than to sit with someone as they face their deepest moment of vulnerability — an act of love denied to so many these last few years.

There’s plenty to be said about the ways the pandemic has laid bare the failures of our eldercare system, how our fear of weakness has driven our entire healthcare system to the brink, how we exorcise this fear through a cycle of abuse that directly impacts our old, young, and poor at alarming rates. How our abject terror of vulnerability robs us all of dignity. Dignity requires witness, to see and be seen; if we are too afraid to look, it slips away.

All I want to focus on now, then, is the sunset. A terribly beautiful sunset, one we all know is the last, one from which we cannot tear our eyes away. Commit that dazzling display to memory. Watch the light as we fade. 

One of my favorite tasks at the nursing home was supervising the 4 p.m. smoke break. Many of the residents were lifetime smokers and no nursing facility was going to curb that habit, so after breakfast and before dinner we’d wheel everyone to a small, glassed-in room off the corner of the dining hall. It stunk like only a room solely used by smokers could stink. Staff hated covering smoke time because of it. But it was also 15 minutes in which all you had to do was light cigarettes and make sure nobody burned themselves. I volunteered every time. 

Everyone’s assigned cigarettes were kept in locked cabinets. The families were responsible for keeping them stocked; no begging or borrowing loosies allowed. I’d separate the packs from their cartons, hand everyone their brand of choice, light them all with the management-issued lighter. Residents would relax back in their chairs, stare out the glass enclosure as though it was a window that looked outside, and drift off into some other beautiful world.

I loved smoke time for the pure peace and bliss of it; not just mine, but theirs. You could see their younger selves when it was smoke time, slouched back like a bunch of hoodlums, yakking and jawing like they were kids getting away with something. The muscle memory of the ritual — inhaling, holding, flicking into ashtrays, stubbing the smoke out when they were finished — transcended dementia. A few might forget, long lines of ash dangling at the ends of their lit cigarettes. But that’s why I was there. To remind them. 

Lisa Bubert is a writer and librarian based in Nashville, Tennessee. Her work has appeared in The Rumpus, Texas Highways, Washington Square Review, and more.

Editor: Peter Rubin

Copy Editor: Krista Stevens