Around the fall of 2017, my uncle was sent to a hospital in the eastern suburbs for rescue due to a sudden cerebral hemorrhage. He was single and childless, and there were not many male relatives, so we had to find hospitalization for him. In the year since then, when he was transferred to various hospitals for rehabilitation, the nurses have changed several times, but fortunately, the uncle has always had the help of the nurses.
1. Replacement of caregivers
After the operation, my uncle was admitted to the intensive care unit of neurosurgery, with many tubes inserted in his head, nostrils and mouth, constantly changing infusions on his hands and feet, and ventilators and monitoring equipment always followed him... In the panic, we took a random one from a pile of business cards placed at the nurse's station and contacted an escort, Master Zhang.
Master Zhang is a native of Weinan, 51 years old, very thin. At first, we were very hesitant, because my uncle weighed more than 200 pounds, and he was tall and fat, and every postoperative physical examination was a major event that alarmed the general department. However, it turned out that the nurse was very suitable for the care of the intensive care unit. For example, he is very sharp in moving people with ingenuity, daily cleaning is also exquisite, regular excrement testing, drainage observation are skilled, and most importantly, he really puts effort into patting his uncle's back. Doctors have warned patients that the major test after surgery is lung infection, so it is necessary to often turn over and pat the patient on the back, shake the sputum out and then use a suction device to remove the body. We did see several patients who died of lung infections, and those scenes are also memorable for a lifetime. Master Zhang did a good job, so that his uncle escaped this disaster.
Twenty days later, my uncle was discharged from the hospital and then admitted to the hospital, admitted to the rehabilitation department of the same hospital, and began a long rehabilitation treatment. At that time he was not fully conscious and his left limb was paralyzed. Since rehabilitation stipulates that the same hospital cannot be hospitalized for more than 14 days at a time and there is a limit on the total cost of treatment, considering the optimal time requirement for rehabilitation, we have to change the hospital for my uncle every ten days. Correspondingly, there have been many turnovers of caregivers in this turnover.
The most difficult thing is to replace Master Zhang for the first time. The difficulty is because we are very dependent on him, so there must be a last resort reason to make this decision. Our relatives gradually ended all kinds of leave and began to work normally, need Master Zhang to undertake the transition from emergency nursing to rehabilitation nursing, although emergency nursing is more difficult, we still increased the salary for Master Zhang, hoping that he can continue to do a good job in the back. The goal of the first stage of my uncle's recovery was to try to sit up. To this end, rehabilitation physiotherapy includes electro-acupuncture, leg electrotherapy, standing bed, head electromagnetic waves, etc., but during this period, Master Zhang has repeatedly expressed the hope that his family will accompany him during the day or he will not be able to do his job. In this way, when it was delayed until we transferred to a private hospital to start the second cycle of rehabilitation, we regrettably dismissed Master Zhang.
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We found an office in that private hospital, similar to a patient service center, to introduce patients to accompany them. We signed an agreement with this center to pay the referral fee and deposit, and they promised to change us at any time if they were not satisfied. Of course, they did change us a few times.
I remember the second time I exchanged the master's surname Xu, a native of Henan, very fat, with a good temper. The only drawback, which is also fatal, is that he can't clean up his uncle's defecation in time, especially after not using a urinary catheter. Moreover, he himself also suffered from a serious eye infection shortly after work due to habits such as not washing his hands frequently, and the hospital prompted us to change people. So we made a replacement shortly after the start of the third cycle of treatment.
Later, we found that although the cost of the caregivers we paid did not change much, the amount of the caregivers paid by the service center was greatly reduced, resulting in the lack of experience and low quality of the recruited caregivers. So, we decided to find a caregiver ourselves, after all, we still have a lot of business cards in hand.
Around the time of the sixth rehabilitation, my uncle was still in a state of inability to stand up and incontinence. This is a well-known tertiary hospital with a variety of treatment programs, which has laid an important foundation for the rehabilitation of my uncle. In addition, my uncle's recovery during this period has made significant progress, thanks to the new nurse Master Li we found.
Master Li's unique point is to actively use his brain to think of ways. He carefully studied the rules of hospital treatment scheduling, avoided unnecessary waiting, made daily treatment more efficient, and made full use of the remaining time after professional treatment, creatively using some basic tools according to the training plan we set, or creating a set of methods to achieve the desired results. In the more than four months of Master Li's care, my uncle was finally able to walk independently, and his left arm was barely lifted. Even his attending physicians were satisfied with this. But what is surprising is that Master Li took the initiative to resign from us. Later, we learned that he came to the hospital to help because of the difficulties of his company, so we were not surprised why he was so different.
In the last two months of all the rehabilitation, we hired a highly reputable nurse for my uncle, Master Zhang, who was the oldest nurse I had ever met, nearly seventy years old, a Shangluo man. Many nurses in the hospital know him and respect him very much, Master Zhang is very kind, although he has no advantages in caring for his uncle, but he is also serious and responsible, and the communication with him always makes people gain a lot of insight.
Summary: During the nearly one-year hospitalization, as many patients have done, my uncle has indeed been able to turn the crisis into a safe situation and finally take care of himself with the help of a large number of medical staff and hospitalized escorts. However, because his uncle was single and had no strong support, but unlike many patients, it can be said that the nurse made the same contribution to his rehabilitation as the medical staff.
■ Stills from "Flying Over the Old People's Home"
2. Ecology of caregivers
Why hire a caregiver? Exploring this question helps us understand the logic of the profession of caregivers.
First, of course, because the patient's relatives are unable to take on the day-to-day care work. Take the uncle as an example to see what nursing work the patient's relatives should undertake:
The first is 24-hour hospitalization escort, especially night accompaniment. This is a rigid rule for hospitals. If the patient's relatives are ordinary office workers, they cannot undertake such work unless they take leave. If the patient has relatives who do not go to work, it will be difficult to be competent for a long time due to health and other reasons.
The second is the regular transfer of patients. Since the patient who is treated for rehabilitation can be hospitalized for up to 14 days at a time, and the best time for recovery is the first six months or the previous year, if the patient wants to grasp the best time to recover as soon as possible, he needs to be discharged frequently and then admitted to another hospital. Then these transfers and settlements are all relatives' business. I remember that every time my uncle was transferred to the hospital, he had to have a male relative ask for leave and do a lot of work.
Third, some of the patient's important basic care needs are the responsibility of the family. For example, often turn over patients, pat their backs, massage and so on.
Fourth, the daily examination of patients needs the assistance of relatives. For example, the patient is sent to the designated place and assisted by the inspector to be placed in the place to be examined, the examination items (excrement, drainage, blood, etc.) are sent to the designated place, and so on. I remember that some hospital examination sites are very scattered, and we have run through many places in the front and back yards and major floors to send for examinations.
Fifth, the patient's daily treatment needs the assistance of relatives, such as: sending the patient back to the ward and returning the stretcher after surgery, observing drip, assisting in the installation of treatment equipment (such as massager, ventilator, acupuncture device, etc.), calling nurses to suck sputum regularly, assisting in treating patient bedsores, sending patients to designated places and assisting doctors and physiotherapists to be placed in treatment places, and so on.
Sixth, the patient's three meals and daily bed cleaning are borne by the patient's relatives. For example, the uncle's nasal feeding during the intensive care unit and the normal three meals in the later stage are borne by relatives and nursing staff. Although the replacement of the nursing mat can be helped by the nurse, it still needs to be handled by relatives and nurses.
Seventh, the daily medication of the patient is operated by the relatives. In the case of my uncle, the nurse distributed the medicine to the bed and instructed our relatives or caregivers to feed it.
Eighth, the rehabilitation exercise during the patient's hospitalization is the responsibility of the relatives. Uncle during the hospitalization of up to 4 rehabilitation treatments per day (which is related to the frequency of treatment, doctor visits, waiting time, etc.), basically there is no treatment after 4:30 p.m., plus there is no treatment on Saturdays and Sundays, so much time has to rely on arranging patients to continue to exercise to consolidate the effect, and this continuous consolidation of exercise is very critical for patients to achieve staged rehabilitation goals. Unless the effect is wanted to be abandoned, relatives must take on the job.
Overall, as long as the above job requirements for treating the patient's relatives as caregivers persist and the professionalism of the caregivers is irreplaceable (the average nanny is incompetent), the demand for caregivers will always exist.
■ Caregiver training | Image source: Xinhua Net
Where do caregivers come from? In fact, every hospital has a large number of nurses, who are both competitive and tandem. Generally, it is mainly based on mutual introduction. For example, we have asked several nurses who are patients to introduce them, and their industry rules are that once they are hired, they should give the introducer 10 yuan per month in the first few months, so they do not want the employer to change people frequently. There is also the vocational agency center, such as the office of the so-called patient service center in a hospital that we have used, the advantage is that there is no need to contact you frequently, and there will be nurses serving patients every day, but the disadvantages are also obvious, so I will not repeat it.
Let's talk about the management of caregivers. Theoretically, caregivers do nursing work on behalf of patients' relatives, so so so-called management can only be a measure between employees and friends. And because the rights and obligations are not very clear, it is difficult to pursue any responsibility. In practice, the patient's relatives are more willing to introduce the nurse to the medical staff in the name of the relative, and the other party is willing to believe. Therefore, as long as the matters assigned by the hospital are completed, in most cases, it is a state of "almost no care".
The frequency of visits by patients' relatives is the key to determining the quality of caregivers' work. We have seen a patient who used to be a deputy director and never saw relatives visit during his hospitalization, so his nurse was relatively free and also took care of other patients. As far as we know, nurses who receive several patients at the same time are not a minority, but also representatives of competent people in the industry.
In addition, each hospital has a sphere of influence of one or two nursing groups, and there has been vicious competition with each other. For example, before we replaced the first Master Zhang, we interviewed several people behind his back, and some people would betray the introducer when they saw that they were not hired, instigating Master Zhang's group to find trouble with the introducer, and the Master Li we had hired did not belong to any group in this hospital, and there would be many people who would come to us to sue him and prompt us to change. In rare cases, nurses and medical staff will also have conflicts, such as our first hired Master Zhang, because our uncle showed signs of pressure sores, and the head nurse was in a fight with the head nurse on the issue of responsibility, resulting in the hospital strongly demanding that we be replaced.
From our experience, there is a process of spontaneous to conscious search for caregivers, and replacement is sometimes unavoidable, but the overall benefits outweigh the disadvantages. The key is to understand the real needs of patients and relatives.
Finally, let's talk about the income of the caregivers. We pay an average of 210 yuan per day for my uncle's caregivers, and my uncle pays more than 80,000 yuan for more than 80,000 yuan (including double wages on some holidays and salary increases for individual nurses). As far as we know, this level is moderate in the industry.
In the daily communication, we also noticed that most of the nurses in large hospitals have rural backgrounds, but their income is good and their lives are relatively stable and comfortable. I remember that the last master We invited once told us that the nurses were mixed, don't underestimate them, some nurses are quite rich, they are not here to earn money.
3. Two hopes and one anxiety
Because the contribution of the nursing profession to inpatients is real, and they have a close connection with the hospital, and their order and quality also need a benign guidance, my first hope is that the nursing staff can be included in the hospital staff management, such as contract management. It is a win-win thing for hospitals to absorb these social resources, train them and use them, thereby reducing the burden on patients' relatives and patients, and creating greater efficiency and more well-being for society.
Some friends once complained to me about their suffering, the father of the family was hospitalized, the brothers and sisters had different opinions, and some wanted to ask for escorts and were afraid of being said to be unfilial, so they had to take turns to accompany each family in the hospital. In reality, we have indeed seen such a situation, and even many family members from other places rent beds to live in the waiting area of hospital family members, and stay for a few days to ten days and nights.
Imagine if caregivers become part of the hospital's medical care, then the vast majority of ordinary families can easily face the illness of their families, reasonably arrange daily work and life, and will not delay the treatment of patients.
The second hope is that the cost of paying for caregivers will be covered by Medicare reimbursement. Nowadays, uncles don't need caregivers, but there are many patients like uncles who don't have caregivers and can't be treated and rehabilitated.
And the cost of this piece is too large, many families can not afford to put down the work in front of them, I have seen some patients relatives almost give monthly wages to the nurse, because this can not lose their jobs. However, these choices are helpless. In the process of an aging society, these helpless choices will further erode the overall benefits of society, after all, we are interconnected groups, and there is no way to completely unaffected.
Written at the end and anxious, today's caregivers, although they represent both the patient's relatives (e.g., instead of completing the work that the relatives are supposed to undertake) and the hospital (e.g., doing what the hospital asks), do not seem to be so legitimate. If the nursing profession cannot develop in a fair manner, not only will the source of nursing workers be worse, but it will be difficult to find or more expensive, which will be more difficult for the patient's family, after all, many people cannot do without them.
Author | Old Xue Chun | Shaanxi people