As the president and chief executive officer of the Colorado Health Care Association, my job is to advocate for the interests of the state’s long term care providers and the residents they serve. While I have experience in health care, government, and politics, I have never worked in a care center. To do my job well, I need to be able to share the experiences and challenges of our providers and their residents in meaningful detail. I have related second-hand stories to policymakers, lawmakers, and members of the general public, but there is no substitute for first-hand experiences. So I set out to live a day in the life of a resident.

I spent the night as a resident of Clermont Park Care Center in Denver. The purpose of this adventure was for me to gain insight into the experiences of the residents and staff at a long-term care center. I wanted to understand the residents’ daily lives and what was important to them. I also wanted to hear from the team of people providing the care to understand their challenges and motivations. Three years into a staffing crisis I want to know why they chose long term care—and why they stay.

The facility administrator created a fictitious diagnosis for me that would serve as the basis of my stay, and for how I would experience my time in the care center. I was there for rehab from a post hip fracture and could only place “toe touch” weight on my right foot and leg. I was to have a history of depression, high blood pressure, and macular degeneration. My impairments were that I was hard of hearing, needed a wheelchair for mobility, and had incontinence.

My Stay Begins

Check-In: I checked in at 1 p.m. I was greeted and shown to my room by the intake coordinator. Upon entering my room, I was told that I was being “red taped” until my evaluation process was completed—meaning that I was to stay in my wheelchair at all times. If I wanted to move to another chair, move to the bed, or use the bathroom, I needed to use the call light to ask for assistance.

The coordinator gave me a general agenda for the day that showed who I would be visited by and when I would dine. I was introduced to my CNA, Anthony, who asked how I was feeling and if there was anything that I needed. He took my vitals and let me know that everything looked good.

I was presented with the 74-page resident service agreement, and the coordinator let me know that I could have a paper or digital copy. He also said that he would be by the next day to review the agreement and respond to any questions I had. He offered to talk with family members or another representative if I would like. Finally, he asked if I had any questions or if there was anything I needed.

Evaluation
Nurse: Next, I got a visit from Boniface, an RN that works full-time at a local hospital and part-time at Clermont Park. He asked me a series of questions about my condition, my medical history, and my current impairments. He let me know how my care planning would take place (including my part in that process) and who all would be coming to see me and when. He made sure I understood everything clearly and answered every question I had. 

New CNA: It’s time for a shift change at 2 p.m. I met two new CNAs: Silvie, who is my primary CNA, and Sarah, who is another CNA on-shift. They both ask me if there is anything I need. Sylvie takes my vitals and lets me know that everything looks good. She tells me that I should use the call button if there is anything I need and that she will be with me until nighttime.

Transition Care Manager: Next, I got a visit from my transition care manager, Tiphany. I learn that in order to be a transition care manager, you need to be an RN and have some background in social work. Tiphany presents me with a Medical Orders for Scope of Treatment (MOST) form. This is a form that I have talked about, read about, and helped promote, but have never had presented to me. I’m a little taken aback by having to consider whether I want life-saving treatment or tube feeding should the need arise during my stay. It’s a lot to take in considering that I’m a relatively healthy 52-year-old that’s getting rehab for a cracked hip. I realize that our residents make life-or-death decisions within two hours of checking into one of our care centers.

Before leaving, she shows me a big binder that I will get when I check out. It includes every instruction I could possibly need as well as the business cards for everyone that has come in contact with me during my stay. When I ask if I will get that at discharge, Tiphany tells me that that they call it “move out” and reminds me that words matter. I was grateful for the reminder.

Life Enrichment: Jackie introduces herself as a member of the life enrichment team. Her job is to make sure that my personal needs are met during my stay. She asks me a series of questions about things that are generally important to me and/or make me uncomfortable. She walks me through the access to activities and enrichment that they offer and says to call with any questions. 

Social Worker: I am next introduced to Bobbie, who is a social worker. I think I don’t need a social worker because I’m a stable guy who is gainfully employed and comes from a solid family. But I’m wrong as the staff can’t treat me correctly until they understand who I am and all that comes with that. Bobbie goes to work on a memory test, a mood evaluation, and a dive into my family history. They understand me better now.

Dietary: Time to consider my dietary needs. Rachel sits to talk with me about my current nutritional state, weight journey, and relationship with food. She wants to know about any special dietary needs I have and any food preferences I have. She lets me know that her goal is to ensure that I have satisfying meals that meet my needs and to make sure that my weight doesn’t fluctuate in meaningful ways during my stay. She also wants to make sure that my body is processing food correctly and they will be tracking that during my stay.

Care Planning: Mark introduces himself as the MDS coordinator and the person who creates care plans. He lets me know that everyone I met today will enter their evaluations into their system and then he will create a plan of care based on that information. Once the care plan is created, he will sit down with me and my family to discuss the care plan and will make any needed adjustments to ensure that it remains person-centered. If I were here for a longer stay, he would schedule regular care conferences. Since I am a short-stay resident, I will have a care plan review every Tuesday. Federal regulation requires that a care plan be created in less than 48 hours, and Mark lets me know that mine will be completed by tomorrow. I learn that to be a care planner, one must be an LPN or RN and have a Regulatory Affairs Certification.

Therapy: Don, who is the executive director, was my therapy evaluator. Before we dive into my physical ability, Don walks me through a process to determine my mental acuity. It’s a process that’s pretty simple but also feels a bit intimidating. Don verbally shares a list of five objects and asks me to try and remember them. Next, he asks me to recite a series of numbers back to him in reverse order. For example, Don said 1734 and my response should be 4371. After we do this a few times, Don casually asks me to recite the five objects he mentioned to me earlier. It oddly feels like pressure to get the answers right. As we continue through the process, I start wondering how this is relevant to physical therapy. Don tells me that it’s an assessment for both physical therapy and occupational therapy. My responses give the therapy team a sense for where I am and set a baseline for improvement.

Now for the physical assessment. Don talks to me about what it means to put “toe touch” weight on my right foot. At no time should I put more pressure on my right foot than allowing my big toe to touch the floor. Next, he takes me through the process of using the walker and how I should get into and out of it. I learn to place my body weight onto my arms while placing toe weight on my right foot. I get to use my left foot normally. Don places a length of rope on the floor and asks me to use my new skill to get to the end of the rope. He’s timing how long it takes me to reach the end. After explaining that he’s using that time to set a baseline for my future progress, we move on to the Clermont Park marathon. It’s not a real marathon but it feels like one. We move into the hallway with my walker, and Don tells me that we are going to walk 100 feet up and down the hallway for six minutes. One more baseline from which to begin my therapy and gage my future progress.

Don let me know that tomorrow we will begin my therapy, asks if there is anything I need, and then it’s time to head to the dining room for dinner.

Dinner

Having had enough of my walker, I pivot back to my wheelchair and head to the dining hall. I start to have a little nervousness about dinner. I love food and am pretty particular about food prep, the consistency of food, the taste of my food, and how taste and consistency go together. In short, I’m picky. Food is more than just sustenance to me, and to some extent my meals can make or break my day.

In the dining room the first thing I notice is the smell. The food smells good, and I start to relax a bit. I have chicken and rice soup, chicken casserole, Spanish rice, and southwestern grilled vegetables. Having completed a marathon this afternoon, I also treat myself to apple honey strudel for dessert. Everything tasted good. I felt like the food quality was high and the taste of everything satisfying. Once my meal was finished, I realized that I would be comfortable with the food here if a longer term stay was in the cards for me.

The Bathroom

One of my bigger fears about this adventure was what would happen when it was time to use the bathroom. I wasn’t sure how far we were going to take me acting like I was a patient, and I was not excited about the prospect of someone helping me use the bathroom. Much to my relief, the acting job stopped at the bathroom door. 

As I went through the evaluation process, I realized that I needed to use the bathroom. I found myself not wanting to bother anyone, or slow down their process, so I continued to wait. Finally I couldn’t wait any longer and told my therapy professional that it was time. He left the room so that I could have some privacy. I rolled myself to the bathroom and as I stood up, I realized I had not locked the wheels. The wheelchair slipped out of my reach. At that point I realized just how easy it is for a fall to occur in this situation. I managed to unintentionally pull the call light string in the bathroom, and I felt a bit foolish.

I talked to the administrator about people who refuse help with using the bathroom (or any other type of assistance). Something I would be very likely to do if I were a real resident. Specifically, I asked if I were to sign something saying that I had refused bathroom help, would that exempt the care center from liability? The answer was nuanced. A reminder that even when everything is care planned, and the care plan is followed, there can still be less than desirable outcomes. And even when that outcome was discussed with a resident in advance and the resident (or resident’s family member) had instructed the staff to allow the resident to use the restroom on their own, there can still be legal and regulatory consequences for the care provider. Note to self: we need to do better on clarifying the lines between resident choices, safety and security, and legal and regulatory consequences.

Wheelchair

Being in a wheelchair is a new experience for me. I am able-bodied enough so that wheelchair operation isn’t too much of a struggle most of the time. As I went through my evaluation process (which lasted about three hours in total), I began shifting back and forth not used to sitting down that much. My backside developed a minor ache, and my upper back started to get sore. By the evening, my lower back felt sore, and my hips were throbbing a little bit. 

I wheeled the chair up to the more comfortable-looking recliner. Having learned my lesson about wheel locking, I remember to lock the wheels before exiting. After sitting about 10 minutes in the recliner, I decided I was getting cold and that it was time to change into my sweats. I reached to grab my wheelchair and pull it closer so that I didn’t fall. And then I remembered that I had locked the wheels. I dragged the wheelchair closer to me and released the brakes, pulled it closer, and re-engaged the brakes before attempting to transfer. Through a few awkward movements, I managed to change into my sweatpants and get myself back into the recliner. As soon as I sat down, I realized that I’d left my sweatshirt across the room. I had to repeat the whole process.

Sounds

I have been told that noise and sounds were one of the more disruptive things people had to adapt to when moving to a congregate setting. Having never lived in one, I could imagine that any unwanted noise would be bothersome. During the daytime hours I could hear sounds of people talking and getting through their day, but I was surprised with how quiet it was. I was expecting to hear loud voices, beeping sounds like in a hospital, lots of bustling sounds from staff members, and maybe the occasional loud noise. I heard none of that. It all sounded quiet and peaceful. 

At one point during my on-boarding process, I was asked about music playing in my room. The staff asked if I was OK with the music, and I said I was. After dinner I was writing down some thoughts about my day and decided to turn off my TV, from which the music was coming. Yet, the music didn’t stop. Now the music that I hadn’t noticed much throughout the day was bugging me. I am certain that I could have pushed my call button, and someone would have quickly turned it off for me. Knowing how busy the care team was likely to be, I decided to try and figure it out for myself. 

I went through the process of getting out of my recliner and loading into my wheelchair. I looked at the remote controls in my room and didn’t see anything that resembled a sound button. I decided to open the curtain dividing my room from the room next to me. I had the room to myself, but the room was designed to be a dual-occupancy space. Once I moved into the adjoining room, I realized that the music was coming from that TV. Simple enough, I’ll turn it off. I looked for the remote but couldn’t find it. I rolled over to the TV and figured out how to turn it off by hand. I realized that there is no way a person with macular degeneration would have been able to do that. I had to take off my “corrective” lenses in order to see the on/off icon that was in a very light script on the screen.

Hearing Loss

Part of my care profile was that I have hearing loss. I was given some cotton to stuff into my ears so that I could experience what it is like to not be able to hear clearly. Through my intake and evaluation process, everyone was considerate about making sure I could hear them clearly. They all spoke up, and I had no troubles at all. 

I left the cotton in my ears for the entirety of my stay except for dinner. During dinner I couldn’t hear my fellow diners very clearly. I decided that I learned enough of the intended lesson of the cotton-stuffed ears and took it out so that I could better engage with my dining companions. I wanted to hear their stories. I now understand how hearing loss can make a person feel like they don’t want to try and be a part of a conversation. As much as I wanted to talk to the people at my dining table, the amount of effort that it took to hear was frustrating. I’ve read that people with hearing loss can become withdrawn, isolated, and less sociable. I now understand why that is true and how it feels.

Vision Loss

Another part of my care profile was that I had macular degeneration. I thought that I would share that fact with everyone that asked about my care needs. Instead, Don gave me a pair of clear lens glasses that had scotch tape all around the periphery. I put them on and found myself having to exert energy in order to see. I no longer had peripheral vision so I had to turn my head to see anything. Looking straight at everything due to the non-existent “corner of my eye” took more effort.

When I began my therapy evaluation, I had to walk the hallway for six minutes to establish a timeline. I took the walker and pretended to not be able to place weight on my right foot. As much as that was a challenge, my mimicked macular degeneration made it that much tougher. I couldn’t see what if anything was on the floor beneath me, I couldn’t make out details of any of the people in the hall, and it was hard to ignore the people moving around. I didn’t comprehend if they were going to cross my path at some point. Now, in addition to my physical struggle I felt disoriented by the lack of clear vision.

Doug Farmer is president and CEO of the Colorado Health Care Association.

In a short period of time, I learned a lot about the perspective of a resident. In part 2 of this article I will share what I learned about the people who care for our residents each day.