Second of two articles
John Hill was once a strapping man who owned a trucking company. Now 93, he is, in his own wry estimation, "no bigger than a dime." On this curtain-drawn morning, he inhabits a nursing home bed--diapered, near deaf, dentures in cups. His room reeks of urine. After Vera McGriff, it will smell of talcum powder.
This cold winter week, McGriff, 47, is Hill's nursing aide. She wields liquid soap, washcloth, a basin of steaming water. The bath, conducted in bed, begins at Hill's brow. She wipes each vellum eyelid, his cheekbones, the hollow now his chest. She washes both bird arms, his creased fingers, backside, legs, feet, each defeated toe.
In exchange for the daily performance of this and other tasks at the Washington Center for Aging Services in Northeast, McGriff earns $240 a week.
The intimate but meagerly compensated role of nursing aides such as McGriff is more vital--and its future more uncertain--than ever. More Americans are living longer, a fact repeatedly cited in national debates over the future of medicine, the future of Social Security, the future of culture. Much less often discussed is the future of one-on-one care for the aged, a role performed by some of the country's lowest-paid and most-injured workers.
The coming boom in the elderly population--there will be a projected 2.8 million-person increase in the over-80 population by 2006--is expected to spur demand for nursing aides at a time when their ranks are thinning. The annual turnover rate among nursing aides is 93 percent. There are 1.3 million aides working today, and the Bureau of Labor Statistics estimates that an additional 333,000 will be needed within seven years.
The pressures are being stoked by changes in medicine as well as demography. To contain costs, hospitals are releasing more patients earlier in their recovery cycles, creating more admissions of the acutely ill to nursing and rehabilitation homes. Advances in medical technology are extending lives but can diminish an elder person's mobility.
"We have a crisis brewing," said Steve Morrisette, president of the Virginia Health Care Association, a nursing home owners group. Relatives of nursing home residents are already seeing the problem. "When we talk with consumers we continually hear this issue of poor quality being connected to lack of staff," said Mark Miller, a consumer liaison for nursing home clients. "It's the most critical issue we're dealing with today."
What does all this mean on the front lines of the aging crisis, where millions of elderly Americans live their last days in the care of--and sometimes die in the arms of--a legion of low-wage strangers? Time spent in the company of Vera McGriff at a typical facility of middle-class residents suggests an ambiguous but melancholy answer: a clouded world of confusion and regression, sweetness and pain. Nursing aides confront the unforgiving and sometimes ugly indignities of aging--loss of control of physical functions, irrational behavior, a grasping need for some measure of love. One aspect stands out--the importance of the nursing aide to the quality of care, the quality of life, the quality of death.
In one sense, Vera McGriff is not at all typical: She is committed to her work, and has stuck with it. The vast majority of nursing aides leave the field within a year. But she wants "to be the best at what I do." The beds she makes are military-taut. On her rounds she carries a shopping bag of powder, perfume, lotion, ribbons--brought from her own home.
The bad days unsettle her--like the time she was bathing a resident who asked whether this was the only job she could get, wiping other people's backsides. McGriff mustered: "I guess so, 'cause I'm wiping yours."
Then there are her friends. "They tell me, 'I wouldn't do that job,' " McGriff says. "And I say, 'Everybody can't be a nurse, everybody can't be a doctor.' "
Some people think they can be nursing aides. It turns out they cannot. Even a casual visit to the Three Blue Unit where McGriff has worked for six years requires tender psychology and sturdy common sense. Here is a resident in a floral dress, a goiter like a cantaloupe at her neck. Here is the woman who cannot sit still, babbling mishmash. Here is the Alzheimer's-bewitched man who takes a swing at McGriff, which she ducks.
Medicine can do little for them. McGriff's job is maintenance--bathing, diapering, feeding. Meals are shared in a room packed with wheelchairs, with "The Price is Right" bellowing. Dementia, Alzheimer's disease, the inability to talk or walk--these losses make socializing seem a sad farce. In most cases, a resident's most intimate relationship is with a nursing aide.
High school graduate McGriff grew up one of seven children in a house without indoor plumbing. She became a nursing aide for the same reasons many women do--a divorced mother of two, she needed a job and had little work experience. To become a nursing aide, a woman needs a high school education and minimal federally mandated training, a threshold that opens the field to many unskilled workers. "When I first started out I was just in there for a job," McGriff says. "Since I've been in there, it's not just a job to me. No." Dennis Lindsay, her husband of two years, says, "I'm always teasing her that she cares more for those old folks than me."
Residents have hit her, spit on her, scratched her. Male residents have made suggestive remarks at bath time. One chased her down the hall. "Men gonna be men," McGriff says with a shrug. "No matter what their age. I just tell them, 'As long as you don't touch me, you can talk all you want.' "
On one frantic Monday at Three Blue, 37 residents needing baths and toilets are backed up like jets on a runway. McGriff arrives 45 minutes early for her 7:30 a.m shift--as she does every day to get a head start. Still, she is rushed.
In whites, braids pulled back, she surveys the three beds in Room 318. It is 7:40 a.m., the light low. She sees three heads under blue blankets. One of them is Annie Williams, one of McGriff's favorites.
At her supply cart, McGriff loads up: three plastic pads, diaper, washcloth, towels. She deposits them near Williams, who is motionless, eyes closed.
"Good morning, Miss Williams," McGriff chimes.
Her roommate, a stroke victim, begins a guttural bleating. On television, a cartoon pops and whirligigs faintly. McGriff switches on a light. The walls are a void; no family photographs, no plaques.
McGriff pulls on latex gloves, and swabs Williams's eyebrows slow, soft.
Soon the singing begins. It's four o'clock in the morning. We danced the whole night through.
"You like to waltz?" Williams asks McGriff, who is applying deodorant.
"I don't know how," says McGriff.
"Well, they have a pretty tune they play and you sway. Ease along. Ease along," Williams reports.
McGriff takes a strawberry patterned dress from the closet. She spritzes Williams with Clinique perfume she has brought from home. "I don't need to smell good," Williams protests.
"Everybody wants to smell good," McGriff says.
On go the powder-blue knee-high socks, the velour slippers, the dabs of Vaseline, smoothed on Williams's cocoa face.
"Alright, time to get up," McGriff announces.
McGriff needs to lift Williams to put her in a wheelchair. She pulls Williams upright and instructs, "Hold on to my neck."
Eyes closed, Williams embraces her, cheek to cheek. McGriff pulls her to half-standing, then pivots, places her in a wheelchair. "Now let go," she says.
Williams opens her eyes wide as windows. It is as if she is seeing McGriff for the first time that morning.
"I thought we were dancing," she says, bewildered, still hanging on.
McGriff opens the door to Room 303 at 10 a.m. She walks into the smell, a fetid presence.
A woman with a rippled crown of gray hair is under a blanket, eyes beseeching. McGriff pulls on her gloves, lifts back the covers. Excrement is smeared everywhere.
To the right of the bed, a reproduction of the face of Jesus is illuminated by a brass fixture on the frame. By that light, McGriff works with her washcloth. Every so often, she talks to the silent woman.
"You don't usually do that. You must want to be extra clean this morning. We're gonna take a shower but I have to clean you up first."
And at the end, "Feel better now?"
There is no response. Then, in a voice like a creaking door, the woman says, "Thank you."
"You're welcome, honey," McGriff says. "You're welcome."
On a dresser, a photograph shows a graduating class of nurses. They wear caps, starched dresses and white shoes. In the bottom row, on the right, stands a younger version of the woman now in the bed.
Over the years, McGriff has jerry-built armor against these images. What does she think about during her more trying duties? "I don't really think about anything." The growls residents can make? "I'm used to it." Ever depressed? "No." Ever cried at work? "Nope."
McGriff is in room 304, John Hill's room. It's 10:45 a.m.
"I need a shave bad," Hill tells her.
McGriff pats arctic white shaving cream on Hill's mahogany cheeks. The Bic razor scratches across his skin.
"She's better than the average ones," Hill tells a visitor, motioning at McGriff. "She's easy. She ain't rough."
He is quiet for a good while. McGriff is now washing his stomach. He asks, "How much do you make an hour?"
"$8.69," she says.
"Can't it be $10?"
More washing, and then, "That old woman that come in here when you was off, ain't worth $5."
In a corner of the solarium, McGriff pulls up a folding chair next to Willie Royster. It is lunch time. "As the World Turns" swells in orchestral crests on television.
Royster cannot feed himself. Like all residents, he wears a disposable bib with a fold at the bottom to catch stray food. Three mystery purees spread on his plate.
McGriff moves a fork from plate to lip, peering into his watery eyes for signals on whether he is ready for another bite. His fingers vibrate. His lips quiver. He looks as if he might cry.
McGriff wipes mucus from his nose, and he looks at her. He smiles, warmly. She smiles back.
Later, dessert gone, she is briefly distracted by a talk with a nurse. Another aide tries to remove Royster's bib. He resists. So McGriff tries to take it off, thinking he is angry because she let someone else do it.
His face is suddenly infernal. He takes a swing at McGriff, but she evades it.
"You don't want it off?" McGriff says calmly.
He is silent.
"Okay," she says.
She waits. She watches him--reading, judging. She takes off the bib. He lets her.
"We don't ask a shoemaker to fly a 747 full of people," said Solanges Vivens, whose company manages the D.C. government-owned nursing home where McGriff works. "But we do expect nursing assistants to behave like they have a PhD in psychology. The expectations are: They will do miracles."
Nursing aides provide 80 to 90 percent of the hands-on care in nursing homes. Most full-time aides are single heads of households, but their incomes are so low that many qualify for food stamps.
Medicare and Medicaid programs, which supply most of a typical nursing home's revenue, have no regulations about how much aides should be paid. Recent cuts in Medicare benefits have put more downward pressure on pay. Wages in the field average $6.94 an hour nationwide; few aides have retirement or health benefits. Not surprisingly, retention of nursing aides is abysmal--annual turnover rates are 93 percent, according to the American Health Care Association, the industry's trade group.
And it is not just the low pay that drives aides away. Even the worst job in a dangerous factory or a bloody slaughterhouse can offer more uplift--a sense of bustling enterprise--than the rooms of loss McGriff works her way through morning after morning.
One day, after punching out on the time clock, a worn McGriff owns up to a sadness she had previously denied. "You know when you asked me if I'd ever cried at work, and I said, 'no?' Well, that wasn't right," she says.
When did she cry?
"Not one time," she says.
"I just, you know, cry. Like, they be suffering. You try to wash them. You know you're not hurting them, but they be moaning. I cry."
CAPTION: Vera McGriff cares for and speaks to John Hill, who is hard of hearing.
CAPTION: The Washington Center for Aging Services in Northeast is owned by the District and managed by a private company. Nursing aide Vera McGriff, 47, usually arrives 45 minutes before her shift begins to get a head start.
CAPTION: Joseph Butler does the "cha cha" in his chair as McGriff cleans. For some in her care, their relationship with McGriff is their most intimate.
CAPTION: McGriff, who brings perfumes and toiletries from her own home, braids Annie Williams's hair.