Can residents recruit their own caregivers?

V. Tellis-Nayak, PhD

You’ve heard enough lectures and homilies on empowerment of staff and residents. Now you should go to Bethel, Connecticut, and visit Bethel Health and Rehabilitation Center and The Cascades Assisted Living. In this nursing home, a Planetree affiliate nestled in a 25-acre wooded site, a quietly smart director of nursing (DON), Diane Judson, RN, has incarnated the concept of empowerment in a remarkably simple form that yields unusually big results.

Judson does not hire her certified nursing assistants (CNAs) anymore. The residents do. You would expect the DON to be involved in every aspect of recruiting a CNA, and Judson is indeed involved. But, at the hour of decision, she silently steps aside and the residents take over.


A team of four to six residents, their homework done and ready to meet the applicant, stroll into the conference room. It is a meeting of the ages. On one side is arrayed the accumulated wisdom of the seniors who look benignly across the table at the eager young aspirant, Angelica Riviera, 19, idealistic but nervous. The dialogue across generations goes on for 45 minutes, with storytelling, jokes, and much laughter, as each side wonders how the other side will affect its future.

The proceedings do not always go smoothly. At one point, Robert Murray, a resident on the recruiting panel, pushed Angelica to the emotional edge; she was in tears. Murray asked her, “Angelica, you see I am only 42; but I am not a whole person any more. Lou Gehrig’s [amyotrophic lateral sclerosis (ALS)] has crippled me. I can barely move around; I cannot talk with you without this amplifier headset. I was a full person once. I am not anymore. Angelica, as my caregiver, what can you do to make me feel whole again?”

“That is not what I had expected,” Angelica told me. “I thought they would ask me about my training, my skills, and my experience. Bob’s question cut through all that I anticipated, it went deep inside me. It told me that what they were looking for was not a CNA; they wanted a caregiver that made them feel like a whole person. I cried.”

The recruiting team got the insight they were seeking. Angelica is now a caregiver at Bethel-a happy one-for about a month now. The team has shown an uncanny and unerring insight-how much sensitivity and kindness an applicant brings to the job. Not all applicants pass the test. Of the 40 or so prospective students or CNAs thus screened and recruited in the past year, only two have left Bethel; one was hired by Judson against the team’s recommendation-she soon discovered they were right-and the other, although big in heart, fell short on competence.


Murray, the resident afflicted with ALS for six years, has been very active in recruiting CNAs. I asked him what prime qualities he and his mates look for in a prospective CNA. Without hesitation and with emotion he replied: “Compassion, empathy, and competence”-a succinct summary of what researchers have heard residents repeatedly tell them.

We should not miss the irony. In long-term care, we ardently advocate staff adequacy and competence; we keep inventing ways to measure them. However, we do not measure compassion or empathy-the two things that research shows are the marks of quality and what residents truly desire.

Judson, a 30-year veteran in healthcare, has left her mark in many settings. As a successful leader, she is tuned in to her residents and her staff. Once, Barbara Habekost, a 76-year-old resident, casually mentioned to Diane how much she wished that the CNA, her caregiver (doing her internship at Bethel), would continue to be her caregiver. Inside Judson, that seed sprouted and blossomed into the program for residents to choose their own caregivers.

“Seeing residents hire their caregivers is rewarding enough,” says Judson. “It has also elevated my understanding of what matters most to the residents. It has made me a better leader and a better person. It is an empowering and uniting experience for us all. Sitting on the sidelines, I listen to residents tell a budding caregiver what living in a facility is all about; at each session I learn something new.”

In long-term care, we ardently advocate staff adequacy and competence. However, we do not measure compassion or empathythe two things that are the marks of quality and what residents truly desire.


The residents on the recruiting team are also riding the learning curve. Together they are a treasure trove of practical wisdom and smarts, but at first, they were not up with all the niceties of labor rules. Curiosity, sometimes, prevailed over legal prudence: “So are you planning on having children?” or “Why do you have that ball stuck in your tongue?” Good nursing homes prove that old hands can quickly learn new tricks of the cyber age.

Encouraged and supported by her Bethel Health Care family, Judson is always up to new tricks. One of her latest is a new program in which residents learn to become friends and partners that not only elevate the quality of their life, but also add quality to their end-of-life experience. Their motto: At Bethel, no one dies alone. Therefore, the residents are mastering the “Meaningful Touch” and the “Hand to Heart” techniques of staying connected with a friend during the last moments of life.

This column, “Exemplars in Long-Term Care,” celebrates the unseen stars and unsung heroes in our midst who pioneer new ways add quality of life to our elders and edify us all. Yes, Diane Judson, RN, DON, we take off our hats to her!

For more information, e-mail at LTL

V. Tellis-Nayak, PhD, is a medical sociologist. He has been a university professor, has conducted research in the United States and abroad, and has authored books and articles. He can be reached at Long-Term Living 2011 March;60(3):22-23

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