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Bicycle Riding for Residents (video)

Adaptive tandem bicycles allow residents the pleasure of riding a bike and feeling the breeze through their hair. As John Brunow of All Ability Cycles puts it in the video below, an adaptive bicycle event triggers reminiscence, stimulates appetites, and reduces depression. Sounds like a win, win, win to me!

To reduce staff turnover, lead with LTC strengths

Here’s my latest article on McKnight’s Long-Term Care News:

To reduce staff turnover, lead with LTC strengths

When I spoke about the challenges of staff turnover at the Louisiana Nursing Home Association convention last week, I asked the group, “If you were able to bring in the same salary you were currently making, would you want to have the job of an aide?”

The response was a ratio that would likely hold at any LTC convention – in an audience of close to two hundred people, only one person said yes.

“You do realize what we’re doing here,” I commented. “Over the next hour or so we’re going to talk about how to get people to take and remain with jobs we wouldn’t want to have ourselves.”

As attendees pointed out, being an aide is physically and emotionally demanding work for low pay, little autonomy and not enough respect. These downsides – once partially offset by longstanding, gratifying relationships with medically stable, cognitively intact residents – have given way to more challenges as facilities take in increasing numbers of shorter-term, higher acuity residents.

To woo workers to the field – and keep them from the lure of relatively stress-free retail positions at the same pay – it might be time to re-envision our role as employers.

They come for the “special sauce” – and they’ll stay for the buffet

The main appeal of jobs in long-term care (our “special sauce,” if you will) is the opportunity to help others. No fast food joint can compete with that. We need to offer more, however, if we want our workers to stick with us.

In addition to traditional benefits, we can enhance our appeal by providing a “buffet” of nontraditional benefits that build on our missions and on employees’ desires to help others.

One of the unique features of LTC is our access to wisdom from elders, which can offer perspective on life and how to live it. If we envision ourselves not just as caregivers for the aged and ailing but also as organizations that can impart life wisdom to those with whom we come into contact, we can strengthen our allure as employers.

For the entire article, visit:

To reduce staff turnover, lead with LTC strengths

What’s all this about PBJ? Guest Post by “Miss Emily Litella”

Here’s my latest article on McKnight’s Long-Term Care News:

What’s all this about PBJ?

(Guest post by Miss Emily Litella)

So what’s all this about peanut butter and jelly? Emily Mongan wrote the other day that, “Providers could face Five-Star sanctions for late PBJ data.”

Why are they keeping track of our peanut butter and jelly sandwiches? I appreciate their concern that we residents might have our lunches served late, but what about the tuna fish sandwiches? And the chicken? Doesn’t it matter if those are served late as well?

Speaking of late, what about the times when the call bell is rung and the aides don’t show up for 45 minutes and then say they were working short? Is the “call bell delay due to working short” on the five-star rating system too?

And regarding shorts, I lost mine in the laundry the other day and they haven’t been able to trace them. I spent a lot of money on those shorts and believe me, clothes in my size aren’t easy to come by. Usually they come in teeny-tiny-itty-bitty little sizes. I had to have my daughter-in-law go to Kmart and Walmart before we finally found them on Amazon.

I have good news about the Amazon, by the way. A friend of mine is working to plant trees in the Amazon, doing her part to give back to the world.

Now that I mention backs, I should tell you that mine is hurting. I went down to rehab to ask them to give me a hot pack, or a cold pack, I forget which it is that they’re recommending these days, but anyway, a nice young man whose name I can’t pronounce or recall, gave me one of them and it felt so much better. But now it’s aching again.

For the entire article, visit:

What’s all this about PBJ?

Wisdom from elders

Here’s my latest article on McKnight’s Long-Term Care News:

Wisdom from elders

I’ve learned a lot from listening to residents over the years, but it’s rare that I request specific advice. This month, I decided to change that.

In private conversations, I told residents that I was writing an article on advice from elders about how to live life and I asked them if they had any wisdom they wanted to share with young people.

Their responses were immediate and enthusiastic, as if they’d been waiting for someone to ask. They were so pleased with the question that I decided to ask my own elder relatives for their opinions as well. One family member, inspired by the inquiry, called to contribute further advice after her initial offering.

Many of the comments focused on wellbeing and taking risks in life:

• “If there’s something you want to do, go for it. Even if it doesn’t work out, at least you tried.”

• “Do what you can while you can do it. Take a chance!”

• “Do things you enjoy and keep as busy as your health will allow.”

• “Don’t overdo it.”

Others centered on maintaining independence:

• “Do the best you can and save a dime, because now when they jump me for money, I got a little something to pull out.”

• “Try to have something of your own, not your mother’s, not your father’s.”

Several people offered relationship advice:

• “Pay attention to your spouse but be an individual too.”

For the entire article, visit:

Wisdom from elders

‘Healthwear’ and other culture changes

Here’s my latest article on McKnight’s Long-Term Care News:

‘Healthwear’ and other culture changes

My mother has a knack for taking something awkward and, as she puts it, “turning it into a feature.”

For example, the previous owners of our family home placed the living room couch in front of a protruding radiator so that the sofa was oddly and obviously a foot away from the wall. By contrast, my mother had shelves installed above the radiator so that it became a pleasant focal point for books, photos and the stereo system.

I follow this line of thought with regard to the need for assistive devices such as canes, walkers, and eyeglasses. It’s possible to convert something unappealing yet necessary into an item that bestows confidence, evinces a sense of humor or becomes more useful.

Turning assistive devices into a feature creates a psychological shift for the wearer. It gives residents an element of control over mostly uncontrollable circumstances and allows them to retain their personal style in a situation that tends to strip them of their uniqueness despite our best efforts.

An organization providing the opportunity to purchase or design desirable devices can generate a change in their culture. Seeing residents sporting colorful walkers or personalized wheelchairs rather than standard equipment sends a message of individualized care and a zest for life despite disability.

In the spirit of giving your residents an emotional boost and taking the sting out of the need for assistive devices, your organization might try some of the following ideas (found through my handy search engine):

• Residents can purchase sophisticated walking canes featuring fancy handles or colorful shafts with a wide selection of items under $50. I know many residents who would find that an excellent use of their Personal Needs Allowance (PNA).

• Another company features a colorful range of walking canes for about $40 each. Choices include floral motifs, Irish themes, US military and biker inspired designs.

• With PNA funds being as limited as they are, a decorating event is a great addition to the recreation calendar. Help residents embellish canes or create personalized walker or wheelchair bags to carry their belongings using colorful duct tape, Velcro and other supplies, or sew a handy cup holder.

For the entire article, visit:

‘Healthwear’ and other culture changes

Reflections on the value of psychology services

When psychologists provide direct care services to long-term care residents, a note is required for every session, documenting symptoms, therapeutic interventions and other information proving that each and every session is medically necessary. The goals and progress of treatment are reviewed every three months. Audits and case reviews by insurers are not uncommon. Other disciplines in the organization read the notes and can incorporate the work into their efforts or, occasionally, question why the resident is being seen.

Sometimes, particularly when I haven’t had a vacation for a while, I wonder if I’m being truly helpful. I don’t want to discontinue treatment too soon because often mine is the only consistent, deep contact a resident has in life, but the steady drumbeat of needing to prove it’s worth it can lead to doubts at times.

Luckily, my residents have a way of letting me know that my services make a difference to them.

I was considering discontinuing treatment with a somewhat confused woman. When I woke her from a nap the other day, she smiled broadly, pointed to my business card which she keeps by her nightstand and almost leaped out of bed to talk to me. She spent the session following up on topics we’d been addressing in previous sessions and proudly showing me her progress on activities in which I’d encouraged her to engage.

I’ll keep going with her a while longer.

Another resident approached me in the hall recently, saying he’d been waiting for me and telling me, “You give me a reason to live.”

I’d consider that medically necessary, wouldn’t you?

NYTimes: Fashion’s Newest Frontier: The Disabled and the Displaced

In Fashion’s Newest Frontier: The Disabled and the Displaced, author Vanessa Friedman writes about clothing for people with disabilities, referred to as “healthwear.”

Among the items now available are Magnaready‘s clothes with magnetic closures rather than difficult-to-manage buttons, and shirts by Care + Wear designed for people with medical ports so that they can stay comfortably dressed and merely unzip the section needed to access the port. Care + Wear also offers PICC line covers that come in a variety of fashionable colors.

Hallelujah! It’s about time! I can’t wait to see what’s next.

Care + Wear’s PICC line cover

Racism and LTC

Here’s my latest article on McKnight’s Long-Term Care News:

Racism and LTC

A friend of mine called me this week, upset about the racial tension making headlines in the news. We discussed what we could do as individuals to improve the situation.

“I called a friend of mine of a different race,” she said. “I told him we need to stay in touch right now, even if we’re busy.”

“My column this week is about the issue,” I responded. We talked about how differences are bridged in a healthcare environment.

In long-term care, we provide services to, and work with, individuals from backgrounds different than our own. Residents share rooms and break bread with types of people they may never have encountered more than superficially in their previous 80 years of life. Barriers recede when we come to know each other as people, yet it’s not always a smooth road.

Studies of racism in LTC

I’ve observed firsthand various culturally charged interactions — both positive and negative — and I wondered what types of racial challenges are common in long-term care.

I turned to the research to see what’s been studied formally and found that racism is observed in the following ways:

• Residents refusing care based on the racial or ethnic group of the caregiver, as noted in the New England Journal of Medicine article, “Dealing with Racist Patients.”

• Unpleasant work environments due to hearing racial remarks by family members or other workers, in “Racism Reported by Direct Care Workers in Long-Term Care Settings.”

• Nursing homes in areas with high poverty being more likely to close: “Why Medicaid’s Racism Drove Historically-Black Nursing Home Bankrupt.”

• The changing demographics of nursing homes due to people from minority groups having increased entrance to that level of care, but reduced access to privately paid home and community-based care such as assisted living: MedicareAdvocacy.org, “The Changing Demographics of Nursing Home Care: Greater Minority Access…Good News, Bad News.”

Increasing inclusion

While some of these problems are beyond the scope of any one LTC organization, there are ways in which the first two points can be addressed within our communities:

For the entire article, visit:

Racism and LTC

NYTimes: Too Old for Sex? Not at This Nursing Home

Food for thought in this New York Times article:

Too Old for Sex? Not at This Nursing Home

By WINNIE HU

JULY 12, 2016

When Audrey Davison met someone special at her nursing home, she wanted to love her man.

Her nurses and aides at the Hebrew Home at Riverdale did not try to stop her. On the contrary, she was allowed to stay over in her boyfriend’s room with the door shut under the Bronx home’s stated “sexual expression policy.” One aide even made the couple a “Do Not Disturb” sign to hang outside.

“I enjoyed it and he was a very good lover,” Ms. Davison, 85, said. “That was part of how close we were: physically touching and kissing.”

Ms. Davison is among a number of older Americans who are having intimate relationships well into their 70s and 80s, helped in some cases by Viagra and more tolerant societal attitudes toward sex outside marriage. These aging lovers have challenged traditional notions of growing old and, in some cases, raised logistical and legal issues for their families, caretakers and the institutions they call home.

Nursing homes in New York and across the country have increasingly broached the issue as part of a broader shift from institutional to individualized care, according to nursing home operators and their industry groups. Many have already loosened daily regimens to give residents more choice over, say, what time to bathe or what to eat for dinner. The next step for some is to allow residents the option of having sex, and to provide support for those who do.

For the entire article, visit:

Too Old for Sex? Not at This Nursing Home

Super-utilizers: LTC has them too

Here’s my latest article on McKnight’s Long-Term Care News:

Super-utilizers: LTC has them too

I was flying home after visiting some family elders last week (a story itself perhaps for another time) when I happened upon a Kaiser Health News article about “super-utilizers” of emergency room services.

Research on Medi-Cal, California’s state health insurance for those with limited income, found that 1% of the patient population accounted for about one-fourth of the healthcare spending.

The reason: Super-utilizers were more often homeless and had substance abuse and mental health problems.

This echoes my experience working as a case manager for a managed care organization years ago. For the particular account I was working on, the mental health managers had access to both the medical and mental health data.

My main observation was that those with the highest medical costs were also those who had been in and out of rehab for substance abuse. The problem was that because our company was a “mental health carve-out,” with HIPAA-protected information, we couldn’t share that information with the medical team.

“Ask them if they’ve been drinking!” I wanted to shout, when I saw they were getting readmitted to the medical hospital for the third time in two months.

It’s a question we might consider asking in long-term care too (along with checking on psychiatric medications). The “super-utilizer” problem affects us in ways that may be less obvious but just as costly.

The super-utilizer in long-term care

Our super-utilizer of services is a resident who exhibits behaviors due to a mental health or substance problem that results in a series of staff meetings and discussions that takes time away from other residents.

It could be someone who needs repeated psychiatric hospitalizations because of psychiatric medication changes during the transition from home to medical hospital to skilled nursing, or an individual ready to be discharged after rehab but difficult to place due to comorbid physical and mental health needs. (A problem also faced in psychiatric hospitals, by the way, when a now-stable patient has comorbid physical health needs.)

Families can be super-utilizers of services. Consider the time-consuming challenges when a substance-abusing relative is found to be taking money from a resident or a discharge home is deemed unsafe because of a mentally unstable family member. I guarantee that’s not a one-meeting decision.

Reducing expense of super-utilizers

For the entire article, visit:

Super-utilizers: LTC has them too