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The Twelve Days of Christmas in LTC

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

The Twelve Days of Christmas in LTC

There are many givers in senior care facilities. Sometimes they don’t even realize it themselves. This holiday season is a good time to recognize them — and the things that make smiles bright.

The Twelve Days of Christmas in LTC

On the first day of Christmas, my residents gave to me a thank you for my good care.

On the second day of Christmas, my residents gave to me two knitted mittens and a thank you for my good care.

On the third day of Christmas, my residents gave to me three candy canes, two knitted mittens and a thank you for my good care.

On the fourth day of Christmas, my residents gave to me four graham crackers, three candy canes, two knitted mittens and a thank you for my good care.

On the fifth day of Christmas, my residents gave to me five beaming smiles, four graham crackers, three candy canes, two knitted mittens and a thank you for my good care.

On the sixth day of Christmas, my residents gave to me six warm handshakes, five beaming smiles, four graham crackers, three candy canes, two knitted mittens and a thank you for my good care.

For the entire article, visit:

The Twelve Days of Christmas in LTC

7 employee wellness ideas for the holidays (and beyond)

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

7 employee wellness ideas for the holidays (and beyond)

After a staff training on reducing burnout in long-term care last week, a look through the evaluation forms was illuminating. A significant number of attendees — mostly nursing aides, nurses, and environmental workers — wrote that the most valuable point they got from the training was how important it was to take time for themselves, even if it was for just a few minutes.

Apparently the 10-minute meditation we practiced using an app on my smartphone made a big impression on them. What struck me was how novel that experience was for them.

With frequent callouts and turnover rates troublingly high (50% for nurses and 51.5% for aides, according to a 2012 AHCA report), working short-staffed seems to be the rule rather than the exception. It means workers are being stretched ever thinner and being pulled in many directions by the needs of their residents.

With the holidays upon us, staff members have extra duties at home — gifts to purchase, parties to plan and attend, and special foods to cook.

By this time in December, your workers are probably maxed out.

This is a great opportunity to show that you’re thinking of them and that you recognize how stressful the holidays can be. It’s also a good way to prevent the staff burnout that leads to callouts, resignations and injuries.

For the entire article, visit:

7 employee wellness ideas for the holidays (and beyond)

Kind words from residents

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

Kind words from residents

At a conference last week, I remarked to my audience of recreation therapists, “None of us went into this field for the money — we did it for the juice.” And by “the juice,” I mean the good feeling we get from helping seniors and the nice things they say to us in return.

This is why your employees stay, despite everything else.

To get us in the spirit of gratitude for Thanksgiving, I’ve included a sample of comments made by residents to their psychologists. (I solicited material from my colleagues in my favorite shrinky organization, Psychologists in Long-Term Care. I actually heard some of them at work myself, but I’m not gonna tell you which ones.)

• “Without you, I’m like a ship without a rudder.”

• “Girl, I am so happy to see you. I love your smiling face. You help me so much when you come. I don’t feel so crazy.”

• “Thank you for listening to me & not giving up on me.” (Written on a “Wow!” card.)

• “I know you understand. I’m not crazy, but sometimes I feel like I am. My family doesn’t get it and the girls here don’t have time to talk to me.” (LTC Alzheimer’s resident with pain issues.)

• “You help me to look at my life here in a way that my family, friends, and nursing staff can’t.”

• “You don’t know how much it helps to have someone come in and listen and talk to me! I’ve just felt lost. I know I forget things, but since you’ve been coming, it seems like I’m less befuddled!” (LTC resident with early onset Alzheimer’s disease.)

For the entire article, visit:

Kind words from residents

Planning for the Holidays

With the start of the holiday season, it’s time for this perennial post from Dr. El:

‘Twas the Week Before Christmas…

MyBetterNursingHome.com

The secret to LTC success? A focus on well-being

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

The secret to LTC success? A focus on well-being

Despite the diversity of the events I attended during my brief visit to the LeadingAge convention in Boston last week, a theme clearly emerged. The thread that ran through the varied offerings was well-being.

Retaining staff

In researcher and consultant Joanne L. Smikle, PhD’s talk on staff retention, rather than focusing on why employees are leaving, she looked instead at why they stay.

Based on her studies of long-term care organizations, she found that “if the leadership of the organization lacks passion, you will have trouble with retention and commitment.”

In healthy organizations, staff members “from the top of the house to the bottom of the house” stay because they can say, “I felt I mattered.” Experiences that contribute to that feeling: Recognizing staff in formal and informal ways, an open dialogue with staff rather than top-down communication, and a focus on the human elements enabling employees to make connections with each other, the residents and the families.

Dementia care

G. Allen Power, MD, FACP titled his presentation, “Enhancing well-being for people living with dementia,” so it wasn’t surprising that this was a central point in his talk.

He asserted that antipsychotics don’t work and don’t treat the true causes of the behaviors associated with dementia. Instead, he recommends focusing on the seven primary domains of well-being, which are part of the Eden Alternative model of care: identity, growth, autonomy, security, connectedness, meaning and joy.

In one instance, a resident who became agitated when he was prevented from leaving the building was allowed outside. The man looked at the cows in a nearby field and returned to spend the rest of the day calmly. The team, who subsequently learned that the resident had been a farmer whose daily routine included an early morning check on his animals, had given him not only autonomy, but had also affirmed his identity and added meaning and joy to his life. His agitation disappeared.

Keynote address

Atul Gawande, MD delivered a Monday morning keynote address. Author of the book “Being Mortal,” Dr. Gawande discussed ways in which to improve end of life treatment. He advocated for care that takes into account the desires of the patient and noted that there is more to living than extending the amount of time we live.

For the entire article, visit:

The secret to LTC success? A focus on well-being

Leonard Florence ALS unit entrance

How to find out why your staff is leaving

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

How to find out why your staff is leaving

During the Q&A section of my McKnight’s Fall Expo webinar “Letting them go with style,” the conversation turned toward why staff members are leaving their long-term care positions.
As I pointed out then, workers often give plausible but incomplete reasons for leaving their positions because they plan to work elsewhere in the industry and don’t want to burn any bridges. Others exit without giving notice. Without knowing the real reasons why employees leave, it’s difficult to make adjustments that will lessen turnover.

Challenging assumptions

Organizations sometimes disparage the departing employee rather than look at what might have contributed to their resignation. Psychologically speaking, this lessens the “narcissistic injury” of someone leaving. A narcissistic injury is one that hurts our sense of self. Rather than feel the pain of being rejected, we reject them.

A typical assumption is that there was something wrong with the resigning worker. For example, they weren’t dedicated enough, they didn’t appreciate the benefits of the organization, or they weren’t very good anyway (the “sour grapes” effect). This leads to the sweeping conclusion that you just can’t find good people these days.

Rejecting someone who has left us may help us get over failed romantic relationships, but it’s a missed opportunity in business, especially if our workers keep marching out the door in droves as they have a tendency to do in LTC.

For the entire article, visit:

How to find out why your staff is leaving

NYTimes: To Reach Seniors, Tech Start-Ups Must First Relate to Them

In To Reach Seniors, Tech Start-Ups Must First Relate to Them, Paula Span discusses the need to create “silvertech” based on what seniors really want, need and are able to use, rather than what younger people devise without consulting them.

In my experience in nursing homes and rehabs, residents would appreciate devices that help them to be more independent. To be able to open and close the windows, adjust the thermostat, and bring the tray table within reach would be a boon for them as well as for the staff otherwise called to their rooms to assist. 

Elders living at home would undoubtedly be pleased to have insurance cards with print large enough to read — not a tech device per se, but a more user-friendly interface with their insurance company. Other aspects of interfacing with corporations are important as well. Span reports that a debit card geared toward seniors found that they prefer to be routed to the appropriate customer service representative rather than to be directed to a website or app when problems arose.

Here’s an except from Paula Span’s article:

Daily, breathless announcements arrive in my inbox, heralding technology products for older adults.

A “revolutionary” gait-training robot. An emergency response device said to predict falls. A combination home phone and tablet system that “transforms how older seniors connect with and are cared for by their loved ones.”

Daily, too, I hear tales of technology failing in various ways to do what older people or their worried families expect. I hear about frail elders who remove their emergency pendants at bedtime, then fall in the dark when they walk to the bathroom and can’t summon help.

About a 90-year-old in Sacramento who stored his never-worn emergency pendant in his refrigerator. About a Cambridge, Mass., daughter who has tried four or five telephones — not cellphones or smartphones, but ordinary landlines — in an ongoing effort to find one simple enough for her 95-year-old mother to reliably dial her number and have a conversation.

Which scenario represents the likelier future for senior-oriented technology? It depends on whom you ask.

For more: To Reach Seniors, Tech Start-Ups Must First Relate to Them

‘The Adventures of The Geropsychologist’!

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

‘The Adventures of The Geropsychologist’!

“The Adventures of
The Geropsychologist!”

Starring Dr. El as
The Geropsychologist!

There have been thousands of movies and TV shows about the exciting work of cops, lawyers, and hospitals, but long-term care? Fuhgeddaboutit!

Here, Dr. El aims to correct that oversight with a show that reveals the versatility and pragmatism of a nursing home psychologist willing to do what it takes to meet the needs of her residents.

Act 1, Scene 1

In today’s episode, Dr. El walks into 85-year old resident Frank Corolla’s nursing home room. His bed is neatly made and the curtain is drawn between his bed and his neighbor’s in their semi-private room. Mr. Corolla is sitting in his chair in his pajamas and bathrobe, listening to the radio.

Dr. El (in a loud voice): Hey, Mr. Corolla! It’s Dr. El. How are you doing today?
Mr. Corolla (looking sad): Not good.
Dr. El (sitting on the edge of the bed): What’s the matter?
Mr. Corolla: My eyes are hurting me so bad I was crying today.
Dr. El: Did that help?
Mr. Corolla: No.
Dr. El: I’m sorry to hear that. I’ll talk to the nurse. I’ll be right back.

Act 1, Scene 2

Dr. El appears at the nursing station and waits while the nurse finishes her phone call. The nurse hangs up.

Nurse: How are you, Dr. El? How can I help you?
Dr. El: Well, I’m good, thanks, but Mr. Corolla eyes are hurting him so badly he was crying today. I wrote a note for the doctor last week but I don’t see any follow up. Do you know what’s happening with that?
Nurse (looking in the computer): I don’t see anything from the doctor. I’ll call the nurse practitioner.
Dr. El: Thanks!

Act 1, Scene 3

Dr. El runs into the nurse in the stairwell.

Dr. El: Were you able to reach the nurse practitioner?
Nurse: Yes. She put in an order to see the ophthalmologist.
Dr. El: Awesome!

[Canned applause]

Act 2, Scene 1

Dr. El walks into Ms. Johnson’s room and finds her frantically rummaging through her closet with one hand. With the other, she holds on to the wall. She looks like she’s about to fall.

Dr. El: Ms. Johnson! Are you OK? What are you doing?
Ms. Johnson (looking up with tears in her eyes): I was looking for a shirt I wanted to wear and look how they do my things! All crammed in here like they was nothing! They’s something to me. They’s all I got.

For the entire article, visit:

‘The Adventures of The Geropsychologist’!

The importance of hearing aids

New York Times writer Jane Brody recently penned two excellent columns on the value of hearing aids and the obstacles to obtaining them. (The links to these articles are below.) The articles led me to reflect on my experience with hearing aids as a psychologist in long-term care. I’ve noticed additional obstacles to hearing aid use:

• The aids are in the dresser drawer rather than the ears of the residents who need them.
• The hearing device is locked in the nursing cart or closet.
• The batteries are no longer functioning and there are no backup batteries.

Here are some suggestions to remedy these challenges:

• Nurses, aides, ombudsmen, readers: Please consider putting in hearing aids as essential a part of getting ready for the day as putting on a shirt.
• Establish a convenient location for all assistive devices so that eyeglasses, hearing aids, and dentures are easy to find and store. A special caddy for a dresser drawer would be very helpful in keeping track of these important items.
• Keep backup batteries available so that dead batteries don’t mean several weeks of isolation. Sell batteries on an Independence Cart, or traveling store.

As Jane Brody points out in her articles, losing the ability to hear can lead to social isolation, cognitive impairment, excessive fatigue and other maladies. Let’s do what we can to keep our residents at their best.

• Hearing loss costs far more than ability to hear
• The hurdles to getting hearing aids

Behavioral health care — not drugs — for dementia

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

Behavioral health care — not drugs — for dementia

Antipsychotic medications have proved ineffective at reducing the symptoms associated with dementia. They also have serious side effects in older adults, including restlessness, dizziness, higher likelihood of falls and other problems that can contribute to an increased risk of death.

Behavioral health interventions, on the other hand, have no such side effects and have been found effective in reducing behaviors such as aggression, care refusal and wandering.

Employing behavioral health techniques with people with dementia becomes increasingly valuable as facilities in this country endeavor to follow the Centers for Medicare & Medicaid Services guidelines and reduce the use of antipsychotic medications.

Global efforts

Dementia care is a pressing issue around the world, and other countries have made headway in shifting from medication to behavioral interventions. Psychologist Paula E. Hartman-Stein, Ph.D., of The Center for Healthy Aging, writes about international programs that implement behavioral health methods in the September/October edition of The National Psychologist.

Dr. Hartman-Stein spoke with Cameron Camp, Ph.D., an expert who consults with long-term care facilities in the United States and abroad.

France

Dr. Camp reports that the French government pays nursing homes to train their staff in non-pharmacological approaches to dementia. The training includes various strategies, including Montessori techniques such as those described by Dr. Camp in his excellent book, “Hiding the Stranger in the Mirror,” and other publications.

Australia

Camp notes that Alzheimer’s Australia provides funding to train staff in behavioral health approaches. Its website, Alzheimer’s Australia Information for Health Professionals, offers helpful information and brief videos that explain the techniques used.

Canada

In Canada, the Canadian Foundation for Healthcare Improvement reports on the success “beyond the team’s expectations” of an effort to reduce antipsychotic medications and implement non-pharmacological approaches. The project saved $400,000 in six months across the Winnipeg region.

STAR-VA in the USA

Here in the United States, the Veterans Health Administration, less constrained by the fee-for-service psychotherapy model that plagues the rest of the country, utilizes staff psychologists and other behavioral health professionals in their Staff Training in Assisted Living Residences (STAR-VA) model.

For the entire article, visit:

Behavioral health care — not drugs — for dementia