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Addressing the healthcare needs of “unrepresented” elders

In Paula Span’s column today in the New York Times’ New Old Age column, Near the End, It’s Best to Be ‘Friended’, she discusses the increasingly common situation of elders who have no representatives assigned to make healthcare decisions on their behalf.

She encourages seniors to dig deep into their social networks to find an appropriate candidate to become a healthcare proxy or to keep detailed directives in a location that’s accessible to healthcare providers.

Span notes state efforts to increase the number of people who can step into such a role — some states allow for a “close friend” or a niece, nephew or grandchild to become a medical decision-maker.

Healthcare organizations such as the Cleveland Clinic have created protocols to assist teams in medical decision-making for “unbefriended” elders who are without the capacity to express their own wishes. As the medical decisions become more serious — such as a surgery or a do-not-resuscitate order — two medical professionals and an ethicist must agree that the procedure is in the patient’s best interest. Withdrawing treatment requires two physicians and the approval of a subcommittee of the hospital ethics committee.

Long-term care facilities would benefit from establishing similar protocols and committees for what will undoubtedly become a more frequent circumstance as baby boomers — who are less often married and more often geographically isolated from relatives — enter our care in greater numbers.

For Paula Span’s article, visit: Near the End, It’s Best to Be ‘Friended’

7 powerful ways to deliver family-centered care

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

7 powerful ways to deliver family-centered care

When families seek mental health treatment, it’s often because of a “problem child.” Family therapists consider this person to be the “identified patient” and recognize that the troubled individual is part of a family unit whose members all benefit from assistance.

By contrast, when a resident enters long-term care, we tend to focus solely on the needs of the resident, even though they’re almost always part of a family system that is being affected by their placement.
Oddly, we do this in spite of the fact that it’s frequently a family member who chooses the facility or community where the loved one will live.

If we consider that we’re admitting families rather than just the residents themselves, we’d recognize the need to provide family-centered care in addition to resident-centered care.

Instead, we repeatedly attend to the needs of families in a haphazard, reactive fashion. Those tense family meetings with the director of nursing and the administrator after the staff “mishandled” an interaction with a family member are more likely a lack of organizational attention to the needs of families and an absence of proper training than they are a reflection of staff error or of a “difficult” family.

Here are some ways to implement family-centered care:

1. Convey essential information to families about your facility or campus in a way that’s easy to access. If your website offers only platitudes about how you really care and then lists insurance options, you’re telling potential customers what you really care about and it isn’t them. Instead, turn your site into a 24/7 support kiosk, answering questions families commonly have about your community and helping them to be better caregivers and community members. Include, for example, information about their role in care plan meetings or how to help their loved one adjust to their new home. Add a list of resources they might want to consult. (My book, “The Savvy Resident’s Guide,” for example, is one way to offer information and soothe the frayed nerves of family members.)

2. Hold regular family meetings on topics that frequently affect them, such as caregiver stress, understanding dementia, and making the most of an off-campus pass (a great session to hold before the holiday season, hint, hint). Even though this may seem like yet another task to add to an already burdened staff, it will save time in the long run: Rather than answer the same questions individually, your staff can direct families to the meetings where questions can be discussed simultaneously and in depth.

3. Reach out to families during transitions in care, such as moving from an independent apartment to the care center in a continuing care retirement community.

For the entire article, visit:

7 powerful ways to deliver family-centered care

Getting good at goodbyes

Over 1000 listeners attended my McKnight’s Fall Online Expo webinar, “Letting them go with style,” which focused on ways to use the loss of employees to strengthen your organization. McKnight’s editor Jim Berklan moderated the event and shared his thoughts about the webinar in his Daily Editor’s Notes column today. I’m gratified to hear that the talk helped participants consider aspects of staff departures in a way they hadn’t previously considered. (Thank you, Jim, for your kind review!)

You can hear the replay of the webinar (archived for a year) at: Expo Registration

Getting good at goodbyes

It’s fairly likely that one or more of your employees will be leaving soon. That’s why you need to read this. It will make your organization healthier, and in ways you might have never imagined.

The goodbye guru would have it no other way.

I typed that name generically — with lowercase g’s — but I just as easily could have written Goodbye Guru. Then I would be referring to a specific person, namely Eleanor Feldman Barbera, Ph.D.

You might know her better as “Dr. El,” as in “The World According to Dr. El,” the award-winning blog that appears twice monthly on this website.

Regardless, she is an eloquent font of knowledge about what makes humans tick, and tock. Wednesday, we had a unique opportunity to hear her address a slightly off-kilter question: How should providers deal with an employee’s departure to create the best circumstances for their long-term care community?

I say “off-kilter” because the most common inference about a webinar named “Letting them go with style” would be that it’s about dying residents. Instead, Barbera fascinated listeners at McKnight’s Fall Online Expo with approaches and implications for dealing with departing employees.

Whether by firing, lay-off, resignation or for other reasons, employees leave long-term care operators often. And the emotional and psychological well-being of whoever remains is typically the worse for it — and usually to an unnecessary degree — Barbera pointed out.

It doesn’t have to be that way. She urged everyone to consider the multiple layers of messages any departure makes. This could mean saddened and suddenly insecure residents (“Who will take care of me?” “Didn’t she like me enough to say goodbye?”) to unnerved or perturbed staff members, to disgruntled or dangerous former employees.

All of which make for an unstable environment. Thus, more care should be taken with departing employees, Barbera emphasized. She illustrated numerous scenarios involving employee terminations, pointing out how providers can handle them better.

For the rest of Jim Berklan’s article, visit:

Getting good at goodbyes

Dr. El presenting at McKnight’s Fall Expo 9/9!

It’s time for McKnight’s Fall Online Expo!

I’m pleased to be presenting at 11am ET on Wednesday, September 9th on the topic of “Letting Them Go with Style.” This free hour-long webinar will focus on how to use the loss of employees to strengthen your organization.

The other two webinars will address reimbursement and technology. The Expo will also offer the opportunity to earn CE credits, visit with vendors and chat with colleagues. It’s a great way to attend a conference without leaving your desk. I highly recommend it.

For more information and to register, visit McKnight’s Fall Expo.

Hope to see you there!

The high cost of rudeness

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

The high cost of rudeness

A study about rudeness in the medical journal Pediatrics got me thinking about the possible effects of rudeness in long-term care.

In “The Impact of Rudeness on Medical Team Performance: A Randomized Trial,” teams were subjected to rude comments by a supposed visiting medical colleague. For example, he suggested that the team members in the neonatal intensive care unit (NICU) “wouldn’t last a week” in his country.

Compared to the control group, teams that had been exposed to the rude comments had lower diagnostic and procedural performance scores.

Naturally, I wondered how this research might translate to senior living.

I’m sure I’m not the only person who has observed rudeness occurring in eldercare settings, whether it’s an administrator being curt with staff, nasty remarks between staff members, a discourteous statement to or from a resident, or a sharp comment by a family member.

To complicate matters, LTC teams are often multi-cultural. What’s considered reasonable for one culture may be deemed rude by another culture.

In addition, a comment can be interpreted differently depending on the ages and genders of the people involved. If an older female staff member compliments a young woman on her outfit, it can come across differently than if an older male staff member similarly compliments his young female colleague.

Long-term care is also very hierarchical. Doctors often “get away with” rude comments to nurses, as do administrators with underlings.

The research, however, suggests that nobody is getting away with anything. Rude statements negatively affect team performance in the NICU and, I suspect, in teams everywhere.

The good news is that the study found two behaviors reduced the impact of rudeness: information sharing lessened the negative impact of rudeness on diagnostic scores and help-seeking reduced the adverse impact of rudeness on procedural performance scores.

Here are some ways to address rudeness in LTC:

For the entire article, visit:

The high cost of rudeness

Radio for Visually Impaired People

Mr. Johnson was in his 90s and had lost his vision many years ago. His great joy in life now was listening to the radio.

When I first came to see him, he had many different types of radios in his room. There were several radio alarm clocks and complicated boom boxes with too many buttons and functions he didn’t need. There was a transistor radio that required expensive batteries and somebody to run to the store to buy them.

All of these devices had crashed to the floor more than once during Mr. Johnson’s attempts to use them. None of them worked.

In long-term care, objects such as radios, telephones, and remote controls are always falling off tray tables and nightstands. I’ve often wished for rubber devices, preferably with a boomerang function that brings them back to the user immediately.

Seeking a replacement for Mr. Johnson, I found a simple, rugged radio that’s perfect for people who are visually impaired and need a fall-proof device. It’s a bit heavy at 6 pounds 9.8 ounces, so take that into consideration, but it’s impact-resistant, water-resistant, has five easy-touch AM/FM preset buttons, no extraneous functions, and has a power cord so no batteries are needed.

Mr. Johnson bought his through Amazon with my help (“Where is this store exactly?” “It’s on the computer, Mr. Johnson.” “But where is it?” “It’s hard to explain. But your radio will get here very quickly.”)

The radio doesn’t have a boomerang function, but at least if it falls, Mr. Johnson can pick it up by its handle and use it again.

Sangean Lunchbox Radio

Spirituality in Long-Term Care

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

Spirituality in Long-Term Care

Last week, a New York Times article referred to the lack of training to prepare doctors to recognize the spiritual needs of their patients. Hospital physician Robert Klitzman, M.D., emphasized in the Well section article the value of meeting these needs.

Psychology graduate school also avoided focusing on clients’ spiritual needs, which were considered to be the province of those with formal religious training. Despite this, I’ve found that many of the conversations I have with residents can be considered spiritual work.

In the beginning of my LTC career, I quickly recognized that in order to be of service in this environment, I needed to come to a spiritual understanding of how such nice people could be dealing with such difficult illnesses. This led me to the book by Harold S. Kushner, “When Bad Things Happen to Good People.” The gist of the book, as I recall it, was that the question is not so much, “Why me, God?” but, “Why not me?”

That stance allows me to help people come to terms with their experiences and also to recognize very clearly that this could be me, or me down the road a few paces. I am merely assisting others as I hope someone will assist me when it’s my turn.

For the entire article, visit:

Spirituality in Long-Term Care

I’m honored to win the 2015 PLTC Professional Service Award!

I’m thrilled to share with you that I’m the recipient of the Psychologists in Long-Term Care Professional Service Award for 2015!

Psychologists in Long-Term Care is “a network of psychologists and other professionals dedicated to the enhancement of mental health and quality of life for those involved in long-term care through practice, research and advocacy.”

They are an amazing group of committed professionals who work diligently on behalf of elders. I’m proud to have my efforts recognized by them.

Dr. El’s Shrinky LTC Fantasy

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

Dr. El’s Shrinky LTC Fantasy

I hung up the phone with the managed care case reviewer. The patient in question was in her late 50s, with multiple sclerosis and other physical problems that had unexpectedly interfered with her ability to return home or even to sit comfortably in a wheelchair. Bed-bound, she was irritable with the staff and distressed about the changes in her life, and in financial circumstances that had resulted in this new insurance coverage.

“You can see her for another 30 days,” the case reviewer told me. “After that, I’ll have to send it to a second level review.”

I sat at the desk in the administration office, hyperventilating. What else would need to happen to this resident in order to get more than a month of treatment? An amputation? The death of her only child?

I took my mind to a better place:

I was in my office at the rehabilitation and care center reviewing the psychology calendar for the month:

• This week I’d shadow the east wing staff and focus on team building.

• My weekly open office hours with the staff had several appointments already filled to discuss conflicts with coworkers, finding better ways to interact with a difficult resident, and how an otherwise excellent worker could get to work on time.

• The topic for the August family group meeting was set: How to partner with the staff.

• The monthly staff training topic was planned to coordinate: How to work with families. Other trainings I had in mind were on facing challenges such as aggressive residents, understanding mental illness, dementia without medication and team management of end-of-life care, in addition to handling work/life balance, reducing stress, time management, and coping with loss.

• The data collection for my research project was progressing nicely. Copies of my book, “The Savvy Resident’s Guide,” had been distributed to the recreation therapists, who were using them to run discussion groups with the residents based on chapter topics such as “Working with the staff” and “Making the most of rehabilitation.” Residents were being measured on acquired knowledge, level of anxiety, conflicts with staff and participation in rehab.

For the entire article, visit:

Dr. El’s Shrinky LTC Fantasy

A good perspective on residents

During a recent senior living conference, I was staying at the well-appointed Embassy Suites in Norman, Oklahoma. The key card to open the room came in a small folder. When I took out my key I found a statement on the folder that struck me as being completely relevant to long-term care and an excellent way to view senior living residents:

Our Guest

You are the most important visitor on our premises. You are not dependent on us. We are dependent on you. You are not an interruption to our work. You are the purpose of it. You are not an outsider to our business. You are part of it. We are not doing you a favor by serving you. You are doing us a favor by giving us the opportunity to do so.