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Diabetes care: Take two betta fish and call me in a week
Here’s my latest article on McKnight’s Long-Term Care News:
Diabetes care: Take two betta fish and call me in a week
More than 25% of the US population over the age of 65 years has diabetes1 and the numbers are far higher for those in long-term care. (Approximately one third of nursing home residents have diabetes.2)
Diabetics often need to track their blood sugar level multiple times daily and administer medication. Uncontrolled diabetes can lead to a host of medical problems, including heart disease, neuropathy, and impaired vision and falls, and can result in hospitalizations and rehospitalizations.
While guidelines suggest that elders with comorbid health problems need less intensive glucose control than younger healthier people (who are more likely to benefit from years of strict control), many residents in our communities still need to keep track of their blood sugar daily.
We can borrow an idea from a recent study of children with diabetes to help empower our elders toward better self-care in our senior communities and more successful transitions home from skilled nursing care.
In an effort to test pairing twice daily glucose checks with pet care, researcher Olga T. Gupta, MD gave betta fish and tanks to children ages 10 to 17 years. The children were asked to feed their fish and check their blood sugar at the same time, and to review their glucose logs with their parents when they cleaned the fish tank each week. The results of this pilot study showed a small but significant improvement in glucose control.
We can adapt this study to seniors and simultaneously take advantage of the health benefits of pet ownership. Caring for a pet has been linked to fewer doctor visits, improvement in activities of daily living, reduced depression and better heart health, among other rewards. 3
For the entire article, visit:
Diabetes care: Take two betta fish and call me in a week
WHCOA: LeadingAge Summary
I wrote about the White House Conference on Aging last October, noting that it was a “once-a-decade” national conference about the needs of our aging population.” (McKnight’s LTC News, October 2014)
Below, LeadingAge summarizes the 2015 White House Conference on Aging, which took place on Monday:
10 Things that Happened at the White House Conference on Aging
After a year’s worth of collecting data and opinions, experts from the field of aging presented new ideas and initiatives at the 2015 White House Conference on Aging (WHCOA).
The White House Conference on Aging facilitated a national conversation on growing older in America through live-streaming social media. LeadingAge hosted a watch party and found the following highlights noteworthy:
- A Call for Caregiver Support Systems: Panelists stressed the importance of establishing support systems for the nation’s 50 million professional and family caregivers, whose numbers will double by the year 2050.
- CMS Proposed Rule: CMS proposed Reform of Requirements for Long-Term Care Facilities, which would affect more than 15,000 nursing homes and skilled nursing facilities. A element of the proposal is new standards for coordinating facility-to-facility patient transfers in order to improve quality of life, enhance person-centered care and services for residents in nursing homes, and improve resident safety.
- HHS Secretary Announces Funding for Workforce: Sylvia Burwell, secretary of the U.S. Department of Health and Human Services (HHS) announced $35.7 million for a new Geriatric Workforce Enhancement Program, preparing the health care workforce to respond to the needs associated with advancing age.
- Dementia Friendly America: A coalition of private sector organizations announced the Dementia Friendly America initiative, which was created to foster communities that are equipped to support people with dementia and their families. There are currently plans to build 15 new pilot sites across the country.
For the rest of the article, visit:
10 Things that Happened at the White House Conference on Aging
Creating Better Deaths in Long-Term Care
Here’s my latest article on McKnight’s Long-Term Care News:
Creating Better Deaths in Long-Term Care
I walked into Mr. Hobart’s room, ready for my initial evaluation. He was a thin, graying man whose loose clothes hung in folds around him. He’d spent every day last week in chemo.
He spoke quietly, discussing his estrangement from his family and the good old days hanging out at the bar. None of his drinking buddies were around. He had no visitors.
Following our talk, I stopped at the nursing station. “What’s his prognosis?” I asked the nurse. “Not good,” she said. I paid a visit to the social worker and asked softly but very bluntly, “Is there a reason we’re medically torturing this man?” “We wanted to put him on hospice, but his brother won’t return my calls,” she told me. She promised to try again. By the next week, hospice services had been arranged. Mr. Hobart died five weeks later.
Unfortunately, this scenario is a fairly typical approach to end-of-life procedures in long-term care. The case highlights common end-of-life challenges in LTC facilities:
• No clear leadership within the treatment team regarding end-of-life care — Often team members, regarding this as a medical situation, expect that the physician will be addressing these issues with the resident and their family. The physician, on the other hand, may view dying as an emotional issue and expect that the social worker and other team members will be handling it.
• Lack of communication with the resident regarding end-of-life wishes — With no designated team member to broach the topic, residents often follow along with the care plan assuming they’re going to get better and that someone will tell them when they’ve reached the point where medical interventions are unlikely to help.
• Lack of communication with family members regarding prognosis and care decisions — Addressing treatment decisions and whether or not to consider hospice or palliative care is often a time-consuming series of discussions with family members and it needs to be handled with sensitivity. This can be difficult to manage in what’s become an ever fast-paced care environment.
• Aggressive medical treatments with very low likelihood of success — There are increasing numbers of medical treatments that can be performed, but questions arise about whether they should be: Is the treatment likely to help? Has the resident been properly informed of the risks and side effects of the treatment? Does the resident understand how it will affect his or her quality of life? Atul Gawande, MD addresses these questions eloquently and in detail in his book, “Being Mortal,” which I highly recommend.
• Late referral to hospice — Hospice is an excellent support for residents and their families. (Unlike in LTC facilities, the entire family –— not just the resident — is seen for treatment.) Most often, however, the referral for hospice services is made when the resident has days or weeks rather than months to live and much of the benefit of hospice services is lost.
As organizations that serve people who are ill and in the last years of their lives, we can create better deaths by improving end-of-life care.
• Establish an end-of-life care committee — Select and train members from various disciplines to be part of the committee. This specialized group can work with the resident’s ongoing treatment team to speak with the resident and their family members about end-of-life care and decision-making.
• Use available tools to discuss care decisions with residents and their families — Here are two resources to be aware of:
For the entire article, visit:
Creating Better Deaths in Long-Term Care
Portrait of multi generations Indian family at home. Asian people living lifestyle.
How to Talk About Dying (Ellen Goodman, NYTimes)
Here’s an important article in the New York Times Opinionator Column by Ellen Goodman, one of the founders of The Conversation Project (which I’m about to investigate further). Note her comment that she expected her mother’s doctors to tell her what to do. The families of our residents are expecting the same from us.
How to Talk About Dying
I was 25 when I flew home for my father’s last birthday. His cancer had returned and he would die three months later at the age of 57. What I remember most about that weekend was the large rectangular gift box he opened. My mother had bought him a new suitcase.
I don’t know if that suitcase qualifies my family for the Denial Hall of Fame. There are so many contenders for that honor. But I’ve carried the psychic baggage over the years. I have never forgotten that image and how we lost a chance to say goodbye. I still wonder if my father was lonely in the silence that surrounded our inability to talk about what we all knew.
Decades later my mother began a long slow decline. By then, I was a newspaper columnist, a job that I often described as “telling people what you think.” I was professionally outspoken. But little had changed since my father’s death.
Yes, my mother and I talked about everything — but we didn’t talk about how she wanted to live toward the end. The closest we ever came to discussing her wishes was when she would see someone in dire straits and say, “If I’m ever like that, pull the plug.” But most of the time there is no plug to pull.
Gradually and painfully, my mother lost what the doctors call “executive function,” as if she were a C.E.O. fumbling with Excel spreadsheets, not a 92-year-old who couldn’t turn on the television or make a phone call. Eventually, she couldn’t decide what she wanted for lunch, let alone for medical care.
In some recess of my mind, I still assumed that death came in the way we used to think of as “natural.” I thought that doctors were the ones who would tell us what needed to be done. I was strangely unprepared, blindsided by the cascading number of decisions that fell to me in her last years.
For the rest of the article, visit:
How to Talk About Dying
The Goodbye Guide: Why and how to terminate tenderly in LTC
Here’s my latest article on McKnight’s Long-Term Care News:
The Goodbye Guide: Why and how to terminate tenderly in LTC
An experienced colleague was recently let go from her job to which she’d been dedicated for 10 years. “We want to take things in a different direction,” she was told by the administrator. “Pack up your office and go.”
An hour later, she was in the parking lot holding a box containing a photo of her kids and mementoes of a decade as head of the social service department. Her replacement started two days later.
There are, of course, occasions when people who are fired or otherwise are terminating employment and need to be escorted from the building. But many workers are career professionals who wouldn’t consider burning bridges with bad behavior. Despite this, I’ve witnessed hasty dismissals and hushed resignations on multiple occasions throughout my career.
Sometimes, departing coworkers will tell me they didn’t want to let anyone know they were leaving because they didn’t want to deal with the residents’ being upset.
In my training to become a psychologist, we spent a great deal of time discussing endings and termination of treatment. While work in long-term care isn’t necessarily a psychotherapeutic relationship, I believe leave-takings in LTC are more important than in other settings and that the style of departure should be given more consideration.
Here are some aspects to consider:
• Due to the nature of the work, staff members form deep relationships over time with the residents and their families. When we depart, it matters to them.
• Because we work with elders and those who are ill, people are constantly leaving — through death, discharges, and hospital transfers — often suddenly and without the chance to say goodbye. This can create small traumas. In compassionately addressing our departures, we have the opportunity to reduce the amount of trauma in the lives of our residents rather than contribute to it.
For the entire article, visit:
The Goodbye Guide: Why and how to terminate tenderly in LTC
Harnessing gratitude
Here’s my latest article on McKnight’s Long-Term Care News:
Harnessing Gratitude
Though it was close to 20 years ago, I’ll never forget the reaction of one of my patients to losing both of her legs to diabetes.
“I’m 81 years old and I’ve traveled and danced as much as I could. I wasn’t sick a day in my life until this happened. I’m satisfied,” Lila told me earnestly.
I was astonished by her acceptance of such a difficult situation. If it had been me, I was sure I would have railed at the injustice of the world.
Residents like her, however, make it quite clear that it is possible to be grateful and to live fully, despite disability.
Lila came to mind recently when I asked a resident, Daisy, how she was doing three years after a debilitating stroke. Her curt reply: “The same old damn thing — I still can’t walk.”
Creating better mood
A 2015 study in Spirituality in Clinical Practice suggests it might be possible to use the tool of gratitude in order to help residents like Daisy.
The study looked at the impact of gratitude and spiritual well-being on a group of asymptomatic heart failure patients with an average age of 66.
The researchers found that “gratitude and spiritual well-being are related to better mood and sleep, less fatigue, and more self-efficacy.” Those positive effects can reduce the chances that an individual will move from being asymptomatic to symptomatic heart failure, which is “associated with a five-fold increase in mortality risk.”
The researchers point to studies that tried to enhance participants’ sense of gratitude. Gratitude is considered part of “positive psychology,” which focuses on the strengths that allow individuals and communities to thrive.
For the entire article, visit:
Harnessing Gratitude
Strengthening Troubled Sibling Bonds to Deal With an Aging Parent (NYTimes)
I’m writing to you from my hotel room in Ontario, Canada today, where I’m finishing up some last minute details before heading out to give a training program on preventing senior bullying (iron suit — check!).
This week’s post comes from Abby Ellin, writing in the NYTimes Money column about the use of elder mediators to help families jointly and sanely make difficult decisions about elder care.
Strengthening Troubled Sibling Bonds to Deal With an Aging Parent
ROSIE, Therese and Linda McMahan were always close, but after their father died unexpectedly in 2011, they found their relationship strained.
They did not know what to do for their 84-year-old mother, Rose, and their brother, Paul, 53, who has cognitive disabilities and is in a wheelchair. The sisters tried to find an assisted-living home nearby, in the Boston area, but couldn’t. And so after many months, they decided that their mother and brother would move in with Rosie’s family in Amherst, Mass.
“We were all confused and upset about the situation,” said Rosie, 51, who is an educator and a counselor for teenagers. “We had so many questions. How much respite should my sisters offer me? Should Mom’s name stay on the deed of the house? Where will either of them go if I can’t keep taking care of them?”
“It was hard to figure it out,” said Therese, 50, a midwife in Somerville, Mass. “How do we make decisions? What do we all feel comfortable with? What are the guidelines we’re going to adhere to? Every conversation ended with someone crying or hanging up, or both.”
To help them navigate those difficult waters, they went to mediation to learn how to “stay in each other’s life and not have it be destructive,” as Rosie put it. “We wanted to stay connected as siblings, but if you don’t get someone else to help you out, you kind of fall prey to your childhood antics. A mediator makes a hard job a little easier.”
For the rest of the article, click below:
Strengthening Troubled Sibling Bonds to Deal With an Aging Parent
Big family together sisters and mother
Psychologists open up about LTC sex and dementia
Here’s my latest article on McKnight’s Long-Term Care News:
Psychologists open up about LTC sex and dementia
A recent Iowa court case acquitted Henry Rayhons of sexually abusing his wife, who had Alzheimer’s dementia and lived in a nursing home. The case not only prompted national debate, it led those in long-term care to consider how to handle sexual activity within the bounds of their facility, particularly in cases when one or both of the parties have a diagnosis of dementia.
Psychologists are frequently asked to determine whether or not a patient has the capacity to understand or authorize various aspects of care, including their ability to consent to sexual behavior.
Eric Redlener, PhD, president of The PsychAssociates Group, a company that provides psychological services to long-term care facilities, held a meeting for its supervisors to discuss the challenges that arise when considering capacity, sexual activity and the senior living environment.
I was on the conference call since I work for them regularly. Here is a fly-on-the-wall account of the concerns raised during the meeting.
Staff issues
Some of the challenges to handling sexual behavior in the long-term care environment involve the reactions of staff members to the situation.
· Some staff members show squeamishness about “Grandma and Grandpa” having sex.
· Staff members may be concerned, rightly or wrongly, that residents will be taken advantage of.
· Staff members project their notion of sex onto elders. Elders may be content with holding hands or heavy petting, but staff might be anticipating people “swinging from the rafters.”
· Sometimes an administrator or director of nursing bans sexual activity among the residents, considering it “bad behavior,” despite the fact that it’s a legal right in many states for residents to be able to engage in sexual relations within a long-term care facility.
Family concerns
The reaction of family members to the romantic/sexual involvement of their elders can vary greatly.
· Some family members are able to accept their loved one’s need for intimacy, despite its sometimes unexpected expression, such as when an elderly heterosexual mother spends time cuddling with another woman on the floor, or a husband with dementia becomes involved with a woman who is not his wife.
For the entire article, visit:
Psychologists open up about LTC sex and dementia
Free Webinar 5/20 @2pm ET: 9 Ways to Improve the Effectiveness of your Social Work Department & Increase LTC Resident Satisfaction
Join Dr. El
Wednesday, May 20th
at 2pm Eastern Time (1pm Central Time)
for a
FREE Webinar on
9 Ways to Improve the Effectiveness of your Social Work Department
& Increase LTC Resident Satisfaction
sponsored by EmLogis
To register:
visit EmLogis Events
About the webinar:
Are your residents depressed, their families distressed, and your staff turnover rate higher than you’d like? Empower your long term care social service department to lead the way to change! Join LTC expert and psychologist Dr. Eleanor Feldman Barbera for a live webinar on Wednesday, May 20, 2015 at 1pm CDT | 2pm EDT as she discusses the importance of social workers and ways in which an effective department can transform your community.
What you will learn:
The most important factors contributing to resident satisfaction
The impact of social workers upon resident, family and staff satisfaction
9 easy-to-implement strategies to develop your social work department
Who should attend this webcast:
Administrators and assistant administrators
DONs, ADONs, social workers
Staff training coordinators
Human resource department staff
The Many Riches of Senior Living Conferences
Here’s my latest article on McKnight’s Long-Term Care News:
The Many Riches of Senior Living Conferences
I’ve been fortunate enough to attend several senior living conventions recently and my enthusiasm for the experience has yet to diminish. If you haven’t yet had the opportunity to be present for a conference (or if it’s been a while since your last one), consider these reasons for attending:
• There are interesting discussions that directly relate to day-to-day work. Hearing different ideas and perspectives can offer a new way to handle problems and can help you get out of a work rut.
• The conference discourse provides a great opportunity to brainstorm, on your own or with colleagues and coworkers.
• Attendees are often equally enthusiastic about LTC and the connections made with others there can help implement changes within your organization.
• The new products offered in the expo hall can improve operations and the lives of residents and staff.
• Sharing the lessons learned with coworkers can expand the value of the conference.
If an onsite convention isn’t possible for now, consider attending a virtual event, such as the annual McKnight’s Online Expo, which not only offers educational sessions but also has chat rooms and a virtual expo hall.
My experience at ALFA
My most recent conference was the Assisted Living Federation of America convention last week in Tampa, where I spoke at the session “The Importance of Environmental Factors in Senior Living.” During my whirlwind visit to ALFA, I was also able to take in two presentations and spend time in the expo hall.
One of the sessions was on using recreational activities as a way to improve morale among residents and staff and to promote your organization in the community. I’ve spoken about these goals in my audio, “10 Steps to Making Recreation the Most Valuable Department in the Nursing Home,” and I was encouraged to hear of unique ways senior organizations have been serving these dual objectives, such as knitting caps for premature babies.
The conversation among participants helped me think about the impact that the pro-social engagement of residents has on reducing the problem of senior bullying. If seniors are busy doing good in the world, not only are they less likely to be engaging in negative behavior such as bullying, but the organization has helped to create a culture of caring.
The second talk was a roundtable on engaging staff in order to reduce turnover. The suggestions focused on hiring for attitude and training for skills, being clear about the mission of the organization, and implementing programs that reward employees for their good work.
Expo hall jewels
As usual, I searched the expo hall to find products I knew my residents would appreciate.
Having heard far too many elders complain bitterly about pureed food, I was delighted to find a company that offered puree solidified into colorful, shaped molds that were far more appetizing than typical puree. The saleslady looked askance at my glee about getting to sample her wares — but regular readers know I like to experience things from the residents’ perspective whenever possible.
For the entire article, visit:
The Many Riches of Senior Living Conferences
