Blog
‘Okie El’ rocks out, and then veges out
Here’s my latest article on McKnight’s Long-Term Care News:
‘Okie El’ rocks out, and then veges out
Given that the bulk of my prior knowledge of Oklahoma came from a 72-year-old musical performed by my class during grade school, I wasn’t quite sure what to expect when I arrived in Norman for the 2015 Oklahoma Association of Health Care Providers/Oklahoma Assisted Living Association conference.
The upshot (based on the journey between the airport and the hotel): No fringed surries. Plenty of flat, open, grassy expanses. Chain stores. A bustling well-run conference. Animated conversations with attendees invested in providing enhanced care for their residents. Life-altering products in the Expo Hall.
Younger adults in senior living
I was invited for two talks, the first of which was on younger adults in senior care. The group focused on ideas for handling the challenges of younger residents, from those with illnesses such as ALS or spina bifida to people who led rough lifestyles prior to the disabling injuries (e.g. gunshot wounds) that led to placement in long-term care.
The talk addressed the emotional reactions caregivers have toward younger residents that can make it more difficult to work with them than with the typical older population. It also got into ways of unifying the team through training and policies, and strategies to engage younger residents in positive activities.
As I wrote in this 2008 article, meeting the needs of our younger residents now will help prepare our facilities for the differing expectations of the coming Baby Boom generation.
Addressing mental health in LTC
My second presentation focused on the need to address mental health problems in long-term care. Not a week goes by without a news story about a behavioral health problem in one of our facilities, such as an assault by a resident on a peer or staff member.
I offered a three-tiered model for addressing mental health care as part of our general healthcare. None of the three tiers — engaging mental health professionals, creating a healing emotional environment, and improving customer service — cost anything more than staff training and increasing the priority paid to behavioral health issues. Well worth it to avoid being the next facility with a negative news headline.
Rocking the expo hall
Between talks, I visited the expo hall in search of exhibits that offered solutions for my residents.
The first thing that caught my eye was the mod-looking geri-recliner.
For the entire article, visit:
‘Okie El’ rocks out, and then veges out
America has a major misconception about aging
I’m honored to be included among the 44 industry experts asked about the future of long-term care in this informative infographic and article:
Girl, paralyzed for 11 days, surprises favorite nurse by walking (video)
Here’s an inspiring video that captures how those who work in healthcare feel for those under their care:
If you’re unable to see the video embedded above, click here: https://www.youtube.com/watch?v=75odu9sxwEA
Loneliness in LTC: Overcoming disability, creating connections
Here’s my latest article on McKnight’s Long-Term Care News:
Loneliness in LTC: Overcoming disability, creating connections
The elevator opened up to the third floor of the skilled nursing facility. Wheelchair-bound residents lined the hall across from the nursing station, some silently watching the staff, some snoozing.
On the second floor of the nursing home, the physical layout was exactly the same but the atmosphere was completely different. Groups of two or three residents were chatting animatedly, commenting wryly on their observations of staff and laughing amongst themselves.
How do we get from Scenario A to Scenario B more often? Is it worth the effort?
The high cost of loneliness
A recent study showed that community-dwelling seniors visited their doctors more often when they were lonely — the trips to medical offices were an important but costly form of social interaction. Similarly, one might speculate that socially isolated residents request help from their nurses, aides and other workers due to feelings of loneliness in addition to addressing specific care needs.
Reducing loneliness among residents would, therefore, contribute to more staff time being available for medically necessary care.
Decreased turnover
The findings from another study suggest a connection between happier residents and staff retention. Researcher Barbara Parker-Bell, PsyD, LPC, ATR-BC, finds that “nurses consistently described the best and most satisfying aspects of dementia care as … the pleasure of seeing residents calm and engaged.”
I know from my own experience that it’s much more uplifting to step onto a unit with laughter than it is to work on a floor where the residents are depressed, lonely and withdrawn. And, of course, it’s better for the residents and their families.
Beyond ‘recreation’
Good therapeutic recreation programs are essential in reducing isolation, providing meaningful ways of spending time and in developing friendships. They’re an important step in reducing loneliness, but are also only one piece of the puzzle.
If all staff members consider the social aspects of the environment — one of the best selling features of life in LTC — we can create friendly, engaging interactions that build upon and extend formal recreation programs.
Challenges to interacting
For the entire article, visit:
Loneliness in LTC: Overcoming disability, creating connections
The medical system may treat you well, but less so after you reach age 80
This Washington Post article by Louise Aronson, MD perfectly describes the failures of our current medical system to address the problems that affect older patients.
The medical system may treat you well, but less so after you reach age 80
The clinic was in a dilapidated old building, yet the entryway retained a worn grandeur. Tapering, semicircular walls extended like welcoming arms, and a half-moon of sidewalk stretched to the quiet side street.
That’s where I first saw her, standing at the curb with her cane propped on her walker, squinting toward the nearby boulevard. The woman was clearly well into her 80s, with a confident demeanor and with clothes and hair that revealed an attention to appearance. She had a cellphone in one hand and seemed to be waiting for a ride.
I had been heading into the clinic for a 4:30 p.m. appointment, and when I came back out, night had fallen. But for her tan winter coat and bright scarf, I might have missed her leaning against the clinic’s curved wall. She still held the cellphone, but now her shoulders were slumped and her hair disheveled by the cold evening breeze.
I hesitated. On one side of town, my elderly mother needed computer help. On the other, our dog needed a walk, dinner had to be cooked and several hours of patient notes and work e-mails required my attention.
I asked this woman whether she was okay. She looked at the ground, lips pursed, and shook her head. “No,” she said. “My ride didn’t come, and I have this thing on my phone that calls a cab, but it sends them to my apartment. I don’t know how to get them here, and I can’t reach my friend.”
She showed me her phone. The battery was now dead. I called for a taxi with my phone. She was tired and cold by then and suddenly seemed frail.
We chatted as we waited. She owned a small business downtown — or she had. She was in the process of retiring, having been unable to do much work in recent months because of illnesses. She’d been hospitalized twice in the past year, she said. Nothing catastrophic, yet somehow after the second stay things had never quite gotten back to normal.
The geriatrician in me noted that she had some trouble hearing, even more difficulty seeing, arthritic fingers and a gait that favored her right side. But her brain was sharp, and she had a terrific sense of humor.
For the rest of the article, visit:
The medical system may treat you well, but less so after you reach age 80
Dialysis: Gauging its need, and how to reduce its stress
Here’s my latest article on McKnight’s Long-Term Care News:
Dialysis: Gauging its need, and how to reduce its stress
As a psychologist observing the effects of medical interventions on the mental health of the long-term care resident, I often ask, “Is this aggressive procedure helping?”
Such a well-intended question can prompt the team to reconsider the course of treatment or to affirm that care is in line with the wishes of the resident and their family.
Conversely, I do what I can to encourage my residents to comply with medical recommendations. When a resident presents with end-stage renal disease (ESRD) and the inevitable recommendation of hemodialysis is given, I work with them to adjust to this turn of events.
That’s why I was surprised to read in Paula Span’s “New Old Age” article in the New York Times last week, “Learning to Say No to Dialysis,” that dialysis isn’t always the best course of treatment for older patients.
Span reports that while dialysis can be very successful for younger and healthier patients, about 40% of patients with ESRD over the age of 75 die within a year and only 19% survive over four years. One study found that 58% of nursing home residents died within a year. Meanwhile, 61% of patients in a Canadian study said they regretted starting dialysis.
What leads to regrets tend to be the following factors, which can contribute to feelings of depression among those on a renal program:
• Physical symptoms such as pain, fatigue, nausea and headaches
• The amount of time spent on dialysis
• Inability to travel
• Dietary restrictions
Span quotes nephrologist Dr. Alvin H. Moss, who notes, “Patients are told, ‘You have to go on dialysis or you’ll die,’ rather than, ‘You could have up to two years without the treatment, without the discomfort, with greater independence.’” I’ve been part of teams that have told residents the exact words of that first message.
Medical management
For older patients, particularly those with other health problems, Dr. Moss asserts that medical management might be a way for them to focus on extending their quality of life and avoiding the discomforts of dialysis. The American Society of Nephrology suggests discussing this alternative to dialysis with patients through a shared decision-making process, as noted in their Choosing Wisely guidelines.
Facilitating treatment discussions
For the entire article, visit:
Dialysis: Gauging its need, and how to reduce its stress
Free Webinar 3/25 @ 2pm ET: 4 Steps to Preventing Senior Bullying in LTC
Join Dr. El
Wednesday, March 25th
at 2pm Eastern Time (1pm Central Time)
for a
FREE Webinar on
4 Steps to Preventing Senior Bullying in Long Term Care
sponsored by EmLogis
To register:
visit EmLogis Events
About the Webinar:
Senior living communities often experience problems with bullying among residents. Join psychologist Dr. Eleanor Feldman Barbera on March 25th at 1pm central for a FREE WEBINAR as she discusses the importance of addressing bullying and outlines the path to creating an atmosphere that discourages bullying within your community.
What you will learn:
The impact of bullying
The types of behaviors considered bullying
Who is more likely to bully and to be bullied
Interventions to reduce bullying at the individual and organizational levels
Who should attend this webinar:
Administrators and assistant administrators
DONs, ADONs, department heads, nursing supervisors, charge nurses, social workers, and direct care staff
Staff training coordinators
Human resource department staff
McKnight’s Free Online Expo 3/25 & 3/26
Those who like the convenience of attending a conference without leaving their desks (and the fact that it’s free!) will be pleased to hear that McKnight’s is holding their online Expo tomorrow and Thursday on the following topics:
WOUND CARE TRACK: “The current science of pressure ulcer prevention (Or It’s Still Rock and Roll To Me)”
CAPITAL TRACK: “2015 seniors housing capital market trends — and influencing factors”
PAYMENT TRACK: “MDS 3.0 Update: Know the new requirements, or else”
QUALITY TRACK: “Ways to reduce rehospitalizations and attract partners”
TECHNOLOGY TRACK: “Using technology to track resident preferences and activities to drive quality improvement”
(After the last McKnight’s webinar on Wednesday, head over to my Senior Bullying webinar at 2pm ET sponsored by EmLogis — think of it as the Mental Health Track.)
You can earn 3 CEUs and visit the vendor booths, as well as chat with other conference attendees via your avatar.
To register for the conference, visit McKnight’s Online Expo
NET Therapy: Dementia Care Best Practices + Rehab = Success
Here’s my latest article on McKnight’s Long-Term Care News:
NET Therapy: Dementia care best practices + Rehab = Success
When I learned about Neurocognitive Engagement Therapy for rehabilitation residents, I had the same reaction I did when I first heard about geriatric emergency rooms: Palm-smack to the forehead, “Why didn’t we think of this before?!”
Of course people with dementia aren’t going to do well in traditional rehabilitation settings. We’ve been putting them in large, over-stimulating rooms and asking them to accomplish tasks that are meaningless to them. No wonder they become agitated or withdrawn and are unable to engage in treatment.
Enter NET therapy. Using a $25,000 grant from the Alzheimer’s Foundation of America, Phoebe Ministries, in conjunction with various academic partners, developed and studied neurocognitive engagement therapy, which combines the best practices of dementia care with the tasks of occupational, physical and speech therapies.
The elements of NET Therapy
Like geriatric emergency rooms, one aspect of the NET model involves changing the physical environment so that it’s calming and more conducive to engagement in treatment, such as working one on one rather than in a group.
For the entire article, visit:
NET Therapy: Dementia care best practices + Rehab = Success
Dutch students live in nursing homes, keep residents company
Here’s an interesting, thinking-outside-the-box idea:
Dutch students choose to live in nursing homes rent-free (as long as they keep the residents company)
NINETY-TWO-YEAR-OLD Johanna beams at the 20-year-old stepping into her room — not a visiting grandson, but rather a housemate at her retirement home.
Town planning student Jurrien is one of six who have chosen to live in the yellow-brick home in Deventer in the eastern Netherlands as part of a unique project that benefits everyone.
The university students pay no rent and in exchange spend at least 30 hours a month with some of the 160 elderly who live here, doing the things professional staff cannot always do — such as just hanging out.
“They go see the pensioners for a chat, they play games, go with them to the shopping centre, (and) do shopping for those who can’t,” says activity coordinator Arjen Meihuizen.
For the rest of the article, visit:
Dutch students choose to live in nursing homes rent-free (as long as they keep the residents company)
