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Senior bullying: How to recognize it, how to handle it

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

 Senior bullying: How to recognize it, how to handle it

Things were different when I was a kid. People regularly drove while intoxicated. The high school archery team practiced on the football field while the track team ran around the periphery. Children bullied their peers without anyone giving it much notice.

These days, drunk driving prohibitions abound, schools are no longer casual about teens with potential weapons, and children start learning about bullies in kindergarten.

When it comes to bullying in senior communities, though, we’re still behind the times.

What is senior bullying?

According to the American Psychological Association, “Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words or more subtle actions.

The bullied individual typically has trouble defending him or herself and does nothing to ‘cause’ the bullying.” Bullying that does not involve physical contact is sometimes referred to as “relational aggression.”

According to senior bullying expert Dr. Robin Bonifas at Arizona State University, 10% to 20% of elders in senior communities experience bullying.

Dr. Margaret Wylde of the ProMatura Group reports that senior bullying occurs in every independent living community studied in her 2014 report, “Make Them Feel at Home,” sponsored by the American Seniors Housing Association.

In that study, bullying fell into the category with the largest relationship to whether or not the community feels homelike. Study participants described problems such as “difficulties making friends, being lonely, not fitting in, not having common interests, bullying by cliques, and missing their friends.”

Wylde notes that increasing residents’ sense of being at home results in fewer departures from the independent living community and reduced staff turnover, leading to an estimated $52,242 in savings over the course of a year. (Far more than enough to fund a bullying prevention program!)

Increased media focus

Senior bullying is receiving increased attention in the mainstream media, with articles such as Paula Span’s New Old Age column, Mean Girls in Assisted Living and Jennifer Wiener’s Mean Girls in the Retirement Home. (“Mean girls” tend to engage in gossip, excluding others and establishing cliques, while male bullies are more likely to yell and threaten.)

Heightened media exposure for the issue increases the likelihood that potential residents and their adult children will be asking about bullying prevention when they’re searching for a senior living community.

Steps to reduce bullying

In order to address bullying in long-term care, several steps should be taken:

For the entire article, visit:

Senior bullying: How to recognize it, how to handle it

Free Webinar 2/25 @ 2pm ET: Motivating LTC Staff with “Nudge” Principles

Join Dr. El

Wednesday, February 25th

at 2pm Eastern Time (1pm Central Time)

for a

FREE Webinar on

Beyond Carrot and Stick: Motivating LTC Staff with “Nudge” Principles

sponsored by EmLogis

To register:

visit EmLogis Events

About the Webinar:

Employee recognition programs reward staff members for good behavior and discipline techniques (such as suspending staff members) discourage bad behavior. By using nudge principles in addition, organizations can develop unobtrusive methods to help staff do the right thing. Join psychologist Dr. Eleanor Feldman Barbera as she discusses nudge principles and how to use them to improve workflow and reduce conflict during a FREE webinar sponsored by EmLogis employee scheduling on Wednesday February 25th at 1pm central.

What you will learn:

What it means to use nudge principles with your staff
Three types of interventions employing this social psychology concept
How to harness nudge theory within your organization

Who should attend this webinar:

Administrators and assistant administrators
DONs, ADONs, department heads, nursing supervisors, and charge nurses
Staff training coordinators
Human resource department staff

Reflections after an LTC and senior living summit

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

Reflections after an LTC and senior living summit

Last week, I attended the MarcusEvans LTC and Senior Living CXO Summit in Los Angeles, where I delivered a keynote address on “Identifying and Repairing Communication Gaps in LTC.” It was a fascinating, energizing event, and not just because I was leaving the frigid temperatures of New York City to dine outdoors in Marina Del Rey.

Of course, I was all jazzed up to speak about my obsession, long-term care. Of the many communication gaps I mentioned that need repairing, the one that most people commented on afterward was the way we handle end-of-life care.

Perhaps the ample feedback reflected how we, as a country, are spending so much money on aggressive medical treatments that are unlikely to help those who are dying and that most people wouldn’t want if they knew what they entailed. Or perhaps it’s because the vast majority of the audience was not only professionals in the field but also had a relative in long-term care. They recognized the value of having a peaceful death both for the resident and for their family.

It was interesting to me that only a few of these C-suite attendees had heard of Atul Gawande, MD, whose recent book on end-of-life care, “Being Mortal: Medicine and What Matters in the End,” became the basis for a “Frontline” documentary that aired last week. Atul Gawande is all the rage in my circle.

I, on the other hand, was gobbling up new information about positioning care facilities to thrive over the long haul. The clinical and the financial sides of the business have a lot to teach each other.

One of the highlights for me was hearing Dr. Margaret Wylde of the ProMatura Group speak about what’s important to residents of senior living communities. I was so excited by her information that I leaped from my seat and shouted, “Yes! Yes! Right on, sister!” At least, that’s what I was doing on the inside, while my outside sat politely nodding in my gray business suit.

For the entire article, visit:

Reflections after an LTC and senior living summit

Addressing residents’ deepest fear

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

 Addressing residents’ deepest fear

In the TV show “Mad Men,” the Sterling Cooper advertising executives find out how consumers feel about the product they’re pitching by holding focus groups. They ask people who use their product what they like and don’t like about it, how they use it and what it means to them.

As a long-term care psychologist, one of my main tasks is to sit down and talk in-depth with residents on a regular basis. I’ve basically conducted 20 years of focus groups. The single most common comment I’ve heard from residents over the years: “I never thought I would end up in a place like this.”

While it’s probably not the case for people who entered swanky continuing care retirement communities of their own accord well in advance of a health crisis, many residents feel like it’s a personal failure to be in long-term care. They think if they’d done something different, or earned more money, or if they’d had children, or had a better relationship with their children, or if they had better children, or something, then they wouldn’t have “ended up” in a long-term care home.

As a psychologist, I assure them that they didn’t do anything wrong and neither did anyone else necessarily. I inform them that many of the nicest and best people I know are living in long-term care. Occasionally, I introduce one awesome person to another. In psychology terms, we call this “normalizing” the experience. It helps a lot.

Below are some ways in which you can allay the residents’ concerns that they have lost the game of life by being in your establishment:

• Include on your website stories of amazing residents. If that exemplary person can be there, potential residents will feel that it’s a club they might want to join too. Include not just individuals who have achieved a traditionally successful life (money, fame, education), but also those who have accomplished unusual feats (raised 11 children, sky-dived in their 70s) or who overcame poverty, prejudice, or disability to lead a good and decent life.

For the entire article, visit:

Addressing residents’ deepest fear

Dr. El talks about LTC on radio show, 1/29 at 12 noon ET

I hope you’ll join me tomorrow, 1/29 when I speak about my work as a psychologist in long-term care with Lisa Singer in her Open Forum radio show on Women’s Radio Network.

Time: Thursday, January 29th, 12 noon ET

Place: Open Forum with Lisa Singer, WRNW1

Click on this link to listen in: www.wrnw1.com/listen-live/ 

6 ways to improve dealing with death in LTC

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

 6 ways to improve dealing with death in LTC

There are moments in life that engender important questions. When an individual is born, we ask, “Is it a boy or a girl?” When the person dies, we ask, “What happened?” In long-term care, we’re not around for the first question, but we often are for the second.

Though infrequently observed by those not involved with direct care, how someone dies is a very important part of the culture of the long-term care organization.

In “Remembering the Lost,” New Old Age blogger Paula Span reports on the typical experience of loss in LTC, where deaths are often barely acknowledged. She describes two alternative programs that offer a way to recognize individuals who have lived and died in LTC.

In “Better death notifications could improve CNA work experience, study suggests,” McKnight’s notes that how the deaths of residents are communicated to CNAs affects the way they feel about their work. The best way to find out, the study concludes, is to be told prior to beginning a work shift. The hardest way to learn of a death is to arrive at the resident’s room and find it emptied of belongings or filled with a new resident.

A front-line perspective

Like others performing direct care, I’ve had to cope with the loss of residents. I felt sucker-punched by the deaths that occurred early in my LTC career. My youth, inexperience, denial, and lack of training in issues around death made the demise of very ill or very old residents seem sudden and shocking.

I quickly got some training in thanatology (the study of death) and I’ve had many years of experience since then. I learned to protect my heart and love with a little cushion of distance around me.

Echoing the findings of the study referred to above, my worst experience by far was coming in to work to find the room empty of a beloved patient, the bed stripped and raised as high as possible after the mattress had been cleaned. By contrast, once an aide rushed to me the moment I got off the elevator to visit one of my patients, telling me she’d passed the night before. I thanked her profusely, hurried to the bathroom and cried.

My rituals around loss do still occasionally involve crying in the bathroom, but more often since I learned to protect my heart I look upward and say, “Rest in peace, John.” Or Mary. Or Viola. Sometimes I talk with other staff members who were close to the resident. Or I write about the person who died.

Creating better ways to address losses in LTC

My personal rituals were developed in the absence of formal, facility-sanctioned acknowledgement of the deaths of residents. As a shrink, I was aware of the need to get training and to recognize the personal impact of these losses.

I suspect that many new staff members don’t make it past the “sucker-punch” phase of losing residents. Instead, they quit, so that new staff members must be hired and trained. For ideas on how to reduce this likelihood, read Absenteeism and turnover in LTC? Death anxiety could be the cause.

Facilities can improve the experience of death and dying for the residents, staff and family by addressing various aspects of the process such as:

For the entire article, visit:

6 ways to improve dealing with death in LTC

The New Old Age Blog absorbed into NYT/Health

As regular readers may know, I’m a big fan of The New York Times’ New Old Age column, which has been a treasure trove of information on issues related to aging and caregiving.  It was founded by Jane Gross in 2008 and continued by Paula Span until the recent decision to discontinue the blog. Paula Span will now write her column twice a month as part of the Health section of The New York Times.

The fact that there was a New Old Age blog was very encouraging to me as I began blogging about my work as a psychologist in long-term care. I’m sorry to see it close in this form and I will follow it to its new incarnation. Thank you, Paula and Jane, for taking on these very important topics.

Use ‘nudge principles’ in LTC to prompt staff in the right direction

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

Use ‘nudge principles’ in LTC to prompt staff in the right direction

Standing by the salad bar in the newly opened restaurant, I recoiled at the sign that read, “Please don’t use your hands.” I suggested to the manager that the notice should instead advise diners to “Please use the serving spoons.” My recommendation for that short-lived establishment followed what’s known as “nudge principles.”

What are nudge principles?

Nudge principles use basic human tendencies to encourage people to engage in positive behavior. One aspect of nudge is to craft messages, like how to use the salad bar, in ways that are more likely to result in positive action.

Another aspect, according to Tori DeAngelis in Coaxing Better Behavior, is to harness “our less laudatory traits — short-sightedness, inertia, inflated optimism and our tendency to submit to peer pressure.”

Research shows people have a “default bias” which makes them more likely to choose the first option in front of them. Putting fresh fruit before the desserts in a cafeteria line would be one way of making positive use of this bias. Another is creating a default option that enrolls employees in a retirement account rather than requiring them to opt into the program.

Care must be taken to create good default options, though, or they can backfire. One poorly constructed automatic retirement account enrollment, for instance, resulted in more individuals contributing, but fewer dollars set aside overall. Why? The default choice set aside less money than what people might have chosen if they’d given it more thought.

Starting with the end result

Some “nudge” researchers identify the outcome they want to see and then look at what methods are most successful in achieving that outcome. In one study, the British government sent letters to delinquent taxpayers, saying, for example, “You are one of the few who have not paid us yet.” They altered the wording of the letters to see which phrasing would result in the greatest collection of outstanding funds — and retrieved an extra $15 million overall.

Applying nudge principles in LTC

For the entire article, visit:

Use ‘nudge principles’ in LTC to prompt staff in the right direction

‘Twas the night before Christmas and all through LTC …

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

 ‘Twas the night before Christmas and all through LTC …

‘Twas the night before Christmas and all through long-term care,
Decorations sparkled and twinkled — no wall was bare.
The recreation department had concerts galore,
The residents enjoyed it — they clamored for more.

The maintenance guys put up outdoor lights,
Vendors sent cookies and other delights.
The nurses wore holiday tops and bright pins,
Each floor had menorahs and dreidels to spin.

Kwanzaa candles were set out next to the trees,
Poinsettias brightened the desk of Security.
IT staff donned elf hats, the business office did too,
Rehab wore red sweaters, with bells on their shoes,

Environmental services polished ’til the whole place gleamed,
Everyone had seasonal spirit, it seemed.
Outfits were chosen by residents with care,
Make-up and hairdos were all an affair.
Aides helped as needed with jewelry and ties,
To make sure “their people” looked fetching and wise.

For the entire article, visit:

‘Twas the night before Christmas and all through LTC …

Holiday Gifts for Nursing Home Residents

This post, along with my Planning for the Holidays article, could be printed out and left for family members in a prominent location.  Think of it as your gift to every nursing home family.  

~Happy Holidays from Dr. El at MyBetterNursingHome.com

With the holiday season upon us, you may be wondering what would make a good present for a relative in a nursing home. In my efforts to banish the barren nursing home room, photos are still my number one pick for holiday gifts, but here are other suggestions (be sure to label everything!):

Nice lotions, soaps, and grooming products
A special bedspread
A “lap” blanket to wear while sitting in a wheelchair
Wheelchair accessories (Google it) like cup holders, side pockets, wheel lights, etc.
Sturdy clothes that can handle being washed in an industrial washing machine
Colorful bangle bracelets to blend in with nursing home wrist bands
My book, The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay But Were Afraid to Ask
Plants, or potted flowers, especially if you can come by to water them regularly

Great gifts from the heart:
Make a commitment to visit once a week, or once a month
Make a commitment to call once a week, or once a day
Organize friends and family so that each person has a week to call or visit
Bring a home-cooked meal
Organize friends and family to bring a home-cooked meal on a regular basis