Blog
Taking vacations when residents can’t do the same (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Taking vacations when residents can’t do the same
Like many, I’m taking some vacation time during the month of August. It got me thinking about the ways workers interact with residents when they take time off from their jobs. It’s more important than you might first think.
Notifying residents
I know some staff members whose residents are so attached to them and become so anxious at the thought of them being away, the staff members don’t tell them they’re going. This seems to me like passing the buck to the covering coworkers who have to deal with the anxiety of the residents plus their feelings of betrayal that they weren’t informed in advance.
Other staff members don’t seem to think that residents will be missing them, so they don’t prepare them for their absence. As their psychologist, I know that residents acutely miss their regular staff members and really appreciate knowing in advance that they’ll be gone. When you’re not there – especially if you’re a CNA – it’s a generally bad time for your residents unless there’s been some consideration of the personalities of the residents and covering staff members.
Psychotherapist model
In my training as a psychologist, we spent a lot of time talking about leave-taking, vacation coverage, and termination of therapy. The gist of it is preparing patients for the vacation in advance, talking about who will be there in the therapist’s absence, and ways patients can cope on their own.
I think that’s a good model to follow in most cases in LTC. It’s respectful to let the residents know you’ll be away and to tell them who’s covering or who might be good to ask for help while you’re gone.
Anxious residents
I once treated a very attached, emotionally fragile resident whom I knew would be panicky about my two-week absence, which we discussed at length prior to my departure. Before I left, I gave her a sheet of paper on which I’d written down the dates I’d be away, the names of staff members she could talk to if she needed help, and healthy activities she could engage in such as journaling or talking to a friend. At the top of the paper I wrote in big letters, “I will return on September 14th.” When she saw that, she laughed with relief.
For the entire article, visit:
Taking vacations when residents can’t do the same
Aunt Sylvia needs your help (video)
Older adults are not included in the Substance Abuse and Mental Health Services Administration’s (SAMHSA) strategic plan, and Aunt Sylvia has something to say about that!
You can say something too, if you comment on their draft by August 18th at http://store.samhsa.gov/leadingchange/feedback/
View Aunt Sylvia above or at this link: http://youtu.be/5nHbxL3uXW4
Aunt Sylvia visits the APA convention
The 122nd American Psychological Association Annual Convention is going on right now in Washington, DC and Aunt Sylvia couldn’t resist dropping in to give a pep talk to the Psychologists in Long-Term Care:
Click on video above or use this link: http://youtu.be/Wa72GFzaNK0
The psychology of falls in long-term care (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
The Psychology of Falls in LTC
According to the American Geriatrics Society, one in three adults over the age of 65 falls each year. Falls represent the leading cause of fatal and nonfatal injuries among older adults. You might be surprised to hear some of the contributing factors of falls and the psychology behind them. I also have advice on ways residents and staff can reduce the likelihood of falls.
Factors associated with falling
Falls are caused by many different influences, often in combination. Some common elements (1) include:
- Medication — the major contributors are psychotropics (especially benzodiazepines, antidepressants, and antipsychotics), medications that reduce blood pressure and anticonvulsants
- Polypharmacy — one study found a 14% increase in fall risk with the addition of each medication beyond a four-medication regime, regardless of the group of drugs studied
- Orthostatic hypotension — researchers noted a 69% increased risk of having an injurious fall during the first 45 days following antihypertensive treatment
- Alcohol abuse
- Diabetes mellitus
- Confusion and cognitive impairment
- Gait and balance disorders
- Muscle weakness
- Poor vision
- Urinary incontinence
- Inappropriate footwear
- Environmental factors including home hazards
Impact of falls for residents
Falls can have a huge effect on the quality of life of our elders, who may have diminished mobility following an injurious fall. One-third of those who have fallen develop a fear of falling again and often reduce their activities in order to decrease the likelihood of similar mishaps. For those who have fallen in a facility, staff may limit the resident’s activities. Restricted activities, whether self-imposed or enforced by others, can contribute to depression. As noted above however, prescribing anti-depressants can increase the risk of future falls.
Concealed falls
Due to fear that their independence will be limited, some elders may hide the fact they’ve fallen. Residents have confessed past falls to me in their psychotherapy sessions, saying they were afraid they’d be forced into a wheelchair if anyone knew, or that they wouldn’t be allowed to go home after rehab. Psychotherapy might focus on the toll of untreated injuries due to silence following a harmful fall, whether or not returning home is realistic, or on ways to safely manage the activity that led to the fall.
(1) http://www.patient.co.uk/doctor/prevention-of-falls-in-the-elderly-pro
For the entire article, visit:
The Psychology of Falls in LTC
Dr. El’s McKnight’s column wins Azbee Award!
I’m excited to share with you that my McKnight’s column won the Gold award in the Upper Midwest Region of the 2014 ASBPE Awards of Excellence in the How-To/Tips/Service category.
My column, “The World According to Dr. El,” focuses on bringing psychological insights to long-term care for the Chicago-based McKnight’s Long-Term Care News magazine. According to The Association of Business Press Editors, the “Azbee Awards of Excellence program is one of the most competitive there is for business-to-business, trade, association, and professional publications. The awards recognize outstanding work by magazines, newsletters, and digital media — Web sites, e-newsletters, digital magazines, and blogs.”
What if psychologists ruled the (LTC) world… (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
What if psychologists ruled the (LTC) world…
In the medically focused setting of long-term care, psychologists are mindful of the emotional environment. While most psychologists almost exclusively address the mental health of the residents due to the current reimbursement system, we’re also aware of the interactions between staff members, families, the physical setting and the organizational culture.
Here are some of the important things psychologists might do to address the emotional climate of long-term care:
- Every resident would be evaluated by the psychologist upon admission (just like other disciplines), because entry into long-term care can be very stressful.
- Every staff member would have access to the counseling services of an Employee Assistance Program, because working in LTC can be very stressful.
- Family members would be able to join regular educational groups so that they better understand the illness(es) of their loved one, how the treatment team works, and how to best manage their important role on the team.
- Administrators, department heads, charge nurses and others in managerial roles would be given management training so that they’d have the skills they need to lead those on their teams, because chances are they didn’t learn management strategies in school.
- Treatment teams would learn communication skills that enhance collaboration between disciplines and improve interactions with residents and families.
- All staff members would be trained in non-pharmacological approaches to dementia care, because the porter needs to know what to do too.
For the entire article, visit:
What if psychologists ruled the (LTC) world…
Preventing Burnout in LTC: Free Webinar 7/17
Join Dr. El
Thursday, July 17th
at 2pm Eastern Time (1pm Central Time)
for a
FREE Webinar on
Preventing Burnout in Long-Term Care
sponsored by EmLogis
To register:
visit EmLogis Events
Aunt Sylvia discusses burnout: http://youtu.be/sIh274aoIF8?list=UUmfhLE_11Y9evQxu-dGxIXg
About the webinar:
Long-term care can be a stressful work environment, contributing to job dissatisfaction, turnover, injury and absenteeism. Join psychologist Dr. Eleanor Feldman Barbera as she discusses factors contributing to job burnout and offers practical, effective ways for managers and direct care staff to reduce and manage stress.
What you will learn:
Factors contributing to burnout in LTC
Strategies for managers that decrease work pressure among staff
Practical techniques to reduce stress for all staff members
Who should attend this webcast:
Administrators and assistant administrators
DONs, ADONs, and department heads
Staff training coordinators
Human resource department staff
All direct care staff
Preventing burnout in long-term care (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Preventing burnout in long-term care
In my recent post, “Stuff I won’t do for residents and why your staff shouldn’t either,” I wrote about the need for individual workers to set appropriate boundaries around caregiving in order to retain the ability to give without burning out. In this article, I examine more closely the symptoms of burnout and ways facilities can reduce its likelihood — which is particularly important given the link between burnout and turnover.
Employers find burnout reflected in high levels of absenteeism and tardiness, extended sick leave, and an increase in worker’s compensation claims. Employees might notice symptoms such as stress-related medical conditions (for example, ulcers or headaches), reduced job satisfaction, feelings of depression, anxiety, cynicism, boredom, discouragement and loss of compassion.
One study found that burned out staff were more likely to be accepting of resident abuse (Shinan-Altman and Cohen, 2009).
What is burnout?
In my research, I came across a number of definitions of burnout. Some definitions, like this early description by psychologist Herbert Freudenberger, focus on the role of the individual:
Burnout is “a state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that has failed to produce the expected reward.” People most likely to burn out are those who are the most “dedicated and committed to their positions, have poor work boundaries and who have an over excessive need to give.”
Ouch.
Other explanations of burnout focus on the environment, such as this one by Pines and Aronson (1988): Burnout is “a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations.”
It’s probable that most burnout is due to a combination of a stressful work environment and an individual’s difficulty balancing self-care with their commitment to their jobs.
Techniques to reduce burnout
The good news for management is that many of the causes of burnout can be addressed by the organization, whether they are due to the environment or rooted in the individual.
1. Training workers, including enhancing the initial orientation process and providing ongoing education programs that go beyond mandated courses, can address many factors that contribute to burnout. Studies suggest the following:
Orientation classes should provide clear job expectations and address ways to prioritize job tasks in order to reduce time pressures.
Managerial staff such as nurses and department heads would benefit from skills training to better help them supervise and manage their teams.
Team building efforts can improve relationships with coworkers and reduce professional isolation.
Training staff on how to manage aggressive behaviors reduces the stress of working with a verbally and physically aggressive population.
2. Scheduling issues are another area where management can make a significant impact on burnout through:
For the entire article, visit:
Preventing burnout in long-term care
Take this to the bank: How to reduce money stress for LTC residents (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Take this to the bank: How to reduce money stress for LTC residents
It was noon at the nursing home and the staff was busy wheeling residents into the dining room. “Are you going to buy me lunch today?” an aide joked as she unlocked the brakes on Mr. Romano’s wheelchair. He smiled, but I could tell he was pained. He’d just spent his last psychotherapy session discussing his now-meager funds after a lifetime of earning and saving.
In my conversations with hundreds of long-term care residents over the years, I’ve found money to be an almost universally sore subject among them. Since money is a primary concern for most of us throughout our adult lives, it should come as no surprise that financial concerns continue to be a stressor for our residents even though they’re living in the mostly money-free society of LTC. The reasons for this financial tension vary, and with some adjustments we can reduce aspects of our residents’ financial distress.
Money stress sources and remedies
• Spending down: Residents who saved money during their lives and are now spending their savings to qualify for Medicaid are particularly sensitive to, shall we say, variations in care.
“This is what I’m paying for?” they’ll ask with incredulity at an unpalatable meal or an unpleasant interaction with a staff member. It’s a bitter pill to scrimp all one’s life and have to pay out of pocket for healthcare with savings, particularly when the lifelong free spender in the next bed is getting exactly the same care paid for by Medicare and Medicaid.
Remedy: While we can’t change the fact of the spend down (and it should go without saying that we provide the best service possible to every resident at all times regardless of their funding source), we as experts can offer suggestions for spending down that allow residents to make the most of this period.
o For example, elders might want to buy a television set, some extra clothes and other belongings they’ll be able to enjoy once they’ve qualified for Medicaid and don’t have as many funds to access. Perhaps they’d like to buy themselves flowers or fruit that arrives monthly for the next year so that they have some luxury in their lives when things get tight. New residents and families have never spent down before and they need our advice about what’s permissible and likely to make them happy in the years to come.
o Residents may be legally allowed a financial gift to a family member who can then use that money for them at a later point.
o Encourage seniors to put aside money for a burial fund, if needed, so that they don’t have to worry about this later in life. Money for burial isn’t counted toward the maximum amount residents are allowed to hold in their personal accounts.
• Personal Needs Allowance (PNA): Residents are entitled to a monthly PNA that allows them to buy things such as clothing, haircuts, special trips and other items not provided for by the facility. Unfortunately, when this amount — which varies by state — was determined back in 1980, no provision was made for inflation. In New York, the $50 PNA from 1980 is now worth $17.32. If the PNA had been adjusted for inflation, the resident would be getting $144.36 each month, which is a reasonable allotment that would permit people to buy the aforementioned goods and services, plus some takeout food or an occasional gift for their grandchildren. Managing personal needs on $50 a month in 2014 is beyond challenging. (For more on this, see the Money Issues anecdotes at My Better Nursing Home and the “Your Money” chapter of The Savvy Resident’s Guide.)
Remedy: Clearly, PNA levels should be adjusted for inflation, but for now we can help residents living on a very tight budget in several ways.
For the entire article, visit:
Take this to the bank: How to reduce money stress for LTC residents
For a humorous take on one resident’s efforts to manage her money, click on Aunt Sylvia Spends Down (http://youtu.be/5ZpdhO9HNmc) or watch below.
Bodybuilder boosts seniors’ physical confidence (inspiring video from NYT)
This article and accompanying video from the New York Times shows the power of a compassionate and inspirational leader and the willingness and dedication of a student (who happens to be 90). Falls prevention at its best. Be sure to check out the photos in the article. And now please excuse me, I’m going to go work out.
A Chiseled Bodybuilder, Frail Clients and a Fitness Story for the Ages
Martin Luther King Addo
Photo by Damon Winter/NYT