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The keys to reducing turnover in long-term care (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
The keys to reducing turnover in long-term care
“They keep giving me these new aides and they don’t know what they’re doing,” a disgruntled resident commented during a psychotherapy session.
“You’re not the first person to tell me that,” I replied, looking for a way to acknowledge her experience without criticizing either the facility or the new aides. “You have the honor of training them.”
“Yes, if they’d listen,” she said with an edge in her voice. “But it’s a lot of work.”
The turnover rate in long-term care is a significant problem, with rates ranging from 55% to 75% for nurses and aides and sometimes over 100% for aides alone. Having personally witnessed a great deal of turnover during my years in LTC, I was curious about why the rate is so high and what could be done about it. I turned to the research to find the answers.
Costs of turnover
I was dismayed by a study that suggested that the persistence of turnover over the years might be because nursing homes could save money by treating their staff like a never-ending supply of fast food workers and avoiding investment in training and retention practices.
To my great relief, I found data indicating that there are many costs associated with turnover, including increased hospital readmission rates, high employee replacement costs, loss of productivity, poorer quality of care, a decrease in staff and resident morale, increased work stress, job dissatisfaction, increased accident and absenteeism rates, increased overtime costs, and resident and family dissatisfaction. Aside from the moral reasons to reduce turnover, it’s also worthwhile on a strictly monetary basis. An estimate of the per-worker cost of turnover in the general U.S. economy is about 20% of the worker’s annual compensation amount.
Much of the literature looked at turnover in aides and nurses and while the findings weren’t always consistent between studies, the following factors were associated with job dissatisfaction and workers leaving their employers.
Factors associated with turnover
For the entire article, visit:
The keys to reducing turnover in long-term care
Resources for Early Career Long-Term Care Psychologists
Before I started working as a psychologist in long-term care, I got some excellent training from the Alzheimer’s Association which focused on dementia care, and I took a helpful course from a practicing long-term care psychologist which reviewed typical care issues and billing concerns.
Despite this training and having worked in two psychiatric hospitals, a college counseling center, two residential treatment centers for adolescents, a high school, an outpatient clinic, a substance abuse center, managed care, and a crisis intervention center, I’d never encountered the situations I came across in the nursing home and felt at a loss at times. Below are some of the books and websites I found helpful early on, and some I wish had been available when I first began my work in long-term care. (I also took a weekend-long course in thanatology — the study of death — because it was hard to handle at first.)
Handbook of Health and Behavior: Psychological Treatment Strategies for the Nursing Home Patient, by Joseph M. Casciani, PhD — This user-friendly handbook outlines medical conditions typically seen in long-term care, common reactions to them, and treatment strategies to address them. Dr. Casciani also offers training at Concept Healthcare.
Psychotherapy with Older Adults, by Bob G. Knight, PhD — An excellent outline of psychotherapeutic issues with older adults in general, the book offers a helpful window into the emotional reactions of both therapist and patient.
Life Worth Living: How Someone You Love Can Still Enjoy LIfe in a Nursing Home, by William H. Thomas, MD — Dr. Thomas is founder of the Eden Alternative and has written extensively on transforming the culture of the nursing home. I read this book early in my career when I was wondering why so little attention was being given to the emotional environment compared to the mental health settings in which I’d worked. For more from Dr. Bill Thomas: ChangingAging.org.
Dementia Beyond Drugs: Changing the Culture of Care, by G. Allen Power, MD — Dr. Power works with the Pioneer Network and his book illustrates that the environment is contributing more to the problems nursing home residents experience than workers in most “typical” facilities realize. He outlines how to undertake a complete transformation. This book will confirm your observations as a psychologist.
Hiding the Stranger in the Mirror: A Detective’s Manual for Solving Problems Associated with Alzheimer’s Disease and Related Disorders, by Cameron J. Camp, PhD — Dr. Camp offers a host of suggestions on how to work with residents who have dementia in this engaging, easy to read volume. This will be the book you recommend to staff members (especially aides and nurses) because we as psychologists aren’t generally able to help staff with residents with dementia in the current reimbursement system.
The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay But Were Afraid to Ask, by Eleanor Feldman Barbera, PhD — I’d be remiss if I didn’t include my own book on the list. If you want a very practical and quick outline of resident concerns and how to handle them, as well as a resource to provide residents and families, please take a look: The Savvy Resident’s Guide.
WEBSITES for psychologists:
Psychologists in Long-Term Care — a group of dedicated professionals who share their experience and wisdom via the listserv. A must-join.
GeroCentral — The collaborative effort of a number of different psychology organizations, the website has links to all of them and to a vast number of resources. Well worth reviewing.
APA’s Resources for Psychological Practice With Older Adults and Their Caregivers — This flyer from APA’s Office on Aging provides a concise list of resources available from APA. More resources can be found at: APA Office on Aging
Employee recognition programs: what works (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Employee recognition programs: what works
After Ms. Ryan’s psychotherapy session, I stopped at the nursing station and asked the nurse for the name of her aide. The nurse pointed to a uniformed woman right next to me, who turned and asked me with hostility, “How do you know it was me?” Surprised, I responded, “I just wanted to tell you Ms. Ryan was really happy with how you did her hair today. She wanted me to thank you for her.” The aide appeared stunned. The nurse commented, “We usually expect complaints, not compliments.”
If your staff is more prepared for criticism than praise about its work, it’s an especially good time to consider positives of an employee recognition program.
Benefits of employee recognition programs
Studies show that employee engagement, productivity and customer service are about 14% better in companies where recognition occurs, compared to companies without a program that acknowledges their efforts. In addition, companies with an effective recognition program have a 31% lower voluntary turnover rate than those with an ineffective program.
Ineffective programs tend to reward employees for tenure rather than performance. (Apparently those 10-year pins aren’t making the desired impact.) Effective programs offer specific feedback about the actions of workers and make it easy to provide that feedback.
Interestingly, there’s a substantial disconnect between the 80% of senior leaders who believe their employees are being recognized on a monthly basis and the 22% of individual workers who report their peers being acknowledged that frequently.
The Oregon Health Care Association’s Staff Retention Toolkit is an excellent resource for information about different types of Employee Recognition Programs (see page 46 in it). The toolkit notes these additional benefits:
For the entire article, visit:
Employee recognition programs: what works
Stuff I won’t do for residents and why your staff shouldn’t either: Preventing burnout in LTC (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Stuff I won’t do for residents and why your staff shouldn’t either: Preventing burnout in LTC
In my last post, I wrote about some of the many things I do for residents as a long-term care psychologist. The astute reader will note that most of the tasks were accomplished during work hours and within the facility. There’s a reason for that.
When I first started out as a shrink, I worked at the Manhattan Psychiatric Center, a setting similar to many nursing homes in that residents didn’t have access to stores and other amenities. “Next time you’re in the supermarket, will you get me some of that lotion I like?” “Can you buy me a new watch battery?”
The small requests were never-ending and because they were so small, I felt I couldn’t refuse.
And then there were the tasks I volunteered for because I could see the need and I was, you know, a nice person.
The breaking point came after I offered to darn a sweater with a small hole in the front. It was only after I got the sweater home that I discovered the large holes in the back. During the hours of mending — I didn’t want to go back on my word — I realized I had to set some limits on these “extras” or I’d quickly burn myself out on my chosen career.
Establishing limits
Knowing I was in this for the long haul, I created a personal “no errands” policy. The exceptions are endeavors that connect residents to their loved ones, such as obtaining and mailing out holiday cards. (And, I admit, I relish Internet searches for estranged family members.) On the occasions where I’m tempted to do something really special, I soul-search and sometimes consult with an advisor to determine if it’s something I’d do for any of my residents or if I’m going too far for one particular person. It’s important to be fair, especially in the “small-town” LTC environment.
Potential for burnout
For the entire article, visit:
Stuff I won’t do for residents and why your staff shouldn’t either: Preventing burnout in LTC
Staying in balance while leaning on each other
Amazon Review #3 of The Savvy Resident’s Guide
5 out of 5 stars Great Resource
by Doris Chun
Dr. El offers good advice and really useful information on a topic most of us want to avoid. She delivers it with a dose of hope and lots of humor. Her book makes the journey see less daunting.
Thanks, Doris Chun!
Stuff I’ve done for residents as a long-term care shrink (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Stuff I’ve done for residents as a long-term care shrink
Many of us in long-term care think of our jobs as a calling. We handle the day-to-day tasks and the business as usual but also get a lot of energy and joy out of taking our work one step further. Here are some actions I’ve taken that have enriched my patients and my role as a psychologist.
1. Set up Facebook accounts so residents can stay connected with their friends and family members.
2. Searched through their charts to find out the outcome of a medical consult.
3. Followed up with the nurse if the recommended course of action wasn’t pursued.
4. Cleaned out messy closets and drawers to give the resident some sense of control.
5. Searched for missing items (and found 90% of them!).
6. Attended one patient funeral early on in my nursing home career, where I sobbed from the moment I entered the room until the moment I left. Never again have I gone.
7. Tracked down and reunited missing family members.
For the entire article, visit:
Stuff I’ve done for residents as a long-term care shrink
Dr. El on Deborah Shouse Writes
Deborah Shouse, author of Love in the Land of Dementia: Finding Hope in the Caregiver’s Journey, recently posted suggestions from several experts (including me) on creating successful holidays when families are affected by Alzheimer’s.
Kindling Holiday Magic During Seasons of Change
“There’s a story behind these butterscotch brownies,” I told our Thanksgiving guests, as my brother Dan served dessert. “Mom created the recipe when Dan was six and became allergic to chocolate.”
There was a collective gasp as people imagined the horror of being allergic to chocolate. Then there were satisfying sighs as they tasted the melting sweetness of the brownies; Dan had re-created the recipe when my mother, disabled by Alzheimer’s, could no longer bake. Fortunately, Mom enjoyed sweets all her life and we always shared the story of these treats with her, reminding her how much we loved and appreciated her.
These brownies were one way my brother and I honored our mother during the holiday season.
For the words of wisdom, visit Deborah Shouse Writes at:
Kindling Holiday Magic During Seasons of Change
Using psychology to reduce roommate conflicts: A handy guide (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Using psychology to reduce roommate conflicts: A handy guide
“My roommate is driving me crazy with his oxygen machine. I haven’t slept in days.”
“Her husband stays in the room all the time, even when she’s in rehab.”
“She always leaves the window open and I’m freezing!”
These are some of the many complaints about roommates I’ve heard from residents over the years. While some roommate difficulties need to be addressed on a situation-by-situation basis, most conflicts revolve around a few basic issues.
Here’s a handy guide to conflicts and potential resolutions to print out and give to staff members involved in making room assignments.
• Temperature of the room: Have the person who likes it colder or hotter by the window/air conditioner/radiator so they are closest to the source. The temperature in the hallway will moderate the atmosphere around the bed near the door. Give extra blankets to those who like to be warm but have a roommate who likes it cool. Or change rooms so that people who like similar conditions room together.
• Noisy medical equipment: Someone with such needs might do better living with a hearing impaired roommate or a sound sleeper or being moved to a private room if it’s a temporary condition.
• Frequently visiting family members: While visiting hours have been expanded in many facilities, it doesn’t mean they need to take place in a resident’s room, especially if it’s disturbing to others. It may be necessary to distinguish between facility visiting hours and in-room visiting hours and to refer families to alternative locations for visits, such as a lounge. Family members can be directed to wait in common areas if their loved one is not in their room.
• Loud televisions: Setting a time (such as 10 p.m.) to lower the volume on TVs and to turn out lights that aren’t in use will help with sleep hygiene on the floors in general and will reduce conflict between roommates (because it’s “policy” and not personal). Those who want a loud television can use a headset or be moved to a room with a hearing impaired roommate.
For the entire article, visit:
Using psychology to reduce roommate conflicts: A handy guide
Instilling Hope: Needed for contentment, helpful for LTC operations (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Instilling Hope: Needed for contentment, helpful for long-term care operations
“I hope Santa brings me a Sony DS,” my 7-year-old told me the other day. I can tell you right now that Santa is not bringing her a video game player, but I didn’t want to tell her that or spill the beans about Santa. So I did what I imagine most parents would do in that situation: I asked her what else she hoped Santa would bring.
There are many benefits of hope, according to an article in October’sAmerican Psychological Association Monitor. Researchers report that, “Hopeful people have a greater sense that life is meaningful.” In addition, “Hope is a strong predictor of positive emotions … and a necessary step on the path to contentment.”
Psychologists differentiate hope from optimism, saying that optimism is a feeling that generally good things will happen, while hope tends to be focused on more specific goals. Researchers state that social connections are an important part of being hopeful, counteracting the feeling of being invisible and alone.
Hope in LTC
So what does this have to do with long-term care? As it turns out, a lot.
The article referred to a 2001 study that examined the level of hopefulness of nearly 800 people aged 64-79. Several years later, 29% of those classified as hopeless had died, compared to 11% of those who were hopeful. Researchers note that hopeful people tend to make better health choices.
If hopeful residents are making better health choices, chances are they’re more likely to comply with medical recommendations and dietary guidelines. They’re more likely to get up and go to rehab, increasing your reimbursement rates. Residents who are hopeful, happy, and satisfied are more likely to refer people to your facility.
Helping residents feel hopeful
Residents often enter our facilities after a demoralizing health problem. They may be cut off from their usual support system and worried or fearful about the future. We can help our residents feel more hopeful by implementing the following ideas:
1. A warm welcome from staff: First impressions really are important. Make sure their initial welcome feels personal and reassuring, reducing their feelings of being invisible and alone. I’ve watched new residents being pushed through the doors in stretchers or wheelchairs. The “pusher,” usually an ambulette driver, consults with the security desk for a room number while the resident is ignored.
Instead, train your staff, especially those at the front desk and those who will greet admissions on the floors, to make eye contact with each new person, smile and say, “Mr. Johnson, welcome to My Better Nursing Home.”
2. A friendly greeting from peers: While staff members can provide important information and reassurance for residents, hearing it from others who have been through the same thing is invaluable. A resident welcoming committee shows newbies that there are people who are happy in your facility, leading them to believe that they can be happy too. Residents also can give the lowdown on things staff can’t say, such as which staff members are grumpy and how to work around them.
For the entire article, visit:
Instilling Hope: Needed for contentment, helpful for long-term care operations
