Blog
Dr. El speaking in NYC on Leadership and Organizational Change
Administrators, join Dr. El
and the Southern New York Association
for a
Long-Term Care Administrators Continuing Education Course
on December 3, 2o13 at 8:30am
at the LaGuardia Marriott Hotel
The morning session will be on Leadership and Organizational Change
The afternoon session will focus on the most recent NYSDOH survey developments, quality improvement projects and managed care updates.
Contact the Southern New York Association to register for this course.
Amazon Review #2
5.0 out of 5 stars A no nonsense guideby Kathleen MearsAs a nursing home resident of 16 years, I have encountered most of the issues in Dr. El’s book, “The Savvy Residents Guide: Everything You Wanted To Know About Your Nursing Home Stay, But Were Afraid To Ask”.
Dr. El’s coping mechanisms and insistence on facility involvement encourages residents to make the most of their new lives.
There is no doubt about her clear understanding of the subject matter.
This book is a “no nonsense” guide to family members. It also provides alert residents with a tool to help them plan their future care.
Thanks, Kathleen Mears!
Improving your customer service for the holidays (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Improving your customer service for the holidays
As the holiday season draws near, more families will be passing through your doors to visit their loved ones at your facility. Out-of-town relatives will be making annual trips and locals will be taking the children to see Grandma during school breaks. This is an ideal time to provide extra services that showcase your high level of care and make the season more pleasant for families and residents.
You’re the experts when it comes to eldercare – most of the families are going through this for the first time. Show your commitment to customer service by giving families the guidance they need to make the most of season.
Here are some ideas:
1. Provide info on planning time with loved ones
Let families know in advance not just about your visiting hours, but also about how to schedule passes home. Which staff members do they need to talk to about taking Grandma out of the facility? What arrangements should they make regarding transportation? Do they need to be giving medication and if so, what kind of training is required and who will be providing it and when?
Write this all down for them and put it on your website or newsletter and/or have an info sheet with holiday information at the front desk. Add an option to your telephone menu with frequently asked questions about visits and passes.
2. Suggest new rituals
People often have difficulty imagining ways to celebrate the holidays other than in the family tradition. They may need your help envisioning possibilities that take into account illness and a long-term care stay. If the family home isn’t wheelchair accessible, families can create new traditions such as enjoying an accessible local restaurant, or they can keep it simple and go out for a manageable coffee and dessert.
If Grandpa isn’t well enough to leave the facility for a celebration, suggest alternatives such as bringing food to him in his room or reserving a common area for an hour. Let families know your dietary staff is available to discuss appropriate foods and that the kitchen staff is ready to reheat leftovers or to puree or chop as needed. Suggest foods that are already pureed or chopped such as mashed potatoes or pureed soups to minimize the feeling of missing out on something.
3. Offer communication tips
For the entire article, visit:
Improving your customer service for the holidays
Telemental health: Who, what, when, where, why you should use it (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Telemental health: Who, what, when, where, why you should use it
Since I now Skype regularly with my 94-year old father-in-law and his wife, the concept of telemental health doesn’t seem as futuristic to me as it used to seem. I was shocked to discover, however, that the American Telemedicine Association (ATA) was established 20 years ago, with the first applications of telemedicine occurring over 40 years ago. Apparently, I’ve been behind the times.
According to the ATA, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”
Telemental health, or telepsychology, as the American Psychological Association refers to it, is simply “the provision of psychological services using telecommunication technologies.” I turned to psychologist Dean Paret, PhD, senior vice president of clinical operations of Brighter Day Health, a provider of telemental health services in long-term care, to answer some of my questions about telemental health.
How telemental health works
According to Dr. Paret, telemental health includes not only psychiatric evaluations and medication management sessions, but psychotherapy as well. Providers use a two-way video system over a secure line to “visit” with LTC residents.
The equipment used includes a camera and a video screen that allows the clinician to see the resident and vice versa. The service is similar to Skype or Facetime, but it involves a secure, encrypted network that leaves nothing on the computer and is HIPAA-compliant. Brighter Day Health works with its facilities to set up the proper equipment. “The big challenge is the Internet speed,” Paret stated, “and the ATA has information on funding sources to upgrade rural systems.”
For the entire article, visit:
Telemental health: Who, what, when, where, why you should use it
Join Dr. El at the Baldwin Public Library at 1pm on 11/13/13
I’m giving a free local talk at 1pm on Wednesday, November 13, 2013 at the Baldwin Public Library on long-term care decision-making and making the most of nursing home stays.
I’ll hope you’ll be able to join me for this hour-long talk and discussion session at my hometown library. (It’s where I checked out literally piles of books when I was a kid.)
Baldwin Public Library
Introducing Aunt Sylvia
Dear Readers, my Aunt Sylvia would like a word with you:
Please share…
The Savvy Resident’s Guide is available on Amazon.com
Shared Decision-Making by Viki Kind, MA, Clinical Bioethicist
In the long-term care setting, we are often called upon to make difficult decisions on behalf of our elders with dementia. Some choices, such as refusing medical care, necessitate a capacity evaluation by a licensed and trained professional. Other decisions are made every day by staff and family members who desire to allow the resident autonomy yet need to keep them safe.
Today’s post is by clinical bioethicist Viki Kind, MA who discusses the use of the shared decision-making model to help residents with dementia and their families make decisions regarding care.
Viki Kind, MA, KindEthics.com
Many caregivers struggle with knowing when and how much to step in to protect the person in their care. It is especially difficult when the person is in the early stages of Alzheimer’s or dementia. As a clinical bioethicist, I have unique tools and strategies to help family caregivers navigate these difficult situations.
The Shared Decision Making Model is one of the tools I teach in my book, The Caregiver’s Path to Compassionate Decision Making: Making Choices for Those Who Can’t. This tool can be used to determine how much your loved one should participate in his or her important life and health decisions. With this tool, you can adjust this process to fit your loved one’s mental abilities as he or she changes over time. If your loved one has fluctuating capacity, you will need to adjust the age range as your loved one’s condition changes each day.
The Shared Decision Making Model states that we should include people in the decision-making process based on their mental age. Whether you estimate your loved one’s mental age or the doctor has given you an approximate age, your answer will fit into one of the following categories. These age ranges will help guide you as you begin to use the Shared Decision Making Model.
Zero to six years old
Seven to thirteen years old
Fourteen to seventeen years old
The way you figure out what your loved one’s mental age is by thinking about what a child would be allowed to do at different ages. (I am never saying that your loved one is a child, it is just a way to imagine how his or her abilities and needs have changed.) Would you leave the person home alone? Would you let them use a knife to butter their bread? Would the person be able to call 911 if there was a fire? Is the person able to remember enough details in order to make an informed and well thought out decision?
Most family caregivers I know either already have an idea of their person’s mental age or can figure it out when thinking about it in these terms. If you are a professional in a nursing facility, you will be able to evaluate for this as you get to know the resident.
And you don’t have to know exactly because these are age ranges, not absolute rules. You can adjust the age ranges up or down a little bit, but be careful about moving the mental age too much or you might end up using the tool in the wrong way.
Here are the basic guidelines of the Shared Decision Making Model. If the person in your care is in the zero-to-six-year-old age range, you will need to make the decisions for him or her because it wouldn’t be safe for the individual to participate in important decisions. If the person is in the seven-to-thirteen-year-old age range, he or she will be able to have a voice in some decisions but will not make the final decision. If the person is in the fourteen-to-seventeen-year-old age range, the individual may have enough capacity to make his or her own decisions.
The second tool that works with the first tool is the Sliding Scale for Decision Making which reminds us that the more dangerous or consequential the decision, the more mental capacity the person needs to have to be including in the decision making process. You wouldn’t allow someone who is six-years-old mentally to choose which nursing facility is right for him but you might allow someone who is mentally sixteen to make the decision or at least share in the decision-making process.
At the same time, you would allow the person who is mentally six to have the power to decide if he would like which activity he would like to attend because that isn’t a serious or important decision to make. The value of this process is it includes and empowers this person to have some control in their life, even when the more major decisions have been made for him.
With these two tools working together, you can evaluate the seriousness of the situation and if the person’s mental capacity changes, you can adjust how much he should participate in the decision-making process. In the nursing facility setting, these tools can give the professional caregiver the confidence to step in when necessary and to step back when it is not a very serious decision and the resident has enough mental ability to make the decision. Caregivers have told me that these strategies have reduced conflicts and improved patient-centered care.
Decision-Making and Dementia: Conversation with Viki Kind, MA
This 40-minute audio is designed for facilities and staff members wishing to learn more about using the Shared Decision-Making Model to address challenging decisions in the long-term care environment. Listeners will learn:
- Ways facilities can help families make decisions on behalf of their loved ones
- How to balance fall prevention with the resident’s desire to walk
- Ways to make good discharge decisions for residents with dementia
- The qualities of an effective ethics committee
- And more
Instant Download: Only $10.99
Audio includes 5 FREE helpful decision-making resources!
Would you want to live in the LTC home where you work? (McKnight’s LTC News)
Here’s my latest article on McKnight’s Long-Term Care News:
Would you want to live in the LTC home where you work?
I used to live in a fabulous old fourth-floor walk-up apartment in Manhattan. When I moved out of Manhattan to a borough of New York City for an elevator building with a laundry room in the basement, I made a conscious choice to pick a place I could live for the rest of my life if I had to. That ramp could come in handy if I need a wheelchair, I reasoned. And if worse comes to worse, I’ll move into a nursing home and blog from there.
A lot of residents tell me, “I never thought this (living in a nursing home) would happen to me.” After hundreds of these conversations, I have the opposite approach. I figure, “Why not me?”
But actually, I wouldn’t want to live in any of the nursing homes where I’ve worked. Sure, if I had to, I’d make do. I’d rabble-rouse and kvetch and roll to the administrator’s office if the situation called for it. I’m ready for a fight.
That was my thinking until last week when I toured the eldercare home of my dreams.
For the entire article, visit:
Would you want to live in the LTC home where you work?
For more on what residents think about living in nursing homes, read The Savvy Resident’s Guide.
.
Connecting in LTC: Seven Sure Ways to Have a Great Visit
This article for families visiting relatives with dementia in long-term care appears as a guest post on Deborah Shouse Writes where Deborah Shouse, author of Love in the Land of Dementia, offers advice and support for families along their caregiving journey.
Connecting in LTC: Seven Sure Ways to Have a Great Visit
It wasn’t just an ordinary visit. I walked into the long-term care facility and made my way to the memory care unit. I paused in front of the locked door, pulled a crumpled scrap of paper out of my pocket and tapped the entry code into the keypad. As I walked to my mother’s room, her new home, I felt sad, confused and guilty. How was I going to connect with my mom in this strange new environment?
Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, has 16 years of experience as a psychologist in long-term care and understands the emotions and confusions family or friends might feel when visiting in a long-term care facility. Here are her tips for having a meaningful connection.
Seven Tips for Visiting a Loved One in a Long-Term Care Facility
Many families find it stressful to visit their loved ones in long-term care, especially if dementia has changed their usual ways of relating. Here are seven ways to make the most of your visits:
- Help the room feel like home by bringing photos and bedspreads, creating an environment that feels more comfortable and familiar to your relative and more pleasant for you to visit. Labeling the photos with names (such as “Oldest son, Sam”) provides reminders in your absence and clues for the staff that are with your loved one daily.
-
Turn off the television or radio and close the door during your time together. When the room is quiet and free of distractions, it’s easier for someone with dementia (and for those with hearing loss) to focus on their visitors.