‘Derek’ — a long-term care shrink’s view (McKnight’s LTC News)

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

‘Derek’ — a long-term care shrink’s view

I was very pleased when I heard there was a program about a long-term care facility on British television. Finally we’re getting our props — at least overseas.

“Derek” is the story of a simple but kind middle-aged man who works in a quiet assisted living home with an assortment of misfits who staff the place. The show is alternatively funny and sad and definitely worth watching, especially to see how our work is portrayed to the public.

 For the entire article, visit:

‘Derek’ — a long-term care shrink’s view

More about Ricky Gervais:

Ricky Gervais is not only the star of ‘Derek,’ he also wrote and directed it. Gervais’ past credits include his work on ‘The Office’ and ‘Extras,’ which he co-wrote and co-directed. He had lead roles in both programs. Below, Charlie Rose talks with Ricky Gervais about ‘Derek.’

Ricky Gervais on ‘Charlie Rose’

For more insider info on what it’s like to live and work in a nursing home, read The Savvy Resident’s Guide.

Why (and How) to Personalize a Nursing Home Room (SeniorCare)

Here’s my latest article featured in SeniorCare:

Why (and How) to Personalize a Nursing Home Room

As a psychologist in long-term care, I’ve walked into thousands of rooms over the years. Among many mostly bare quarters, a few stood out for their warmth and their ability to convey the life of the person living there.

Why is it so important to decorate the room of your loved one when they aren’t able to do it themselves?

For the Resident

Even if their stay is expected to be a brief one, it’s important for their room to have a personal touch. Moving from home to hospital to rehab can be disconcerting for most people and disorienting for many, especially those with dementia.

Having a personal item or two can be reassuring and can act as what mental health professionals call a “transitional object.” A transitional object for a young child might be a teddy bear that accompanies them to a sleepover; a transitional object for an adult could be a treasured photo of their parents or their wedding day.

Aside from providing a touchstone during a difficult time, room decor can be a powerful reminder of who your loved one has been in their life before they became “a patient.” Staff may refer to Mrs. Rivera as “the lady in 214,” but when she enters a Room 214 filled with reminders of her life and accomplishments she can feel comfortable and proud.

A resident with a few photos on the side table has constant reminders that there are people who care how they’re doing—their personal cheerleading squad. For residents with dementia, it’s helpful to write the names of the family members and their connection. Mrs. Cook, for instance, can look at the photo and be reminded that she is seeing her youngest son Tom and not a familiar face she realizes she should know but doesn’t.

For the staff

A personalized room reminds staff that someone is checking on Mrs. Cook. It also helps them give Mrs. Cook the care she needs. For example, if staff members see a photo of her in her flower garden, they’ll be able to make a personal connection, perhaps sharing a discussion of gardening while engaging in previously challenging personal care. If they know Mr. Smith used to work nights, they’ll be more able to understand and perhaps accommodate his unusual schedule.

How to decorate

There are many ways you can personalize a room, but if you can do only one thing, bring or mail in labeled photos of the family. Use copies, not originals. Other important items include a picture of the resident as a young person, photos of them engaging in valued activities (such as heading to work, on a special trip, or with grandchildren), and copies of awards or diplomas reflecting their contribution to the world. Asking your loved one if there’s something they’d like from home can identify what’s most important to them and increase their sense of control. As wonderful as fresh flowers are, if you’re not there in three days to remove them or to regularly water a plant, consider long-lasting artificial flowers to cheer a windowsill. A (labeled) quilt not only transforms the look of a room from institutional to homey, but allows your loved one to feel literally covered with affection.

Care model for more than just medical condition needed in long-term care (McKnight’s LTC News)

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

Care model for more than just medical condition needed in long-term care

Of the most efficient countries for healthcare, the United States ranks second in healthcare costs per capita but 46th in efficiency (out of the 48 countries ranked!). The move from a biomedical to a biopsychosocial model of healthcare might be able to change that.

Consider the following scenario: Estelle’s fall at home sent her to the hospital. She was diagnosed with a hip fracture and diabetes and transferred to the nursing home for short-term rehab. A biomedical model would treat both conditions and send her home again. A biopsychosocial model would also address her need to make dietary changes, her fears of falling again, the alcoholism that contributed to both her diabetes and her fall, and her noncompliance with the rehab staff.

From biomedical to biopsychosocial

In her American Psychological Association presidential address, psychologist Suzanne Bennett Johnson discussed the change from a biomedical model of care to a biopsychosocial model of healthcare. The biomedical model of care that has “dominated Western medicine … for over 100 years” focuses solely on biologic factors to understand illness. It’s resulted in cures for infectious illnesses such as tuberculosis, pneumonia, and influenza, and increased life expectancy from 49 years in 1901 to 77 years in 2001. The biomedical model has been a great success in many respects.

As Johnson points out, however, “while infectious disease was the leading cause of death in 1900, today most Americans die of chronic disease: heart disease, cancer, chronic lower respiratory diseases, and stroke.”

Underlying these diseases are behaviors such as smoking, poor dietary habits, sedentary behavior, and substance abuse. In addition, she notes, “as many as 40% of medical patients are co-morbid for a mental health disorder and as many as 75% of seriously mentally ill patients are co-morbid for a physical health disorder.”

Implications for LTC

Clearly, in order to reduce chronic disease in this country (and to decrease medical costs), we need to address the behaviors – the psychological and social factors — underlying the diseases. But we work with elders, you might say, the damage caused by years of poor self-care has already been done! Perhaps.

But as a psychologist talking with seniors over the years, I’ve found that many of my lovely old dogs were ready for new tricks. We need to intervene, however, in certain key ways:

For the entire article, visit:

Care model for more than just medical condition needed in long-term care

Navigating the Caregiver’s Journey: LTC Offers a Valuable Viewpoint — Guest Blog by Author Deborah Shouse

Navigating the Caregiver’s Journey: Long Term Care Offers a Valuable Viewpoint

When my parents relocated from Memphis to Kansas City to be closer to me, they packed decades worth of clothes, souvenirs, books, and furniture. The process of helping them move overwhelmed me and I fervently wished they’d had fewer possessions. But three years later, I yearned for those stacks of boxes; my mother’s possessions had dwindled considerably since she’d progressed deeper into Alzheimer’s. Now she needed additional care and was moving from assisted living to a memory care facility.

That blustery September day, as my dad and I helped transfer my mom to her new home, Mom had only a suitcase full of clothes and toiletries.

Taking the First Steps

Once at the home, the administrator welcomed us but her cordial greeting couldn’t dispel the chill I felt.  I had worried about moving Mom into this brand new facility, but the home was close to my dad, who was already having some trouble driving.

“Where is…?” my mother asked, tugging on her sweater. “What are…”

“We’re fine, Frannie,” my father said.

My stomach clenched as we walked into the shiny new unit. After we’d taken a few steps, a woman in a white nursing uniform hurried towards us.

“Frances, how lovely to see you. And you too Paul. You must be Deborah.” The woman, Pam, was the nurse in charge. Dad had met her earlier and had told me how nice she was.

“I’m so glad you’re all here,” Pam said. She turned to Mom and said, “Paul told me you were a nurse during World War II.”

“She was,” Dad said proudly. “She served in Iceland and England.”

”That was very courageous of you,” Pam said. She linked her arm through Mom’s and she and Mom strolled down the hallway together. “You must have had many adventures.”

Mom looked blank and then smiled. “We skied to hot springs.”

Some fragments of Mom’s WWII stories were still intact and Pam listened encouragingly as Mom shared phrases from the same story several more times. They settled at a table in the cozy dining room and Pam served us all coffee and cookies.  She seemed relaxed and welcoming; she was getting to know a new friend.

Embracing a New Viewpoint

When I listened to my mom’s stories, I usually wrote down every word, worried I might not hear them again; I felt I was losing an old friend. But Pam wasn’t worried when Mom repeated herself or misplaced letters. She didn’t panic when Mom started a sentence and couldn’t retrieve her thought. Pam just wanted to get to know Mom. Through her actions, Pam silently invited me to appreciate my mother just as she was.

As I hung up my mother’s meager collection of clothes in her new closet, I was grateful for her pared-down possessions. Mom had let go of many material reminders of the past, just as I was letting go of the woman my mother used to be and embracing the woman she was. ##

Deborah Shouse: Bringing Words to Life

Deborah Shouse is a writer, speaker, editor and creativity catalyst.

This November, Central Recovery Press is going to publish an updated edition of her book Love in the Land of Dementia: Finding Hope in the Caregiver’s Journey.  Originally, Deborah self-published and used the book as a catalyst to raise more than $80,000 for Alzheimer’s programs and research. She will continue donate a portion of her proceeds to Alzheimer’s.

Deborah and her partner Ron Zoglin have performed her writings for audiences in the United States, New Zealand, Nova Scotia, Puerto Rico, England, Ireland, Chile, Costa Rica, Italy, Turkey and the U.S. Virgin Islands.

To learn more about Deborah’s work, visit her blog DeborahShouseWrites

Or follow her on Twitter: DeborahShouse@Twitter

Join Dr. El at Freeport Library on 9/18/13 at 3pm

I’m giving a free local talk next week at the Freeport Memorial 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.

McKnight’s Free Online Expo tomorrow, 9/10 at 11am ET

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 on the following topics:

• Enhancing relationships with key referral sources  – Tuesday September 10^th  11:00 AM
• Changes looming for the MDS 3.0  – Tuesday September 10^th  12:30pm
• Issues that keep operators awake at night  – Tuesday September 10^th  2:00 PM

You can earn 3 CEUs and visit the 12 vendor booths, as well as chat with other conference attendees via your avatar.

To register for the conference, visit McKnight’s Fall Expo

Same-sex couples: Are you and your staff prepared? Probably not (McKnight’s LTC News)

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

Same-sex couples: Are you and your staff prepared? Probably not

Last week, McKnight’s staff writer Tim Mullaney wrote about the new Medicare guidance that guarantees that same-sex married couples can live in the same nursing home. Perhaps, like many of our current opposite-sex married couples, they’ll share the same room or apartment. Is your staff prepared to offer them the same respectful service they’re providing for your male/female couples? Are you prepared to lead the way, regardless of your personal beliefs regarding homosexuality? I’ll bet you’re not.

Why do I say this? Maybe your religion denounces homosexuality, yet you strive to be open (and have your facility open) to people from all walks of life. You might take a “live and let live” approach.  But even if you are openly gay yourself and comfortable with your sexuality, chances are excellent that there are people on your staff who feel very uncomfortable with homosexuality and will need additional training in order to be able to successfully assist gay couples.

I say this because I worked with a well-meaning aide who, despite knowing nothing about my background really, repeatedly thought she had to try to “save” me through conversion to her (anti-gay) religion. As a psychologist, I could read and deflect her good intentions, but I doubt a gay couple under her care would feel the same way.

For the entire article, visit:

Same-sex couples: Are you and your staff prepared? Probably not

6 common problems a shrink on staff can solve (and your consultant can’t): McKnight’s LTC News

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

6 common problems a shrink on staff can solve (and your consultant can’t)

As a psychologist consulting in long-term care facilities, I was paid through Medicare, Medicaid, and/or private insurance for only one task: direct contact with residents. That’s it. I provided a lot more because it was needed, but that’s all I was paid for.

There was much more help that I didn’t offer, not only because I wasn’t paid for it, but also because the organization wasn’t structured to accept this type of assistance. The facilities’ needs were the kinds of things that made me sigh and shake my shrinky head in frustration. Oh, what we psychologists could do for you if we were on staff!

Here are some examples:

Problem #1: Admissions decisions

As your admissions department scrambles to fill beds and wonders whether the facility can manage a new resident with a psych history and a recent diagnosis of cancer, imagine if they could ask the opinion of the psychologist likely to be treating the resident. Now imagine if they could do this for every questionable admission. Psychologists could set up mental health services upon the new resident’s arrival and you would have the support necessary to meet the mental health needs of the residents under your care.

As the number of residents with behavioral issues increases, this psychological screening becomes an increasingly important element of providing good care and preventing time-consuming problems on your units after admission.

Problem #2: Team Communication

Watching two aides argue about giving care to a resident over said resident’s head or observing an essential piece of information get lost between shifts, I’ve fantasized about offering in-service training to eliminate these destructive behaviors. Not half-hour meetings sandwiched in between resident care, but real training that allows time for examples and practice as well as observation and feedback on the floors.

Real training provides the opportunity for staff to turn to the psychologist for guidance in handling the sticky interpersonal dynamics that are inevitable as people work in groups.  It also offers assistance in designing and implementing procedures that facilitate written and oral communication.

Problem #3:  Interacting with residents

Improperly trained staff members frequently escalate tense situations, cause unintended distress in residents, or miss cognitive changes that signal physical illness. They aren’t doing this on purpose — they just haven’t been taught how to handle such situations.

For the entire article, visit:

6 common problems a shrink on staff can solve (and your consultant can’t)

4 Simple Ways Families Can Make a Difference During a Long-Term Care Stay (SeniorCare)

Here’s my first article for SeniorCare.com:

4 Simple Ways Families Can Make a Difference During a Long-Term Care Stay

When your mom or dad is in a long-term care home—whether it’s for rehab or a longer stay in a nursing home or assisted living—it’s a big adjustment for the whole family. Nerves are often frayed from dealing with major decisions during a medical crisis, and it’s likely you’re concerned about your loved one getting proper care.

While certain aspects of the situation are frustratingly out of your control, there are some steps you can take to make your loved one more comfortable and their time in the home more rewarding.

1.  Attend the Care Plan Meeting

Early on in your parent’s long-term care stay and periodically thereafter, there will be a meeting to discuss how treatment is going and what adjustments are needed. This is the single most important time for a family member to be at the nursing home (or to connect via conference call or video chat). Key people from each department are gathered to discuss how Mom or Dad is faring, so this is your best opportunity to raise concerns and have them addressed and written into the plan of care.

2.  Bring food from home

Of all the complaints I’ve heard as a nursing home psychologist, among the most common is one about the food. Of all the compliments mentioned about family visits, the highest praise is reserved for a visit followed by the comment, “And they brought me something to eat.” Give mom or dad a break from the facility kitchen by bringing in a special treat – and be sure to check with the dietician or nurse first to be sure it meets with dietary guidelines. If your parent is on a chopped diet due to swallowing difficulties, for example, the kitchen may be able to chop up the food so it’s safe or the dietician can recommend foods that are already sized appropriately.

 3.  Set up a chain of contacts

Admission to a long-term care setting is a hectic time and often one family member takes the lead in keeping track of the situation. To reduce the pressure on the one family member and to increase the number of social supports for mom and dad, consider giving more structure to the help offered by friends, neighbors, and relatives. For example, one friend, neighbor, and relative might be designated to call others, so that the lead family member only has to contact three people in order to start the chain of support. Or a schedule can be created for calls, visits, and outside meals. With four people on the schedule each taking a week, your loved one can be assured of weekly contacts while the helpers are responsible on a manageable once-a-month basis.

 4.  Bring photos and other mementos

Even for a brief stay, having a family photo on the table can be hugely reassuring for a resident, reminding them of who they are, who they’ve been, and that there are people who care about them. It reminds the staff too, and gives them an inkling of whom they’re helping. Remember to bring a copy of a photo and not a precious original and to label everything. Other ideas: a picture of your loved one in their younger days, a quilt or blanket to make the room homey, and a telephone programmed with frequently called numbers.

SeniorCare features new column for families by Dr. El

I’m pleased to announce that my writing is now being featured at SeniorCare.com!  My new column will focus on helping families grapple with eldercare issues.    You can find my articles here:  Dr. El at Senior Care