Dr. El - August 11, 2013 - Common Nursing Home Problems and How Psychologists Can Solve Them, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Psychology Research Translated, Resident care, Stress/Crisis management
Here’s my latest article at McKnight’s Long-Term Care News:
According to researchers, 11% to 43% of LTC residents have thoughts of suicide1-3, with higher rates in larger facilities and in those with more staff turnover4. Other stressors include medical illness, the presence of a mood disorder such as depression, social isolation, and recent life stressors5 – factors that frequently affect our residents.
The MDS 3.0 requires that facilities ask residents questions regarding their risk of suicide. If a risk is identified, then effective protocols should be employed. In a June 2013 Annals of Long-Term Care review article, Challenges Associated with Managing Suicide Risk in Long-Term Care Facilities6, authors O’Riley, Nadorff, Conwell, and Edelstein offer alternatives to the procedures frequently in place in LTC settings – close observation or transfer to a psychiatric facility. These methods are often used unnecessarily, the authors note, due to staff fear of legal liability, concerns regarding their perceived competence in handling suicide risk, and the personal fear of losing a resident to suicide.
Essential for immediate risk
The authors argue that while close observation and hospitalization are essential when residents have the means, intent, and ability to end their lives at any moment (high risk situation), they’re ineffective in situations where there is a minimal or low risk of imminent death by suicide. For example, a resident may express thoughts of suicide but have no access to a means to do so or no ability to make use of an available means, making suicide very unlikely or virtually impossible. Other times a resident may have thoughts of suicide but no plans to do it any time soon. “If things get worse down the road,” they’ll sometimes say, “then I’m going to end it all.”
Ineffective for minimal risk
While a low or minimal risk should still be taken seriously, there is no evidence that it’s effective to put a resident on 15-minute checks or to send him or her to the psychiatric hospital.
For the entire article, visit:
1.Haight B K. Suicide risk in frail elderly people relocated to nursing homes. Geriatr Nurs.1995;16(3):104-107.
2. Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry. 2009;25(8):843-849.
3. Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2-3):97-116.
4. Osgood NJ. Environmental factors in suicide in long-term care facilities. Suicide Life Threat Behav. 1992;22(1):98-106.
5. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451-468.
6. O’Riley A, Nadorff MR, Conwell Y, Edelstein B. Challenges associated with managing suicide risk in long-term care facilities. Annals of Long-Term Care. 2013;21(6):28-34.
Dr. El - July 26, 2013 - Boomers, Business Strategies, Customer service, McKnight's Long-Term Care News
Here’s my latest article at McKnight’s Long-Term Care News:
“You do so much for seniors,” my friends tell me, having heard too many stories about the horrors of nursing homes. “Those places need more people like you.”
“Actually,” I respond, “there are lots of people like me out there trying to do the right thing for our elders.”
Nowhere was this more apparent than at the 50th annual LeadingAge Florida convention this month, where I was speaking about the psychosocial needs of baby boomers. I was surrounded by people who, like me, were all jazzed up about long-term care and excited about the possibilities for improving services.
My talk about the needs of baby boomers generated an exciting exchange of ideas, with members of the audience sharing innovative best practices with each other. Among the best practices mentioned:
- To address boomers’ need and expectation of being socially connected while in a long-term care setting, many of the Florida facilities have WiFi and use the Internet to help families stay connected. Skype and other video chat services are available for care plan meetings as well.
- Individual preferences for music were met at one site through an iPod program that offered an iPod for each interested resident, complete with “their” music chosen from the thousands of songs in the home’s music library.
- Lending credence to my assertion that a strong resident council is the driving force of a good home, one CCRC reported that the dynamic and thriving resident council of their independent living facility generates innovative suggestions that the administration follows to make successful improvements. For tips on how to rejuvenate a lackluster resident council, start here for the first in a 3-part blog series designed to create effective meetings that energize your community.
For the entire article, visit:
For more on boomer needs, read
Dr. El - July 17, 2013 - Boomers, Business Strategies, Customer service, Talks/Radio shows, Younger residents
I’m honored to be speaking at LeadingAge Florida’s 50th annual convention this year. I’ll be talking tomorrow morning about the anticipated psychosocial needs of baby boomers. If you’re at the convention, please come by to hear me and be sure to say hello afterward. Hope to see you there!
Dr. El - July 11, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Customer service, McKnight's Long-Term Care News, Role of psychologists
Here’s my latest article at McKnight’s Long-Term Care News:
John O’Connor’s recent
post on the pain/depression cycle raised some interesting points about depression in long-term care. He referenced a 2009 study that found that over 47% of nursing home residents suffer from some level of depression, and he reported on a University of Pittsburgh Medical Center study showing the effectiveness of talk therapy with elders.
Despite this, O’Connor points out, psychological services in LTC are often underutilized. As I noted in my 2010 article, Improving the treatment of mental health issues in nursing homes, we can do more to identify residents who may benefit from psychological services and systematically refer them for treatment before problems become entrenched.
Learned helplessness
The University of Pittsburgh study reported that one of the helpful aspects of psychotherapy is the reduction of the learned helplessness often seen in depression. Learned helplessness comes about when a person believes that they have no control in a situation, even when they do….
Learned helplessness in LTC residents
There are many situations in long-term care that can lead to learned helplessness among our residents. Every time a call bell goes unanswered for too long, it leads residents to conclude that there’s no point in asking for help. When a staff member tells a resident she’ll follow through on a task and then doesn’t, that experience is reinforced.
For the entire article, visit:
My book, The Savvy Resident’s Guide, is a great tool for reducing learned helplessness. Please consider giving it to your residents or loved ones.
Dr. El - June 28, 2013 - Books/media of note, Boomers, Business Strategies, McKnight's Long-Term Care News, Resident care, Younger residents
Here’s my latest article at McKnight’s Long-Term Care News:
Young adults in long-term care: a new resource for caregivers
According to a 2010 NPR report, young adults have been one of the fastest growing long-term care populations over the past 10 years, with 14% of nursing home residents under the age of 65. Some live in facilities that have specialized in the care of younger residents and others are in settings where almost all the other residents are seniors.
Both scenarios pose challenges in terms of accommodating the unique physical, emotional, and recreational needs of younger adults — and the reactions of staff members to their young charges.
Having spoken with many young residents and their bewildered staffers over the years, I know firsthand how challenging interactions can be. I wrote about some of the psychological issues and remedies in my 2008 McKnight’s guest column, Young adults in long-term care: the canaries in the coal mine, where I argued that the problems arising with young adults now are precursors to those that will be endemic when the assertive baby boomers arrive at our doors — unless we adapt as providers.
Younger adult toolkit
Recognizing the need for facilities to be better prepared, the American Medical Directors Association has released a toolkit on “The Younger Adult in the Long Term Care Setting” as part of its LTC Information Series. I had the pleasure of working on this project, which covers a wide range of matters affecting young adults and provides recommendations for addressing them.
The guide is one of the few sources of information on this understudied population. If your facility has even one young or boomer resident that staff members consider “demanding” or “a problem,” you’ll find this report invaluable.
For the rest of the article, visit:
Dr. El - June 20, 2013 - Savvy Guide reviews
In the spirit of not hiding the light of The Savvy Resident’s Guide under a bushel, I’ve decided to post the Amazon reviews of the book here on the blog. As the author, I can tell you that new and long-time residents, staff, and family members have loved the tone of the book, found it very helpful and said they’ve learned a lot from reading it, but here’s a chance to hear it from the readers themselves:
Thank you Dr. El for such a great resource guide!
by Susan Samek
Whether you have been newly admitted to a nursing home (for short term rehabilitation or a long term stay) or have been in one for some time, Dr. Eleanor Feldman Barbera gives useful, straightforward suggestions to make life less stressful in a nursing home. I particularly enjoy her sense of humor and use of vignettes to illustrate her points. The “Savvy Resident’s Guide” provides vital information into the workings and understanding of how things are done in a nursing home. The book is not only an excellent resource for the resident, but for the family or anyone who needs to gain insight into life in a nursing home. …And, it is in large print!
Dr. El - June 14, 2013 - Boomers, Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News
Here’s my latest article at McKnight’s Long-Term Care News:
5 lessons long-term care providers can learn from Joan Lunden
Award-winning journalist and author Joan Lunden and I met recently to talk about eldercare issues. Joan’s mother is 94 years old and happy in a small care home after living for years in the community with home care.
Joan, a physician’s daughter, talks with family caregivers around the country as part of her mission to educate people about the challenges of eldercare.
The observations she shared in our conversation deserve attention from LTC providers looking to meet the needs of residents and their families. As a spokeswoman for family caregivers, her experience echoes that of millions of families across the country.
1. Help people choose the right level of care for their loved one.
The small care home was the third placement for Joan’s mother once she could no longer live in the community.
Lunden: When I finally moved my mother into a facility, I moved her into a place that would have been great for my mother 10 years ago. I moved the mother that was in my head. In reality, the beautiful dining room scared her because she didn’t recognize people, she was alone in her apartment when she started sundowning. The place terrified her. I had chosen the completely wrong facility.
As LTC providers, who recognize the toll it takes on elders and their family members to move from facility to facility, we can do more to help families find a placement that meets the needs of their loved one.
- We can strive to provide the family with a realistic assessment of needs and what a facility can offer.
- We can refer residents to other levels of care within our systems.
- We can build relationships with other facilities so that we refer potential residents to each other.
2. Assist families with the transition to parenting their parent
Joan points out that shifting the roles in the family can be very challenging.
Lunden: When you get to that life transition when you become the parent to your parent, it doesn’t feel natural because you’ve spent a lifetime learning to be a child to them and they have always been in that parental position. To all of a sudden have that role reversed is very disconcerting to a lot of people. It’s a hard one to accept. It often feels uncomfortable to tell your parent what they can do or can’t do.
Some families come to us having negotiated the shift in roles for years, but more often we find adult children and their loved ones struggling to find a way to handle dramatic role changes in the midst of a health crisis.
We can assist families with the role transition when we:
- Offer family education groups.
- Refer to counseling resources in the community.
- Recommend written resources such as David Solie’s book, “How to Say It to Seniors” which focuses on the communication challenges between adult children and their aging parents.
- Use our consulting psychologists to help the team with challenging family issues.
3. Provide an opportunity for staff to take a break
Joan offers a place for caregivers to recharge through her Camp Reveille.
Dr. El - June 5, 2013 - Anecdotes, Boomers, Communication, Engaging with families, For Fun
Award-winning journalist and author Joan Lunden takes time from her busy schedule to talk with Dr. El of My Better Nursing Home about her experiences caring for her 94-year old mother and speaking with other family caregivers around the country.
Dr. El: Joan, you’re part of what’s called “The Sandwich Generation,” taking care of your young children and an aging parent while maintaining a high-profile career. How do you manage this?
JL: After working on Good Morning America for twenty years where you never know what part of the world you’re going to be in while raising 3 daughters, I don’t think anything could get any harder than that. But I think having kids the second time around, you have to decide what you’re like and are you physically and psychologically up to the task. I wasn’t even daunted about having a second round of children. But no matter what we do as women, running businesses and keeping hectic schedules, the day you start taking care of a parent, that can really bring you to your knees….When you get to that life transition when you become the parent to your parent, it doesn’t feel natural because you’ve spent a lifetime learning to be a child to them and they have always been in that parental position. All of the sudden to have that role reversed is very disconcerting to a lot of people. It’s a hard one to accept. It often feels uncomfortable to tell your parent what they can do or can’t do.
Dr. El: The caretaking you’re talking about can be quite stressful and I saw on your website you have a place called Camp Reveille. Can you tell me about that?
JL: I got remarried and I married a guy who runs summer camps for children. I’m no dummy, I married a guy with a 50-foot climbing wall and 17 tennis courts! I started spending my summers up in Maine with him and at the end of every summer I would find that I was my least stressed, my absolute most fit, I was one with nature again….One day we were walking by the lake and I said to my husband, “I’m always talking to these women’s groups all over the nation. I should have a summer camp for women.” And my husband said, “The facility is yours. Do it.” And the next summer we ran our first Camp Reveille, which is a 3-night, 4-day stay because women don’t have wives and can only deal with being away for that amount of time. That’s long enough to unhook from electronics, unwind from the hectic pace of life…and connect with the women….The emotional strength that comes from getting a group of 150 women together is really powerful. The sharing of stories, the understanding that you’re going to get to the other side [of what you’re going through], learning from each other, motivating each other in a safe environment. They go back not just refreshed, but I feel a lot of them experience a transformation and are able to let go of a lot of baggage they didn’t even know they were carrying around.
Dr. El: Is the camp mostly for family caregivers or is it also for professional caregivers?
JL: It’s for women in general. About 75% of the women identified themselves [in their pre-camp questionnaires] as caregivers. Several women had just lost their husbands and came to the camp with their hospice workers. I never have seen such a transformation as these two women [a widow and her hospice worker] who came in and when they left on the last day I almost didn’t recognize them because they had let go of so much stress and heartache that they were like two giddy little girls, laughing.
Dr. El: For most families, one of the stresses of eldercare involves the financial challenges, including medication costs. What are your thoughts on how to manage this?
JL: I do a lot of health campaigns and I’m a doctor’s kid who always thought I’d grow up to be a doctor until I worked in a hospital and found out that scalpels were not happening in my career. But truly the dissemination of health information and the ability to help people make better decisions is at my core. I’m working right now with Walgreens who has really made great strides in trying to figure out ways to bring prescription costs down. One of the ways is Medicare Part D. The real area that it seems people can get some savings is that a lot of these programs that you have to sign up in when you sign up for Medicare Part D are now affiliating themselves with pharmaceutical chains. When they do that, you need to review your plan and ask if there is a preferred pharmacy network so you can get the lowest copays.
Dr. El: This is an important issue because sometimes people will skip their medication because they can’t afford it and this leads to a whole host of problems and readmissions to the hospital and nursing home.
JL: That’s what this Walgreens survey found, that one in five people were skipping doses to make a prescription last longer or not getting them refilled. And one in four said that when a doctor wrote a prescription for them, they never got it filled. Nonadherence to medication therapy is estimated to cost the healthcare system 300 billion dollars a year…. I don’t know how we’re going to reform healthcare in this country unless we do it grassroots, person by person, just like we got people to stop smoking. It’s a huge educational process to help seniors and caregivers understand how they can get the most cost savings from these plans that they belong to.
Dr. El: Let’s talk a little bit about your personal situation. Your mother is in a care facility right now. Can you tell me about how you chose that place and what it’s like there?
JL: I had kept my mom and my brother in a condo together and had a person come in to help them. My brother had Type II Diabetes and he had all the complications one could have with it and he was unable to keep a job for several decades, so I paid for them. The condo worked pretty well until my brother died about 6 or 7 years ago and it became abundantly clear to me that there was no way my mother at 88 years old could continue to live in that condo by herself. And that is one of the toughest things, when I talk to people, making that decision that their parents need to move out of their house or apartment and into a care facility. And I think that part of the reason is that we’re living with this myth that the minute you leave your house and move into a nursing home, you die, and that’s absolutely not the way it works, at least from what I’ve seen.
Dr. El: I work in nursing homes and it’s not what I’ve seen either.
JL: When you leave a place, hopefully you make that decision before it’s a crisis, but most people wait until somebody’s had a fall or has an accident in the car or wait for the crisis call. Once you move your loved one into a facility, I’ve found they’re often better off instead of being by themselves in their house. I think if I’d have gotten my mother into senior living far sooner, she would have been much better off today because she would have had conversations with people. She became a recluse at home. When I finally moved my mother into a facility, I moved her into a place that would have been great for my mother ten years ago. I moved the mother that was in my head. In reality, the beautiful dining room scared her because she didn’t recognize people, she was alone in her apartment when she started sundowning….The place terrified her. I had chosen the completely wrong facility.
Dr. El: And how would you know because you’d never done this before.
JL: And not only that, I hadn’t been living with her. I was typical of many families in that I lived far away and when people come into town for a visit, everyone puts on their best face — there’s no problem, we’re doing fine. And you don’t realize that they haven’t opened the mail for the last two years. In retrospect, there were warning signs that my mother needed more help. I came back to Sacramento, California and moved her to the next place, but she kept falling. Her neurologist recommended a small care facility in a house setting with five residents. That was the best advice I ever got. She now lives in a ranch-style house that’s not at all institutional. She gets out of her room every day, they play bingo — she’s the reigning champ, she reads the newspaper to the other residents in their 90s and they do chair exercises. It’s fastidiously clean. It was the best move I ever made.
Dr. El: It’s so amazing when you find the right place because it changes your relationship from the worried, intense caregiving to I’m visiting my mom and we’re having a relationship like we used to have.
JL: Yes. Instead of spending the entire time in town figuring out what’s wrong, now I can go in — and my mom can have good days and bad days, she does have dementia — but I made up these books with photographs and she can sit and reconnect. The man who runs the place gave me the advice that the more you can engage with the older person in the life they knew, rather than trying to engage them in your life, the more comfortable they are and the better they begin to have a discussion with you. When I talk about what life was like when I was a little girl, my mother opens up like a flower.
Dr. El: You’re talking about flipping the roles of family members, and one of the chapters of my book, The Savvy Resident’s Guide, is for elders to help them see that they still have a role in parenting by helping their children adjust to the fact that they’re aging and dealing with end of life issues. Are there ways that your mom is still in the mom role with you?
JL: Not in any significant way other than that I still want her to like the way I dress, I dress for her when I go there. She still wants to feel the pride of a momma. They don’t want to know you won a certain award particularly, they want to know you’re happy. I’m in the child role in that I’m still trying to make sure that my momma is proud.
Dr. El: You speak with family caregivers all over the country. Is there anything you’d like to say to professional caregivers on behalf of the families?
JL: Thank you, thank you, thank you, thank you! I take my hat off to those people who work as caregivers. It is a testament to their compassion and their patience. I can go to sleep at night because I know the heart of these women who are taking care of my mom all day long… I thank God that we have those people in our society that are willing to dedicate themselves truly to someone else’s minute-by-minute happiness.
Dr. El - May 30, 2013 - Anecdotes, For Fun, Inspiration, Personal Reflections, Something Good About Nursing Homes
Here’s my latest article at McKnight’s Long-Term Care News:
Someone posted a story I Liked on Facebook about an 85-year old woman who graduated from college and already had a job offer. “She’s my new hero!” a Friend commented. That got me thinking about all the resident heroes I meet at work every day. They’re the ones who help me along the journey to having the kind of life I can look back on without regrets when I’m in my nursing home room in my senior years.
Lesson No. 1: Chutzpah
Back when I first started in long-term care, I was called upon to work with many younger residents who were admitted to the facility as a result of unfortunate incidents that occurred while they were taking a walk on the wild side. Their still-wild ways weren’t going over so well in the nursing home, but I admired how they stood up for themselves and their rights.
“Everyone knows not to mess with me,” one young lady declared, “because if they do, I’ll have a hit put out on them.” Wow! Now that’s assertiveness! I thought to myself, as I worried about the nuances of phrasing a request to a coworker.
Yes, threatening to put out a hit on someone was on the extreme side of the assertiveness scale, but wasn’t it possible I was too far on the mild side? Those young residents helped me edge a notch or two closer to asking for a reasonable amount of what I want and need from others.
Lesson No. 2: Keep on keeping on
Nina and Roberta had a routine. In the mornings, they sat in the lobby and greeted all who entered the facility. At lunch, they went from table to table and wished everyone well before dining. In the afternoon, they visited the very ill and prayed with them before returning to the lobby to welcome the evening shift.
In a private discussion with Nina, she talked about her younger years when she preached with her sister on the streets of New York City. Nina is my role model because she lived her whole life doing what she loved, adjusting for changes along the way.
Lesson No. 3: Live for today
Dr. El - May 17, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Customer service, McKnight's Long-Term Care News, Motivating staff, Something Good About Nursing Homes
Here’s my latest article at McKnight’s Long-Term Care News:
In long-term care we spend a lot of time focused on the physical health of those in our care. With increased emphasis on culture change and the update to the MDS (and hopefully as a result of this column), we’ve begun to address the mental health of our residents more adequately.
We do this not only by assessing the needs of individuals, but also by creating a healing emotional environment for all residents. It’s easier for our staff members to create an emotionally healing environment for residents when the work environment is psychologically healthy for them.
What makes a psychologically healthy workplace?
The American Psychological Association (APA) Center for Organizational Excellence recognizes five different elements that contribute to a healthy environment:
- Employee involvement includes efforts to involve employees in decision-making and give them more opportunity for autonomy.
- Work-life balance is a recognition that responsibilities outside work can impact on performance on the job, leading to programs that assist workers in managing childcare, eldercare, financial crises, etc.
- Employee growth and development focuses on offerings that provide employees with the opportunity for new skills and experiences such as coaching or mentoring, continuing education, tuition reimbursement, etc.
- Health and safety comprises programs that work to maximize employees’ physical and emotional health such as stress management programs, adequate insurance, healthy lifestyle motivators, safe practices training on the job, and Employee Assistance Programs (EAPs).
- Employee recognition includes ceremonies that acknowledge individual and group contributions to the organization, performance-based bonuses and pay increases, and acknowledgement of milestones.
The benefits of a psychologically healthy workplace
According to the APA Center for Organizational Excellence, which has been honoring exemplary company practices since 1999, having a healthy workplace isn’t just good for employees. A psychologically healthy environment can reduce staff turnover and absenteeism, improve performance, and enhance the quality of services provided.
