Dr. El - May 3, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, End of life, McKnight's Long-Term Care News, Motivating staff, Psychology Research Translated
Here’s my latest article at McKnight’s Long-Term Care News:
I started working in long-term care when I was in my early 30s and I was shocked at first when the residents died. I was used to falling in love with my patients — I consider it a prerequisite for psychotherapy. I wasn’t used to them dying on me.
In the years since, I’ve lost many, many people who have touched my heart, but I can still remember very clearly the ones who passed when I was new. In order to make it in LTC, I’ve protected myself by falling in love in a different way.
A recent New York Times article, “Is Giving The Secret of Getting Ahead?”, piqued my interest when it touched on the impact of death anxiety at work, suggesting that it could have an effect on absenteeism and turnover. Working with residents in LTC is all about coping with death, and facilities have huge problems with absenteeism and turnover —surely there was a connection. I raced through the article, located the research paper it mentioned, “The Hot and Cool of Death Awareness at Work,” and plowed through that too. What I read seemed very applicable to long-term care, so I’m going to present the gist of the research and ways to reduce absenteeism and turnover based on these ideas.
Mortality cues
In “The Hot and Cool of Death Awareness at Work,” authors Grant and Wade-Benzoni outline different types of work where mortality cues can be chronic or acute, internal or external to the job, and personal or vicarious. A firefighter, for example, is constantly in a work situation that threatens his life. This would be considered a chronic, internal, personal mortality cue. A nursing home employee would have a chronic, internal, vicarious mortality cue because they are repeatedly exposed to other people at work who are dealing with end-of-life issues.
Reactions to mortality cues
The authors state that there are two different reactions to being aware of death at work. A “hot” reaction leads to self-protection and “stress-related withdrawal behaviors” such as absenteeism, tardiness, and turnover. A “cool” reaction leads to prosocial behaviors such as helping, mentoring, and thinking of work in the context of contributing to society. They refer to the hot reaction as “death anxiety” and the cool reaction as “death reflection” and note that chronic exposure to mortality cues can shift a worker from death anxiety to death reflection.
This shift from death anxiety to death reflection describes my experience as I continued in long-term care. It also explains why some new workers bail out early and others persevere to become beacons of light in a challenging environment. In addition, the researchers propose that as we age, we become more likely to experience death reflection rather than anxiety. Younger workers, therefore, are more likely to withdraw from the nursing home environment.
Retaining new young workers
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Coping with Grief, for Staff Members: Conversation with grief expert Courtney Armstrong, LPC
Beloved residents decline and then die, their families stop visiting the nursing home — coming to terms with these losses is an unacknowledged challenge of our work. Especially helpful for training directors, new employees, or those struggling with a current loss either on or off the job, this 20-minute audio will help staff members:
- Understand their feelings
- Recognize symptoms of grief
- Identify coping skills
- Assist each other in creating a supportive community
Includes FREE:
- Signs of Grief checklist
- LovingKindness Meditation Sign suitable for posting at the nursing station
Instant Download: Only $7.99
Dr. El - April 17, 2013 - Dementia, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Resident care
Here’s my latest column at McKnight’s Long-Term Care News:
I was hoping not to have occasion to write another column about tragedy so soon, but the terrible events at the Boston Marathon have prompted another look at how we deal within our facilities with distressing news.
In my previous article, Helping Your LTC Community Cope in the Wake of Hurricane Sandy, I offer post-disaster recommendations that are applicable in this situation. In this column, I focus on the amount of information we provide to residents about distressing outside events.
Sandy Hook
An aide was the first person who informed me about the shootings at Sandy Hook Elementary School last December, calling me into the dining room to see the news broadcast. “Children,” she said, “just little children. This is awful.” The TV was filled with images of horror and the dining room was filled with residents, all of who were in wheelchairs or recliners and most of whom had dementia. They were more or less trapped in there, watching repetitive distressing reports of a vulnerable population being inexplicably attacked.
Many residents talked about the children in their psychotherapy sessions that week. Staff members stopped me in the halls to comment and to be heard and comforted by the psychologist. My daughter is six years old, the same age as most of the Sandy Hook victims. I was present at work as needed and at home I skimmed the headlines and tried not to read the details.
Dr. El - April 8, 2013 - Business Strategies, Communication, Customer service, Depression/Mental illness/Substance Abuse, Engaging with families, McKnight's Long-Term Care News, Resident care
Here’s my latest column at McKnight’s Long-Term Care News:
I have great respect for those who attend to the often complicated physical needs of our long-term care residents, but if your facility doesn’t have a solid social service department, it isn’t as good as it could be. Yes, the medical care is vital, but the social service department addresses many of the issues essential to resident satisfaction.
Market researcher Margaret A. Wylde, PhD, notes that the three most important elements of satisfaction with a long-term care community are the friendliness of staff, the degree to which residents feel the community is their home, and the opportunity they have to stay connected with the rest of the world.
In her 2010 McKnight’s Online Expo talk, she stated that it’s very satisfied residents who refer others to their communities.
Consider the multitude of tasks the average social worker performs:
· Helps the resident settle into the facility
· Handles roommates conflicts
· Facilitates room changes
· Assists with the purchase of new clothing
· Locates or arranges for reimbursement of lost clothing
· Facilitates the signing of financial forms
· Explains and establishes advance directives
Dr. El - April 7, 2013 - Savvy Guide reviews
I’m pleased to share this review of The Savvy Resident’s Guide by the Happy Dietitian: A foodie at heart with a passion for nutrition. Thank you, Wendy!
Don’t let the cover and title fool you, this book isn’t just for residents’ of nursing homes. The entire health care industry as well as the public would benefit from reading this book. Why?
The elderly residing in long-term care is estimated to reach 4.4 million by 2040. That means most of us will visit a relative or stay at a LTC facility in the foreseeable future. Some may be admitted for short term rehab-post knee replacement, hip replacement, injury, stroke, etc. and others move in permanently. There’s a huge stigma attached to nursing homes, which is a barrier that is stopping people from seeking help. From my experience, most nursing homes with good ratings and/or Joint Commission accreditation are actually pretty awesome.
Dr. Eleanor Feldman Barbera has over 15 years experience as a nursing home psychologist. Her blog,My Better Nursing Home is a great resource for the health industry. I had the pleasure of working with Dr. El (as we call her) back in New York and I can always count on her to offer us insight to take better care of our residents. Her in-services were always enjoyable because of her charisma and sense of humor. I thought I’d add Dr. El’s dedication page below.
The vignettes between Dr. El and the residents were my personal favorite.
Dr. El - April 3, 2013 - Books/media of note, Role of psychologists, Talks/Radio shows
I was on the plane home from the American Psychological Association conference last August when I noticed that the man across from me had the same APA conference tote I was carrying. My friendly inquiry led to a very pleasant 3-hour conversation on the flight with psychologist Dr. Jeffrey Zimmerman of The Practice Institute. The Practice Institute features educational resources for mental health practitioners, including interviews with authors of books on various aspects of building and maintaining a private practice. It’s a treasure trove for psychologists, with timely and essential information from well-established therapists.
On Tuesday, April 9, 2013 at 1pm ET, I’ll be talking with Dr. Zimmerman about
- Working as a psychologist in long-term care
- How The Savvy Resident’s Guide can be used with elders and their families
- The Savvy Guide’s place in the classroom to acquaint students with the concerns of residents and a reasonable approach to addressing these concerns
- The use of social media to expand a private practice
If you’re not able to listen to the call on Tuesday, the recorded interview will be available for members of The Practice Institute on their website.
You can register for this FREE event at The Practice Institute’s Event Registration page. I hope you’ll join us!
Dr. El - March 28, 2013 - Business Strategies, Customer service, Long-Term Living Magazine, Resident care
Here’s my latest article in Long-Term Living Magazine online:
When the psychologist arrived at Mrs. Winters’ room, she found her distraught and disheveled. “Last time you saw me I was stuck by that dresser in the corner and couldn’t get out. This time it’s something else!” She shook her fist at the ceiling and looked heavenward. “You know what that aide said to me?” She continued without waiting for a response. “When I told her I wanted to take my shower at night instead of this morning, she said I couldn’t! It was this morning or nothing. Of course I refused. What kind of nonsense is that? I’ve been taking nighttime showers my whole life!”This article, which follows last month’s post on physical design features in the long-term care setting, addresses two additional areas of care that can be modified to offer more control and autonomy to those we serve—scheduling and training. Increasing control is important because residents often enter long-term care due to sudden and unexpected health problems that have thrown them intocrisis. When residents perceive control over what is generally a highly structured new environment, it helps them cope with stressors, reduces their depression and anxiety and increases their satisfaction with care.
SCHEDULING FEATURES
Offering increased flexibility within daily schedules can provide opportunities for residents to have more choice in how their days unfold. They engage in the same activities such as rehab and dining, but they can arrange their days to meet their own preferences rather than subsume their desires to the nursing home schedule.
Many adjustments in scheduling can be made without dramatic shifts in the staff routine, such as offering residents their choice of shower time. Rather than incorporating a multitude of changes simultaneously, new areas of flexibility can open up sequentially, giving the staff (and residents) time to adapt and to consider other parts of the schedule that can become more adjustable.
TRAINING FEATURES
Offering more choices for residents will be as successful as the reception from the staff. If resident requests receive sighs, frowns and obvious irritation, residents will quickly learn that the options are for marketing purposes only and that they won’t be implemented without repercussions. In that case, because their wellbeing depends on the good will of the staff, only the feistiest residents will take advantage of newly created choices.
For more, visit LTL magazine online:
Dr. El - March 26, 2013 - Business Strategies, Customer service, Dementia, McKnight's Long-Term Care News, Resident care
Here’s my latest column at McKnight’s Long-Term Care News:
Secrets to making your environment ’emotionally healing’
Back when I worked in psych, one of our most effective tools to improve mental health was maintaining a healing emotional environment, or therapeutic milieu. That’s why I was shocked when I first entered long-term care.
I couldn’t believe the din that faced me on the floors or the way some people spoke to the residents or the lack of coordination of care. In some ways, the settings are so similar —inpatient care, short- and long-term stays, family involvement, treatment teams, etc. — but the focus on physical versus mental health creates completely different atmospheres.
The reality is that even though our residents are entering LTC due to physical problems, their medical troubles impact their mental health and vice versa.
Dr. El - March 18, 2013 - Business Strategies, Technology
Once again, McKnight’s will host its annual online expo, which is a chance to attend a conference without leaving your desk. Register for the conference in advance, and then log in to hear the talks, visit the vendors, and chat with the reps and attendees. This year’s topics are:
PAYMENT An MDS 3.0 Update March 20, 10 am EST / 7 am PST
QUALITY Immediate Jeopardy: What You Can Do March 20, 11:30 am EST / 8:30 am PST
TECHNOLOGY Avatars In Senior Care Settings March 20, 1 pm EST / 10 am PST
WOUND CARE Wound Care Update: Lessons We’ve Learned March 21, 11 am EST / 8 am PST
CAPITAL Finding Capital in 2013 March 21, 1 pm EST / 10 am PST
You can create your own avatar when you log in, so your avatar can chat with others about avatars!
To register, visit: McKnight’s Expo
Dr. El - March 12, 2013 - Common Nursing Home Problems and How Psychologists Can Solve Them, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Resident care, Role of psychologists
I’m very pleased to announce the debut of my new column at McKnight’s Long-Term Care News. The World According to Dr. El is a twice monthly column that will address mental health issues in LTC.
Please visit and “Like” the page on McKnight’s to show your support for addressing the mental health concerns of all those involved with LTC.
Inside the mind of an LTC shrink
I sat in morning report as the nursing supervisor announced the arrival of a new resident. An 80-year old woman was taken to the hospital after a fall at home, where she received a below-knee amputation and contracted C. diff before being transferred to our facility.
I looked around the room and speculated about what each of my team members were thinking, imagining thought bubbles over their heads:
- The wound care nurse was wondering how the leg was healing.
- The rehab director was considering the chances an 80-year old woman might be able to manage on a prosthetic leg.
- The infection control specialist was mentally reviewing a checklist of infection control procedures that needed to be put in place.
- The social worker was hoping the woman lived in a ground-floor apartment.
What was I thinking about this new admission? I was worried she might be suffering from symptoms of Post-Traumatic Stress Disorder if she had been alone on the floor for any length of time after her fall.
I pondered how she might be handling the assault on her femininity of losing a leg. I wondered about the quality of her family supports and whether she’d consider attending the choir performance where one of the soloists was a glamorous amputee from the third floor.
