Blog

McKnight’s FREE Online Expo 6/20/19

I’ll be speaking about Behavioral Health in Senior Living at McKnight’s free Online Expo at 11am ET on Thursday, 6/20. To register for the virtual Expo, see the info below.

McKnight’s Online Expo, FREE, Thursday June 20^th
Earn 3 Free CEUs at 3 Free webinars

Finally, a virtual trade show just for senior living professionals! During this one-day event on June 20, you’ll hear from dynamic speakers with great ideas about the senior living issues that matter. This is the show you’ve been waiting for and you don’t even need to leave your desk to attend!

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:

• Behavioral Health in Senior Living: Improving Practices, Reducing Risk
• Mobile Tech: Friend or Foe in the Senior Living Workplace?
• The Talent War: 3 Strategies for Winning in Today’s Competitive Market

To register, go to: www.mcknightsseniorliving.com/June20Expo

NextAvenue: What Some Nursing Homes Do to Retain Quality Staff

Thank you to author Deborah Quilter and Next Avenue for an even-handed article about nursing homes and for mentioning my work. NextAvenue is “public media’s first and only national journalism service for America’s booming older population. [Their] daily content delivers vital ideas, context and perspectives on issues that matter most as we age.”

What Some Nursing Homes Do to Retain Quality Staff

Keeping great caregivers is one of the biggest challenges the facilities face

Massaging elderly residents’ hands is one of the favorite parts of Kathy Hehl Curran’s job at Filosa’s Hancock Hall, a nursing home in Danbury, Conn. The registered nurse says it makes her charges feel relaxed, and sometimes they’ll confide their worries.

“It’s a way to make them feel good and to validate their concerns,” Curran says. “If something comes up that needs to be taken care of, then I need to go to the right person and make that happen.”

Curran has been at her job for 36 years. This speaks volumes about not only her devotion to her work but also Hancock Hall’s winning formula for retaining caregiving staff. Curran credits this to the facility being owned and operated by a family rather than a corporation.

“If you’re not taking care of your caregivers, how are they going to deliver good care for your clients?”

When Curran wanted to go back to school, her employers made it possible for her to do that and keep her position. She could move to several different jobs within the company, rather than leave her job to gain other experience. Curran also likes the teamwork and supportive administration at her workplace.

Curran’s experience highlights many reasons why caregivers stay: devotion to the population, having their needs met by administration and the autonomy to correct problems that arise.

For the entire article, visit:

What Some Nursing Homes Do to Retain Quality Staff

What if nursing homes had a ‘well-being budget’?

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

What if nursing homes had a ‘well-being budget’?

Last week, New Zealand passed the country’s first “well-being budget,” with billions in funding directed towards mental health, suicide prevention, addiction treatment and combatting poverty. This development had me considering what a “well-being budget” would look like in long-term care facilities.

Reducing financial hardship

Combating poverty in nursing homes would have to address adequately funding treatments so that facilities are bringing in enough money to cover the expense of services as well as to manage upkeep and comply with regulations. It’s difficult for a business to engender well-being when under the threat of insolvency.

At the same time, any effort to reduce poverty in long-term care would certainly require living wages and reasonable benefits for workers at all levels. That would make it more likely that facilities could attract and retain capable staff.

A well-being budget would also need to increase the Personal Needs Allowance (PNA) of residents to account for inflation. While a few states have provided modest increases in resident’s monthly allowances over the years — with Florida the trailblazer at $130 – most have remained the same for decades¹. In my state, New York, for example, the PNA was set at $50 in 1980. Adjusting for inflation would make New York’s PNA $155 in 2019, a more reasonable amount considering that residents are responsible for paying for their own clothes, haircuts, telephones and other personal items and have become impoverished in order to qualify for Medicaid. Sadly, however, it is still $50.

Worker well-being

To improve the mental health of those who live in nursing homes, my well-being initiative would first tend to the mental health of those who work in long-term care. If employees aren’t emotionally well-balanced, it’s much more difficult for their charges to be.

For the entire article, visit:

What if nursing homes had a ‘well-being budget’?

Ways to increase trust, reduce hospital transfers

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

Ways to increase trust, reduce hospital transfers

In McKnight’s Long-Term Care News this month, there was a report on a study examining factors that contribute to transfers of frail residents from skilled nursing facilities to emergency departments.

Using focus groups of residents and family caregivers, researchers found four main contributors to the transfers: “(1) doubts about the quality of skilled care facility nurses’ assessments; (2) perceptions that physicians were absent from the nursing home; (3) misunderstanding the relative capabilities of skilled care settings and emergency departments; and (4) beliefs that responses to medical needs were inadequate.” In addition, the lead author found that some of the transfers were due to a lack of acceptance on the part of family members that their relative was near the end of life.

The study authors stated that telehealth could address some of these factors. While that may be the case, my experience suggests that there are additional ways in which facilities can address family concerns and reduce potential hospital transfers. These center on educating residents and families, and on setting reasonable expectations.

One of the most frequent discussions I have with residents and families is regarding their impression that they “never see the doctor.” As I point out in my book, “The Savvy Resident’s Guide,” the nurses notify the doctor if there are any problems. I tell residents that because the doctor visits mainly when something is wrong: “If you’re not seeing the doctor, it’s a good thing.” This shift in perception can make a huge impact, whether it’s conducted via a one-to-one conversation, a book or some other communication method.

One of the contributors to mistrust is that the families of short-term residents tend to be in crisis and to have dealt with a multitude of healthcare providers prior to admission. They are often being pulled in many directions and don’t know whom to rely upon for good care of their relative.

In a previous column, “7 powerful ways to deliver family-centered care,” I noted that if we considered that we’re admitting families rather than residents, we’d put additional focus on family members. People turning to healthcare professionals in the middle of a personal catastrophe will be more likely to trust those who recognize their moment of crisis and treat them accordingly. Sometimes even small things like being offered a cup of tea while filling out paperwork can create a feeling of safekeeping for them and their loved one. See the above-mentioned article for ideas on family-centered care.

For the entire article, visit:

Ways to increase trust, reduce hospital transfers

Preventing violence in long-term care

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

Preventing violence in long-term care

As I developed a training program on violence prevention, I reflected on a scenario I’ve witnessed many times in my career. A resident who had been physically aggressive toward aides and nurses got sent to the hospital only after he hit the attending physician.

Situations like this send the message to nursing department staff that they aren’t important, and that violence is just part of the job. That attitude explains why nurses are estimated to report violent behaviors just 30% of the time¹.

Instead of accepting aggressive behaviors as normal, facilities would be wise to approach then as anomalies that can and should be addressed. As research indicates,² aggression toward workers decreases staff satisfaction and increases burnout. Violence prevention efforts reduce turnover costs and improve morale, and result in fewer lawsuits and a reduction in worker’s compensation claims.

Violence prevention programs

According to the Occupational Safety and Health Administration, a violence prevention program has several key elements:

• Management commitment and employee involvement
• Worksite analysis
• Hazard prevention and control
• Training and education
• Record-keeping and evaluation of program

The thrust of such programs is to support and encourage staff to report events so that there can be an accurate evaluation of the circumstances contributing to violence. Using the information gleaned from this analysis, adjustments are made to the environment and workers are trained to handle aggressive behaviors. These steps are followed by reevaluation and readjustment as needed.

The efforts can be remarkably effective. In one hospital-based program,³ Operation Safe Workplace, the incidence of violent behaviors was reduced by 55%! While hospitals have different factors contributing to these problems, such as a younger, more physically able population, there are many aspects of a long-term care environment that could be adjusted to reduce the likelihood of aggressive behaviors.

For the entire article, visit:

Preventing violence in long-term care

The added value of social workers and psychosocial services

The top recommendation in the April 9 McKnight’s article “Researchers share 6 tips to improve nursing home care for blacks and Latinos” was to include a social worker on staff in the facility. “Great,” a reader commented, but “ask CMS … if they will pay for it.”

Perhaps, though better yet, social workers will pay for themselves.

A study published in March discussed the role and value of social work staff, with the surprising finding that deficiency scores are reduced twice as much when there’s an increase in social service staffing as compared to an increase in nursing staff. Lower deficiency scores can translate into better CMS star ratings and increased admissions, as well as reduced liability risk, creating a financial savings worth the price of a social worker salary.

The research brief goes on to report that while there’s been an increase in staffing in many other departments over time, the number of social workers remains low. The authors also note that there are no mandated qualifications for social work staff but that when social workers have higher qualifications such as a master’s degree, resident outcomes improve.

Interestingly, the other department that had almost as much effect on improving deficiency scores was the activities department, another psychosocially focused part of the team. (They didn’t study consulting psychologists, but I’d like to think we would have helped as well!)

For the entire article, visit:

The added value of social workers and psychosocial services

Benefits of acknowledging success

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

Benefits of acknowledging success

“My column won a bronze award for best blog in the 2019 American Society of Healthcare Publication Editors competition,” I informed a friend of mine, “but I feel funny telling people.”

“Women have such a hard time with this!” she said with some exasperation. “You HAVE to tell them, Eleanor. Who else is going to let them know but you?”

With her words in mind I posted about it on LinkedIn, Facebook, Twitter and my main psychology group, Psychologists in Long-Term Care. I received many wonderful, supportive, unexpected replies. I wasn’t going to write about it for this column (because, gosh, wasn’t that enough already?), but I decided to for several reasons.

I view part of my job as a psychologist as being a role model. On the units, I’m aware that the aides and my other co-workers are observing how I speak to them and to the residents and families. Similarly, in writing this column, I represent psychology to those who work in long-term care management. If people, particularly women, find it difficult to talk about their accomplishments, then perhaps I can model sharing an achievement in order to encourage more colleagues to do the same.

Dealing with extensive regulations, reimbursement challenges, elaborate documentation requirements and a punitive environment can erode the joy of helping elders. Acclamation for accomplishments, on the other hand, can bring joyfulness back to the job. I could have told just my mother and while that would have been nice, by sharing it with a larger group, the positive response is magnified, giving me added energy to continue my work. I’m sure there’s a scientific, dopamine thing happening, but the gist is that it feels good to be acknowledged. The reverse is true as well: Offering a genuine compliment can make the giver feel better too.

For the entire article, visit:

Benefits of acknowledging success

“The World” column wins ASHPE bronze for best blog!

I’m pleased to announce that my biweekly McKnight’s LTC News column, The World According to Dr. El, won a bronze award for best blog in the 2019 American Society of Healthcare Publication Editors competition.

Why Five-Star ratings should measure staff retention, not staff ratios

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

Why Five-Star ratings should measure staff retention, not staff ratios

The Five-Star Quality Rating System reports the results of health inspections, staffing and quality measures. I suggest we replace the current staffing measure with one tracking staff retention.

Here’s my logic:

The existing staffing score is the ratio of nursing staff to residents, taking care needs into account. In allowing for self-reporting of the data, some nursing homes overstated their resident/staff ratio. It therefore hasn’t been a particularly accurate measure of staffing.

It also misses the fact that while some residents have low-acuity physical health needs, they — or their family members — may have high-acuity emotional or mental health needs that require a great deal of staff time and attention. In such situations there are enough workers for the facility to be compliant technically but understaffed in reality.

If we shift to a system that measures staff retention rather than staff ratio, however the whole picture changes.

Staff turnover is a strong signal that something is wrong with a nursing home.

As I noted in an earlier post here, “Reducing Turnover in LTC,” employees tend to leave facilities not just because the pay and benefits are low, but also because of a high workload, poor staffing, unsatisfactory work conditions and a lack of appreciation. Unless they’re older, invested in the facility and perhaps looking forward to retirement benefits, employees depart when a facility isn’t a good place to work.

If a nursing home isn’t a good place to work, it’s an even worse place to live.

Residents and their families want clean, safe environments with quality care and reasonable food — and they especially want workers who know and respect them. High turnover makes meeting these expectations virtually impossible.

For the entire article, visit:

Why Five-Star ratings should measure staff retention, not staff ratios

12 steps to starting a new job with serenity

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

12 steps to starting a new job with serenity

In my last column, “How to quit like a shrink,” I outlined ways to exit a nursing home that solidify the connections made there and offer the opportunity for healing. Assuming you’re not independently wealthy, what follows after leaving one position is beginning another.

The start of a new job, while exciting and hopeful, also can be very stressful. Perhaps it’s your first position, or maybe you’ve taken on a supervisory role or increased your responsibilities. Even if you’re performing the same types of tasks you’ve completed for years, you’re now in a new setting, adjusting to an unfamiliar work culture with different people and systems.

Here are 12 steps that may make the transition more manageable:

1. Give it time.I estimate that it takes six months before your new coworkers — who may have seen them come and go many times over — actually believe you’re there. It’s not until you go on vacation and they miss you that they realize you’re a solid part of the team.
2. Give it time. Relationships with coworkers won’t be established overnight. Be pleasant. Be professional. Be chill. It will happen and it will be better if you don’t try to force it. Join coworkers in the cafeteria if invited but bring a book to read just in case.
3. Don’t let ’em see you sweat. You’re not imagining it. Everyone IS checking you out to see what kind of person you are and whether or not you’ll be able to do your job. This is a good time to “act as if” you’re unperturbed even when you can’t locate the restroom or there’s a code for the copy machine no one told you about. Freak out at home or with your friends but maintain a calm façade while at the facility. If anyone asks, things are going great.
4. Ask questions. Even when you’re trying your best to showcase your competence, there will be times when you don’t know the answer. It’s better to ask how particular tasks are accomplished at the facility than to assume that they’re done the same way they were at your last nursing home or how you were taught in school. Reasonable questions showcase competence more than erroneous assumptions.
5. Be aware of dynamics. If you’re lucky, you’re following in the footsteps of someone truly awful at their work and everyone will be rejoicing at your arrival. More often than not, however, there are mixed feelings about your replacement of a former employee and unspoken interpersonal and departmental dynamics. Maintain the aforementioned calm façade while people adjust to your presence and if problems arise, consult with a wise friend, former colleague or current supervisor.
6. Get organized. One of the best ways to gain a sense of control over a new situation is to begin putting systems in place. After you’ve discovered what you need to do, taking the time to figure out how to do it most swiftly and successfully will pay off in the long run. Create paper or digital files, post telephone numbers by your desk and/or enter them into your phone and establish order to calm your mind and make your process easier.

For the entire article, visit:

12 steps to starting a new job with serenity