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Family Members: 5 Ways to Turn Fault Finders into Fans (LTL mag online)

Here’s my latest article in Long-Term Living magazine online:

Family members: 5 ways to turn fault finders into fans

For most families, entry into a nursing home is like being teleported onto a strange new planet. The arrival is often swift and unanticipated, and the customs are foreign and frequently unnerving. Think back to your first days in long-term care, subtract your training, add a sick loved one and consider from that vantage point what services you can offer to improve the experience of anxious family members. Here are five ideas to get you started:

1. Provide essential information up front.

Your admissions packet probably includes the basics already, such as a copy of the residents’ rights and information on how to finance a nursing home stay and how to file a grievance. Consider going beyond the essentials to provide helpful details such as the names of the nurses, aides, doctors and social workers, and the fact that, for example, nurses wear white and aides wear blue and what the difference is in their roles in the facility. Anticipate the need for other information such as the location of the business office or how the discharge process works.

2. Offer emotional support via family meetings.

Nursing home entry is an extremely stressful event in the life of a family. Family members may consider nursing home placement to be “the beginning of the end” and be experiencing anticipatory grief as they look toward losing their loved one, even though the loss might be many years away. Most families are negotiating the added life tasks of trying to decide what’s best for Mom and perhaps selling a home or dispersing a lifetime of possessions. Family disagreements are common. Nursing homes that offer supportive and informative sessions run by the social worker or psychologist, with community referrals as needed, are more likely to be viewed with gratitude for meeting this unspoken need than to become targets of misplace anxiety and rage. Examples of meeting topics could include “understanding dementia,” “supporting your loved one during nursing home placement” and “coping with changing family dynamics.” In addition, offering information on illnesses such diabetes, provided by a knowledgeable staff member or by a local representative of an organization such as the American Diabetes Association, can improve the compliance of families with residents’ special diets and reduce conflict with staff (and residents) around this issue.

3. Support the family council.

For more, visit LTL mag online: Family Members: 5 Ways to Turn Fault Finders into Fans

Disaster Preparedness Can Minimize Emotional Devastation: Caring for the Ages Magazine

This month’s Caring for the Ages magazine features an article by Joanne Kaldy on reducing the emotional distress of resident through disaster preparedness.  Here’s my contribution:

During a disaster, staff might be surprised at how calm many residents actually are. “A lot of residents aren’t as upset as we think. We need to be careful not to think that everyone is distressed,” said Eleanor Feldman Barbera, PhD, a psychologist who consults in long-term care facilities in the New York City area. For some residents, a hurricane or a snowstorm isn’t as significant as a personal disaster such as a roommate’s death, Dr. Barbera said.

Other residents may not display their significant concern. “People might be in their rooms quietly freaking out,” Dr. Barbera said. Some cultures think it is inappropriate to express feelings, and men may feel that they should act strong and not show their emotions. “Count on aides who know the residents better than anyone,” she advised. “Have regular in-service programs about signs of trauma, and make sure [staff] know who to report their concerns to.”

For the full article, click this headline:

Preparedness Can Minimize Emotional Devastation During Even the Worst Disasters

Coping with Loss by Embracing Life

Psychologically speaking, it’s healthy to embrace life’s challenges and to find strength and humor within them.  I sometimes suggest that residents hold an “open house” party to gather their friends and family members instead of waiting for them to visit.  In my post, Having Fun in a Nursing Home, I wrote about how my residents and I often laugh at the odd goings-on that can only be funny when you’ve been in a nursing home for a while, and noted a company, Draisin, that sells tandem bicycles so that an able-bodied person can accompany someone who wouldn’t otherwise be able to peddle a bike.

Draisin Tandem Bike

Beautiful carry-all bags are available for wheelchairs and walkers at HDS Medallion, and a Google search for “designer canes” turns up many wonderful options, including those available at Pat Heyward Canes.

HDS Medallion CarryAll Bag

Pat Heyward Canes

This weekend I heard a story on NPR about Bespoke Innovations, which makes fairings, described as “specialized coverings that surround an existing prosthetic leg.”  The fairings express the individuality of the wearer and those interviewed reported many compliments on their prostheses.

Bespoke Innovations

Bespoke Innovations

These are a few of the many ways we can “flip the script” on the experience of loss for those in the nursing home.  Feel free to add ideas of your own in the Comments sections.

Doctor-Patient Communication

Early in my blogging, I wrote a post for residents about how to speak to doctors, outlining what I call the Newspaper Headline Approach.  It’s designed for residents to make the most of their interactions with their physicians.  I was reminded of the Newspaper Headline approach when I read a recent Mind the Gap post by Stephen Wilkins, MPH titled Why It’s So Important For Physicians To Listen – The Patient’s Perspective.  How to talk and why to listen — a great combo.

Dr. El’s Newspaper Headline Approach

Talking to a medical doctor is not like talking to a normal person.  In a regular conversation, one person says, “Hi.  How are you?”  The other says, “Fine.  And yourself?” And they go from there.  If busy Dr. Shah stops by Mrs. Crenshaw’s room, inquires how she is, and hears that she’s “Fine,” he’s likely to be on to the next room before Mrs. Crenshaw can utter another word.  Instead, I suggest the Newspaper Headline Approach.

5 team building practices that will make your staff WANT to stay (LTL mag online)

Here’s my latest article in Long-Term Living Magazine online:

5 team building practices that will make your staff WANT to stay

According to a 2011 American Health Care Association study, the average nursing home turnover rate is 35 percent for all staff and 43 percent for CNAs. By contrast, Fortune magazine reports that the 100 best companies to work for in 2011 had a turnover rate of 3 percent or less. Clearly, most nursing homes are in need of staff retention strategies. One of these strategies is team building, which has a “long term positive relationship between employee morale and retention.” When it comes to building a team, forget corporate retreats and singing “Kumbaya” around the campfire. Here are five practical, easy-to-incorporate strategies you can use at your nursing stations starting today.

1. Develop a clearly communicated larger purpose for your organization.

Give people a reason to show up for work beyond their paycheck. If you were asked to fill in the “X” of the statement, “We do X here,” what would your answer be? Is your facility goal getting a great survey? While that may be energizing for you, it’s not likely to be motivating for most of your staff. Generate a vision that excites the team. For example, Signature Healthcare, which ranked in Modern Healthcare’s top 100 best places to work in 2009 and 2010, states that part of its mission is to “earn the trust of every resident, family and community we serve.” A staff member can use this barometer to make decisions about how to handle situations, i.e., “Is this going to earn trust?” A vision for a company or facility dedicated to addressing the mental health as well as the physical health of its residents could be, “We treat the whole person,” giving staff the impetus to care for both the physical illness and the emotional distress it causes. Elaborate upon ways in which your “X” is accomplished through your mission statement, employee training, staff recognition programs, and other communications.

2. Recognize staff members who further the organization’s values.

Whether or not your facility has developed a specific mission, there are certain qualities that stand out as desirable and create an environment more conducive to staff retention, such as teamwork, helping others and kindness. Staff recognition programs provide an opportunity to promote qualities that are valued within an organization. They are the “carrot” to the “stick” of disciplinary action. Schools use this technique when, for example, they discourage bullying by presenting their students with award certificates for “helping” or “caring.” Similarly, LTC facilities can offer kudos of varying types (certificates, gift certificates, parking spaces, free lunches, first choice of holiday schedule, etc.) for good customer service, going the extra mile for the team, helping a coworker care for a resident, and other valuable contributions. Employee recognition can be done on a facility-wide or unit-by-unit basis, allowing for great flexibility and the opportunity to institute this tool immediately.  For example, a charge nurse inspired by this idea could ask in the next change-of-shift report: “Let’s try to encourage each other.  Did anyone notice any good qualities about a coworker today?”

3. Help new employees integrate into the team.

For more, visit LTL mag online: 5 team building practices that will make your staff WANT to stay

Nursing Home Resident Blogs

I’m lucky enough to hear the private perspective of nursing home residents every day, but for those of you wondering what residents really think about living in long-term care, here are some blogs that generously offer their often surprising, sometimes shocking, viewpoints.

Straw Flowers, “one woman’s 20+ year journey through the elder care system,” is 78-year old Marya Methven’s wise and engaging chronicle of her life and long-term care experience.

Kathleen Mears blogs for Long-Term Living Magazine about her 16 years of life in nursing homes as an incomplete quadriplegic.  She is very attuned to the social dynamics of the nursing home and to the impact of rules and regulations on the residents.

Worthless Goddamn Cripple is the angry, profane, insightful blog written by a man who had a stroke at the age of 33 (see the synopsis page for details).  He offers a youthful perspective well worth the read and, despite the fact that the blog mysteriously ended in 2008, it’s still relevant.

If you know of other nursing home resident blogs, please add the urls to the Comments section.  Thanks!

Nursing Home Mental Health: The Case of the Call Bell

“I had a couple of relapses this week,” Betty told me, looking ashamed.

We’d been working in psychotherapy on her efforts not to snap at the aides and nurses who came to care for her.

“I try not use to my call bell,” she went on.  “Sometimes I sit here for two hours thinking about it before I press it.”

“Maybe that’s part of the problem,” I suggested.  “If you’re waiting for two hours before you let them know you need help and then it takes them a little while to get here, by the time they arrive you’re ready to explode.”

She nodded.  “That’s true.”

Betty was more psychologically-minded than many residents, so I took things a step further.  “It’s also not taking very good care of yourself to wait two hours to ask for help.  If you had a child who needed help, would you make them wait two hours?”

“No!”  Betty’s bulletin board was filled with the Mother’s Day, birthday, and Christmas cards her only child sent instead of visiting.

“Now you have a chance to give yourself the care you didn’t get as a child.”

“What do you mean?” she asked sharply, “My parents took care of me!”

“From the things you told me about what went on in that house, you children were not getting enough supervision.”

Betty, an incest survivor, stared at me.  “I never thought of it that way.”

“This may sound corny, but now Grown-up Betty has the chance to take care of Little Betty, and ask for what she needs when she needs it.'”

Betty burst into tears.  “Wow…wow…I never thought of it like that.”  She pulled a tissue out from the box on her tray table and blew her nose.  “I could do that. I could take care of myself.”  She gave me a piercing look.  “Wow…thank you!”

Nursing Home Residents: Favorite Quotes from “People of Age”

As a psychologist talking with nursing home residents, I’m honored to share their lives and hear about their pasts.  We discuss their families, how to tell the aide to close the window at night, and ways in which they can make their current lives feel more like their old ones.  Residents sometimes reveal traumas they’ve told no one for all of their 80+ years.  Often they phrase their experiences in a way that begs to be shared.  So enough with the begging, here are a few of my favorite quotes:

“I’m learning how to be old and young at the same time.”  

“Seeing a doctor is like pulling hen’s teeth.  And you know that’s rare, because a hen don’t have no teeth.”

“The physical pain is just physical pain, but the psychological pain is more extreme.”

“To be 51 is like being born again!”

“I’m just a miserable, sick old creature, sitting around, waiting on time.”

“I was one of those people who never wanted to be in a nursing home, but I’m having a ball here!”

“I thank you for being one of the people who brought me back to life.”

Do I have a great job, or what?  Please share your own favorites from your own residents in the Comments section below.

Person-Centered Care Contest: We Have a Winner, or Two!

On Monday, I blogged about a contest to transform “a day in the life of the resident.”  I like this contest because it asks staff members for their often-overlooked expertise, and is designed to improve life for the residents, centering the nursing home day around their needs rather than vice versa.  I got an update on Tuesday from Dave Sedgwick, initiator of the Ensign Group’s $150K e-prize contest.  He reports not one, but two winners, with $100K going to Brookfield Healthcare in Downey, California, and a $50K Special Honors prize to Julia Temple in Englewood, Colorado.

Brookfield’s winning entry focuses on the theme of being a “Brookfield Zero,” meaning zero deficiencies on surveys, and has customer service at its core.  According to their application, they used to be a “traditional” nursing home — “bland, generic, colorless, and flavorless,” until they made the decision to “show the world that skilled nursing facilities are no longer a place to die, but a place to live, learn, and grow.”  Some of the highlights:  They harnessed the passion and enthusiasm of their staff to create programming that engages the residents, such as tai chi and computer classes.  Showers are provided by two dedicated “shower girls” who offer them at the frequency requested by the residents.  Nurses answer the call bells as soon as they’re rung, and all staff members greet resident requests pleasantly.  To compensate for a small parking lot, valet parking is provided.  Brookfield’s application is in the form of a recipe book to encourage replication of their process.

Special Honors were given to Julia Temple, based on their “jaw-dropping” transformation of a facility for residents with dementia.  Dave reports that when he entered the facility on the day Ensign acquired it, he was, for the first time in his career, afraid of being in a facility.  At that time, it was common to observe physical restraints of agitated residents in order to administer sedating medication.  Now, he describes the environment as “peaceful, loving, calm, and productive .”  Using the Allen’s Cognitive Levels model to assess the abilities of residents, Julia Temple groups residents into neighborhoods based on their abilities, and offers programs to enhance their experience at each level.  They also emphasized increasing the involvement and satisfaction of staff members.   For example, they created an employee council to improve communication between management and caregiver, and a wellness program that, among other offerings, provides free massages to staff members on their lunch breaks.

While some of the innovations in the contest facilities required site renovations, more of the changes leading to success were focused on rethinking systems and improving customer service — something that can be accomplished by every facility, everywhere.

Person-Centered Care Contest: Behind the Scenes with Dave Sedgwick

Back in August 2011, I posted about A Contest for Person-Centered Care, run by the Ensign Group, asking those working at their facilities to transform “a day in the life of the resident.”  The goal was to change the daily experience of the resident as a cog going through the wheels of the nursing home routine, and to create an environment that adapts to the residents as individuals.  The prize: $150,000

I spoke recently with Dave Sedgwick, who initiated the contest in his role as VP of Organizational Development and President of Ensign Facility Services, to find out the latest on the e-prize.

Me:  What were you hoping to see from the contest?

Dave:  What we expected was what a lot of people did – the staff looked at how limited the choices were of the residents and how constrained they were by requirements of the facilities/environments, in terms of eating, bathing, etc.  We expected to see more choices, and we were looking to see more little changes that make a big difference  — something as simple as not placing a resident on a pvc-type shower chair wrapped in a sheet, but instead to change them in the shower room.

There’s a poem called The Calf-Path, by Sam Walter Foss, about how a calf went down a crooked path, and that path become a road, which later turned into a highway.  We tend to go down the same path just because that’s the way it’s been done before.  We were hoping to create new paths.

Me:  What surprised you about the contest?

Dave:   I was surprised at the level of emotion of the caregivers, judges, and others involved in the contest.  The status quo in most organizations is that the know-it-all of corporate figured out the jigsaw puzzle of how things work and the staff should follow along.  The e-prize is the ultimate show of trust in the staff as the ones who know the residents and can express their passion, pride, and creativity.

Me: How did you engage the staff in this effort?

Dave:  Each administrator had to solve the puzzle on their own of how to get the staff together to address the e-prize contest – it was announced at a meeting, and there was a follow-up call regarding whether or not they wanted to participate.  Participation meant they had to contribute several hundred dollars to the pot.  100% did this, but some could only do this because they had other things going on.  75% worked on it but didn’t follow through with the applications in a timely manner.  We had about 20 applications (out of about 80 facilities).

Me:  How did you pick the winner?

Dave:  We wanted the ideas of the winner to be replicable throughout the facilities.  We wanted to look at system changes that have a big impact and don’t cost a lot of money.

Me:  Who won the contest?

Dave:  We plan to announce the results on May 7th.  We’ll surprise the winners at their facility and stream the announcement live for Ensign employees.

For more about the e-prize and to hear about the finalists, visit the e-prize website.  I’ll update my site with the contest winner ASAP after it’s announced.