Dr. El - June 20, 2018 - Business Strategies, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Motivating staff, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
With the high-profile deaths this month of designer Kate Spade and chef Anthony Bourdain, the crisis of suicide has been thrust into the spotlight. Suicide deaths in the United States have increased 25% between 1999 and 2016, with an estimated 45,000 occurring per year.
I’ve written about suicide prevention in older adults and protocols for managing suicidal residents before. This column focuses on what organizations can do to address employee suicide.
As I prepared for this article, I realized that we don’t hear much in the industry news outlets about suicide among our staff members. But that doesn’t mean it isn’t happening.
Research has shown that physicians are twice as likely to commit suicide as the general population, and while there is a notable lack of information about the suicide rates for nurses in the US, a report from the UK finds that “for females, the risk of suicide among health professionals was 24% higher than the female national average; this is largely explained by high suicide risk among female nurses.”
A suicide death in the small-town atmosphere of a nursing home can have a devastating ripple effect, deeply affecting other staff members, as well as residents and their families. It can be particularly difficult to absorb a suicide death in an environment where others are struggling to live, despite age and disability and where the job of workers is to keep people alive.
A death by suicide leaves those around the deceased wondering how they might have failed their coworkers and teammates. This feeling can be particularly acute among individuals who pride themselves as excellent caregivers — the kind of people who work in long-term care.
How employers can help
The Suicide Prevention Resource Center (SPRC) points out that it is not only more humane to create an organizational culture of physical and mental health, but it also leads to more productive employees. They suggest a comprehensive approach based on the following three elements to make workplaces more supportive to those who are struggling with depression.
For the entire article, visit:
Dr. El - June 13, 2018 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
McKnight’s Long-Term Care News frequently notes stories about rogue employees engaging in illegal and disturbing behavior and then trying to cover it up after the fact.
There are regular reports about intra-organizational systems that fail, leading to wrongful death lawsuits and other problems, such as this one about a resident who died from scabies.
Occasionally there’s an article about a whistleblower alerting the authorities about a questionable practice, resulting in repercussions for the company.
It’s very likely that there were employees who noticed that things were going awry before these stories became stories.
I know I’m not the only one who has observed that in some facilities, staff reports of potential problems are met with appreciation for the alert before rectifying the situation, while in other nursing homes, information is so often ignored that it is no longer reported. These vast differences in the culture and communication style of organizations directly impact health outcomes.
In a New York Times article last week, “A More Egalitarian Hospital Culture Is Better for Everyone,” author Pauline W. Chen, M.D. detailed efforts to alter interactions between hospital staff members, moving from an authoritarian style to a more egalitarian approach.
In authoritarian hospital cultures — those with a “do as I say” management strategy — nurses feel powerless to affect change. Patients fare worse in authoritarian environments than in egalitarian hospitals where nurses are regularly asked for input and senior management staff meet consistently with clinicians.
The article describes a program called Leadership Saves Lives, which created significant cultural changes in a relatively short time frame and improved clinical outcomes. The effort involved “guiding coalitions,” with the more successful coalitions having more diverse membership, including participants across departments as well as frontline, mid-level and top leadership and administrative staff.
Effective groups were able to elicit authentic contributions from members, who felt that their perspective was welcomed and valuable, and they found ways to handle conflict, fatigue and motivation over time.
While this particular study focused on hospitals, long-term care — with its similar interdisciplinary team approach and fragile population — might take note. Authoritarian, top-down communication makes it less likely that workers will notify supervisors about practices that could negatively affect the health of residents and could potentially lead to litigation and unfavorable press.
Teachable moments
While there’s a temptation to blame rogue workers for their mishandling of an event (and to feel relief that the situation happened elsewhere), we’d be better off viewing these events as teachable moments for any organization.
For the entire article, visit:
Discussion forum of multicolored wooden toy figures on white background
Dr. El - May 24, 2018 - Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News, Psychology Research Translated
Here’s my latest article on McKnight’s Long-Term Care News:
Earlier this month, I took some much-needed time off to go on a cruise. I came home to a LinkedIn notification about “The big cost of not taking vacation,” reflecting on a CNN article regarding the vast number of vacation days forfeited by Americans. The author notes that people who travel tend to be happier with their jobs and companies than those who don’t.
It got me thinking (and researching) more about burnout and long-term care staffing problems. Certainly one piece of the puzzle is taking scheduled time off in order to refresh and gain perspective.
As I’ve noted in the past, there are many tactics employers can use to decrease burnout and turnover. In The keys to reducing turnover in LTC, I outlined the causes of the alarming rate of staff turnover in LTC, which can range from 55% to 75% for nurses and up to 100% for aides.
Preventing burnout in long-term care addressed training, staff scheduling and other adjustments that have been shown to reduce turnover. In another piece, I focused on ways to make long-term care jobs appealing enough to compete with less stressful jobs in the same salary range.
In my recent perusal of the research, I came upon a study that looked at factors contributing to the levels of anxiety experienced by staff members. The study suggested that the two biggest contributors to staff anxiety were “guilt about the care offered” because it wasn’t up to the standards of the individual workers and the “poor quality of the relationship with the residents’ family.”
Many of the suggestions I’ve offered in the articles noted above can improve the quality of care, but I was intrigued by the notion that improving relationships with residents’ families could have a significant impact on the anxiety levels of workers and thereby reduce burnout and turnover.
For the entire article, visit:
Dr. El - May 14, 2018 - Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
You know the scenario: A resident wants to eat donuts, but it will send her blood sugar skyrocketing. The staff members aren’t sure whether to let her indulge as part of person-centered care or to insist on a sugar-free alternative so that they’re not out of compliance with her care plan.
A recent study by Parker et. al examined the staff-perceived conflicts between providing services that are consonant with resident-centered care and those that are in compliance with regulations and the rights of other residents, referred to in their research as “care quality.” They made recommendations based on their findings to ease these conflicts.
The research
They interviewed nursing home staff at 12 different Veterans Administration facilities, including senior leaders, middle managers and direct care staff, asking them questions about care such as, “Is resident-centered care implementation competing with other facility goals?”
All of the nursing homes found some level of conflict between resident-centered care and quality.
The three main areas of divergence were in 1) resident preferences versus medical care, such as issues around dietary compliance, 2) resident preferences and the rights or safety of others, such as someone disrobing in common areas, and 3) “limits on staff ability to respond, related to either time or regulations.”
The first type of conflict was the most common by far, with issues not only around dietary compliance, but also around situations such as when the resident wants to go outside to smoke but weather extremes make it physically unsafe, or residents who are in danger of falling but want to assume the risk and walk unaided.
The second area of friction was related to social or emotional health, such as roommate conflicts. Others related to concerns about physical health, such as when a resident with an infection wants to engage in activities that could put the health of others at risk.
A complicating factor in these instances was the need to explain these situations to family members who might feel that the limits being put on a loved one are not consonant with resident-centered care.
In the third category of conflict, staff members found it difficult to accommodate resident preferences when they were short-staffed, especially at mealtimes when there were multiple demands on their time.
The recommendations
The authors of the study made several recommendations to help minimize these conflicts in the approach to care.
• Determine how each resident feels about the balance of quality of life versus long-term survival. Assess and document the risks involved in their choices and the efforts of team members to mitigate the risks. Helpful tools and examples can be found in this Ideas Institute document, “A Process for Care Planning for Resident Choice.” McKnight’s blogger The Real Nurse Jackie wrote more about the document here.
For the entire article, visit:
Dr. El - April 27, 2018 - Business Strategies, Customer service, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Resident care, Role of psychologists, Stress/Crisis management, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
In Editorial Director John O’Connor’s April 16th column, he reported on a study from the Kaiser Family Foundation indicating that increasing numbers of new residents have dementia, are more physically ill and are more likely to be on psychoactive medications.
The study showed that there has been a shift away from long-term services and toward short-term rehab treatment. O’Connor noted the pressure that this puts upon facilities to provide high-quality care in the midst of the churn of residents.
There are many difficulties that can arise from this shift in pace and population, but I’ll focus here on the mental health aspects and their effects on nursing facilities.
One problem that occurs when the length of stay decreases is that the team has a shorter period in which to get to know their residents. They are less likely to notice subtle changes in behavior and mood and they have less time to make the type of personal connection that reassures residents.
Adding to this, the fact that many facilities are operating short of staff in an environment of high employee turnover creates a “perfect storm” of emotional neglect.
Residents enter long-term care facilities in distress. When I adapted the classic Holmes-Rahe Stress Inventory to the circumstances of nursing home admission, I found that residents are experiencing a level of stress considered to be a “life crisis” that puts them at a high risk for further health breakdown. Their families also tend to be in crisis.
Residents and their family members are likely to expect that when they enter long-term care, staff members will provide compassionate medical treatment. Instead, what they frequently find are stressed out nurses and overworked aides who have just enough time to dispense medications or to make up a bed, but none to sit and talk with an understandably anxious resident and their family members about what they can expect regarding their stay and their future.
Social workers — most of whom got into the field in order to provide such counsel — are now buried under a flood of admissions and discharges. They cannot offer emotional sustenance when they need to complete the paperwork on three new admissions and order a walker for the lady whose family wants to take her home tomorrow because her insurance coverage ran out.
It is impossible for direct care staff to provide the same level of service that they did prior to this change in acuity and length of stay. In turn, distress over providing suboptimal care contributes to staff turnover, exacerbating the problem.
For the entire article, visit:
Dr. El - April 13, 2018 - Business Strategies, Communication, Customer service, End of life, Engaging with families, McKnight's Long-Term Care News, Resident care, Stress/Crisis management, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
In one of the more disturbing encounters I’ve had in long-term care — in a 5-Star deficiency-free nursing home — I offered my condolences to an aide on the loss of a resident she’d cared for over a period of two years.
The aide, a heavyset woman, smiled as she told me that she’d known the resident was dying and had urged the nurse to send her to the hospital quickly. The reason? She didn’t want to wrap the body of the equally heavyset resident after she died.
The resident died among strangers in an ambulance on the way to the hospital.
While I’d like to think the incident was an anomaly, I suspect many if not most nursing homes lack a mission statement for end-of-life care and that most teams can be better prepared for the last months and days of their residents.
Without leadership and training, disorganization and staff priorities can derail the care philosophy of the facility.
Providing decent end-of-life care is more than determining if a resident is DNR or full code. It includes recognizing that someone may be nearing the end of life, referring him or her to hospice while they’re most able to benefit from it, communicating regularly with the resident and their family about their needs, and treating the dying person, their remains and their belongings with respect.
Impact on families
Incidents such as the one above reflect poorly on the organization, even if family members don’t realize that it could have been averted with proper staff training. We often hear how important it is to make a good first impression, but as community institutions relying on reputation and referrals, it’s also essential to make a good last impression.
I’ve heard family members comment that they hadn’t always been pleased with the care at the home but they felt that their mother’s death had been handled with great respect. They left with a feeling of overall satisfaction.
Other families had been reasonably satisfied all along, but departed from the facility in shocked dismay at the end of their parent’s life at the poor communication, insufficient pain management and casual disregard for the belongings of the deceased.
Resident impact
Residents are closely observing how their neighbors’ deaths are handled because they know that this is how they will be treated when their time comes. Based on my experience, the things they find most disturbing are inadequate pain management, unacknowledged deaths and seeing the belongings of their friends removed in clear plastic garbage bags rather than in labeled boxes. They find it most comforting when they see that patients are referred to hospice, surrounded by loved ones, sleeping calmly through the night and when there’s a discussion of the loss among the residents, staff and chaplaincy.
Staff impact
The ways in which facilities handle deaths can have a big impact on staff members as well. As I suggest in “Absenteeism and turnover? Death anxiety could be the cause,” lack of attention to the experience of staff members in handling loss can contribute to employee turnover.
For the entire article, visit:
Dr. El - March 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News, Resident education/Support groups, Technology, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
At Maimonides Medical Center, 24 frail older adults were taught to use laptops so that they could manage their health information from home. The technology facilitated communication between patients and providers and improved the quality of life of participants.
The program was a collaboration between the Department of Geriatrics at Maimonides and the Older Adults Technology Services (OATS), who trained the elders and installed the laptops in their homes. I met with OATS founder Tom Kamber, Ph.D., to follow up on our conversation earlier this year and to hear more about how technology can play a role in reducing costs and improving the quality of care for nursing home residents.
Kamber was enthusiastic about the Maimonides program, noting that the elders, with an average age of 85, were able to use the devices to manage information, communicate with the care team and explore areas of interest.
Fun, he emphasized, is crucial to success.
The desire to connect with the grands on Facebook is a more powerful motivator to learn new skills than is tracking blood sugar levels.
For facilities, particularly those working in healthcare systems focused on providing care at the lowest cost (i.e. in the community or in skilled nursing rather than in the hospital), the ability to remain virtually connected provides a host of benefits. Patients remain within the network, medical issues can be tracked and health crises can be averted before needing expensive hospitalizations. Tailored health information can be offered effortlessly, such as sending out post-surgery information videos at a scheduled time. Patient and family satisfaction increases, as does that of care providers who can quickly answer questions via email rather than return lengthy phone calls at the end of a long workday.
From a mental health standpoint, the program is a winner. Residents and their families are typically anxious about discharge and how to manage once they’re home. A virtual system reduces anxiety because it allows for easy access to medical professionals, offers continuity of care and averts costly, stressful and frequently debilitating hospitalizations.
For the entire article, visit:
Tom Kamber,PhD
Executive Director, OATS
Older Adults Technology Services
Dr. El - March 19, 2018 - Books/media of note, Business Strategies, McKnight's Long-Term Care News
Here’s my latest article on McKnight’s Long-Term Care News:
Three new books on aging and healthcare recently crossed my desk, each with completely different takes on our industry.
One focuses on ways in which companies, including long-term care organizations, can save on healthcare costs. In another, the author’s insights into elder wisdom can be used by facilities to add to the quality of life of residents. The final book offers an outsider’s view into how our field is perceived by older adults and their families.
Cost savings
In “Health-Wealth: 9 Steps to Financial Recovery,” author Josh Luke, Ph.D., a former hospital CEO turned “healthcare futurist,” argues that our healthcare delivery system is so badly broken that we should seek a new model for the healthcare needs of employees.
He outlines a method to implement a consumer-driven model that improves pricing transparency and control over costs. Some of the suggestions are likely to both reduce expenses and increase employee satisfaction. For example, an organization-wide emphasis on health and wellness can be a popular program with medical savings.
Other ideas, such as charging the employee a percentage of care costs over their maximum deductible, won’t be universally appealing but could influence workers to choose more affordable “centers of value” during a health crisis.
If organizations find creative ways to reduce healthcare expenditures for their employees, the market is bound to shift in unexpected directions — and that’s exactly what “industry disruptor” Josh Luke is hoping for.
Quality of life
The second book, “The End of Old Age” by Marc Agronin, M.D., offers a hopeful view of aging that will resonate with those in the field.
I was particularly struck by the fact that Agronin, a geriatric psychiatrist, began his book with a chapter on why we should grow old, addressing issues around end of life choices and the way we approach old age. The foundation of acknowledging that some people don’t actually want to live to old age is a crucial exploration that sets the tone for the rest of the book.
Subsequent chapters point to the value of aging in very specific ways. While older adults may not surpass younger people at tasks that require speed or visual acuity, for example, Agronin details five different forms of wisdom in which elders excel. The book includes tools so that others, such as families and staff members, can use his model to help elders make use of their strengths and recognize their purpose at this phase of life.
For the entire article, visit:
Dr. El - March 9, 2018 - Books/media of note, Business Strategies, McKnight's Long-Term Care News
McKnight’s Online Expo, FREE, March 14th and 15th 2018
Earn 5 Free CEUs at 5 Free webinars
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: Operational strategies for surviving regulatory, payment and database changes
WOUND CARE: Is the Braden Scale increasing your facility’s risk of malpractice?
TECHNOLOGY: Telehealth and Reimbursement: What you need to know for the near term
QUALITY: Beyond a fire drill: Emergency prep steps for active shooters in your building
CAPITAL: The new funding sources
Dr. El - March 3, 2018 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
When we think of teamwork in long-term care, we envision a group of dedicated specialists working together to provide the best care for our residents. They read notes from other disciplines, bounce ideas off colleagues at the nursing station and convene care plan meetings.
In reality, teamwork in long-term care is much more complex.
Teamwork basics
Team members include not just clinical staff, residents and family members, but other workers who frequently have an influence on care, including housekeepers, laundry workers, maintenance staff and security guards. To enhance teamwork, these employees should be included in in-service trainings that might initially appear beyond their purview, such as customer service training and education about the medical and behavioral information they may need to relay to the nurses.
Teamwork is strengthened when team members understand the work of their colleagues and when it can best be utilized. For example, a lack of understanding of the difference between psychology and psychiatry services can cause delays in the receipt of needed treatment. Consider monthly training lunches that can boost morale, increase interdepartmental understanding and improve team functioning.
Team members also include those outside the facility, such as medical specialists, dialysis centers and hospitals, as well as consultants who provide onsite care such as psychiatrists, dentists, respiratory therapists and others.
Unifying all these team members requires uncomplicated and reliable conversation and correspondence. Communication can be enhanced in a variety of ways, including computerized records that eliminate paper consults and indecipherable handwriting, enhanced change of shift reports that include behavioral as well as physical information and a management commitment to staff retention to create the stability necessary for a solid team.
Taking it further
Once teamwork basics of role understanding, stable staffing and communication are covered, teams can begin to address teamwork at a deeper level.
Deep teamwork involves observing how the floor, unit or neighborhood is functioning as a whole over different shifts.
A team is not functioning well if a disruptive resident is keeping others awake at night or frightened during the day. Nor is it a high functioning team if two staff members are in a personal argument that’s obvious to all who walk onto the floor.
Deep teamwork calls for observing the interactions of the team and intervening as necessary to guide them back on track.
For the entire article, visit:
