Category: Business Strategies
Posted by Dr. El - September 6, 2013 - Business Strategies, Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Last week, McKnight’s staff writer Tim Mullaney wrote about the new Medicare guidance that guarantees that same-sex married couples can live in the same nursing home. Perhaps, like many of our current opposite-sex married couples, they’ll share the same room or apartment. Is your staff prepared to offer them the same respectful service they’re providing for your male/female couples? Are you prepared to lead the way, regardless of your personal beliefs regarding homosexuality? I’ll bet you’re not.
Why do I say this? Maybe your religion denounces homosexuality, yet you strive to be open (and have your facility open) to people from all walks of life. You might take a “live and let live” approach. But even if you are openly gay yourself and comfortable with your sexuality, chances are excellent that there are people on your staff who feel very uncomfortable with homosexuality and will need additional training in order to be able to successfully assist gay couples.
I say this because I worked with a well-meaning aide who, despite knowing nothing about my background really, repeatedly thought she had to try to “save” me through conversion to her (anti-gay) religion. As a psychologist, I could read and deflect her good intentions, but I doubt a gay couple under her care would feel the same way.
For the entire article, visit:
Posted by Dr. El - August 23, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, McKnight's Long-Term Care News, Role of psychologists
Here’s my latest article at McKnight’s Long-Term Care News:
As a psychologist consulting in long-term care facilities, I was paid through Medicare, Medicaid, and/or private insurance for only one task: direct contact with residents. That’s it. I provided a lot more because it was needed, but that’s all I was paid for.
There was much more help that I didn’t offer, not only because I wasn’t paid for it, but also because the organization wasn’t structured to accept this type of assistance. The facilities’ needs were the kinds of things that made me sigh and shake my shrinky head in frustration. Oh, what we psychologists could do for you if we were on staff!
Here are some examples:
Problem #1: Admissions decisions
As your admissions department scrambles to fill beds and wonders whether the facility can manage a new resident with a psych history and a recent diagnosis of cancer, imagine if they could ask the opinion of the psychologist likely to be treating the resident. Now imagine if they could do this for every questionable admission. Psychologists could set up mental health services upon the new resident’s arrival and you would have the support necessary to meet the mental health needs of the residents under your care.
As the number of residents with behavioral issues increases, this psychological screening becomes an increasingly important element of providing good care and preventing time-consuming problems on your units after admission.
Problem #2: Team Communication
Watching two aides argue about giving care to a resident over said resident’s head or observing an essential piece of information get lost between shifts, I’ve fantasized about offering in-service training to eliminate these destructive behaviors. Not half-hour meetings sandwiched in between resident care, but real training that allows time for examples and practice as well as observation and feedback on the floors.
Real training provides the opportunity for staff to turn to the psychologist for guidance in handling the sticky interpersonal dynamics that are inevitable as people work in groups. It also offers assistance in designing and implementing procedures that facilitate written and oral communication.
Problem #3: Interacting with residents
Improperly trained staff members frequently escalate tense situations, cause unintended distress in residents, or miss cognitive changes that signal physical illness. They aren’t doing this on purpose — they just haven’t been taught how to handle such situations.
For the entire article, visit:
Posted by 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
Posted by 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!
Posted by 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.
Posted by 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:
Posted by 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.
Posted by 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.
Posted by 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
Posted by 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
