Category: Business Strategies
Posted by 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:
Posted by 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.
Posted by 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
Posted by Dr. El - February 26, 2013 - Business Strategies, Customer service, Long-Term Living Magazine
Here’s my latest article in Long-Term Living Magazine online:
What design features do LTC residents most want?
The psychologist walked into Mrs. Winters’ room and found her in the corner, muttering under her breath. “Is everything okay?” the psychologist asked, concerned. Mrs. Winters was usually a calm lady, but today her face was tight with anger.“Thank goodness you’re here!” Mrs. Winters cried. “I came over here to get a letter from my nightstand and now I can’t get out of this spot!” She tried to move her chair backward but the wheels jammed into the wall. She pushed the chair forward and ran into the bed. “I’ve been stuck like this for almost an hour and my call bell is on the other side of the bed. It’s a good thing I’m too angry to cry because I can’t reach my tissues either!”Renovations and redesigns large and small can breathe new life into a facility, especially when they’re focused on the needs of the people who live and work within them. The changes that are most important to the residents tend to be those that center on their psychological need to regain control. Most residents enter long-term care after a fall or other health crisis takes them from their home and thrusts them into an unfamiliar environment with rules not of their own making. Meals are served on schedule, toileting depends on staff availability, and discharge plans rely on a host of factors and players that can’t be managed by the resident. When the big things in life are spiraling out of control, being able to direct the small things can make a world of difference. Here are some design changes that matter most to the residents.
WITHIN RESIDENT ROOMS
To provide increased control within each room, consider that most nursing home residents have limited mobility and are often in wheelchairs that are difficult to maneuver in small spaces. Residents spend significant amounts of time in bed, unable to get out on their own. While most LTC facilities have mechanical beds that allow residents to adjust themselves as needed, there are many additional aspects of the environment that could be under resident control.
- Room temperature. Many times the call bell is ringing because a resident wants a window opened or closed or wants the air conditioning adjusted. Providing remote controls for the air conditioning and heating system allows the residents to take care of this function and frees staff time for other concerns. If the windows can be opened by remote (or easily opened manually) this improves quality of life, especially because getting outside for fresh air can be such a challenge.
- Large remote control for TV. Residents may have remote controls for their televisions, but have difficulty using them due to overly complicated designs with small buttons and tiny labels. The best remote controls are simple, with large well-labeled buttons, yet are not so heavy that frail elders have trouble holding them. Provide recommendations to family members as part of a good customer service program.
- User-friendly telephone. Similarly, the best telephones are the least complicated. They have large buttons, a loud ringer and speaker, are impervious to liquids and can withstand the inevitable falls that occur during use in long-term care. If families are providing phones, offer them these suggestions because you’re the experts and they’re probably going through this for the first time.
Posted by Dr. El - January 28, 2013 - Business Strategies, Long-Term Living Magazine, Motivating staff
Here’s my latest article in Long-Term Living magazine online:
3 small changes promise big impact in motivating your LTC staff
The new year has just begun and even without an official resolution, January holds the promise of a fresh start. This could be the year to address perennial problems plaguing your organization. It can be a challenge, though, to know where to begin on the mountain of tasks needing attention. Perhaps you have neither the time nor the budget for major changes. The good news is that
psychological research suggests small goals tend to be more successful than great ambitions. With that in mind, make use of the new year’s momentum by making minor adjustments in three areas for a big impact: appreciation, repair and organization.
1. APPRECIATION
Studies show that long-term care staff members aren’t in it for the money. Because workers tend to be more motivated by recognition of their efforts than by remuneration, showing appreciation will reap great rewards.
- Start small by simply thanking the people around you for their efforts. Recognize triumphs, commitment to the team and attempts even if they don’t result in success. As leaders within the organization, your attention to appreciation can create a ripple effect as others model their behavior after you and start thanking their coworkers and subordinates.
- Make it a habit to recognize one person, unit or action in each morning report or department head meeting. By calling attention to positive behaviors, you provide a roadmap for your employees or coworkers regarding the kind of work you’d like to see. Ask coworkers to “tell on” their peers, and vary who receives acknowledgement so that the unsung heroes shine as much as the obvious go-getters. Use this powerful tool, for example, if you sense a new employee might be feeling anxious, commending their work in front of colleagues to generate a feeling of inclusion and welcome.
- Take appreciation a step further by establishing an official recognition program such as “Employee of the Month.” Rewards can be as simple as a good parking spot, a plaque on the wall or a gift certificate to a local restaurant.
2. REPAIR
In any establishment there are things that break down. The New York City subway system, for example, is over 100 years old and in constant need of repair. The Metropolitan Transit Authority moves station to station with complete renovations that transform the location from dingy and crumbling to bright and freshly tiled. A recent sign in a subway car, however, announced a change in its repair program: instead of complete overhauls while most stations languished in disrepair, they’d now be attending to the most urgent needs of all stations. If the MTA can use this triage approach, so can long-term care.
Posted by Dr. El - December 13, 2012 - Business Strategies, Engaging with families, Long-Term Living Magazine, Tips for gifts, visits
Here’s my latest article on Long-Term Living magazine online:
The holiday season is a time when family members are more likely than usual to visit their loved ones in long-term care facilities. Out-of-town relatives may be making their annual visit, or grandchildren off from school might be stopping by to see Grandma or Grandpa. Now’s your chance to roll out the red carpet and show families what nursing homes are really about—caring treatment of their loved ones, an engaged staff that considers family members part of the team and good customer service. Where to start taking advantage of this opportunity to shine? At the front desk…
1. Encourage staff to provide an extra-warm holiday welcome.
LTC staff members are used to the hustle, buzzers, equipment and jargon of facility life, but the environment can be jarring to occasional visitors. Counteract their expectations of a sterile setting by offering a cheerful hello from a holiday-themed lobby, providing directions to their loved ones that show personal knowledge of the resident (“Your aunt is probably at lunch on the first floor right now so you might want to check there before you go to her room.”) and suggesting guests have a look at the visitor’s information provided by the facility. This material can be displayed as informally as a stack of newsletters on the counter, or with the fanfare of a labeled magazine rack filled with the elements outlined below and complete with resident greeter.
2. Reach out to family members through the facility newsletter.
Have relatives sign up to receive the missive so they can be informed of events and happenings all year round—and create a facility newsletter if you haven’t already done so. It’s easy and inexpensive to offer an electronic version, so now is the time to capture those email addresses and save on printing and mailing costs. Deliver helpful information and news consistent with the mission of your facility at a realistic frequency that can be maintained by your staff. It’s much better to offer a quarterly or semi-annual publication that can be delivered regularly than to commit to a monthly contact and not be able to follow through.
3. Offer tips for families to make the most of their visits.
For more, visit LTL magazine online:
Posted by Dr. El - November 8, 2012 - Business Strategies, Stress/Crisis management
It’s been a challenging time here in New York, leading me to write this guest post for McKnight’s Long-Term Care News:
Helping your LTC community cope in the wake of Hurricane Sandy
In the aftermath of Hurricane Sandy, long-term care facilities may be wondering how to help their own residents, families, and staff members or those directly affected by this devastating storm.
1. Be aware of our own feelings: If we’re anxious ourselves, it’s unlikely we’re going to be of much assistance. We should take time to calm ourselves, or let others take on the task of reassuring residents, staff, and family members until we’re ready to do so.
2. Allow community members to express their concerns: Sometimes we don’t need to fix things, but can be more helpful acting as a sounding board. Often if we listen long enough, the speaker can get through the frightened feelings on his or her own.
3. Acknowledge feelings: It’s not uncommon to be fearful or anxious, which will diminish over time. Knowing this is normal can be comforting.
4. Emphasize safety procedures: Reviewing the safety procedures in the nursing home, such as backup generators, evacuation plans, and water pumps, can increase the sense of safety and control. If it seems necessary, separate group discussions can be offered for residents, staff, and family members.
5. Utilize spiritual supports: Natural disasters such as this reinforce the capriciousness of fate, and, for some people, may lead to questions of how this could have happened. Help them to understand it in terms of their spiritual beliefs.
Posted by Dr. El - October 24, 2012 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Customer service, Depression/Mental illness/Substance Abuse, Talks/Radio shows
Where was I last week and why didn’t I update my blog as usual? I was in Denver, speaking about Mental Health in Nursing Homes at the National Aging Services Risk Management conference sponsored by Caring Communities, Peace Church Risk Retention Group, and ECRI Institute. I addressed the fact that facilities are exposing themselves to multiple risks if they aren’t providing appropriate mental health care, and I offered practical, low- or no-cost ideas on how to improve mental health treatment in long-term care settings. The talk was recorded and will be available to ECRI Institute members at their website: ecri.org. In their words: ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care.
Posted by Dr. El - October 10, 2012 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, McKnight's Long-Term Care News, Transitions in care
Here’s my latest guest post on McKnight’s Long-Term Care News:
Long-term care psychologists are a valuable resource for facilities looking to reduce their hospital readmission rates. As the only team member whose role it is to sit and talk with the residents for an extended period of time on a regular basis, psychologists are privy to a relationship that can help address root causes of readmission such as medication noncompliance and the recognition and timely reporting of symptoms, as well as follow-through with medical appointments after discharge.
Psychologists can:
1. Notice mental status changes before other staff members. Because interactions are based on extended conversations with residents, psychologists are frequently able to spot subtle alterations in cognition that wouldn’t be noticed during a med pass or routine caregiving.
2. Discover previously unreported symptoms. Due to the amount of time psychologists spend with the residents and the level of trust that develops in the psychotherapeutic relationship, residents often reveal important symptoms of their illnesses they might not share with medical staff.
3. Gather information from communication-challenged residents. Psychologists can gather info from residents who speak slowly or need to use communication devices and then share it with the team, saving staff time and providing important details.
For more, visit McKnight’s LTC News:
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For more on how nursing home psychologists can help those in LTC:
Free Audio: Interview by Psychotherapist Bill O’Hanlon
In this audio, mental health expert Bill O’Hanlon talks with Dr. El about the role of nursing home psychologists and how their work can transform facilities and improve the lives of residents, families, and staff members.
Free Download!
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Now available on Amazon:
Everything You Wanted to Know About Your Nursing Home Stay
But Were Afraid to Ask
Posted by Dr. El - October 2, 2012 - Business Strategies, Communication, Customer service, Long-Term Living Magazine, Resident care, Resident education/Support groups
Here’s my latest article on Long-Term Living magazine online:
“Thanks, Doc, for telling me about this group!” Mr. Jones smiled and held up the magazine he’d gotten from the National Parkinson Foundation. “Except for that actor, I didn’t even know one person with Parkinson’s before I got my diagnosis—now I find out there are enough of them to have a whole Foundation!”“You feel better knowing you’re not alone,” the psychologist reflected.“Not only that,” he said, “but I’m learning a lot about Parkinson’s and how to handle it. I used to get so angry when I couldn’t do the things I used to do, but now I see it’s my illness. I’m gonna figure out how to deal with it,” he said with conviction.Like Mr. Jones, many residents enter long-term care with medical illnesses that are unfamiliar to them, sometimes years after their diagnoses. As discussed in the article 5 Reasons to Educate Residents About Their Illnesses, not only are properly educated residents more compliant with healthcare recommendations, but the coming baby boomers are going to demand information about their illnesses. Nursing homes that provide education for residents (and families) will be offering cutting-edge services that enhance the experience of their facilities and increase customer satisfaction.Here are seven simple methods to educate residents that are easy to implement and will help your facility stand apart from the crowd:
- Encourage discussion with medical staff upon admission and diagnosis. Part of the initial assessment of new residents should include asking them whether or not they know what their diagnoses are. Nurses and doctors can offer a brief explanation of unfamiliar terms and assess the need for more information, the length of time since diagnosis (the more recent the diagnosis, the more likely the resident will be in emotional distress and may benefit from mental health support), and the level of family involvement (involved family may need information too). Any new diagnoses after admission should be discussed with the physician and followed up as needed.
- Dispense fact sheets about illnesses. Every illness is Google-able. Chances are that your boomer residents and/or their family members will be researching their illnesses on their smartphones or laptops, but the details they’re obtaining may not be from reputable sources. By providing information from established medical sites, staff can direct residents to credible resources. The staff members also will have easy access to the information and can familiarize themselves with the illnesses and required care. Fact sheets could be in a binder available at the nursing stations for the staff to distribute or in a magazine rack accessible to the residents and visitors.
- Provide information about illness organizations and how they can join. Along with the basic details an illness fact sheet provides, residents can be offered information about disease-specific organizations. The mere knowledge of the existence of such groups can be helpful, since many residents feel alone with their illnesses, despite the fact that they may be sitting in the hallway next to another resident with the same disease. Privacy laws prevent staff members from sharing such similarities, and residents might not feel comfortable discussing their physical concerns with a neighbor on their floor. Illness-related societies can offer support, coping strategies, hope and perspectives that others are unable to provide. Joining such organizations can be an important step in regaining a sense of control over one’s life.
For more, visit LTL magazine online:
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Now available on Amazon:
Everything You Wanted to Know About Your Nursing Home Stay
But Were Afraid to Ask
