Category: Business Strategies

5 Reasons to Educate Residents About Their Illnesses (LTL mag online)

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

5 reasons to educate residents about their illnesses

“How long have you had Parkinson’s?” the psychologist asked Mr. Jones during his initial evaluation.

“They just told me the diagnosis when I got here last week, but I suppose I’ve had it for a while.” He said it casually, but his hands were clenched and his voice held a note of tension.

“Did the doctor explain what it is or give you information about the Parkinson’s Foundation?”

“No. All I know is that it’s the same disease that young actor has—what’s his name?”

“Michael J. Fox.”

“Yeah, that’s the one.”

The psychologist assured the resident she’d bring him a pamphlet from the Parkinson’s Foundation the following week. It would work better, she thought to herself, if the medical staff provided the physical health information so she could follow up with the mental health aspects.

Residents often enter long-term care with surprisingly little knowledge about their conditions, whether they have a recent diagnosis or have been living with an illness for many years. This lack of information isn’t good for residents, families or facility staff.

Here are five reasons why we should teach our residents about the illnesses they live with:

1. Education leads to more active resident involvement in care.

When residents have information about their illnesses, they are more able to accurately report their symptoms to the medical team and to provide the type of information that improves treatment. A resident without knowledge is a passive recipient of medication and care; a resident with knowledge can partner with his or her medical team to address needs and find effective solutions. Joan, for instance, had multiple sclerosis and was keenly aware that the hot summer made it difficult for her to walk in rehab. She was able to work with her therapist to find more manageable activities so that she could continue with her rehab program during the summer months. Contrast this with Leon, who blamed himself for his MS symptoms, believed his difficulty walking was a personal failure, and was referred for psychotherapy when he stopped attending rehab. With encouragement and some psychoeducation about his illness, Leon was literally able to get back on his feet again.

2. Knowledge increases compliance.

Uneducated individuals are less likely to comply with treatment recommendations or may reject medications due to side effects without fully considering potential benefits. Individuals who understand why particular medications are given and how to cope with potential side effects are more likely to comply with treatment. They’re also more likely to have reasonable, informed objections for foregoing a particular course of treatment—reasons that can be readily understood and documented. For example, Lucille was initially resistant to the dialysis treatments that were recommended for her. Once she gathered information and spoke to some other residents in the dialysis program, she ultimately decided that its life-saving benefits were worth the time and discomfort of the treatments. Thomas, on the other hand, decided against dialysis and was able to explain and document his end-of-life wishes clearly, based on his knowledge of his illness.

3. Information reduces anxiety. 

For more, visit Long-Term Living Magazine online: 5 reasons to educate residents about their illnesses

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

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

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.

The “Single” Boom: Problems and Solutions for LTC (McKnights online)

Here’s my most recent article in McKnight’s Long-Term Care news online:

The “Single” Boom: Problems and Solutions for Long-Term Care

According to recent reports, one-third of the baby boomers who will be arriving at the doorstep of long-term care are unmarried. Many of them have no children. Just as our healthcare system relies on unpaid family caretakers, LTC relies on close family members who help our residents through their stays.

The demographic trends, however, suggest we need to prepare for increasing numbers of residents without close relatives.

Below are four ways we can expect this shift to impact our residents, and suggestions for how we can adapt to this change:

1. Lack of POAs, healthcare proxies or legal guardians

The Problem: Currently, most residents have someone available in their lives to make medical and legal decisions on their behalf. This trusted helper is able to collect the documents necessary to apply for Medicaid, for example, or to sell a home for the resident.

Typically, family members are informed of the need to sign or gather paperwork, and the nursing home awaits the documents. They generally arrive with or without further prompting, allowing for successful completion of the transactions.

In the absence of an involved family member, these essential activities are virtually impossible for a resident to accomplish independently from inside the nursing home, no matter how robust their condition. Residents, who often make a sudden trip from home to hospital to nursing home, generally don’t have important phone numbers, access to legal papers, Internet connectivity, or the wherewithal to make arrangements on their own, from afar, in the middle of a health crisis.

As we begin to see increasing numbers of elders in this situation, it will become apparent that what we are viewing is not an individual problem, but a systems problem.

The Solution: As a system, we’ll need more court-appointed powers of attorney, proxies and guardians available to our residents, as well as a greater emphasis on obtaining advance directives and community supports. Streamlining the process of obtaining these assistants will make life easier for everyone, and can be accomplished using some of the methods below:

• When assessing social supports upon admission, we can educate residents about the need for assistance in navigating their healthcare. It’s important to plant the seed early in admission because we can expect this idea to meet with resistance as residents struggle to maintain their independence. We can explain that obtaining helpers is not a reflection of a personal failing, but is unavoidable in a complicated healthcare system.

• We can offer increased independence via discussion of advance directives, which allow residents to make their own decisions regarding their healthcare.

• We can discuss with residents who among their family, church, and community members might be willing to assist them with their care and begin outreach toward potential helpers. Offering prepared pamphlets or other educational materials about what is involved in taking on a specific caregiving task will allay the concerns of those considering a helper role and reduce the burden on the social work staff communicating the information.

• Within our facilities, we can increase our connections to the local community. There we might find church volunteers, for example, who would be willing to take an active role in the lives of our residents, such as signing a back-up agreement for home healthcare or becoming a legal guardian.

• We can help residents create a personal caregiving team by connecting more distant relatives or friends who may be able to offer only limited assistance, but together meet the needs of the resident.

• We can increase the number and training of social workers in our centers, so they can take on the additional tasks required to address the above suggestions in a manner that enhances the reputation of the facility.

2. Lack of errand-runners

The Problem:  A LTC facility often becomes the resident’s entire world, but not all of their needs can be met within the walls of the facility. A major and important function played by family members is that of procurer of outside items. Currently, residents rely on their family members to bring them home-cooked foods, clothing or items from the community, such as a favorite lotion or shampoo.

Residents without family or friends have come to rely on the kindness of strangers, like their roommate’s daughter, or the friendly aide who makes a grocery store run on her lunch break. This lack of control over formerly simple tasks leads to frustration and depression. Chores such as fixing a watchband become monumental in a nursing home. Using generic toothpaste instead of the brand enjoyed for 70 years can be a twice-daily reminder of lost independence.

Again, what appears to be an individual problem is actually a systems problem within each setting. An increase in the number of single residents will propel us to adjust the way we handle resident needs.

For more, visit McKnight’s Long-Term Care News online: The “Single” Boom: Problems and Solutions for Long-Term Care

5 Secrets Your Line Staff Wishes You Knew (LTL mag online)

Here’s my latest article in Long-Term Living magazine online, 5 Secrets Your Line Staff Wishes You Knew:

Click-clack. Click-Clack.  The hard-bottomed shoes of the administrator echoed through the halls once again, this time accompanied by the high heels of the director of nursing. The crepe-soled nursing staff moved about the floor, silently hoping the bigwigs would notice and address the problems that frustrate them on a daily basis.

Do you ever wonder what your staff isn’t telling you? Are you puzzled why, despite all your efforts, the organization isn’t functioning as efficiently as you’d hoped? In January, I revealed the secrets your line staff doesn’t want you to know. Now, here are the secrets the staff won’t say, but wants to—secrets that will transform your facility.

1. The staff members who are doing their jobs properly wish you’d be on the floors more often. 

They’d never “rat out” their coworkers, but they’d like you to catch how often their colleagues disappear for unscheduled breaks, or the way they talk to some of the residents. Your frequent and unexpected presence raises the level of professionalism of your staff and keeps you in touch with the realities of day-to-day care. By taking some time to sit at the nursing station, for example, workers can observe and emulate your style of interacting with the residents and their families. Participating during the change of shift report can offer the opportunity to influence the type of information offered during this important transition. You become more familiar and approachable, rather than a “bigwig” in an office, and find out more of the information you need to know to make your nursing home proactive and productive.

2. All this disorganization is driving them crazy.

It’s not in the nursing job description to reorganize the file drawer—but isn’t it in somebody’s job description? Please, send someone over to put the forms in place, because if it takes each staff member 10 minutes to locate the MD order form, that is way too much time wasted. While you’re at it, organize the linen, pantry and supply closets—and make them the same on every floor, so floaters can quickly find the things they need. The time it takes to do this properly—with some forethought and planning about what goes where—will quickly pay off as multiple staff members on multiple floors can easily locate the tools essential for their jobs.

How to Eliminate the Silo Effect in LTC Organizations (LTL mag online)

Here’s my latest article, on The Silo Effect, at Long-Term Living magazine’s online site:

The employees listened carefully to their boss as he outlined a new procedure.

“Any questions?”

None were raised, and the boss, pleased at the consensus, adjourned the meeting. But outside the conference room, the murmurs started.

How do they expect us to do that? Don’t they know that’s going to lead to this other problem? If they want that to happen, why didn’t they just do it this way? You and I both know that’ll never work, but I’m not going to be the one to say anything.

Me neither.

What is the Silo Effect?

The Silo Effect refers to a lack of information flowing between groups or parts of an organization. On a farm, silos prevent different grains from mixing. In an organization, the Silo Effect limits the interactions between members of different branches of the company, thus leading to reduced productivity.

Long-term care silos

Silos operate at various levels of long-term care. They can be found in the silent acquiescence of department head meetings, hospital transfers without complete documentation, care plan meetings where key players are missing, and nursing home admissions that neglect to provide residents and families with the information they need to become proactive members of the team.

In fact, our current healthcare system is one of silos: private insurers, Medicare, Medicaid, hospitals, nursing homes, home healthcare, regulators—all working independently, but connected, to haphazardly manage the nation’s healthcare.

For more, visit LTL mag: How to eliminate the silo effect in LTC organizations

McKnight’s Online Expo, FREE, March 21st – 22nd, 2012

Have you ever attended an online conference?  If not, here’s your chance to try something new for the first time.  McKnight’s annual event offers the opportunity to attend a conference, and get CE credits, without travel.  Simply 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 is our Sixth-Annual Expo, and this year the event takes place on March 21st and 22nd. The event is free, but you must register now to attend. It only takes a moment and all registrants are entered into a drawing to win an iPad!
Register to attend this free event by clicking HERE

Earn 5 free CEUs at the EXPO webcasts on:
Payment: Making the most of the newest MDS 3.0
Capital: Finding capital in 2012
Technology: HER implementation that actually works
Wound Care: Avoiding costly wound care mishaps
Quality: The business case for quality

Not surprisingly, I was most intrigued by the Quality talk, by consultant and former Centers for Medicare & Medicaid Services official Sheila Lambowitz at 1 p.m. (ET) on Thursday, March 22nd.

“It is well known that quality care makes for good clinical practice. But there are also bottom-line reasons why a quality-driven approach to care is wise. This informative session will examine the sticks and carrots being put in place to ensure residents receive the best care possible.”

The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay, But Were Afraid to Ask

I’m excited to announce my forthcoming book, which will become available in the next month or two:

The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay, But Were Afraid to Ask

The Savvy Resident’s Guide, based on my 15+ years as a nursing home psychologist, is the first book written just for residents and is designed to help them become an informed member of the treatment team.  Using the voices of several composite “residents,” I explain how the nursing home works, what to expect, and ways to successfully manage this stressful life experience.

Facilities and staff members will find the book helpful for current residents and as part of their admissions package because it can answer common questions, reduce resident anxiety, increase compliance with care, and free up time for staff to attend to other care needs.

Family members can offer this book to their loved ones to ease the transition into the nursing home, and can read it along with them to find answers and techniques to handle common challenges in long-term care.

Residents will find the Savvy Resident’s Guide an invaluable and accessible resource that helps them understand and negotiate the nursing home system, become successful partners in their own care, and find meaning and purpose during this phase of life.  You are not alone!