Category: Business Strategies
Posted by Dr. El - November 12, 2018 - Business Strategies, Dementia, McKnight's Long-Term Care News, Motivating staff, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I headed to the 2018 LeadingAge convention last week looking for a fix of long-term care enthusiasm and that’s exactly what I got.
I met up with old colleagues, put faces to voices I’d spoken to for years and wandered through the expo hall catching snippets of conversations that might be exciting only to long-term care professionals.
PDPM
Armed with a large cup of black coffee, I attended an early morning seminar on the Patient-Directed Payment Model (PDPM), mostly so I’d know what everyone was freaking out about at work. “Are there any payment adjustments for residents with behavioral health problems?” I inquired of the speakers. “No,” came the reply.
Facilities will continue to have to manage residents with anxiety, substance abuse and other difficult and time-consuming behaviors without financial remuneration through PDPM. For those looking for immediate answers, consulting psychologists can be a good resource for staff training and local associations may be able to offer educational sessions on specific topics across facilities.
Team building
I participated in a session offered by Christopher Ridenhour, GFN entitled, “The Other Voice: Race, Class, Culture and the Other ‘Isms’ in Aging Services.”
“And you wonder why we have a staffing crisis,” he said, pointing out, for example, that attendees walking briskly through the conference hall without acknowledging one another were likely to be doing the same thing with their staff members back at home.
Ridenhour emphasized that all workers, regardless of their race, age or any other characteristic, want to be recognized and appreciated.
The session included practice exercises that highlighted commonalities between participants. I left with a new friend with whom I “LinkedIn” the next day. We were born in different countries, work in different LTC roles and have almost a decade between us, but given the directive to “tell each other your life story in thirty seconds,” we found the kind of common ground that any employer would want for their team members.
Montessori for staff
The theme of connection was echoed in a session offered by psychologist Cameron Camp, Ph.D., and his colleagues at the Center for Applied Research in Dementia on teaching Montessori techniques to staff members.
Posted by Dr. El - October 24, 2018 - Business Strategies, Customer service, McKnight's Long-Term Care News, Resident care, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
Long-term care success is about steady, reliable relationships. That’s my takeaway after attending two recent conferences that echo my experiences in the field.
The first event delivered the results thus far of an ongoing program that won a coveted grant from the Center for Medicare & Medicaid Services’ Center for Innovation. The OPTIMISTIC project is an effort of Indiana University and local partners, including the University of Indianapolis Center for Aging and Community. OPTIMISTIC is an acronym for Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care.
The model entails placing registered nurses in nursing facilities, as well as giving staff access to nurse practitioners. The nurses function as educational trainers and as resources for the team.
The consistent relationships with these nursing experts produced astounding results, including a 32.6% reduced relative risk of potentially avoidable hospitalizations and a net savings to Medicare of $3.4 million.
The second conference in which I participated was a National Readmission Collaborative event.
Keynote speaker Eric A. Coleman, M.D., discussed research on phone calls following up with patients after discharge from the hospital. While such contacts have been touted as an effective means of identifying and remedying precursors to hospital readmission, patients are often barraged with contacts from various service providers. These well-intentioned efforts thus become annoyances without real value to the patient and their family.
Having one consistent, informed care manager across the healthcare continuum proves more useful and effective, he reports.
As a psychologist, I’m not at all surprised.
For the entire article, visit:
Posted by Dr. El - September 19, 2018 - Business Strategies, McKnight's Long-Term Care News, Technology
Wednesday September 26, 2018
Earn 3 Free CEUs at 3 Free webinars
Once again, McKnight’s will host its annual Fall 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:
· TECHNOLOGY: Cyber threats and compliance challenges: Managing technology risk in aging services
· STAFFING: New strategies in staffing: Developing a partnership with your local university
· PAYMENT: Are you ready for the changes coming to MDS 3.0?
Posted by Dr. El - September 5, 2018 - Business Strategies, Depression/Mental illness/Substance Abuse, Engaging with families, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
In most of my long-term care career, I’ve witnessed short-term rehabilitation (STR) residents housed together, but occasionally facilities have scattered them throughout the building. I don’t know the reasoning behind dispersing residents, but from my perspective, dedicated rehab units work better.
My thinking is based on the fact that people entering rehab are almost invariably in the middle of a life crisis (see The stress of nursing home admission) – as are their family members – and that staff members are often stretched to the limits of their capacity to manage their responsibilities.
Keeping rehab residents together is better because:
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STR residents lodged together find a group of peers in the same situation as themselves, which can be enormously reassuring in anxiety-provoking times.
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Co-housing makes it more likely that STR residents will develop stress-reducing friendships and find a team of peers to support their progress in rehab. The ability to form friendships with peers is one of the major strengths and selling points of long-term care.
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Being around LTC residents can be alarming for STR residents, who usually have fears that they’ll “never get out.” Observing others being discharged upon completing rehab can ease their apprehension.
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STR residents, who are frequently younger and more cognitively intact, can feel isolated on LTC floors that have fewer people with whom to engage socially, and none in their particular situation. This increases their depression and anxiety.
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Family members can benefit greatly from talking with other families in similar situations. They’re much more likely to meet other families “in the trenches” on an STR unit. Yes, there are families on the long-term floors, but they’re in marathon mode while STR families are sprinting through a crisis that has reordered their lives.
For the entire article, visit:
Posted by Dr. El - August 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, Inspiration, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
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Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
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Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
For the entire article, visit:
Posted by Dr. El - July 31, 2018 - Business Strategies, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I once rode down a crowded afternoon elevator with the CEO of a managed care company. “It must be 5:01,” he commented wryly. I heard a measure of scorn for his employees’ lack of dedication to the job. What I saw was a group of people fleeing from utterly uninspiring and unappreciated work.
Similarly, in long-term care facilities with high staff turnover, some may see an absence of commitment on the part of workers, while others recognize that there’s something wrong with the job and the way employees are being treated. If workers are fleeing for the private sector, it’s not because they have an intense desire to work at Burger King.
Managers are no doubt familiar with many ramifications of turnover, such as the time and expense of finding and training new hires, the overtime costs for filling in shifts and the need to engage expensive agency workers. It’s also recognized that staff become demoralized in a high-turnover environment and that the quality of care can suffer — two points worth considering in more depth.
When key employees depart — such as nursing supervisors, department heads and nurses — direct care staff may be hesitant to bring problems to new workers just settling in to their jobs. Without the ease that develops between team members over time, important information may not be relayed, glitches in the system aren’t identified and resolved, and problems can fester and multiply.
When staff retention is low, workers become burned out on meeting new team members. They don’t want to put in energy toward welcoming newbies because they know the likelihood is that the individual isn’t going to stick around. This exacerbates the problem because a new worker who doesn’t feel welcomed is less likely to remain with the job.
The impact on residents is profound. Residents are in a vulnerable position, reliant on others for their most personal needs. It’s difficult for them to adjust to being assisted with toileting and bathing by a familiar person, but an unpredictable rotation of strangers who are new to the work adds another level of stress to their lives. For residents with dementia, expect an increase in distress — and the kinds of behaviors that make new hires less likely to remain on the job.
Turnover begets more turnover.
Posted by 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:
Posted by 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
Posted by 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:
Posted by 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:
