Category: Business Strategies
Posted by Dr. El - October 25, 2017 - Business Strategies, Customer service, McKnight's Long-Term Care News, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
Long-term care providers have an opportunity to thrive with value-based care, escape cynicism and join the growing wave successful at avoiding readmissions.
Last week, I was part of a panel discussing readmission prevention at the National Readmission Prevention Collaborative’s C-Suite Invitational: New York Transformational Healthcare, which focused on Accountable Care Organizations, bundles and readmissions. The goal of the forum was identifying ways for providers at all ends of the healthcare continuum to prevent hospital readmissions and to thrive in a value-based care model.
Unlike fee-for-service care, which compensates providers for each procedure, value-based care pays for the episode of care, making it essential to coordinate between providers and to avoid unnecessary medical utilization. Efforts to avert hospitalization and readmission are paramount.
The conference offered several takeaways for skilled nursing facilities and other post-acute providers.
From hospital to post-acute provider
Presenters emphasized the importance of being part of a continuing care network rather than a stand-alone facility and of working closely with referral sources. Because crucial information is easily lost during care transitions, best practices suggest a “warm handoff” rather than an exchange of information on paper or via computer, meaning that providers have an actual conversation about care.
To facilitate this, both the referral source, such as the hospital, and the accepting organization, such as the nursing home, should have someone to collect and relay information. To reduce costs, this needn’t be a clinical role as long as the necessary details are conveyed. Communication can be streamlined using a “hotline” between the hospital and the post-acute provider so that phone calls can be made directly rather than routing through the emergency department.
The transition to home
Hospitals are being monitored for readmissions and may have several post-acute care options. The facility most likely to prevent rehospitalization after discharging residents is the one most likely to get referrals.
For the entire article, visit:
Posted by Dr. El - September 28, 2017 - Anecdotes, Business Strategies, Communication, Customer service, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
Both of my mothers-in-law live in long-term care communities in Florida. (I’ll keep the backstory about having two MILs a mystery.)
One MIL lives in a place that was excellent about how they communicated with family members before, during and after Hurricane Irma. The other MIL’s facility handled that aspect of care poorly.
At Bentley Village in Naples on the southwest coast of Florida, all 800 residents of the CCRC were evacuated in advance of the storm, even when everyone thought the hurricane was heading toward the East Coast. While not every organization can afford to evacuate their residents to plush hotels, all of them can afford to do what Bentley did next.
At the top of the home page of its website they placed a bright red banner instructing site visitors to click upon it for more information on Hurricane Irma. The following page contains continually updated reports on the progress the management is making toward assessing and repairing the damage to their homes, as well as an estimate of how long the process will take. A typical entry contains the date and time of the posting, the work that’s been done and what has yet to be accomplished.
They recently added photographs of the damage to the community. The photos clearly show even those most eager to return to their homes why they must wait.
In addition, there’s a list of locations where people are sheltering since residents from skilled nursing, assisted living and independent living were sent to different locales. A pet-friendly hotel was selected for independent living residents with animals.
When I discovered my MIL’s cell phone wasn’t working, I checked the website, got the phone number of the hotel where she was staying and was immediately connected to her room. She claimed they were “having a ball.”
Very reassuring.
For the entire article, visit:
Posted by Dr. El - September 13, 2017 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
I often speak with healthcare groups, giving psychological insights about a variety of issues within long-term care. Sometimes I address a C-suite audience; other times I train direct care staff.
I noticed during the course of these talks that some of the group exercises that generated excitement and intense discussion among direct care staff were met with relative restraint when presented to executives.
After pondering the discrepancy in reactions, I adjusted my talks accordingly and came to this conclusion: Healthcare executives and managers are very different from those they manage.
Understanding and utilizing these differences can facilitate leadership in a variety of ways.
How execs differ from direct care staff
We can consider the discrepancies between the two groups by looking at the traits generally exhibited by each. I’ve borrowed a tool from career counselors, who test their clients’ personality traits to determine what types of jobs best suit them.
One such test is the Myers-Briggs Type Indicator, which examines four different aspects of an individual’s personality as it relates to career choice. The summary below is from an article with a handy chart based on the book, “Do What You Are.”
For the entire article, visit:
Posted by Dr. El - July 18, 2017 - Business Strategies, McKnight's Long-Term Care News, Technology
Here’s my latest article on McKnight’s Long-Term Care News:
I was at the nursing station the other day when some unusual cracking noises caused me to look up from my documentation. A very old, petite lady was sitting in her wheelchair popping bubble wrap. She wore th
e same contented expression that comes over virtually everyone popping a sheet of bubble wrap.
This low-tech soother was on my mind during my visit to New York City’s CE Week. CE, in this case, is not Continuing Education but Consumer Electronics.
In March, I wrote about attending Aging2.0, a tech conference geared toward elders. The CE Week NY isn’t specifically aging tech, but the 50+ set was invited by tech50+ and Senior Planet and I went to see what could be appropriated for people much older than 50.
I was thinking of the happy bubble-wrap popping elder when I came across FidgetTech, a table of high-tech “fidgets.” A fidget spinner is a small, flat plastic device with a central core that remains stable while the three-pronged body is spun in circles. Often marketed as a tool to help children maintain their focus, they’ve become a craze like yo-yos or Silly Bandz.
The display offered a wide variety of fidgets with various electronic capabilities (music! USB hubs!), but what stood out to me was the possibility of calming agitated elders with a basic, silent fidget that, unlike bubble wrap, wouldn’t disturb those around them. I liked the fidget that had “arms” filled with liquid and glitter so that when it stopped, the glitter settled in a slow, mesmerizing fashion. I could imagine a “Fidget Hour” mitigating the agitation that frequently occurs late in the day.
Farther down the exhibit hall, the Rapael Smart Glove display demonstrated virtual reality-based rehabilitation using a variety of computerized games and a plastic sensor “glove.”
(Think Wii for hand and arm rehabilitation.) In addition to the high-tech demonstration, they offered low-tech photocopies of a 2016 study published in the Journal of NeuroEngineering and Rehabilitation outlining the glove’s utility for post-stroke patients. The device would be a useful and impressive addition to rehabilitation services.
For the entire article, visit:
Posted by Dr. El - July 6, 2017 - Business Strategies, Customer service, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The team huddled around the nursing station talking in panicked whispers after the management meeting ended.
“How do they expect us to do that?” a young nurse wondered.
“Yeah,” an aide replied, “we’re stretched thin enough already!”
A more experienced worker piped up. “Don’t worry,” he said bluntly. “I’ve seen these ideas come and go. It’ll never happen.”
There was a collective sigh of relief and everybody went back to business as usual.
The scenario above illustrates some of the many ways organizations are resistant to change.
In this situation, the new procedure is viewed as a temporary fad not worth investing time and energy. The workers haven’t been consulted for their input prior to implementation, they fear that they won’t be able to handle the work and the benefits of doing so aren’t clear. In addition, the employees don’t trust their management to guide them through the process of change.
Think of how hard it is to adjust our own routines and then multiply that by, say, every employee, resident and family member. Then cube that number.
Speaking of adjusting personal routines, a few months ago I wrote that I was going to try to meditate daily this year. I haven’t.
Consider trying to make changes in the context of family life, such as going for a walk after dinner (a good idea that never happened) or eating healthy food (I do, she does, he doesn’t). Pushback and inertia can make it difficult for even the most well-intentioned modifications to take hold.
This is why it’s necessary to have a guide along the way for changes to take hold, whether it’s a friend to meet you at the gym or the Pioneer Network to help your organization navigate through the culture change process.
Full disclosure: While I don’t get paid to say this, as a psychologist I find that culture change principles are better for the mental health of the residents, staff and families. As a change agent, I know how important it is to enlist an agent of change.
For the entire article, visit:
Posted by Dr. El - June 22, 2017 - Business Strategies, Communication, Engaging with families, Inspiration, McKnight's Long-Term Care News, Something Good About Nursing Homes
Here’s my latest article on McKnight’s Long-Term Care News:
One of the things that most brightens my workday is when I see long-term care residents hanging out together.
In particular, I’ve noticed two ladies who attend activities in tandem wearing dresses with hats and costume jewelry, a threesome of confused residents who sit near the nursing station laughing at jokes only they understand, and an African-American and a Caucasian octogenarian twosome who are amazed to be best friends since neither of them had a friend of the other race before.
Men gather for card games, guys group in the hallway offering wry observations on the behaviors of the staff and other residents, and rehab patients tell me how inspired they are by someone they meet lifting weights in physical therapy. Sometimes I’ll discover that the resident they mentioned is, in turn, inspired by them.
What long-term care offers, aside from medical help and safety, is the opportunity to connect with peers and to maintain a social life. One of our best selling points is the fact that folks can get to activities without needing a coat or umbrella. New residents are often surprised and reassured to learn that there are “transporters” who will bring them to and from daily recreation programs, all for free.
For the entire article, visit:
Posted by Dr. El - May 25, 2017 - Business Strategies, McKnight's Long-Term Care News, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
Last week a nurse, aide and police chief were killed at an Ohio nursing home, along with the gunman, who died of a self-inflicted gunshot wound. While it’s impossible to prevent all tragic events, especially those involving an armed assailant entering the building despite an order of protection against him, there are ways to reduce the likelihood of workplace violence.
According to a 2014 Scientific American article, “Health-care workers experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S., according to data from the Bureau of Labor Statistics.”
The article goes on to discuss the institutional acceptance of violence against nurses, the lack of violence prevention training and the implication from management that the employees were responsible for the assaults against them.
While the Scientific American article focused on nurses in a hospital setting, a 2016 study of nursing staff in long-term care facilities finds that “65% of the participants had experienced workplace violence while 41% believed that management shows little or no concern for their safety.”
I’m reminded of the many times over the years that residents have hit, spit on and otherwise abused nursing staff, and a team meeting was convened or a resident transferred to the psych hospital only after assaulting the doctor. If we want to retain staff, we need to convey that the safety of each individual is important regardless of their stature within the organization.
We also might hypothesize that people who have grown up in homes without violence are unlikely to stay in positions where they feel endangered; similarly, the staff members who stay have some level of comfort with aggressive behavior, perhaps due to exposure to domestic violence as children. Research on the “cycle of violence” indicates that childhood exposure increases the likelihood of violent relationships as an adult.
If that hypothesis is true, it becomes even more crucial for the facility to set the standard that violence is not “normal” and that the safety of those in their community is paramount.
For the entire article, visit:
Vector illustration of the Dove of Peace
Posted by Dr. El - May 10, 2017 - Business Strategies, Communication, McKnight's Long-Term Care News, Resident/Family councils
Here’s my latest article on McKnight’s Long-Term Care News:
Last week during a talk at the Pennsylvania Department of Aging 2017 Ombudsman Conference, audience members told me that they’re having difficulty speaking to administrators and other senior staff when they visit the facilities. In fact, some people reported that the administrators close their office doors when they find out the ombudsman is in the building!
While I can imagine from an administrator’s point of view that an unexpected interruption from someone complaining about problems is not exactly a welcome visit, perhaps there’s a way to shift the relationship to mutual advantage.
In fact, ombudsmen may be able to use their resources to help you solve problems within your facility.
Their role
Long-term care ombudsmen act as advocates for residents to address problems and to facilitate quality care. According to The National Long-Term Care Ombudsman Resource Center, ombudsmen promote “the development of citizen organizations, family councils and resident councils.” Ombudsmen and the councils can identify areas of potential improvement and, if properly guided, can offer solutions and assistance.
Local ombudsman’s offices have, for example, sponsored training programs on culture change and invited facility staff free of charge. Ombudsmen have arranged trips for staff to visit nearby Green Houses and provided free staff training on various resident care matters.
Pennsylvania’s Ombudsman Program is very active in promoting resident participation. Their ombudsman-trained PEERs (Pennsylvania’s Empowered Expert Residents) focus on improving the quality of life for residents. PEER efforts include initiating activities in which elders have the opportunity to assist others, such as a program making blankets for the homeless. That would make a nice mention during the prospective resident tour, don’t you think?
Ombudsman contact tips
While it’s likely that your ombudsman will be sharing resident complaints with you, it’s better to hear about these problems from them than from a state surveyor. Consider the following methods to improve your working relationship and to enhance resident care:
For the entire article, visit:
Posted by Dr. El - April 26, 2017 - Business Strategies, Customer service, Engaging with families, McKnight's Long-Term Care News, Personal Reflections
Here’s my latest article on McKnight’s Long-Term Care News:
Due to a series of unfortunate events, both of my previously independent parents were recently injured over the course of five weeks. In the past, I’d been the granddaughter, the niece and the daughter-in-law of someone in long-term care, but I’ve now taken on the very different role of daughter of a resident.
In between errands, trips to medical appointments and calls to the facility, I’ve been making mental notes of insights afforded me by my new perspective and that of my family members.
Here are some thoughts from someone who’s seen the long-term care world from both sides now:
• It’s worthwhile to have a pleasant and efficient receptionist. I don’t often call the facilities in which I work so it hasn’t affected me personally if the automated telephone system sends callers into a netherworld of options and hang-ups or if the receptionist is curt or bumbling.
As a family member, however, it’s tremendously reassuring to have a calm, competent individual answering questions and guiding me to the appropriate staff member.
• Visitor areas are scrutinized. While my general philosophy is that I’d much rather be in a place that focuses on emotional and physical comfort than on outward appearances, my visiting family members are definitely aware of disrepair, cleanliness levels and shabbiness.
For the entire article, visit:
Posted by Dr. El - April 13, 2017 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
Having enough of it at work, I tend to avoid drama in my entertainment choices unless it involves aliens or post-apocalyptic nonsense. My family and I are currently enjoying the creative spectacle of Project Runway “Teams” version from a few seasons ago. In it, the judges of the clothing design competition repeatedly make the point that “teams are only as strong as their weakest link.”
A significant part of the Project Runway teamwork challenges involve communication. Collaborators who take over the project and those don’t speak up can both get penalized by the judges. Similarly, teamwork within the long-term care setting heavily relies on communication. For the best healthcare outcomes, it’s essential for all team members to contribute their expertise.
An article in the American Psychological Association Monitor, however, suggests that people who feel powerful are more likely than those who don’t feel powerful to share “opinions that differed from the norm,” a important element of team interactions.
Further, the authors cite research that describes how “people who feel powerless are more likely to…behave in inhibited ways. People in positions of greater power, on the other hand, are more likely to…act in uninhibited ways.” A care team member who feels inhibited is less likely to speak up and contribute to a group discussion.
In the hierarchical world of LTC, administrators, nursing directors and medical directors have more perceived power than, say, charge nurses or recreation therapists, despite whatever layers of upper management and accountability exist.
In my conversations with aides and residents, there is consistent disagreement among them regarding who has the power. Aides will argue that the “Resident’s Bill of Rights” gives the residents control, while residents, waiting on aides for intimate care, feel that the aides are in charge. Both struggle to deal with the moods and behaviors of the other.
Family members can be considered a part of the team that wields power in the form of potential phone calls to senior staff, the ability to transfer their loved one to a different facility, a negative social media review or a lawsuit. At the same time, relatives are often overwhelmed by the new and unfamiliar situation and the shifting dynamics within their families and many feel powerless in relation to the staff members upon whom they depend for good care for their loved one.
The challenge for LTC is to empower all team members to overcome their “inhibitions,” so that they offer their expertise despite the imbalance of power and in perceptions of power.
For the entire article, visit:
