Category: Business Strategies

How to find out why your staff is leaving

Here’s my latest article on McKnight’s Long-Term Care News:

How to find out why your staff is leaving

During the Q&A section of my McKnight’s Fall Expo webinar “Letting them go with style,” the conversation turned toward why staff members are leaving their long-term care positions.
As I pointed out then, workers often give plausible but incomplete reasons for leaving their positions because they plan to work elsewhere in the industry and don’t want to burn any bridges. Others exit without giving notice. Without knowing the real reasons why employees leave, it’s difficult to make adjustments that will lessen turnover.

Challenging assumptions

Organizations sometimes disparage the departing employee rather than look at what might have contributed to their resignation. Psychologically speaking, this lessens the “narcissistic injury” of someone leaving. A narcissistic injury is one that hurts our sense of self. Rather than feel the pain of being rejected, we reject them.

A typical assumption is that there was something wrong with the resigning worker. For example, they weren’t dedicated enough, they didn’t appreciate the benefits of the organization, or they weren’t very good anyway (the “sour grapes” effect). This leads to the sweeping conclusion that you just can’t find good people these days.

Rejecting someone who has left us may help us get over failed romantic relationships, but it’s a missed opportunity in business, especially if our workers keep marching out the door in droves as they have a tendency to do in LTC.

For the entire article, visit:

How to find out why your staff is leaving

Behavioral health care — not drugs — for dementia

Here’s my latest article on McKnight’s Long-Term Care News:

Behavioral health care — not drugs — for dementia

Antipsychotic medications have proved ineffective at reducing the symptoms associated with dementia. They also have serious side effects in older adults, including restlessness, dizziness, higher likelihood of falls and other problems that can contribute to an increased risk of death.

Behavioral health interventions, on the other hand, have no such side effects and have been found effective in reducing behaviors such as aggression, care refusal and wandering.

Employing behavioral health techniques with people with dementia becomes increasingly valuable as facilities in this country endeavor to follow the Centers for Medicare & Medicaid Services guidelines and reduce the use of antipsychotic medications.

Global efforts

Dementia care is a pressing issue around the world, and other countries have made headway in shifting from medication to behavioral interventions. Psychologist Paula E. Hartman-Stein, Ph.D., of The Center for Healthy Aging, writes about international programs that implement behavioral health methods in the September/October edition of The National Psychologist.

Dr. Hartman-Stein spoke with Cameron Camp, Ph.D., an expert who consults with long-term care facilities in the United States and abroad.

France

Dr. Camp reports that the French government pays nursing homes to train their staff in non-pharmacological approaches to dementia. The training includes various strategies, including Montessori techniques such as those described by Dr. Camp in his excellent book, “Hiding the Stranger in the Mirror,” and other publications.

Australia

Camp notes that Alzheimer’s Australia provides funding to train staff in behavioral health approaches. Its website, Alzheimer’s Australia Information for Health Professionals, offers helpful information and brief videos that explain the techniques used.

Canada

In Canada, the Canadian Foundation for Healthcare Improvement reports on the success “beyond the team’s expectations” of an effort to reduce antipsychotic medications and implement non-pharmacological approaches. The project saved $400,000 in six months across the Winnipeg region.

STAR-VA in the USA

Here in the United States, the Veterans Health Administration, less constrained by the fee-for-service psychotherapy model that plagues the rest of the country, utilizes staff psychologists and other behavioral health professionals in their Staff Training in Assisted Living Residences (STAR-VA) model.

For the entire article, visit:

Behavioral health care — not drugs — for dementia

7 powerful ways to deliver family-centered care

Here’s my latest article on McKnight’s Long-Term Care News:

7 powerful ways to deliver family-centered care

When families seek mental health treatment, it’s often because of a “problem child.” Family therapists consider this person to be the “identified patient” and recognize that the troubled individual is part of a family unit whose members all benefit from assistance.

By contrast, when a resident enters long-term care, we tend to focus solely on the needs of the resident, even though they’re almost always part of a family system that is being affected by their placement.
Oddly, we do this in spite of the fact that it’s frequently a family member who chooses the facility or community where the loved one will live.

If we consider that we’re admitting families rather than just the residents themselves, we’d recognize the need to provide family-centered care in addition to resident-centered care.

Instead, we repeatedly attend to the needs of families in a haphazard, reactive fashion. Those tense family meetings with the director of nursing and the administrator after the staff “mishandled” an interaction with a family member are more likely a lack of organizational attention to the needs of families and an absence of proper training than they are a reflection of staff error or of a “difficult” family.

Here are some ways to implement family-centered care:

1. Convey essential information to families about your facility or campus in a way that’s easy to access. If your website offers only platitudes about how you really care and then lists insurance options, you’re telling potential customers what you really care about and it isn’t them. Instead, turn your site into a 24/7 support kiosk, answering questions families commonly have about your community and helping them to be better caregivers and community members. Include, for example, information about their role in care plan meetings or how to help their loved one adjust to their new home. Add a list of resources they might want to consult. (My book, “The Savvy Resident’s Guide,” for example, is one way to offer information and soothe the frayed nerves of family members.)

2. Hold regular family meetings on topics that frequently affect them, such as caregiver stress, understanding dementia, and making the most of an off-campus pass (a great session to hold before the holiday season, hint, hint). Even though this may seem like yet another task to add to an already burdened staff, it will save time in the long run: Rather than answer the same questions individually, your staff can direct families to the meetings where questions can be discussed simultaneously and in depth.

3. Reach out to families during transitions in care, such as moving from an independent apartment to the care center in a continuing care retirement community.

For the entire article, visit:

7 powerful ways to deliver family-centered care

Dr. El presenting at McKnight’s Fall Expo 9/9!

It’s time for McKnight’s Fall Online Expo!

I’m pleased to be presenting at 11am ET on Wednesday, September 9th on the topic of “Letting Them Go with Style.” This free hour-long webinar will focus on how to use the loss of employees to strengthen your organization.

The other two webinars will address reimbursement and technology. The Expo will also offer the opportunity to earn CE credits, visit with vendors and chat with colleagues. It’s a great way to attend a conference without leaving your desk. I highly recommend it.

For more information and to register, visit McKnight’s Fall Expo.

Hope to see you there!

The high cost of rudeness

Here’s my latest article on McKnight’s Long-Term Care News:

The high cost of rudeness

A study about rudeness in the medical journal Pediatrics got me thinking about the possible effects of rudeness in long-term care.

In “The Impact of Rudeness on Medical Team Performance: A Randomized Trial,” teams were subjected to rude comments by a supposed visiting medical colleague. For example, he suggested that the team members in the neonatal intensive care unit (NICU) “wouldn’t last a week” in his country.

Compared to the control group, teams that had been exposed to the rude comments had lower diagnostic and procedural performance scores.

Naturally, I wondered how this research might translate to senior living.

I’m sure I’m not the only person who has observed rudeness occurring in eldercare settings, whether it’s an administrator being curt with staff, nasty remarks between staff members, a discourteous statement to or from a resident, or a sharp comment by a family member.

To complicate matters, LTC teams are often multi-cultural. What’s considered reasonable for one culture may be deemed rude by another culture.

In addition, a comment can be interpreted differently depending on the ages and genders of the people involved. If an older female staff member compliments a young woman on her outfit, it can come across differently than if an older male staff member similarly compliments his young female colleague.

Long-term care is also very hierarchical. Doctors often “get away with” rude comments to nurses, as do administrators with underlings.

The research, however, suggests that nobody is getting away with anything. Rude statements negatively affect team performance in the NICU and, I suspect, in teams everywhere.

The good news is that the study found two behaviors reduced the impact of rudeness: information sharing lessened the negative impact of rudeness on diagnostic scores and help-seeking reduced the adverse impact of rudeness on procedural performance scores.

Here are some ways to address rudeness in LTC:

For the entire article, visit:

The high cost of rudeness

Dr. El’s Shrinky LTC Fantasy

Here’s my latest article on McKnight’s Long-Term Care News:

Dr. El’s Shrinky LTC Fantasy

I hung up the phone with the managed care case reviewer. The patient in question was in her late 50s, with multiple sclerosis and other physical problems that had unexpectedly interfered with her ability to return home or even to sit comfortably in a wheelchair. Bed-bound, she was irritable with the staff and distressed about the changes in her life, and in financial circumstances that had resulted in this new insurance coverage.

“You can see her for another 30 days,” the case reviewer told me. “After that, I’ll have to send it to a second level review.”

I sat at the desk in the administration office, hyperventilating. What else would need to happen to this resident in order to get more than a month of treatment? An amputation? The death of her only child?

I took my mind to a better place:

I was in my office at the rehabilitation and care center reviewing the psychology calendar for the month:

• This week I’d shadow the east wing staff and focus on team building.

• My weekly open office hours with the staff had several appointments already filled to discuss conflicts with coworkers, finding better ways to interact with a difficult resident, and how an otherwise excellent worker could get to work on time.

• The topic for the August family group meeting was set: How to partner with the staff.

• The monthly staff training topic was planned to coordinate: How to work with families. Other trainings I had in mind were on facing challenges such as aggressive residents, understanding mental illness, dementia without medication and team management of end-of-life care, in addition to handling work/life balance, reducing stress, time management, and coping with loss.

• The data collection for my research project was progressing nicely. Copies of my book, “The Savvy Resident’s Guide,” had been distributed to the recreation therapists, who were using them to run discussion groups with the residents based on chapter topics such as “Working with the staff” and “Making the most of rehabilitation.” Residents were being measured on acquired knowledge, level of anxiety, conflicts with staff and participation in rehab.

For the entire article, visit:

Dr. El’s Shrinky LTC Fantasy

The Goodbye Guide: Why and how to terminate tenderly in LTC

Here’s my latest article on McKnight’s Long-Term Care News:

The Goodbye Guide: Why and how to terminate tenderly in LTC

An experienced colleague was recently let go from her job to which she’d been dedicated for 10 years. “We want to take things in a different direction,” she was told by the administrator. “Pack up your office and go.”

An hour later, she was in the parking lot holding a box containing a photo of her kids and mementoes of a decade as head of the social service department. Her replacement started two days later.

There are, of course, occasions when people who are fired or otherwise are terminating employment and need to be escorted from the building. But many workers are career professionals who wouldn’t consider burning bridges with bad behavior. Despite this, I’ve witnessed hasty dismissals and hushed resignations on multiple occasions throughout my career.

Sometimes, departing coworkers will tell me they didn’t want to let anyone know they were leaving because they didn’t want to deal with the residents’ being upset.

In my training to become a psychologist, we spent a great deal of time discussing endings and termination of treatment. While work in long-term care isn’t necessarily a psychotherapeutic relationship, I believe leave-takings in LTC are more important than in other settings and that the style of departure should be given more consideration.

Here are some aspects to consider:

• Due to the nature of the work, staff members form deep relationships over time with the residents and their families. When we depart, it matters to them.

• Because we work with elders and those who are ill, people are constantly leaving — through death, discharges, and hospital transfers — often suddenly and without the chance to say goodbye. This can create small traumas. In compassionately addressing our departures, we have the opportunity to reduce the amount of trauma in the lives of our residents rather than contribute to it.

For the entire article, visit:

The Goodbye Guide: Why and how to terminate tenderly in LTC

Free Webinar 5/20 @2pm ET: 9 Ways to Improve the Effectiveness of your Social Work Department & Increase LTC Resident Satisfaction

Join Dr. El

Wednesday, May 20th

at 2pm Eastern Time (1pm Central Time)

for a

FREE Webinar on

9 Ways to Improve the Effectiveness of your Social Work Department

& Increase LTC Resident Satisfaction

sponsored by EmLogis

To register:

visit EmLogis Events

About the webinar:

Are your residents depressed, their families distressed, and your staff turnover rate higher than you’d like? Empower your long term care social service department to lead the way to change! Join LTC expert and psychologist Dr. Eleanor Feldman Barbera for a live webinar on Wednesday, May 20, 2015 at 1pm CDT | 2pm EDT as she discusses the importance of social workers and ways in which an effective department can transform your community.

What you will learn:

The most important factors contributing to resident satisfaction
The impact of social workers upon resident, family and staff satisfaction
9 easy-to-implement strategies to develop your social work department

Who should attend this webcast:

Administrators and assistant administrators
DONs, ADONs, social workers
Staff training coordinators
Human resource department staff

America has a major misconception about aging

I’m honored to be included among the 44 industry experts asked about the future of long-term care in this informative infographic and article:

http://www.seniorcare.com/featured/misconception-on-aging/

McKnight’s Free Online Expo 3/25 & 3/26

Those who like the convenience of attending a conference without leaving their desks (and the fact that it’s free!) will be pleased to hear that McKnight’s is holding their online Expo tomorrow and Thursday on the following topics:

WOUND CARE TRACK: “The current science of pressure ulcer prevention (Or It’s Still Rock and Roll To Me)”

CAPITAL TRACK: “2015 seniors housing capital market trends — and influencing factors”

PAYMENT TRACK: “MDS 3.0 Update: Know the new requirements, or else”

QUALITY TRACK: “Ways to reduce rehospitalizations and attract partners”

TECHNOLOGY TRACK: “Using technology to track resident preferences and activities to drive quality improvement”

(After the last McKnight’s webinar on Wednesday, head over to my Senior Bullying webinar at 2pm ET sponsored by EmLogis — think of it as the Mental Health Track.)

You can earn 3 CEUs and visit the vendor booths, as well as chat with other conference attendees via your avatar.

To register for the conference, visit McKnight’s Online Expo