Category: Common Nursing Home Problems and How Psychologists Can Solve Them
Posted by Dr. El - May 23, 2012 - Anecdotes, Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, Role of psychologists
“I had a couple of relapses this week,” Betty told me, looking ashamed.
We’d been working in psychotherapy on her efforts not to snap at the aides and nurses who came to care for her.
“I try not use to my call bell,” she went on. “Sometimes I sit here for two hours thinking about it before I press it.”
“Maybe that’s part of the problem,” I suggested. “If you’re waiting for two hours before you let them know you need help and then it takes them a little while to get here, by the time they arrive you’re ready to explode.”
She nodded. “That’s true.”
Betty was more psychologically-minded than many residents, so I took things a step further. “It’s also not taking very good care of yourself to wait two hours to ask for help. If you had a child who needed help, would you make them wait two hours?”
“No!” Betty’s bulletin board was filled with the Mother’s Day, birthday, and Christmas cards her only child sent instead of visiting.
“Now you have a chance to give yourself the care you didn’t get as a child.”
“What do you mean?” she asked sharply, “My parents took care of me!”
“From the things you told me about what went on in that house, you children were not getting enough supervision.”
Betty, an incest survivor, stared at me. “I never thought of it that way.”
“This may sound corny, but now Grown-up Betty has the chance to take care of Little Betty, and ask for what she needs when she needs it.'”
Betty burst into tears. “Wow…wow…I never thought of it like that.” She pulled a tissue out from the box on her tray table and blew her nose. “I could do that. I could take care of myself.” She gave me a piercing look. “Wow…thank you!”
Posted by Dr. El - March 4, 2012 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them
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!
Posted by Dr. El - February 28, 2012 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Long-Term Living Magazine, Psychology Research Translated, Role of psychologists
Check out my article, 4 Ways Psychology Can Improve Your Bottom Line, featured on Long-Term Living Magazine’s online site:
It’s common knowledge that mental health and physical health are connected, but are you aware that applying mental health concepts to your organization could save you money? Observe the four theories below and my hypothetical long-term care scenarios. Who knows, this could be you.
1. Take a tip on workplace behavior from industrial-organizational psychology.
The nurse searched through the file drawer for a Consultation Form, flipping through one torn, faded manila folder after another. “I don’t have time for this now!” she said to no one in particular, eyeing a stack of paperwork at the nursing station. “I’ll get it on the way back from lunch.”
But the afternoon brought a new admission, and the referral never occurred. This didn’t escape the notice of the state surveyors, who cited it as a deficiency. The missed referral also resulted in a downturn in the health of the resident, who required a readmission to the hospital. Her family later filed a lawsuit for negligence.
The nurse, visiting Starbucks while searching for a new job, watched the barista prepare her coffee drink. All his equipment was in reach and clearly labeled. With a few movements, her drink was set on the counter for pick up—the same way it’s done in every Starbucks everywhere. She sighed. If only that Consultation Form had been within reach….
Borrow franchise-like organization systems to streamline functioning, with standardized tools in standardized locations, facilitating movement of staff between facilities and from unit to unit, which cuts time spent on repetitive tasks. Five minutes per staff member spent searching for a pantry key, a syringe or some clean linens quickly adds up, even if they don’t contribute to a citation, hospital readmission or lawsuit. Get organized and save yourself a bundle.
For more, read 4 Ways Psychology Psychology Can Improve Your Bottom Line…
Posted by Dr. El - November 4, 2011 - Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, Engaging with families, Tips for gifts, visits
With Thanksgiving upon us in less than three weeks, it’s time for this perennial post from Dr. El at mybetternursinghome.com:
‘Twas the Week Before Christmas…
And 83-year old Albertha assured me her family was planning to take her home for the holidays.
“Have you talked to them about it? Have they called the social worker to arrange a pass, and meds, and transportation?”
“No,” she replied, “but they’re coming to get me.”
‘Twas the week after Christmas, and Albertha was glum.
“They didn’t show up. I waited all day, but they didn’t come.”
Albertha spent Christmas day watching other people go out on pass and return, and seeing families arriving with food and gifts and smiles.
Now my patients and I start discussing the holidays a few weeks in advance, addressing wishes and practicalities, phoning families if needed, and getting the social worker involved. We set up a hierarchy of plans.
Plan A: Go home for the day.
Plan B: Go out to a wheelchair accessible restaurant with family.
Plan C: Have visitors come with food and go around the corner for coffee, if possible, just to get out.
Plan D: Stay in with visitors and food.
Plan E: Talk to family members on the telephone, discussing plans for a future visit, while sitting in a room festooned with cards and holiday decorations. Attend the nursing home holiday party.
Plan F: Have a small holiday gathering in the room with nursing home friends after the facility party.
Since then, my people know what to expect from the holidays, even if the expectation is that their family might not arrive as hoped.
Posted by Dr. El - June 20, 2011 - Books/media of note, Common Nursing Home Problems and How Psychologists Can Solve Them, Stress/Crisis management
When nursing home residents are evacuated from their facilities after any type of disaster, they typically move to another nursing home rather than to a public shelter. They therefore miss the opportunity to speak with trained first responders who can help them address their emotional reactions to the experience.
Developed by psychologist Lisa M. Brown, PhD, and colleagues, the guidebook is based on the idea that, like medical first aid, anyone can be trained in psychological first aid techniques. The Psychological First Aid: Field Operations Guide for Nursing Homes provides training information specific to the needs of nursing home residents, including those with dementia.
The guidebook is an incredibly valuable resource, generously made available for FREE, and worth the click. A quick perusal of the table of contents will give you a sense of whether or not you and your staff members are prepared to help the residents in the event of a disaster.
Posted by Dr. El - November 3, 2010 - Common Nursing Home Problems and How Psychologists Can Solve Them, Role of psychologists
Part Three of a Three Part Series
I recently interviewed Jeff A. Beaty, D.H.Ed., LMSW, QDCP, SSBB, Chief Development Officer for Signature HealthCARE, about the role of psychology at Signature.
I was pleased to hear that in addition to providing direct care to residents (which is generally paid through the resident’s insurance), Signature contracts with psychologists at least 20 hours per month for additional consultation. Their work includes:
- Staff training
- Assistance with research projects
- Intervening with staff as needed with particular residents
The services have resulted in medical cost offset through:
- Reduced use of psychopharmacology
- Reduced inpatient hospitalizations
According to Beaty, Serenity provides training programs to educate staff on the behavioral and psychological symptoms of dementia, particularly agitation. These psychosocial interventions have been shown to reduce caregiver emotional distress, he reports.
Serenity HealthCARE, in conjunction with the International Center for Long-Term Care Innovation and its partners, also has several ongoing research projects geared toward helping those with dementia lead more satisfying lives. One study focuses on matching residents and staff by personality type and attitude, anticipating an improvement in quality of life for residents and staff, reduced resident/staff conflicts, and improved employee retention. It reminds me of what my old supervisor used to say (and I have found to be true): “There’s a lid for every pot.”
I’m always interested to hear how mental health interventions reduce other costs, so if you have an example at your facility, please feel free to email me via the Contact button in the right sidebar, or add your comment below.
Posted by Dr. El - October 11, 2010 - Common Nursing Home Problems and How Psychologists Can Solve Them, Role of psychologists
Dear Researchers,
I’ve been a nursing home psychologist for the last 14 years, and, while there are many fascinating areas to be studied in the field of geropsychology, I’m writing to you with the hope that we’ll see more research on the medical cost offset of psychological services.
One type of study could look at archival data from Medicare/Medicaid or private insurance companies comparing the medical costs of beneficiaries receiving psychological services with those who do not. I’d expect to see decreased use of medications, and possibly reduced use of aggressive end of life treatments. Studies showing reduced medical expenditures could result in changing regulations to require psychological consults upon nursing home admission, much like therapeutic recreation and dental service evaluations are required, and would increase the likelihood that insurers would promote mental health services in physical health environments.
Another type of study would take place within individual nursing homes, comparing floors or units receiving psychological interventions with those that don’t. Such studies could examine the effectiveness of psychotherapy provided to residents on measures of resident, staff, and family satisfaction, absenteeism, incidents, turnover, etc. Other studies could measure the effects on those variables of a broader application of psychological services, such as team-building on a unit, communication skills training, conflict resolution, establishment of a therapeutic milieu, etc. If research indicated that providing psychological interventions to residents and staff decreased overall costs within individual nursing homes, perhaps we’d begin to see psychologists funded as part of the nursing home budget and able to provide a greater range of services.
If you’re a researcher who’s been working on medical cost offset studies, please contact me if you’d like a blog post about your research. Let’s get the word out.
Sincerely,
Dr. El
Posted by Dr. El - October 5, 2010 - Common Nursing Home Problems and How Psychologists Can Solve Them, Resident care, Role of psychologists
A recent article in McKnight’s Long-Term Care News (September 2010) caught my eye: Attitude appears to affect healing process for wounds. The article cites a research study in the August issue of Dermatologia that found patients who were less depressed had wounds that healed faster. It also found slower healing in those who had “confrontational” coping styles and therefore had difficulty with the loss of control around waiting for a wound to heal.
It turns out this isn’t an isolated conclusion. A
2008 study in the Journal of the American Podiatric Medical Association found similar results regarding depression and healing. Stress and depression were found to affect healing in a
2001 study in Psychosomatic Medicine. In 2008,
researchers at Cairo University found the use of relaxation techniques helped reduce depression and improve wound healing and recovery in post-Coronary Artery Bypass Grafting (CABG) patients.
- Residents recovering from wounds or surgery
Posted by Dr. El - August 17, 2010 - Anecdotes, Common Nursing Home Problems and How Psychologists Can Solve Them, End of life, Transitions in care
“I never say goodbye,” Mr. O’Hara told me, “because that’s what my mother said when she left me as a child. Then she died and I never saw her again.”
At 91, Mr. O’Hara was slim and getting slimmer. He began our next session as usual, discussing the procedures he was receiving from the doctors to save his fingers. “It feels like the knives are still in me.” He grimaced, gently caressing his bad hand with his good one. “They want me to come back in two weeks.”
Mrs. O’Hara appeared in the doorway, wearing her trademark red lipstick and bright suit. We spoke for a while about his health, her health, and their 65-year marriage. She came every day at lunchtime, bearing his favorite foods and spending an hour coaxing him to eat before they headed to the afternoon’s recreational activities.
On the way off the unit, I spoke to the nurse at the front desk. “Mr. O’Hara looks awfully thin lately.”
“Yeah,” she said, “the doctor wants him to go on hospice, but the family refuses.”
Alone with him a few weeks later, I asked Mr. O’Hara if he’d ever discussed dying with his wife.
“Oh no, we never talk about it. That’s a big good-bye.”
“I suppose it is. What do you think happens after people die?”
Mr. O’Hara was silent for a moment. “I’ve been taught that we’ll all meet in Heaven, and I sure hope so. I’d like to see my mother again.”
“That would be some reunion, wouldn’t it?” I glanced at the framed photo on the dresser of a stern-looking woman in a flowered dress. “Can we talk to your wife about this the next time I see her?”
“Yes. I guess that would be all right.”
“Okay then. Take care,” I told him as I left.
Two weeks later, Mrs. O’Hara arrived carrying her home-cooked meal, and I motioned for her to sit down on the bed. “Your husband and I were talking the other day, and he said he thinks we’ll see the people we love after we’ve died. Is that what you believe?”
Mrs. O’Hara didn’t even blink at the question. I was talking about the elephant in the living room.
“Oh yes, I believe that too.”
“That must be a great comfort, to know you’ll see each other when you pass on.”
Mr. O’Hara spoke up. “At 91, there are a lot of people waiting there for me. I’m going to be busy.”
“Well, you’d better make time for me!” Mrs. O’Hara joked, and we all laughed.
A few weeks later, Mr. O’Hara went to the hospital and I stopped at the nursing station to see when they expected him back. “He’s not coming back,” the nurse told me. “His family decided to do hospice at the hospital.”
“Oh,” I said, happy and sad at the same time.
Goodbye, Mr. O’Hara. Goodbye.
Posted by Dr. El - January 26, 2010 - Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, Customer service, Depression/Mental illness/Substance Abuse, Resident care
An iatrogenic illness is one which results from health care treatment, and iatrogenic depression is typically a side effect of medication. I take a broader view of “treatment” and think of iatrogenic depression as a customer service failure. I see nursing home residents who have become depressed as a result of interactions with staff that left them feeling unimportant, and with nursing home systems that resulted in feelings of powerlessness. The good news is that this type of iatrogenic depression can be cured by training staff and adjusting systems to be accountable to the residents.
Resident/Staff Interactions
Without Accountability
Staff: “I’ll be right back.” (Never returns.)
Resident: feels neglected, invisible, possibly paranoid (why are they doing this to me?), angry, anger turns inward to depression
With Accountability
Staff: “I’ll be back in about ten minutes, after I finish up with someone down the hall.” Returns in about ten minutes.
Resident: knows how much of a wait to expect, which reduces anxiety; feels cared for and respected
Or, Staff: “I’m sorry about yesterday. I meant to come right back to you, but I had an emergency and didn’t remember until I was halfway home. Please accept my apology.”
Resident: will probably take some time to forgive and begin to trust again, but feels better having the situation acknowledged
Nursing Home System
Without Accountability
Resident Council Staff Representative/Leader: “Great suggestion. I’ll bring it up with the administration.” (The last the group hears about it.)
Residents: feel bringing up concerns is pointless, the resident council meaningless, and that their experiences aren’t valued
With Accountability
Resident Council Staff Representative/Leader: “The administration and I discussed the suggestion raised by the group at the last meeting, and we’re going to begin the project by taking this first small action.”
Residents: feel their recommendations and experiences are valued and that they’ll get their needs/wants met by a responsive organization; feel energized as a group
Or, Staff Rep: “The administration and I discussed last month’s suggestion, but there were some obstacles in the way. Let’s work as a group to think of ways in which we might overcome them and move forward with the project.”
Residents: feel respected and included in decision-making even though they might be disappointed their suggestion wasn’t immediately implemented.
