Category: Communication

The added value of social workers and psychosocial services

The top recommendation in the April 9 McKnight’s article “Researchers share 6 tips to improve nursing home care for blacks and Latinos” was to include a social worker on staff in the facility. “Great,” a reader commented, but “ask CMS … if they will pay for it.”

Perhaps, though better yet, social workers will pay for themselves.

A study published in March discussed the role and value of social work staff, with the surprising finding that deficiency scores are reduced twice as much when there’s an increase in social service staffing as compared to an increase in nursing staff. Lower deficiency scores can translate into better CMS star ratings and increased admissions, as well as reduced liability risk, creating a financial savings worth the price of a social worker salary.

The research brief goes on to report that while there’s been an increase in staffing in many other departments over time, the number of social workers remains low. The authors also note that there are no mandated qualifications for social work staff but that when social workers have higher qualifications such as a master’s degree, resident outcomes improve.

Interestingly, the other department that had almost as much effect on improving deficiency scores was the activities department, another psychosocially focused part of the team. (They didn’t study consulting psychologists, but I’d like to think we would have helped as well!)

For the entire article, visit:

The added value of social workers and psychosocial services

12 steps to starting a new job with serenity

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

12 steps to starting a new job with serenity

In my last column, “How to quit like a shrink,” I outlined ways to exit a nursing home that solidify the connections made there and offer the opportunity for healing. Assuming you’re not independently wealthy, what follows after leaving one position is beginning another.

The start of a new job, while exciting and hopeful, also can be very stressful. Perhaps it’s your first position, or maybe you’ve taken on a supervisory role or increased your responsibilities. Even if you’re performing the same types of tasks you’ve completed for years, you’re now in a new setting, adjusting to an unfamiliar work culture with different people and systems.

Here are 12 steps that may make the transition more manageable:

1. Give it time.I estimate that it takes six months before your new coworkers — who may have seen them come and go many times over — actually believe you’re there. It’s not until you go on vacation and they miss you that they realize you’re a solid part of the team.
2. Give it time. Relationships with coworkers won’t be established overnight. Be pleasant. Be professional. Be chill. It will happen and it will be better if you don’t try to force it. Join coworkers in the cafeteria if invited but bring a book to read just in case.
3. Don’t let ’em see you sweat. You’re not imagining it. Everyone IS checking you out to see what kind of person you are and whether or not you’ll be able to do your job. This is a good time to “act as if” you’re unperturbed even when you can’t locate the restroom or there’s a code for the copy machine no one told you about. Freak out at home or with your friends but maintain a calm façade while at the facility. If anyone asks, things are going great.
4. Ask questions. Even when you’re trying your best to showcase your competence, there will be times when you don’t know the answer. It’s better to ask how particular tasks are accomplished at the facility than to assume that they’re done the same way they were at your last nursing home or how you were taught in school. Reasonable questions showcase competence more than erroneous assumptions.
5. Be aware of dynamics. If you’re lucky, you’re following in the footsteps of someone truly awful at their work and everyone will be rejoicing at your arrival. More often than not, however, there are mixed feelings about your replacement of a former employee and unspoken interpersonal and departmental dynamics. Maintain the aforementioned calm façade while people adjust to your presence and if problems arise, consult with a wise friend, former colleague or current supervisor.
6. Get organized. One of the best ways to gain a sense of control over a new situation is to begin putting systems in place. After you’ve discovered what you need to do, taking the time to figure out how to do it most swiftly and successfully will pay off in the long run. Create paper or digital files, post telephone numbers by your desk and/or enter them into your phone and establish order to calm your mind and make your process easier.

For the entire article, visit:

12 steps to starting a new job with serenity

How to quit like a shrink

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

How to quit like a shrink

Employees leave their positions for many reasons — organizational restructuring, family needs, a better offer — and they exit their jobs in a variety of different ways. Some sneak out quietly so that their coworkers find out only after they’re already gone. Others have a swift, drama-filled exit, walking off after an argument, never to return.

While we as individuals may have no say over how our companies discharge workers, if we’re voluntarily leaving an organization, we’re likely to have a significant amount of control over how we depart. For professionals hoping to maintain connections with colleagues, leave-taking is an opportunity to create a positive last impression. While we’re making the effort to finish up our work and create a smooth handoff of responsibilities, we also can showcase our expertise in handling exits.

As I noted in a column about how to fire staff members, “The Good-bye Guide: Why and how to terminate tenderly in LTC,” endings of all kinds are especially important in this field. Beloved residents may die unexpectedly or be transferred to the hospital and vanish from our lives. With the departure of each resident, their families disappear as well, compounding the loss.

This steady but generally unacknowledged drumbeat of sadness has a strong impact on workers. (I believe it’s why many employees don’t complete their first year. For more on that topic, see “Absenteeism and turnover in LTC? Death anxiety could be the cause”.) In an environment where there are many sudden and sometimes disturbing endings, well-planned departures can be opportunities to heal some of this pain.

They also can help to solidify connections and offer an opening to obtain contact information for colleagues with whom you’d like to stay in touch after you’ve gone.

There are entire volumes devoted to the psychological process of termination, but I’ve created a quick guide below based on my experiences with leave-taking in LTC:

1. Give people time to emotionally and practically process your departure. Typically, this is two to four weeks, depending on the level of your interactions with them.

For the entire article, visit:

How to quit like a shrink

A gift from LTC families

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

A gift from LTC families

A study of interactions between families and healthcare providers published in the BMJ this month sparked my interest. It showed that improving communication between the two groups reduced harmful medical errors by 39%.

As if that vast reduction in medical errors weren’t enough, it was caused by harnessing the input of team members who don’t cost facilities a penny. In an era of intense financial pressures for the industry, free team members are a gift that shouldn’t be overlooked.

According to the researchers, the study “indicates that improving communication between families and healthcare providers doesn’t just feel good, it can help improve the safety and quality of care.”

Family strength

In Editor Jim Berklan’s excellent blog postlast month, he points out research that shows that families “don’t know what they’re talking about” when it comes to loved ones’ end-of-life care preferences. (If that’s so, we as experts should be facilitating Care Conversations.)

While family members may fall short on end-of-life wishes, they’re generally more expert than we are on their parents’ medical history and behavior. They know that their father didn’t react well to a particular medication when he took it at home or that Mom is “acting funny,” even if they don’t know why.

I myself have gone to the nursing station with the complaint that a resident is “off” somehow and been dismissed in my concerns, to the detriment of the resident’s health. Over the years, I’ve learned that I should phrase it as a “change in mental status” and to speak in a tone that conveys the depth of my experience and the seriousness of my observations, but basically I’m saying that the resident is “acting funny” and it seems physical, not psychological. I’ve detected sepsis, strokes and other emergencies this way.

If the nurses aren’t receptive to perhaps poorly-phrased information from psychologists, recreation therapists and other non-medical personnel, they may also be missing valuable information from families.

The BMJstudy shows how we can train staff to be more responsive to family input.

Family-centered rounds

For the entire article, visit:

A gift from LTC families

Healthcare changes that burn me out — and burn me up

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

Healthcare changes that burn me out — and burn me up

I was recently required to take an online training module on burnout for physicians and allied professionals. It was the first time in 20-plus years that I’d received a formal message about self-care from any long-term care institution (aside from yearly staff appreciation barbecues and survey completion parties).

While I was impressed and grateful for the focus on caregiver well-being, a couple of points bothered me.

The questionnaire asked readers to select the phrase they most associated with provider burnout. There were options such as “workplace dissatisfaction” and “challenging patients.” I chose “changes in the healthcare system,” which triggered a pathway specific to that option.

I was guided through a series of vignettes discussing issues old-timers might have trouble with, such as adapting to the electronic medical record. Following the vignettes, helpful strategies were offered to manage stress.

Then came the part I found disturbing: The details of the “changes in the healthcare system” choice included “the emphasis on the healthcare experience of consumers” and “the shift from volume to value.” Let me explain why that irks me.

The experience of healthcare

Regarding consumer experience, most of my direct care team members and I have been very focused over the years on accommodating the needs of residents. It’s become more difficult, however, to maintain care quality and orderly surroundings in a healthcare environment where financial pressures have led to staff reductions and increased turnover amidst higher acuity residents.

Trying to deliver a decent customer experience without the necessary tools is part of the change in the healthcare system that induces my feelings of burnout — not the “new” attention to perceptions of consumers.

I’d be gratified to see a genuine, top-down focus on the healthcare experience of residents and their families — complete with Resident Experience Officers in every long-term care facility (sign me up!). Such an emphasis would realign resources with a mission of care that can stabilize staffing and sustain facilities over time.

Volume to value

“The shift from volume to value” stresses me in a different way.

Part of my role as a psychologist in the “volume” approach has been to aid residents in negotiating their illnesses and treatments.

If necessary, I could help them stop a lucrative but unwanted onslaught of painful medical interventions by fostering communication with their physicians and families.

For the entire article, visit:

Healthcare changes that burn me out — and burn me up

The sounds of LTC

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

The sounds of LTC

Observing the customary cacophony at the nursing station, I’d estimate that so-called “alarm fatigue” contributes to more than a few tragedies in long-term care.

Here’s one example that resulted in a lawsuit filing after a resident died when nursing staff ignored the alarm signaling that her ventilator had become disconnected.

That’s why I was so interested in a Stat news article “Anatomy of a Beep,” which focused on collaboration between Medtronic, a medical device company, and Yoko K. Sen, an ambient electronic musician. The feature describes how medical devices came to have the sounds that they do — “alarms that are easily confused and difficult to learn and don’t really tell us what’s wrong” — and efforts to create a more helpful and appealing healthcare soundscape.

While the Medtronic project is geared toward a hospital emergency department with its plethora of health monitors, long-term care operators hoping to avoid alarm-fatigue-related medical catastrophes might take note of their efforts.

Among the many sounds typically competing for the attention of nursing home staff members are ringing telephones, television sets, conversations among staff members, overhead pages, elders calling for help, chair alarms, escalating arguments between residents, completed tube-feed nutrition cycle indicators, noisy nebulizers and oxygen concentrators, exit door and elevator warnings, and call bell signals. Specialized units such as ventilator programs will blare additional alerts.

While some employees are fortunate enough to be able to move to a quieter unit to complete their duties, most must contend with a din they have limited power to change. Researchers have found that noisy healthcare environments can significantly increase workers’ level of distress.

Residents, unless they can independently ambulate, have virtually no ability to escape the hubbub, which can border on an abusive level of noise pollution and can negatively affect their perceptions of their stays. In addition, studies have shown that noise can disrupt sleep and increase the likelihood of delirium.

Consider taking a moment to listen to the soundscape of your facility. Stand by the nursing station, close your eyes and imagine that the sounds are the backdrop for your eight-hour workdays, or your life, 24/7.

Below are some adjustments that can enhance the aural environment:

For the entire article, visit:

The sounds of LTC

Dr. El’s ‘Quality of Life’ star ratings are the way to go

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

Dr. El’s ‘Quality of Life’ star ratings are the way to go

Dr. El’s ‘Quality of Life’ star ratings are the way to go

Enhancing organizational communication improves outcomes, reduces adverse incidents

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

Enhancing organizational communication improves outcomes, reduces adverse incidents

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:

Enhancing organizational communication improves outcomes, reduces adverse incidents

Discussion forum of multicolored wooden toy figures on white background

To reduce burnout and turnover, improve family-staff relationships

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

To reduce burnout and turnover, improve family-staff relationships

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:

To reduce burnout and turnover, improve family-staff relationships

The importance of leadership in creating good deaths in LTC

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

The importance of leadership in creating good deaths in LTC

For the entire article, visit:

The importance of leadership in creating good deaths in LTC

Aging Insider Article