Category: Communication
Posted by Dr. El - November 29, 2010 - Boomers, Business Strategies, Communication, Customer service, Engaging with families, Technology, Younger residents
Looking for a great, inexpensive way to create some good will and holiday cheer at the nursing home this year? Why not set up a call center using Skype? Residents, families, and staff members can sign up to call loved ones around the globe, conversing with them via video call.
What it would take:
- A laptop or desk-top computer set up with FREE Skype
- A semi-quiet, semi-private area for conversations
- Tech support, or volunteers who know how to use Skype (for example. high school students or tech-savvy residents)
- A pre-call information sheet for families so they can set up Skype on the computers of those they plan to call.
- A sign-up sheet to maintain order in what is likely to be a wildly popular service
Posted by Dr. El - November 16, 2010 - Communication, Engaging with families, Tips for gifts, visits
I posted this before the holidays in 2008, but it’s worth repeating:
‘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 - September 27, 2010 - Communication, Resident care
After my session with Evelyn, who painstakingly typed her thoughts on her computer, I stopped at the nursing station to relay her message.
“Can you tell me which aide works with Evelyn Booth in 302?” I asked the nurse.
“Ms. Johnson,” she said, and pointed to a Certified Nursing Assistant (CNA) in a light blue uniform.
Hearing her name, Ms. Johnson turned and glared at me. “How do you know it was me?”
Surprised, I smiled and spoke in a soothing tone to reassure her. “Did you work with Ms. Booth this morning?”
She put her hands on her hips and spit out a single word. “Yes.”
“Well, she wanted me to let you know she really liked the way you did her hair today.”
“Oh.” She appeared surprised by the compliment, but unwilling to discard her initial suspicion. “Thanks.” She turned and walked away.
In 14 years as a psychologist in long-term care, I’ve occasionally come across an aide who was willing to collaborate with me in helping a resident. We discussed troublesome behavior and found ways to work around it, shared information, and developed a friendly collegial relationship. I’m disappointed such instances are exceptions rather than the rule, and I’d like to see this change. The way I see it, the psychologist is the CNA’s friend, here to make your job easier, not to write you up.
The current punitive system, where CNAs are more likely to be disciplined than rewarded, poses challenges to collaboration, but I think we can do better. I’d like to find ways to bridge this divide, and I need your help. If you have suggestions, or experience with developing alliances between nursing staff and other members of the team, please leave them in the comments section, or send me an email via the Contact Me button. Let’s start the teamwork right here.
Posted by Dr. El - September 20, 2010 - Communication, Customer service, Resident care
Complaint #5: There’s no one here for me to talk to.
Untrue! But we need to prove it to residents by helping them connect with their peers.
The false impression they’re alone in the nursing home is based on several factors:
- New residents carry the prejudices of most people outside the nursing home, believing everyone inside is confused or too ill to carry on a conversation.
- The tendency of people to believe they’re unique, when in fact there are many uniquely interesting people in nursing homes. I know. I’ve spoken to them.
- Nursing home “old-timers” who are more alert tend to leave their units to attend activities. When newbies arrive, they try sitting in the hall or in the day room and, finding the more confused residents, they come to the conclusion that everyone is confused and then retreat to their rooms.
- Because most residents are visibly physically disabled, people often incorrectly assume they’re cognitively disabled as well.
Techniques for Family Members to connect residents include:
- Attending activities with loved ones and talking with other residents/families there.
- Asking nursing, recreation, and social work staff about other residents with interests similar to your loved one and helping to facilitate conversations about commonalities.
- Asking recreation, dietary, or nursing staff to seat your loved one near their friends during meals and activities if your loved one is unable to ambulate on their own.
Techniques for Staff Members to connect residents include:
- Introducing new residents to others with similar interests.
- Encouraging them to attend activities before they settle into spending their days alone in their rooms.
- Recognizing strengths and sharing them with others in the community. For example, a new resident agreed to be interviewed for a feature story in a nursing home newsletter.
- Helping residents establish a welcome committee.
Posted by Dr. El - September 9, 2010 - Communication, Customer service, Resident care
Complaint #4: Nighttime disturbances
The main culprits:
- TVs blaring into the wee hours
- Agitated neighbors
- Loud conversations between workers
Steps toward improved sleep hygiene:
- Implement a TV curfew and require night owl viewers to use headsets past the curfew
- Encourage night shift workers to report resident sleeplessness so sleep/wake cycle disturbances can be reversed and medications adjusted if necessary.
- As part of inservice training, address ways in which night staff can communicate with each other to avoid disturbing sleeping residents.
Good sleep hygiene on an individual basis can reduce irritability, improve memory, and promote healing. Good sleep hygiene on a unit-wide basis is good customer service that can benefit the physical and mental health of residents and reduce conflict between residents (it’s hard to be friendly toward someone who’s kept you up all night).
Posted by Dr. El - August 24, 2010 - Communication, Customer service, Resident care
Complaint #3: The Patient Lift
The patient lift is a machine used to transfer a resident from their bed to their wheelchair and back. No resident I’ve met likes using one, and I suspect the reason is the combination of loss of control, the frightening feeling of being suspended, helpless, in midair, and a lack of training which makes the procedure more alarming and uncomfortable than it needs to be.
When I was in grad school, all psychologists-in-training were required to undergo psychotherapy. Similarly, aides could gain perspective from a ride in the lift as part of their orientation or ongoing training. (I’d like to do this and blog about it, so if there’s a home in the New York Metro area willing to let me, please contact me.)
A professional approach by staff members with a focus on increasing confidence in the transfer procedure can reassure anxious residents. Techniques that reduce anxiety include:
- letting residents know what’s about to occur at each step of the process
- engaging in a dialogue with residents so they know the focus is on them
- listening to feedback about how they’re feeling (frightened, uncomfortable, etc) and responding to their concerns
What techniques do you use to make this procedure more pleasant?
Posted by Dr. El - August 10, 2010 - Communication, Customer service, Resident care
Complaint #2: The Food
Where is the Emeril of nursing home food? It’s time to kick things up a notch. There’s a huge opportunity for improvement in the quality, number of choices, and presentation of the food in nursing homes, and to affect the satisfaction of the residents with their meals.
A good start is to increase the food rotation schedule to at least a four week rotation. Residents also appreciate having their hot food hot and their cold food cold. Restaurant-style service, where residents are offered options while sitting at their table, is as popular as the flowers decorating said tables.
I’ve heard of facilities stimulating appetites by filling the dining rooms with the aroma of fresh-baked bread. What other meal-enhancing ideas are out there?
[Second post in a biweekly series. Here is Post #1]
Posted by Dr. El - July 25, 2010 - Communication, Customer service, Resident care
Complaint #1: No One Coming When the Call Bell is Pressed
I’ve worked on units where the moment the call bell goes off, the charge nurse immediately and calmly asks an aide to check on the room. The bell goes off, someone arrives. Simple customer service. This leads to a unit full of residents who feel confident their needs will be addressed in a timely fashion, and are therefore far less anxious. Staff training is a good way to change the nursing home culture on this issue, but each worker can take it upon themselves to make it their own personal policy even if the nursing home as a whole isn’t making it a priority.
[First post in a biweekly series]
Posted by Dr. El - June 30, 2010 - Communication, End of life, Resident education/Support groups
The Health Insurance Portability and Accountability Act (HIPAA) ensures that the personal information of our nursing home residents stays personal, but sometimes it’s taken too far. Well-meaning staff members, not wanting to violate HIPAA, are unsure whether or not to share news of a resident’s death with their friends in the nursing home, so they err on the side of caution. This leaves other residents wondering what happened, and, if they suspect a death occurred, they’re left with the unhappy knowledge that their own death could also pass unacknowledged.
Some members of Psychologists in Long Term Care recently discussed this and the consensus was that since someone’s death is a matter of public record, letting other residents know about it is not in violation of HIPAA. To follow up on this, I contacted the New York State Department of Health Nursing Home Hotline (888-201-4563) and they concurred: it’s okay to tell others that the person died, but not to give medical details.
Similarly, it’s within HIPAA guidelines to let a roommate know, for example, that their friend in the hospital should be returning to the nursing home soon, but not to discuss details of their health condition without the permission of the hospitalized resident or their family.
Part of creating more homelike nursing facilities is honoring the bonds created between residents. It’s important to share news, within the limits of HIPAA, of how friends and neighbors are faring, and it’s especially important to acknowledge the lives and deaths of those in our care.
Posted by Dr. El - May 24, 2010 - Business Strategies, Communication, Customer service, Engaging with families, Technology
For families with hectic schedules, trying to attend Care Plan Meetings, which occur during daytime work hours, can be a major challenge. Of course they don’t want to miss the opportunity to meet with the whole treatment team to provide and gather information, and to advocate for their loved one. On the other hand, taking time from work and other obligations may prevent even the most dedicated family member from being able to show up for this very important meeting. Using the free Skype or another video call option would allow family members to be present from almost anywhere — even halfway across the world.
For nursing homes, offering families the option to Skype into Care Plan Meetings shows their understanding of the challenges faced by family members and their dedication to customer service. It highlights their commitment to providing the best possible care for the residents, which includes facilitating the ability of families to be part of the treatment team. And did I mention it’s free?
