Category: Communication
Posted by Dr. El - May 10, 2010 - Business Strategies, Communication, Customer service, Engaging with families, Technology
My hip 80-something mother-in-law uses
Skype’s free video calls to view the family as she talks with them over the computer. I’d like to see video calls in nursing homes, either via a video phone or over the Internet in the resident computer room (what, your facility doesn’t have a computer room yet?).
- Families could literally see how their loved ones are doing, relieving anxiety and contributing valuable information to the treatment team. (Who knows better than her family that Mother isn’t quite right today?)
- It would allow long-distance family members to participate more actively in the lives of their loved ones.
- A laptop could be put on a movable cart in a wifi hotspot nursing home to bring to the rooms of residents who are unable to get to the computer room, reducing isolation.
- It’s a great marketing tool for families and residents alike.
Posted by Dr. El - April 13, 2010 - Communication, Psychology Research Translated, Transitions in care
There’s an interesting article about stroke rehabilitation by Tori DeAngelis in the March 2010 issue of the Monitor on Psychology. In “
New help for stroke survivors,” she writes about research showing that a “transfer package” is an essential component in maintaining the gains of inpatient rehab once the patient returns home. The transfer package includes elements such as “behavioral contracts, progress diaries, phone calls with their therapists and physical restraint of the arm outside the training setting.”
I believe some of these elements could be easily generated by the nursing home rehab staff prior to departure, such as a behavioral contract, and others could be implemented through a stroke-oriented support group following discharge. Residents would benefit if nursing home staff helped connect them to online and in person support groups prior to discharge.
There are several organizations that provide information and support for stroke survivors. I’ve listed some of them below:
Posted by Dr. El - March 9, 2010 - Anecdotes, Business Strategies, Communication
Okay, so it didn’t involve a disguise, but I did make an anonymous phone call to the New York State Department of Health.
When
I interviewed Mark Kissinger, their Deputy Commissioner of Long Term Care recently, he and Jacqueline Pappalardi, the Director of the Division of Residential Services, were friendly and reasonable. They said the Nursing Home Complaint hotline (888-201-4563) was open, and that in addition to taking complaints, the State was there to help facilities and staff with questions and problems that might arise. So I phoned to see if there could be a collaborative exchange with the DOH via the hotline.
I dialed *67 before the call, so my name and number wouldn’t be visible, and asked them whether or not it was against State regulations to use a cell phone in a nursing home. And guess what? They answered right away and were friendly, reasonable, and knowledgeable!
According to the hotline staff, there are no State regulations against using cell phones, but there may be a facility policy against it. There
is a State regulation about using the camera function in the nursing home. The Health Insurance Portability & Accountability Act (
HIPAA) states that it’s a violation of a resident’s privacy to take a photo of them without their permission. A resident needs to sign a waiver to agree to a photograph by a staff member, and care should be taken to ensure that another resident isn’t in the background of the photo, in violation of their HIPAA rights. I found this to be very helpful information, delivered in a respectful, collegial manner.
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.
Posted by Dr. El - January 19, 2010 - Anecdotes, Communication, Customer service, For Fun
Today’s story, courtesy of Sandra Cherry, LMT (Licensed Massage Therapist), is a humorous reminder to those of us in long term care to be mindful of jargon and the words we choose when speaking with those new to the nursing home.
Today I visited my dad at the nursing home and, as I prepared to leave, I came in contact with a fairly new resident who was somewhat agitated.
Me: Ms. Williams, why are you so upset?
Ms. W: I am so sick of these people in here. They want me to sit in this wheelchair and I keep telling them no. I don’t know how to work that chair and no one has even tried to help me with it. That old aide over there told me she wasn’t going to be helping me up and down that hallway anymore. Well, I’ll just sit here in this chair!
Me: Ms. Williams, they’re supposed to send someone to help you learn how to operate the chair. Are you sure no one has come to help you?
Ms. W: The only person that’s been coming is some boy saying he want to take me to occupational therapy. He comes every day. I look at the clock when he comes to my room. Every day he comes between 10 and 10:30 and every day I tell him no. I don’t know who he is, and why I got to go for some occupational therapy? I ain’t looking for no job. What, they expect me to be doing some work, and I’m here in a nursing home. They must think I’m crazy!
Me: (Trying to contain my laughter) Okay, I’ll ask them to stop sending the occupational therapist to you and send the wheelchair guy down instead.
I explained the confusion to the nurse, who immediately went to Ms. Williams and confirmed that the wheelchair guy would be there on Tuesday to help her with the chair. She appeared quite relieved.
Posted by Dr. El - January 12, 2010 - Business Strategies, Communication
Last month I had the opportunity to speak with Mark Kissinger, the New York State Deputy Commissioner of Long Term Care, and Jacqueline Pappalardi, Director of the Division of Residential Services in the New York State Office of Long Term Care. They answered some of my burning questions about the present and future of nursing homes.
I understand with the long term care restructuring going on in New York State, there’s a movement from nursing homes toward assisted living, but there will continue to be a need for nursing homes. How would you suggest nursing homes prepare for the future?
People will try to stay at home and at lower levels of care. The more client-centered nursing homes can be, the more helpful it will be to them. We’d suggest they diversify into rehabilitation care. More short-term rehab will help from a financial standpoint.
Are there efforts by the Department of Health to provide guidance for nursing homes? For example, is there anyone at the State Department of Health that nursing home staff can turn to for guidance if they want to start creative new programs?
Jackie meets regularly across the state to talk with the providers and with regional program directors. Regional staff are invited to these meetings and to the central office (in the Albany area). The staff at the Division of Residential Services, which includes nursing homes, assisted living, and intermediate care, can be reached via email. Every other week there are telephone calls with the Health Department about H1N1, for example. We also put out “Dear Administrator” letters to give guidance.
I see some residents and families afraid to say things to the staff, the line staff afraid of the administration, and the administration afraid of the DOH. Is the DOH afraid of the feds? If so, why?
No, we’re not afraid of the feds at all. We speak weekly with Annette Tucker-Osborne (Branch Chief at the Centers for Medicare and Medicaid Services). We work collaboratively with the federal government. The issue of people being afraid to talk to us is definitely out there, but we try to let them know they can call to talk. We have over 9000 calls on an annual basis.
Nursing home staff sometimes comment that State inspections appear to focus on arbitrary criteria. Staff are often puzzled about why certain issues are noted by the State, while others they expected to be problems aren’t seen as such. What’s your perspective on this?
Our staff are trained on state and federal guidelines. It’s not arbitrary, it’s a very set agenda. The nursing staff are very aware of what the guidelines are, and most administrators are very aware of what will be looked at. On a quarterly basis, we discuss the top five deficiencies surveyors find. While it might seem arbitrary to a staff member within one nursing home, things might be seen by surveyors as a systems problem after looking at several nursing homes.
How do you think nursing homes can be improved in general?
Through better management at the administrator level and better communication between certified nursing assistants, nurses, and administration. Examine systems and listen more to residents and staff. Constant quality assurance should be infused into the nursing home practice. The resident really should be at the center, and include their families. We encourage nursing homes to talk about best practices with each other. To facilitate best practices, for example, a chef could come in and talk to staff about meals. A spa-like environment could be created in the bathroom.
Posted by Dr. El - December 5, 2009 - Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, Customer service, Resident care
“You’re bleeding, Mr. Ramsey! Go upstairs with your aide!” The nurse’s well-meaning directive was falling upon deaf ears.
“I ain’t goin’ nowhere until I get my money!” Mr. Ramsey clutched a tissue to his bloody lip with one hand and waved his other hand around in a fist.
The aide took hold of the handle bars of his wheelchair. “Come on, Mr. Ramsey. Come with me.”
Mr. Ramsey swung his fist around in an attempt to hit the aide.
“Mr. Ramsey! Stop it! Calm down! You’ve got a bloody lip! You’ve got to get cleaned up!” The nurse turned to the aide. “I’m going to page Security.”
It was clear to me the staff had escalated the resident to the point of aggressive behavior. It was equally clear they had no idea they’d done so. I debated the pros and cons of intervening and perhaps undermining staff authority versus a showdown between Mr. Ramsey and the security guard.
“The social worker will be back in just a minute with your money, Mr. Ramsey. Just let him get his money and then he can go upstairs calmly.” They looked at me like I was speaking a foreign language.
Luckily, the social worker, who’d realized Mr. Ramsey was adamant in his position, rushed back from the business office with his funds. Immediately mollified, Mr. Ramsey went upstairs without further incident.
Psychologists spend years examining the nuances of human interactions and are trained to deescalate situations like this, which happen every day, in the nursing home and out. While many nursing homes have psychologist consultants who work with the residents and provide an occasional hour-long staff training on communication skills, very few have psychologists on staff. A psychologist on staff at least part-time could provide intensive interpersonal training to reduce resident/staff conflict, increase resident, family, and staff satisfaction with the nursing home, reduce time spent on incidents, and increase the quality of care.
Posted by Dr. El - December 4, 2009 - Communication, Customer service, Resident care, Tips for gifts, visits
In a staff meeting the other day, the social worker mentioned her new resident was having difficulty because he didn’t speak any English. It was arranged that the director of the Dietary Department would go up to act as translator.
“I know a website where you can get language cue cards with health-related words on them,” I told the team.
“What language do you need?” I asked her, looking at a list of over 60 languages ranging from Italian, Spanish, and German to Ukranian, Farsi, Swahili, and Japanese.
“Punjabi.”
A few seconds later the pages printed out, and were at the 4th floor nursing station within the hour.
Each sheet contained pictures of important social and medical issues, with the English and Punjabi words for them below. The selection included “husband,” “wife,” “sit down,” “shower chair,” “diabetes,” “pain,” and “hospital.” Nestled between “audiologist” and “psychiatrist” was the Punjabi word for “psychologist.”
Posted by Dr. El - November 17, 2009 - Communication, Engaging with families, For Fun, Resident care, Uncategorized
The holidays can be a difficult time of year, especially for residents in nursing homes. Many residents once hosted family gatherings, or were regulars at a holiday event, but now their physical disability complicates their participation in familiar rituals. Last year I wrote a post on this topic from the residents’ point of view,
‘Twas the Week Before Christmas…. This year I’m hoping to gather creative ways family members have come together to celebrate the holidays with their loved ones, despite the challenges of physical limitations. Here I offer a few suggestions, and hope you’ll add your ideas and experiences to the Comments section below.
A few years ago, my Aunt Bevy wasn’t feeling well enough to join us for our annual family gathering, so my cousins and I stopped by with leftovers and a quiet chat after the festivities. I know she appreciated that visit, especially since it was the first time she’d ever missed our party.
Most residents would like to be at the home of a family member to celebrate the season, but once they’re in the nursing home, it’s not as simple as picking them up at the door. With some advance planning, the physicians can write out the home pass orders, and the nurses can gather the necessary medications and provide instructions so loved ones can spend a few hours with the family.
If the holidays will be spent in a home that’s not wheelchair accessible, the family could gather for a separate meal in an accessible restaurant, or some members could join the resident for dinner at the nursing home.
If a resident is on a special diet, such as puree, for example, a variety of pureed soups and puddings could be offered, as recommended by the dietary department.
I once knew a man who wasn’t able to eat and was on a tube feed. At Thanksgiving, he and his children gathered at the nursing home for a gratitude ceremony, sharing aloud the things they were grateful for that year, and the qualities they treasured in each other. It wasn’t the Thanksgiving everyone was used to, but they’d created a ritual that fit for their new circumstances.
Posted by Dr. El - November 11, 2009 - Business Strategies, Communication, Customer service, Engaging with families, Resident/Family councils
In Part One of the Family Council posts, Karlin Mbah of FRIA discusses the role of the Family Council in improving the nursing home environment. In today’s follow-up post, she addresses ways in which to organize families to create a Family Council. In addition to her suggestions, some of the tips I provided in my posts on Resident Council Meetings can be adapted for connecting with potentially interested families.
Overcoming Challenges to Family Council Organizing
The most frequent question asked by Family Councils is: how do we get more members?
Recruiting and maintaining members seems to be one of the biggest challenges to Family Council organization. First and foremost, it is important for Family Councils to realize that you do not need mass numbers to be successful! A Family Council of 4-5 can often make a big difference. Additionally, arranging Family Council meetings at a time families can easily attend and conducting well-run, focused meetings often helps increase numbers.
Family Councils often spring up when a major issue occurs and then die down when the concern is resolved. Finding positive projects to keep Family Councils running when no major concerns are present will help keep the momentum going and show the nursing home that the Council is dedicated to a positive growing relationship. Some Family Councils achieve this by conducting educational forums on long term care; others have activities such as picnics and entertainment.
A second major challenge to overcome is resistance on the part of the nursing home administration.
Family Councils can address administrative resistance in several ways. From the beginning, in talking with the administration, emphasize the supportive, constructive role Councils can play. Look for concrete ways to be helpful and connect personally with staff. Effective Family Councils walk a fine line between sometimes cooperating with administration, and taking a strong, independent stand at other times.
Where to Get Help
FRIA and many other citizens’ advocacy groups help Family Councils organize in nursing homes in their respective states. FRIA also has published a Family Council Manual and Tool Kit: A Guide to Creating and Sustaining Effective Nursing Home Family Councils.
For information on Citizen Advocacy Groups in your State go to the
NCCNHR website. (NCCNHR, formerly the National Citizens’ Coalition for Nursing Home Reform, is the national umbrella group of all long term care citizens’ advocacy groups).
Additionally, your local ombudsman can assist with Family Council formation. (The Ombudsman is the federally mandated nursing home advocate. Your nursing home is responsible for posting the name and number of your ombudsman in the nursing home).
Finally, you can seek out help by asking other well-established councils to mentor your group or getting assistance for a community organizing group such as a union or a non-profit.
