Reflections after an LTC and senior living summit

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

Reflections after an LTC and senior living summit

Last week, I attended the MarcusEvans LTC and Senior Living CXO Summit in Los Angeles, where I delivered a keynote address on “Identifying and Repairing Communication Gaps in LTC.” It was a fascinating, energizing event, and not just because I was leaving the frigid temperatures of New York City to dine outdoors in Marina Del Rey.

Of course, I was all jazzed up to speak about my obsession, long-term care. Of the many communication gaps I mentioned that need repairing, the one that most people commented on afterward was the way we handle end-of-life care.

Perhaps the ample feedback reflected how we, as a country, are spending so much money on aggressive medical treatments that are unlikely to help those who are dying and that most people wouldn’t want if they knew what they entailed. Or perhaps it’s because the vast majority of the audience was not only professionals in the field but also had a relative in long-term care. They recognized the value of having a peaceful death both for the resident and for their family.

It was interesting to me that only a few of these C-suite attendees had heard of Atul Gawande, MD, whose recent book on end-of-life care, “Being Mortal: Medicine and What Matters in the End,” became the basis for a “Frontline” documentary that aired last week. Atul Gawande is all the rage in my circle.

I, on the other hand, was gobbling up new information about positioning care facilities to thrive over the long haul. The clinical and the financial sides of the business have a lot to teach each other.

One of the highlights for me was hearing Dr. Margaret Wylde of the ProMatura Group speak about what’s important to residents of senior living communities. I was so excited by her information that I leaped from my seat and shouted, “Yes! Yes! Right on, sister!” At least, that’s what I was doing on the inside, while my outside sat politely nodding in my gray business suit.

For the entire article, visit:

Reflections after an LTC and senior living summit

Addressing residents’ deepest fear

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

 Addressing residents’ deepest fear

In the TV show “Mad Men,” the Sterling Cooper advertising executives find out how consumers feel about the product they’re pitching by holding focus groups. They ask people who use their product what they like and don’t like about it, how they use it and what it means to them.

As a long-term care psychologist, one of my main tasks is to sit down and talk in-depth with residents on a regular basis. I’ve basically conducted 20 years of focus groups. The single most common comment I’ve heard from residents over the years: “I never thought I would end up in a place like this.”

While it’s probably not the case for people who entered swanky continuing care retirement communities of their own accord well in advance of a health crisis, many residents feel like it’s a personal failure to be in long-term care. They think if they’d done something different, or earned more money, or if they’d had children, or had a better relationship with their children, or if they had better children, or something, then they wouldn’t have “ended up” in a long-term care home.

As a psychologist, I assure them that they didn’t do anything wrong and neither did anyone else necessarily. I inform them that many of the nicest and best people I know are living in long-term care. Occasionally, I introduce one awesome person to another. In psychology terms, we call this “normalizing” the experience. It helps a lot.

Below are some ways in which you can allay the residents’ concerns that they have lost the game of life by being in your establishment:

• Include on your website stories of amazing residents. If that exemplary person can be there, potential residents will feel that it’s a club they might want to join too. Include not just individuals who have achieved a traditionally successful life (money, fame, education), but also those who have accomplished unusual feats (raised 11 children, sky-dived in their 70s) or who overcame poverty, prejudice, or disability to lead a good and decent life.

For the entire article, visit:

Addressing residents’ deepest fear

Planning for the holidays

With the start of the holiday season, 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.

Three tips from Dr. El for the holidays (click here or view below): http://youtu.be/8HTjVoKQmKo

Working on how to communicate in facilities (McKnight’s LTC News)

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

Working on how to communicate in facilities

Poor communication and coordination between staff members contribute to medication errors and adverse events. These problems are more likely to occur during a transition of care from one setting to another.

AMDA, The Society for Post-Acute and Long-Term Care Medicine, working with the National Transitions of Care Coalition (NTOCC), recently released its free Transitions in Care in the Long-Term Care Continuum guideline. The goal of the document is to identify areas where problems in transitions occur and to offer methods to avoid these common errors.

Reading through the guideline got me thinking about the in-house communication glitches I’ve noticed in my role as a psychologist. While we clearly need to address communication and coordination between settings, we also can look within our own facilities to see if there are areas where communication could be improved.

Below are examples of problems I’ve observed in some high-quality facilities. (Imagine how much better the care would be if these problems were addressed!) While I mentioned my concerns to the relevant staff members, interdepartmental communication issues can sometimes fall into that gray area between job descriptions and don’t always receive the attention they deserve.

• Each floor of one facility had a notebook where staff members could leave messages for the social worker. Except that the social workers never looked at those notebooks. New staff members would leave notes in there until they learned it was pointless. But nobody took the notebooks away.

• There are communication books for the attending physicians at most nursing stations, but the doctors vary in their diligence about looking at the information. Sometimes I’d check the log to see the status of something I’d previously reported and see that nothing had been checked off in the book for a month or even several months. While very urgent information should be reported directly to the charge nurse, many staff members don’t have the training to know what’s urgent.

• Along those lines, I once mentioned to a charge nurse that I wrote a note in the communication book and she said, “Oh, Dr. Smith never looks in there. If you have something important to tell him, you let me know and I’ll write it on a sticky note and tell him when he comes in.” She pointed to the ledge of the desk filled with scrawled memos. Things I pondered: What if the sticky note loses its “stick,” falls to the floor, and is swept up by the porter? Who else is leaving notes in the logbook without realizing they’re never seen? What if the nurse is off from work on the day the physician comes in? The nurse retired shortly thereafter. I wonder what they’re doing now.

For the entire article, visit:

Working on how to communicate in facilities

Preventing difficult family situations (McKnight’s LTC News)

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

Preventing difficult family situations

I listened with great interest last week to McKnight’s Fall Expo talk on Pain relief: Dealing with difficult family and resident situations. Attorney Matthew J. Murer provided excellent information on how to work with families to prevent conflicts over treatment and other care issues.

Here, from a psychological perspective, are some additional ideas to prevent or reduce disagreements over care, thereby decreasing the likelihood that the situation will result in legal action.

1. Create systems that easily allow family members to be part of the treatment team.

We collect initial data from families upon admission, but there’s often more family members can and want to add to care.

Staff members may have difficulty adequately involving families because it’s not a fluid part of their workflow. Family members tend to visit in the evenings and weekends when the administrative and day shift workers are no longer in the facility, for example, and care plan meetings are held during working hours when many family members aren’t available.

Inviting relatives to meetings via secure video chat, establishing weekend or evening hours for key personnel such as social workers, and implementing a comprehensive communication system that transmits family information between shifts and departments can help.

In addition, staff members should be trained so that they’re genuinely receptive to information provided by loved ones rather than creating the impression that the family is a nuisance. (I’ve seen this!)

2. Educate families about the illnesses of their loved ones.

Many residents are given diagnoses just prior to or upon admission, but receive little information about their conditions. Similarly, family members often struggle to come to terms with new diagnoses and have many time-consuming questions to ask of staff.

They also may look for health information from less-than-reputable resources. Set up a magazine rack in the lobby with information and resources about common illnesses such as diabetes or stroke and/or add a page to your website with helpful links for families. This meets a genuine need, generates more knowledgeable conversations between families and staff, and helps to create more realistic expectations on the part of families regarding treatment and prognosis.

For the entire article, visit:

Preventing difficult family situations

5 Ways to Encourage Teamwork in Your LTC Facility: Free Webinar 9/4

Join Dr. El

Thursday, August 4th

at 2pm Eastern Time (1pm Central Time)

for a

 FREE Webinar on

5 Ways to Encourage Teamwork in Your LTC Facility

sponsored by EmLogis

To register:

visit EmLogis Events

Aunt Sylvia at the nursing station, discussing teamwork: Click here or view below: http://youtu.be/7KTqBbjaJro

About the Webinar:

How much more could your facility accomplish in a day, week or month with more effective teamwork?

Are you building a culture of teamwork? Do you make it okay to ask for help? Can better teamwork be an affordable way for your facility to keep employees longer and make residents happier?

Join us for a live webinar on the 4th of September 2014 at 1pm CST to learn 5 (or more!) steps that you can take to encourage teamwork in your long-term care facility with expert Dr. Eleanor Barbera. Do you have very specific teamwork challenges? Dr. El will be available at the end of the webinar to answer your questions live!

Attend and you will learn:

Organizational strategies for fostering teamwork
Practical techniques for managers, department heads, supervisors, and charge nurses that enhance team relationships
Ways to address challenging staff behaviors

Who should attend this webinar:

Administrators and assistant administrators
DONs, ADONs, department heads, nursing supervisors, and charge nurses
Staff training coordinators
Human resource department staff

Taking vacations when residents can’t do the same (McKnight’s LTC News)

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

Taking vacations when residents can’t do the same

Like many, I’m taking some vacation time during the month of August. It got me thinking about the ways workers interact with residents when they take time off from their jobs. It’s more important than you might first think.

Notifying residents

I know some staff members whose residents are so attached to them and become so anxious at the thought of them being away, the staff members don’t tell them they’re going. This seems to me like passing the buck to the covering coworkers who have to deal with the anxiety of the residents plus their feelings of betrayal that they weren’t informed in advance.

Other staff members don’t seem to think that residents will be missing them, so they don’t prepare them for their absence. As their psychologist, I know that residents acutely miss their regular staff members and really appreciate knowing in advance that they’ll be gone. When you’re not there – especially if you’re a CNA – it’s a generally bad time for your residents unless there’s been some consideration of the personalities of the residents and covering staff members.

Psychotherapist model

In my training as a psychologist, we spent a lot of time talking about leave-taking, vacation coverage, and termination of therapy. The gist of it is preparing patients for the vacation in advance, talking about who will be there in the therapist’s absence, and ways patients can cope on their own.

I think that’s a good model to follow in most cases in LTC. It’s respectful to let the residents know you’ll be away and to tell them who’s covering or who might be good to ask for help while you’re gone.

Anxious residents

I once treated a very attached, emotionally fragile resident whom I knew would be panicky about my two-week absence, which we discussed at length prior to my departure. Before I left, I gave her a sheet of paper on which I’d written down the dates I’d be away, the names of staff members she could talk to if she needed help, and healthy activities she could engage in such as journaling or talking to a friend. At the top of the paper I wrote in big letters, “I will return on September 14^th.” When she saw that, she laughed with relief.

For the entire article, visit:

Taking vacations when residents can’t do the same

The psychology behind good customer service (and why it’s more important than you think) — McKnight’s LTC News

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

The psychology behind good customer service (and why it’s more important than you think)

At the front desk, the workers were having an argument. Some residents watched the proceedings with interest and others with expressions of alarm. A waiting family member shifted from one leg to another and began sighing with exasperation as the loud conversation wore on without her presence being acknowledged.

We may talk about the term “customer service” and ask our staff members to avoid public arguments like the one above, but nevertheless, similar situations happen every day. Why does it matter so much? Using the model of the family as a guide, I discuss the psychological importance of good customer service in all our interactions.

With other staff members – Just as the relationship between parents forms the foundation of a family, our relationships with our coworkers are the foundation of good customer service.

o As shown in the above example, the residents observe how we treat one another. If our conversations are respectful and collegial, residents feel comfortable discussing concerns because they perceive their caregivers to be levelheaded and understanding. Angry, shaming interactions between staff members create an unsafe environment, making residents less likely to share information — including details that may affect medical care.

o Difficult interactions with coworkers are frequently transmitted to resident care. This is known in psychological terms as displacement. In the classic case, the boss yells at the father, who comes home and yells at his wife, who yells at the kid, who kicks the dog. If the nursing supervisor publicly criticizes the nurse who then chastises the aide, the residents are likely to be on the receiving end of the aide’s aggravation. Alternatively, if the nursing supervisor compliments the nurse who in turn praises the aide, the residents are more like to be met with a cheerful, upbeat caregiver.

o How senior staff members talk to subordinates is passed along to the next level of subordinates, not just through displacement, but also through modeling. Senior staffers are showing through example “how we handle things here.” When an administrator uses “teachable moments” to calmly point out what aspects of a crisis were managed well and what could be done differently for mismanaged parts, this becomes its own teachable moment in terms of how to provide constructive feedback.

For the entire article, visit:

The psychology behind good customer service (and why it’s more important than you think)

Employee recognition programs: what works (McKnight’s LTC News)

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

Employee recognition programs: what works

After Ms. Ryan’s psychotherapy session, I stopped at the nursing station and asked the nurse for the name of her aide. The nurse pointed to a uniformed woman right next to me, who turned and asked me with hostility, “How do you know it was me?” Surprised, I responded, “I just wanted to tell you Ms. Ryan was really happy with how you did her hair today. She wanted me to thank you for her.” The aide appeared stunned. The nurse commented, “We usually expect complaints, not compliments.”

If your staff is more prepared for criticism than praise about its work, it’s an especially good time to consider positives of an employee recognition program.

Benefits of employee recognition programs

Studies show that employee engagement, productivity and customer service are about 14% better in companies where recognition occurs, compared to companies without a program that acknowledges their efforts. In addition, companies with an effective recognition program have a 31% lower voluntary turnover rate than those with an ineffective program.

Ineffective programs tend to reward employees for tenure rather than performance.  (Apparently those 10-year pins aren’t making the desired impact.) Effective programs offer specific feedback about the actions of workers and make it easy to provide that feedback.

Interestingly, there’s a substantial disconnect between the 80% of senior leaders who believe their employees are being recognized on a monthly basis and the 22% of individual workers who report their peers being acknowledged that frequently.

The Oregon Health Care Association’s Staff Retention Toolkit is an excellent resource for information about different types of Employee Recognition Programs (see page 46 in it). The toolkit notes these additional benefits:

For the entire article, visit:

Employee recognition programs: what works

Using psychology to reduce roommate conflicts: A handy guide (McKnight’s LTC News)

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

Using psychology to reduce roommate conflicts: A handy guide

“My roommate is driving me crazy with his oxygen machine. I haven’t slept in days.”

“Her husband stays in the room all the time, even when she’s in rehab.”

“She always leaves the window open and I’m freezing!”

These are some of the many complaints about roommates I’ve heard from residents over the years. While some roommate difficulties need to be addressed on a situation-by-situation basis, most conflicts revolve around a few basic issues.

Here’s a handy guide to conflicts and potential resolutions to print out and give to staff members involved in making room assignments.

•       Temperature of the room: Have the person who likes it colder or hotter by the window/air conditioner/radiator so they are closest to the source. The temperature in the hallway will moderate the atmosphere around the bed near the door. Give extra blankets to those who like to be warm but have a roommate who likes it cool. Or change rooms so that people who like similar conditions room together.

•       Noisy medical equipment: Someone with such needs might do better living with a hearing impaired roommate or a sound sleeper or being moved to a private room if it’s a temporary condition.

•       Frequently visiting family members: While visiting hours have been expanded in many facilities, it doesn’t mean they need to take place in a resident’s room, especially if it’s disturbing to others. It may be necessary to distinguish between facility visiting hours and in-room visiting hours and to refer families to alternative locations for visits, such as a lounge. Family members can be directed to wait in common areas if their loved one is not in their room.

•       Loud televisions: Setting a time (such as 10 p.m.) to lower the volume on TVs and to turn out lights that aren’t in use will help with sleep hygiene on the floors in general and will reduce conflict between roommates (because it’s “policy” and not personal). Those who want a loud television can use a headset or be moved to a room with a hearing impaired roommate.

For the entire article, visit:

Using psychology to reduce roommate conflicts: A handy guide