Category: Customer service
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 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.
Posted by Dr. El - October 20, 2009 - Boomers, Business Strategies, Communication, Customer service, Resident care, Resident education/Support groups, Technology
A recent study by the Phoenix Center looked at adults 55 and over, but not employed or in nursing homes, and found that Internet use decreased their level of depression by 20%. I’m not at all surprised by this, and I believe a similar decrease in depression levels would be observed in nursing home residents as well.
While residents are living together rather than isolated in their own homes, and therefore have more opportunities for socialization, there are still many people who don’t partake of the recreational activities offered for their enjoyment. Some residents never leave their rooms due to physical or psychological barriers, and some don’t like crowds. Other residents feel uncomfortable socializing because of the physical changes of illness, wish to pursue activities other than those available in the nursing home, or miss connecting with those outside the home. The Internet offers the opportunity for nursing home residents to transcend their physical illnesses, leave the boundaries of the facility, and connect with the world.
In an earlier post, I shared ways in which I use the Internet for therapeutic purposes, and I believe they’re worth repeating here:
1. Psychoeducation Regarding Illness:
Often residents are given diagnoses, but little information about them, leaving them confused or upset, which can result in noncompliance with medication and care. I search for a resident’s illness with them on the computer, and discuss the symptoms and treatment, which enhances cooperation with medical staff. Some residents are more receptive to information coming from a “neutral” source than from their own caregivers, and most residents appreciate a print-out of information they can refer to over time. Posting a list of illnesses and the Web addresses of important sites near the computer would facilitate this process (eg; The American Diabetes Association, the Amputee Coalition of America, etc).
2. Support Regarding Illness:
Most of the residents deal with their illnesses in isolation, when there are many avenues of support available to them on the Internet. Having the opportunity to “discuss” their concerns anonymously with peers can often be more effective than trying to generate a conversation between two or more residents at the nursing home, due to discomfort at revealing personal information. At strokenetwork.org, for example, stroke survivors can “meet” other survivors on-line and get information and emotional support, as can their caregivers. To find the appropriate support groups, enter the name of a particular illness and “support” into the browser window and look around from there. Another option: Look for a Yahoo group about the illness and sign up the resident after establishing a free email account through resources such as Yahoo or Google.
3. Connection with Family and Friends:
Why should residents have to limit themselves to family visits or phone calls when most of the rest of the country is communicating via email, Twitter, or a social networking site such as Facebook or MySpace? I’ve established email accounts for octogenarians to help them keep up with the grands, and a free Facebook page would accomplish the same thing with a bit more zing.
4. Reminiscence:
I once worked with a terminally ill 88-year old man who’d left Barbados in his thirties and had never realized his dream of seeing his country again. Imagine his expression as I entered “Barbados” into Google Images and up popped photos of the country he thought he’d never be able to see again. This intervention generated a flood of memories and a profound sense of relief and closure. Reminiscence could also be conducted in a group format, with connection to a large screen, so that residents should share with others information about their home countries or hometowns.
5. People Search:
One of my favorite things to do with residents on-line is to find their long-lost friends and relatives. For example, through the Internet white pages, I helped one extremely lonely and depressed resident find a friend with whom he lost touch sixty years ago. They are now enjoying an exchange of letters and photos, and my patient has something else upon which to focus besides his poor health and lack of visitors.
6. Fun & Miscellany:
Acting under the theory that doing something enjoyable will begin the upward spiral out of depression, I’ve occasionally brought a resident to the computer to listen to their kind of music (try shoutcast.com), to check out the latest fashions, or to see photos of famous movie stars (Google Images). Once a 97-year old Panamanian resident told me she’d felt unattractive all her life because she thought her lips were too big. “Oh, no,” I told her, “your lips are considered beautiful and the height of fashion.” She believed me after I clicked on Google Image photos of Angelina Jolie.
Do you have more therapeutic uses of the Internet? Please add them to the Comments section.
Posted by Dr. El - October 2, 2009 - Anecdotes, Customer service, For Fun, Something Good About Nursing Homes, Volunteering
This positive story about long term care is from the perspective of a nursing home administrator/president. If you’d like to add your own good news, please use the comments box at the bottom of the post, or for a possible featured blog post, send me an email using the Contact Me button on the top right corner of the blog. Enjoy!
“Having been a part of the Long Term Care profession for more than 38 years, I find myself always being defensive. You are right in the fact that most of the good news in nursing homes never gets printed, just those about the bad things. I would love to share a couple of projects we are doing in our facility which have been wonderful for those residents entrusted into our care.
One is a writing class. It started out with residents writing/telling something about their first day at school, or their first car, things of that nature. It was fun to hear them share. We had some assistance from our activity staff and a couple of volunteers. We collected these short stories and printed them into a book and invited their friends and family to come to a reading. Most of the residents read their story. It was a blast to watch a gentleman with Alzheimer’s disease read flawlessly as if he were giving a presentation to the city committee. He never missed a beat. Yet when he had finished and a couple of others shared their story, he asked when his turn would be. To assist in our second book, we asked the our local college if any English majors would be interested in coming and assisting the resident in writing their stories. We were able to have two students come for a semester and would record the story and help the resident in getting it ready for print. We have printed 3 booklets of short stories and each resident and family member receives a copy.
Our second project was a dream of one of our staff members and it’s like the “Make a Wish” program. It’s called “Day Dreams.” We have a dream team made up of staff, who then volunteer their time in helping residents have a wish come true. These dreams can vary from going a local restaurant with their loved ones, to flying model airplanes, to traveling out to their homestead, to riding in a parade in a convertible with the top down. There is no cost to the resident of this experience. We have been able to receive some donations to help cover the costs. We have been able to do over 45 dreams since 2005. These are only a few of those dreams.
I share these with you to encourage others, that being a Caregiver in a Nursing Home is a wonderful profession. It is not for everyone, but most of those caring for others are angels.
Thanks for stating there is a lot of good going on in Nursing Homes.”
Gary M. Riffe, CNHA, Fellow
Administrator/President
Hi-Acres Manor Nursing Center
Jamestown, ND
Posted by Dr. El - September 15, 2009 - Communication, Customer service, Dementia, Resident care
This article from McKnights.com suggests that a key factor in reducing staff stress and injuries during transfer is understanding each resident with dementia and tailoring your approach to the individual.
Posted by Dr. El - August 26, 2009 - Customer service, For Fun, Inspiration, Something Good About Nursing Homes
Today I learned of an Indianapolis-based volunteer organization with a mission “to make the dreams of elderly and terminally ill adults come true.” How cool is that?
Never Too Late has helped an 88-year old man race around the Indy 500 track, an 83-year old woman go sailing, and a 70-year old man learn to read, among the 1825 wishes granted to date.
Posted by Dr. El - August 24, 2009 - Anecdotes, Boomers, Customer service, Resident care
Here’s an interesting article on a brief nursing home stay by a medical student as part of her training.
Experiencing Life, Briefly, Inside a Nursing Home
By Katie Zezima
Published: August 23, 2009
MAMARONECK, N.Y. — For 10 days in June, Kristen Murphy chose to live somewhere she and many others fear: a nursing home.
Ms. Murphy, who is in perfect health, had to learn the best way to navigate a wheelchair around her small room, endure the humiliation that comes with being helped in the bathroom, try to sleep through night checks and become attuned to the emotions of her fellow residents.
And Ms. Murphy, 38, had to explain to friends, family and fellow patients why she was there.
Ms. Murphy, a medical student at the University of New England in Biddeford, Me., who is interested in geriatric medicine, came to New York for a novel program that allowed her to experience life as a nursing home patient.
To read the full article, click on the link below:
Posted by Dr. El - August 20, 2009 - Business Strategies, Customer service, Tips for gifts, visits
I saw this great idea posted on McKnights this morning. My suggestion is, if needed, the residents address it in their Resident Council Meetings to see if they want to raise the funds themselves.
http://www.mcknights.com/Turning-on-the-lights-for-nursing-home-residents/article/146809/
Turning on the lights for nursing home residents
Eric Smith August 19, 2009
In 2004 I accepted a position at a skilled nursing facility (SNF) as a maintenance assistant. I was excited to have this new job as I felt the experience of being in an environment among senior citizens would be very rewarding. I had previously assisted the elderly and I remembered how enjoyable it was. The job however, was challenging, but I loved the work and it was a great job.
For the first 18 months I worked under a maintenance director whose favorite answer to almost all issues was “fix it,” and he would further go on to add, “I don’t care how long you take just fix it.” Well, one of those issues happened to be me constantly replacing the over-the-bed light switches. The problem was that the residents would tie the string that activated the light switch to their bed rails, electrical cords, bed sheets, stuffed animals or to anything they could reach easily due to their limited dexterity. Whenever these items were moved by the staff or sometimes by the residents themselves, they would inadvertently rip the string from the light switch damaging the switch, making it inoperable. Now the maintenance director had a problem with not just me spending the time to replace the switch but also incurring the cost to replace the damaged switches.
I did not like his solution to the problem. My boss had made a decision that all strings that were tied to bed rails, etc., be cut loose immediately. Unfortunately for me, I was instructed to carry out this unpleasant task. To this day, it remains among one of the most difficult things I have had to do. Residents begged and pleaded to me, used vulgarity, cursed me and even tried to bribe me not to cut their strings loose.
Then the company promoted me and moved me to another facility. I was now the maintenance director and the “string problem” existed here too. The strings were tied to call cords, bed rails, stuffed animals and even towels. I have further come to recognize that not only do the residents have limited physical dexterity; they also have a problem gripping the very thin strings that come with these light fittings. This is a common problem I have seen it in every SNF I have visited. Some buildings were new and the residents had those silly strings tied to anything they could reach.
I had an idea and a friend of mine and I fabricated a bracket. We installed the bracket to the reading light in the nursing home and it WORKED!!!!. We then had a tooling company build 10 of the brackets and I installed some of them in my building. The residents loved them. The first resident that got a bracket for her light was Mrs. Pittman. I asked Mrs. Pittman to tell me in her own words what she thinks about the bracket. These are her words:
The new overhead light switch is great. It is easy to reach from my bed and to locate. The chain is a whole lot better than the string as it is clean and doesn’t wrap around anything. Just pull the chain and the light is there. Sure looks nice the way it is put up. Thanks so much.
Frances Pittman
I installed five more brackets after that and everyone thought they were great. When a resident would move to another room that didn’t have a bracket they would ask me to move the bracket to the new room. Family members would ask me if I could put one in their loved ones room. I even had a resident that intentionally kept breaking her light string in the hopes of us putting a bracket in her room. Unfortunately, my resources were limited. We only had 10 units. The residents that had a bracket in their room told me there is no way they could reach their light string without it. I’ve also been told by the residents how nice and clean they are.
I have since talked to nursing home owners, CEOs, administrators, designers, architects, builders and even the Department of Aging and Disability. Everyone thinks it is a great idea, but nobody wants to do anything about it. In the four years I have worked in SNFs, I have come to understand how things work or how the “game is played.” Things change only if the guidelines, rules or the code dictates it. The phrase, “we will wait for the state to write it up then we will fix it,” is commonplace in our business. In other words, we’re not going to spend any money until we have too. I think that is exactly the same mindset I’m seeing with this problem. Nobody wants to spend the money to address the problem until they have to. In the meantime the residents are the ones that are doing without.
The Texas Administrative Code, Title 40 Part 1 Ch. 19 Subch D Rule 19.334(a)(6) states:
Each room must have general lighting, bed reading light, and night light. …. A durable nonglare (opaque front panel) reading light securely ancored to the wall, integtrally wired, must be provided for each resident bed. The switch must be within reach of the resident in the bed.
I would venture to say that more than 80% of SNF residents cannot reach their switch from their bed.
Eric E. Smith is director of maintenance at the Winters Park Assisted Living and Memory Care in Garland, TX. Smith can be reached at Eric2960@gmail.com.
**The EasyReach Bracket is available for sale. For ordering information and sample requests, contact Niven Padachy at (800) 641-2345. Check out the Web site at http://txerich.com/
Posted by Dr. El - August 11, 2009 - Boomers, Business Strategies, Customer service
As Father Bart pointed out in his July 28, 2009 blog interview, one of the greatest challenges facing the residents of nursing homes is their dependence upon others to meet their needs. I often work with them on coming to terms with this unavoidable fact of life, and to find ways in which they can retain control over their situation. After numerous discussions about the frustrations of relying on busy staff or family members to purchase items for them, I began to consider the merits of an Independence Cart.
An Independence Cart is a roving store on wheels. Imagine if twice a week the residents could buy stationery, pens, stamps, phone cards, eyeglass repair kits, personal care items, or order a birthday present for a grandchild. It would give them some means of accessing the goods available in the outside world, and free up time that good-hearted staff and family members spend on burnout-inducing errands.
I once worked in a nursing home with a candy and soda cart that traveled from floor to floor. Items purchased in bulk were sold at discounted prices, and the money from the venture funded resident activities. Residents helped the recreation department leaders stock and staff the cart. It was a dietary disaster, but a practical and financial success. I believe that this concept, taken in the right direction, could be successful in every way.
