Category: Engaging with families
Posted by Dr. El - November 9, 2019 - End of life, Engaging with families, McKnight's Long-Term Care News
The holiday season will soon be upon us and with it will come out-of-town family members visiting their loved ones in long-term care settings.
Early November is a good time to increase the focus and training on customer service so that the facility is performing at its best when those infrequent but important guests arrive. It’s also a suitable moment to consider how to best aid families in discussing end-of-life care for their aging relatives.
Visitors who haven’t seen loved ones in several months may notice a physical or cognitive decline, making them more aware that life’s end is approaching. The holidays are also a time when several family members may be together and can discuss end-of-life concerns in collaboration.
While many residents will have completed advance directives upon admission, there are others who haven’t done so and those whose desires have changed. In addition, there are other details that may need addressing, such as readiness for hospice care, funeral arrangements, a last effort to repair fractured relationships or a chance to say good-bye.
Families invariably need assistance with these conversations and, as those who provide care to the ill and dying, this is a good opportunity to showcase the organization’s compassion and expertise in this area.
For the entire article, visit:
Posted by Dr. El - September 5, 2018 - Business Strategies, Depression/Mental illness/Substance Abuse, Engaging with families, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
In most of my long-term care career, I’ve witnessed short-term rehabilitation (STR) residents housed together, but occasionally facilities have scattered them throughout the building. I don’t know the reasoning behind dispersing residents, but from my perspective, dedicated rehab units work better.
My thinking is based on the fact that people entering rehab are almost invariably in the middle of a life crisis (see The stress of nursing home admission) – as are their family members – and that staff members are often stretched to the limits of their capacity to manage their responsibilities.
Keeping rehab residents together is better because:
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STR residents lodged together find a group of peers in the same situation as themselves, which can be enormously reassuring in anxiety-provoking times.
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Co-housing makes it more likely that STR residents will develop stress-reducing friendships and find a team of peers to support their progress in rehab. The ability to form friendships with peers is one of the major strengths and selling points of long-term care.
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Being around LTC residents can be alarming for STR residents, who usually have fears that they’ll “never get out.” Observing others being discharged upon completing rehab can ease their apprehension.
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STR residents, who are frequently younger and more cognitively intact, can feel isolated on LTC floors that have fewer people with whom to engage socially, and none in their particular situation. This increases their depression and anxiety.
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Family members can benefit greatly from talking with other families in similar situations. They’re much more likely to meet other families “in the trenches” on an STR unit. Yes, there are families on the long-term floors, but they’re in marathon mode while STR families are sprinting through a crisis that has reordered their lives.
For the entire article, visit:
Posted by Dr. El - August 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, Inspiration, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
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Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
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Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
For the entire article, visit:
Posted by Dr. El - May 24, 2018 - Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News, Psychology Research Translated
Here’s my latest article on McKnight’s Long-Term Care News:
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:
Posted by Dr. El - April 13, 2018 - Business Strategies, Communication, Customer service, End of life, Engaging with families, McKnight's Long-Term Care News, Resident care, Stress/Crisis management, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
In one of the more disturbing encounters I’ve had in long-term care — in a 5-Star deficiency-free nursing home — I offered my condolences to an aide on the loss of a resident she’d cared for over a period of two years.
The aide, a heavyset woman, smiled as she told me that she’d known the resident was dying and had urged the nurse to send her to the hospital quickly. The reason? She didn’t want to wrap the body of the equally heavyset resident after she died.
The resident died among strangers in an ambulance on the way to the hospital.
While I’d like to think the incident was an anomaly, I suspect many if not most nursing homes lack a mission statement for end-of-life care and that most teams can be better prepared for the last months and days of their residents.
Without leadership and training, disorganization and staff priorities can derail the care philosophy of the facility.
Providing decent end-of-life care is more than determining if a resident is DNR or full code. It includes recognizing that someone may be nearing the end of life, referring him or her to hospice while they’re most able to benefit from it, communicating regularly with the resident and their family about their needs, and treating the dying person, their remains and their belongings with respect.
Impact on families
Incidents such as the one above reflect poorly on the organization, even if family members don’t realize that it could have been averted with proper staff training. We often hear how important it is to make a good first impression, but as community institutions relying on reputation and referrals, it’s also essential to make a good last impression.
I’ve heard family members comment that they hadn’t always been pleased with the care at the home but they felt that their mother’s death had been handled with great respect. They left with a feeling of overall satisfaction.
Other families had been reasonably satisfied all along, but departed from the facility in shocked dismay at the end of their parent’s life at the poor communication, insufficient pain management and casual disregard for the belongings of the deceased.
Resident impact
Residents are closely observing how their neighbors’ deaths are handled because they know that this is how they will be treated when their time comes. Based on my experience, the things they find most disturbing are inadequate pain management, unacknowledged deaths and seeing the belongings of their friends removed in clear plastic garbage bags rather than in labeled boxes. They find it most comforting when they see that patients are referred to hospice, surrounded by loved ones, sleeping calmly through the night and when there’s a discussion of the loss among the residents, staff and chaplaincy.
Staff impact
The ways in which facilities handle deaths can have a big impact on staff members as well. As I suggest in “Absenteeism and turnover? Death anxiety could be the cause,” lack of attention to the experience of staff members in handling loss can contribute to employee turnover.
For the entire article, visit:
Posted by Dr. El - March 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News, Resident education/Support groups, Technology, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
At Maimonides Medical Center, 24 frail older adults were taught to use laptops so that they could manage their health information from home. The technology facilitated communication between patients and providers and improved the quality of life of participants.
The program was a collaboration between the Department of Geriatrics at Maimonides and the Older Adults Technology Services (OATS), who trained the elders and installed the laptops in their homes. I met with OATS founder Tom Kamber, Ph.D., to follow up on our conversation earlier this year and to hear more about how technology can play a role in reducing costs and improving the quality of care for nursing home residents.
Kamber was enthusiastic about the Maimonides program, noting that the elders, with an average age of 85, were able to use the devices to manage information, communicate with the care team and explore areas of interest.
Fun, he emphasized, is crucial to success.
The desire to connect with the grands on Facebook is a more powerful motivator to learn new skills than is tracking blood sugar levels.
For facilities, particularly those working in healthcare systems focused on providing care at the lowest cost (i.e. in the community or in skilled nursing rather than in the hospital), the ability to remain virtually connected provides a host of benefits. Patients remain within the network, medical issues can be tracked and health crises can be averted before needing expensive hospitalizations. Tailored health information can be offered effortlessly, such as sending out post-surgery information videos at a scheduled time. Patient and family satisfaction increases, as does that of care providers who can quickly answer questions via email rather than return lengthy phone calls at the end of a long workday.
From a mental health standpoint, the program is a winner. Residents and their families are typically anxious about discharge and how to manage once they’re home. A virtual system reduces anxiety because it allows for easy access to medical professionals, offers continuity of care and averts costly, stressful and frequently debilitating hospitalizations.
For the entire article, visit:
Tom Kamber,PhD
Executive Director, OATS
Older Adults Technology Services
Posted by Dr. El - June 22, 2017 - Business Strategies, Communication, Engaging with families, Inspiration, McKnight's Long-Term Care News, Something Good About Nursing Homes
Here’s my latest article on McKnight’s Long-Term Care News:
One of the things that most brightens my workday is when I see long-term care residents hanging out together.
In particular, I’ve noticed two ladies who attend activities in tandem wearing dresses with hats and costume jewelry, a threesome of confused residents who sit near the nursing station laughing at jokes only they understand, and an African-American and a Caucasian octogenarian twosome who are amazed to be best friends since neither of them had a friend of the other race before.
Men gather for card games, guys group in the hallway offering wry observations on the behaviors of the staff and other residents, and rehab patients tell me how inspired they are by someone they meet lifting weights in physical therapy. Sometimes I’ll discover that the resident they mentioned is, in turn, inspired by them.
What long-term care offers, aside from medical help and safety, is the opportunity to connect with peers and to maintain a social life. One of our best selling points is the fact that folks can get to activities without needing a coat or umbrella. New residents are often surprised and reassured to learn that there are “transporters” who will bring them to and from daily recreation programs, all for free.
For the entire article, visit:
Posted by Dr. El - April 26, 2017 - Business Strategies, Customer service, Engaging with families, McKnight's Long-Term Care News, Personal Reflections
Here’s my latest article on McKnight’s Long-Term Care News:
Due to a series of unfortunate events, both of my previously independent parents were recently injured over the course of five weeks. In the past, I’d been the granddaughter, the niece and the daughter-in-law of someone in long-term care, but I’ve now taken on the very different role of daughter of a resident.
In between errands, trips to medical appointments and calls to the facility, I’ve been making mental notes of insights afforded me by my new perspective and that of my family members.
Here are some thoughts from someone who’s seen the long-term care world from both sides now:
• It’s worthwhile to have a pleasant and efficient receptionist. I don’t often call the facilities in which I work so it hasn’t affected me personally if the automated telephone system sends callers into a netherworld of options and hang-ups or if the receptionist is curt or bumbling.
As a family member, however, it’s tremendously reassuring to have a calm, competent individual answering questions and guiding me to the appropriate staff member.
• Visitor areas are scrutinized. While my general philosophy is that I’d much rather be in a place that focuses on emotional and physical comfort than on outward appearances, my visiting family members are definitely aware of disrepair, cleanliness levels and shabbiness.
For the entire article, visit:
Posted by Dr. El - January 19, 2017 - Dementia, Engaging with families, McKnight's Long-Term Care News
Here’s my latest article on McKnight’s Long-Term Care News:
As I’ve mentioned in past columns, delivering high quality care for residents and their families means accepting our role not only as care providers but also as educators throughout the process.
This often involves teaching family members about illnesses so that they can become strong members of the treatment team, rather than bringing sweets to someone with diabetes or inadvertently agitating a resident with dementia.
As anyone who’s visited a doctor knows, however, it’s easy to become overwhelmed and to have the information presented by the medical professional blur so that it sounds like a Charlie Brown cartoon teacher declaring, “Wa wa wa wa, wa wa wa wa wa wa.”
I recently learned of a promising program to teach families — particularly Hispanic families — about dementia in a manner that makes the information easier to hear: an audio-visual novella called “Forgotten Memories” (“Recuerdos Olvidados”), which is available on YouTube in English and in Spanish.
The novella, by the University of Southern California School of Pharmacy in association with USC Good Neighbors Campaign, USC Dornsife College of Letters, Arts and Sciences, and USC Alzheimer Disease Research Center, tells the story of a man whose forgetfulness begins to impact his daily life and to affect three generations of his family.
For the entire article, visit:
Posted by Dr. El - December 22, 2016 - Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News, Tips for gifts, visits
Here’s my latest article on McKnight’s Long-Term Care News:
In his Dec. 6 McKnight’s Senior Living column, Editorial Director John O’Connor reported on a senior living center in Jiangsu province in China that offers cash rewards to people who visit their loved ones. Ten visits in a two-month period led to the equivalent of about $10; thirty visits brought about $29.
The result? The number of residents receiving regular visitors jumped from 10% to about half, no doubt making a huge impact on the lives of the residents and on the culture of the facility.
While this “positive reinforcement” obviously can be very valuable — and I agree with O’Connor’s alternatives to cash such as gift cards or entry into a raffle for a local restaurant — there’s a lot we can do to make family visits inherently more rewarding.
When long-term care providers accept the role of teachers, we can add great value to our services and enhance the experiences of the families who come to us for assistance.
The reality is that many relatives have no idea how to best engage with their loved one in long-term care.
Visitors often ask questions in ways that lead to frustration or embarrassment rather than the heart-to-heart they’re seeking. A television blaring in the background can make it difficult to maintain a conversation. Family members trying to do the right thing by visiting are met with disappointment and frustration rather than joyful connection. When visits don’t go as hoped, it can create what feels like punishment instead of reward.
Take a moment to listen to the comments of the visitors on the way out the door this holiday season. Look at their expressions. Do people seem satisfied with their visits or can more be done to create a pleasant experience? Astute administrators and nursing directors might overhear remarks such as, “Dad didn’t hear a thing I was saying,” or, “She couldn’t remember anything. I didn’t know what to say to her.”
Family visits can be vastly improved with some basic tools and education. Here are some ideas for this year and next:
For the entire article, visit:
