Category: Engaging with families
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 - May 5, 2010 - Dementia, Engaging with families, Tips for gifts, visits
Dr. Green suggests simplifying previously enjoyed activities to the point where they’re manageable, but not childish. Using a calm approach in a quiet setting, and shifting activities if your relative becomes frustrated will lead to better results. New Old Age readers added the following suggestions:
- Doing jigsaw and crossword puzzles for puzzle enthusiasts, especially personalized ones such as a crossword about favorite subjects or events, or a jigsaw made from a family photo
- Sorting through Grandmother’s button collection, letting her describe each button and the memories it triggers
- Winding or sorting skeins of yarn for knitters and crocheters
- Being in calm and silent companionship rather than finding the need to fill the space
- Reviewing and discussing garden catalogs for former gardeners
- Reading Erma Bombeck columns
- Positive reminiscing, steering clear of painful memories and otherwise going with the flow
- Singing the first line of a well-known song and lettting the resident come up with the next line (New York, New York, a helluva town)
Posted by Dr. El - February 24, 2010 - Engaging with families, Tips for gifts, visits
In my years as a psychologist in long-term care, I find it’s normal for new residents to be feeling some depression or anxiety. Most of us would take time to adjust if we were away from home, feeling poorly, not able to get around like we used to, and living among strangers. With a few simple interventions, family members can help ease this adjustment process and reduce the likelihood the depression or anxiety will be long-lasting.
Call or visit regularly – It helps residents to know that Junior will call or visit every Sunday, or the first Monday of the month, rather than wondering when their next visitor will arrive. If schedules need to be more flexible, calling in advance of a visit will provide days of looking forward to your arrival.
Attend activities together – One of the best features of nursing homes is the opportunity to try new things and meet new people. Check the recreation calendar to find events of interest to your loved one, attend them together, and point out other activities that might be enjoyed in your absence.
Facilitate friendships with other residents – Ask the social worker or recreation therapist if they know other residents with similar interests, and bring them together to talk about baseball, their hometown, music, etc.
Bring photos or other mementoes – Even if the stay will be a brief one, it can be comforting to have a family photo or other sentimental object in the room. Bring items that are important but not irreplaceable.
Throw a room-warming party – For residents who enjoy company, invite friends and relatives to an open house to encourage visitors. For more on this, see my blog post
Throw Me A Party.
Enjoy some home-cooked food – Sharing a home-cooked meal, or some take-out, within dietary guidelines, is a great way of bonding and of bringing the comforts of home into the nursing facility.
Request an evaluation by the psychologist – If you’re worried about your loved one, ask the team for a psychological evaluation. Most psychologists schedule weekly sessions, if needed, to discuss concerns, but don’t prescribe medication. (That’s the job of the psychiatrist.)
Develop your own supports – Residents often worry about the burden they’re placing on their family members. Help them by helping yourself. There are tons of support options out there, from online resources to in-person support groups, with some of them listed in the Resources for Family Members section in the sidebar of my blog.
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.
Posted by Dr. El - November 3, 2009 - Engaging with families, For Fun, Tips for gifts, visits
In my post, What I Want My Nursing Home Room to Look Like, I mention I’d like to have family pictures in my room. Actually, I’d like everyone to have family photos in their nursing home rooms, in addition to photos of themselves when they were young. Before I started in long-term care (I was working at the state psychiatric hospital at the time) and Grandma Lily was in a nursing home, I bought a multi-photo frame, inserted pictures of the family, and hung it on her wall. It transformed the previously anonymous space and I felt happy to see her surrounded by loved ones whenever I came to visit. Pictures and memorabilia tell the story of someone’s life and remind everyone who the person is. They’re the single most homey addition to a room and they last longer than flowers. I’ll be talking more about the holidays as they approach, but if you’re wondering what to get a nursing home resident, photos are an excellent gift.
My parents were thrilled with their 50th wedding anniversary gift of a photoscope created by the talented Sue Samek of Photoscope Gifts. Sue creates one-of-a-kind artwork from your photos.
Here’s a photoscope of Sue’s family, and a detail of the work. She also creates photoscopes for hobbyists (cat lovers, gardeners, etc), travel buffs (a great idea for vacation photos), and any series of photos you can imagine.
Posted by Dr. El - October 27, 2009 - Engaging with families, Resident/Family councils
Today, guest poster Karlin Mbah, of the New York-based organization Friends and Relatives of the Institutionalized Aged, explains what Family Councils are and how they can work with nursing homes to improve care for the residents. In a later post, she’ll discuss ways to create a successful family council.
Background on FRIA and Karlin Mbah:
FRIA: The Voice and Resource for Quality Long Term Care is a not-for-profit organization dedicated to fostering the dignity and independence of seniors in long term care settings, with a special focus on nursing home residents, and to ensuring that they receive prompt, high quality compassionate care. We seek to accomplish this by helping friends and relatives become more informed and effective caregivers for the needs of their loved ones.
Karlin Mbah is the Family Council Coordinator and Policy Advocate for FRIA. As the Family Council Coordinator, Ms. Mbah provides technical support and assistance to Family Councils in the New York City greater metropolitan area.
Currently FRIA conducts quarterly “Advocates of Nursing Home Reform” (ANHR) meetings at which Family Council members and leaders from all over the City meet to discuss issues and projects in their nursing homes. FRIA will also be assisting ANHR members in publishing a quarterly newsletter, by and for Family Councils, which will begin distribution in 2010.
Ms. Mbah also works on FRIA’s free telephone helpline (212-732-4455) which is open M-F 10AM-5PM to answer your questions about long term care.
Parts of this blog contribution were taken from FRIA’s Family Council Manual and Tool Kit by Jean Murphy and Jessica Herold.
Family Councils:
What is a Family Council?
Family Councils can play a very important role in helping residents of a nursing home have good quality of care and quality of life. A typical Family Council is a group of committed families and friends of nursing home residents who work together to improve the quality of life for all residents in a particular facility. For simplicity, I will refer to Family Councils and their members as families, but friends, partners, significant others, and all regular caregivers participate equally in Family Councils and are included when I refer to “families.”
Family Councils have the right to organize under the law. Under Federal Law, the 1987 Nursing Home Reform Act (OBRA ’97) recognizes that families are an important part of a nursing home community and serve as advocates for good care. The Act guarantees families of nursing home residents the right to meet together in a facility, and to be provided with space, privacy and staff assistance, if sought. Administrators are required to listen to, and act upon, the recommendations and grievances of Family Councils. Several States, including New York, have strengthened and empowered Family Councils by enacting laws that give additional rights and protections to councils, beyond those provided by federal law.
What Do Family Councils Do?
Family Councils bring about positive change in nursing homes. The structure and activities of councils vary greatly, depending on their membership and the issues they decide to address. Some typical Family Council activities include:
· Welcoming new families and friends to the nursing home
· Offering support to each other
· Raising concerns and complaints and working to resolve them
· Providing education and information
· Improving communications with the home
· Arranging joint activities for families, friends and residents
· Recognizing staff for good work
· Connecting to community resources
· Speaking out on public issues
· Taking the lead in bringing new models of long term care to their communities, such as person centered care, also known as Culture Change.
Family Councils allow a venue for families to address their concerns in a safe setting and get support for the resolution of these concerns. Nursing home staff attend Family Council meetings by invitation only and must respond to recommendations and grievances presented by the council. These recommendations and concerns can be made in the name of the group, thus providing anonymity to individuals and a united front of families working for better care.
Posted by Dr. El - March 17, 2009 - Anecdotes, Communication, Engaging with families, Resident care, Tips for gifts, visits, Transitions in care
Please:
- Hang my psychology diplomas on my wall, so I’m reminded of my accomplishments.
- Display family photos, so I feel surrounded by my loved ones.
- If I have Dementia, label my photos so the staff can talk to me about my family and help me to remember.
- Put a quilt or bedspread on my bed from home so my room won’t look so institutional.
- Over my bed, put up the Halloween photo of me dressed as Wonder Woman, to remind everyone of my hip and glamorous past.
- Make sure I have some nice clothes in my closet (and some lipstick on my lips), so I can continue my hip and glamorous life.
Posted by Dr. El - January 8, 2009 - Communication, Engaging with families, Tips for gifts, visits, Transitions in care
I recently met a new resident who demanded almost constant attention from her loved ones. Her family visited daily for hours at a time, and she’d call them soon after they’d left and tell them she was lonely. Trying to please her, they were exhausted, frustrated, irritable, and terribly sad. I reminded her tearful daughter about the recommendation of flight attendants for those traveling with people in need of care — put on your own oxygen mask first. For many families, the road to the nursing home has been long and difficult, and it’s okay to take a breath now that your loved one is here.
It reminded me of my work with a wonderful 50-something man with Multiple Sclerosis, who spend most of his time in his room, hanging out with Jaime, the private aide his wife had taken a second job to afford. He was very depressed about his situation. Moving to the nursing home, he felt his life was basically over. “George,” I tried to persuade him, “come out of your room and join the activities. There are some really nice people here and fun things going on.” But no, he was fine talking with Jaime. Until his frantic wife, collapsing under the stress of her work schedule, finally dropped the second job, and Jaime. George emerged from his room and tentatively attended the trivia group I thought he might enjoy. He went back again the next week, and then added word games to his recreation schedule. He started meeting people, making friends, and cracking jokes. And his wife, who had recuperated from her burnout, was able to visit more frequently now that she wasn’t pulling double shifts at work.
The first weeks and months at a facility are hard on everyone, no matter what the particulars of the situation. Residents are often frightened and can feel abandoned despite regular family contact. Families frequently feel guilty about the move, as necessary as it might be. One of the benefits of a nursing home for the residents is the social environment — meeting new people, attending recreational activities, and making connections with others in similar situations. I often suggest that family members accompany their loved one to activities they might like, to help break the ice. Another benefit of a nursing home is that, to a large extent, it gives the resident back their independence from relying heavily on their family as caretakers. It creates more opportunity for family members to enjoy each others company without the tensions of day-to-day caregiving.
Posted by Dr. El - December 19, 2008 - Communication, Engaging with families, Tips for gifts, visits
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.
