Category: Long-Term Living Magazine
Posted by Dr. El - March 28, 2013 - Business Strategies, Customer service, Long-Term Living Magazine, Resident care
Here’s my latest article in Long-Term Living Magazine online:
When the psychologist arrived at Mrs. Winters’ room, she found her distraught and disheveled. “Last time you saw me I was stuck by that dresser in the corner and couldn’t get out. This time it’s something else!” She shook her fist at the ceiling and looked heavenward. “You know what that aide said to me?” She continued without waiting for a response. “When I told her I wanted to take my shower at night instead of this morning, she said I couldn’t! It was this morning or nothing. Of course I refused. What kind of nonsense is that? I’ve been taking nighttime showers my whole life!”This article, which follows last month’s post on physical design features in the long-term care setting, addresses two additional areas of care that can be modified to offer more control and autonomy to those we serve—scheduling and training. Increasing control is important because residents often enter long-term care due to sudden and unexpected health problems that have thrown them intocrisis. When residents perceive control over what is generally a highly structured new environment, it helps them cope with stressors, reduces their depression and anxiety and increases their satisfaction with care.
SCHEDULING FEATURES
Offering increased flexibility within daily schedules can provide opportunities for residents to have more choice in how their days unfold. They engage in the same activities such as rehab and dining, but they can arrange their days to meet their own preferences rather than subsume their desires to the nursing home schedule.
Many adjustments in scheduling can be made without dramatic shifts in the staff routine, such as offering residents their choice of shower time. Rather than incorporating a multitude of changes simultaneously, new areas of flexibility can open up sequentially, giving the staff (and residents) time to adapt and to consider other parts of the schedule that can become more adjustable.
TRAINING FEATURES
Offering more choices for residents will be as successful as the reception from the staff. If resident requests receive sighs, frowns and obvious irritation, residents will quickly learn that the options are for marketing purposes only and that they won’t be implemented without repercussions. In that case, because their wellbeing depends on the good will of the staff, only the feistiest residents will take advantage of newly created choices.
For more, visit LTL magazine online:
Posted by Dr. El - February 26, 2013 - Business Strategies, Customer service, Long-Term Living Magazine
Here’s my latest article in Long-Term Living Magazine online:
What design features do LTC residents most want?
The psychologist walked into Mrs. Winters’ room and found her in the corner, muttering under her breath. “Is everything okay?” the psychologist asked, concerned. Mrs. Winters was usually a calm lady, but today her face was tight with anger.“Thank goodness you’re here!” Mrs. Winters cried. “I came over here to get a letter from my nightstand and now I can’t get out of this spot!” She tried to move her chair backward but the wheels jammed into the wall. She pushed the chair forward and ran into the bed. “I’ve been stuck like this for almost an hour and my call bell is on the other side of the bed. It’s a good thing I’m too angry to cry because I can’t reach my tissues either!”Renovations and redesigns large and small can breathe new life into a facility, especially when they’re focused on the needs of the people who live and work within them. The changes that are most important to the residents tend to be those that center on their psychological need to regain control. Most residents enter long-term care after a fall or other health crisis takes them from their home and thrusts them into an unfamiliar environment with rules not of their own making. Meals are served on schedule, toileting depends on staff availability, and discharge plans rely on a host of factors and players that can’t be managed by the resident. When the big things in life are spiraling out of control, being able to direct the small things can make a world of difference. Here are some design changes that matter most to the residents.
WITHIN RESIDENT ROOMS
To provide increased control within each room, consider that most nursing home residents have limited mobility and are often in wheelchairs that are difficult to maneuver in small spaces. Residents spend significant amounts of time in bed, unable to get out on their own. While most LTC facilities have mechanical beds that allow residents to adjust themselves as needed, there are many additional aspects of the environment that could be under resident control.
- Room temperature. Many times the call bell is ringing because a resident wants a window opened or closed or wants the air conditioning adjusted. Providing remote controls for the air conditioning and heating system allows the residents to take care of this function and frees staff time for other concerns. If the windows can be opened by remote (or easily opened manually) this improves quality of life, especially because getting outside for fresh air can be such a challenge.
- Large remote control for TV. Residents may have remote controls for their televisions, but have difficulty using them due to overly complicated designs with small buttons and tiny labels. The best remote controls are simple, with large well-labeled buttons, yet are not so heavy that frail elders have trouble holding them. Provide recommendations to family members as part of a good customer service program.
- User-friendly telephone. Similarly, the best telephones are the least complicated. They have large buttons, a loud ringer and speaker, are impervious to liquids and can withstand the inevitable falls that occur during use in long-term care. If families are providing phones, offer them these suggestions because you’re the experts and they’re probably going through this for the first time.
Posted by Dr. El - January 28, 2013 - Business Strategies, Long-Term Living Magazine, Motivating staff
Here’s my latest article in Long-Term Living magazine online:
3 small changes promise big impact in motivating your LTC staff
The new year has just begun and even without an official resolution, January holds the promise of a fresh start. This could be the year to address perennial problems plaguing your organization. It can be a challenge, though, to know where to begin on the mountain of tasks needing attention. Perhaps you have neither the time nor the budget for major changes. The good news is that
psychological research suggests small goals tend to be more successful than great ambitions. With that in mind, make use of the new year’s momentum by making minor adjustments in three areas for a big impact: appreciation, repair and organization.
1. APPRECIATION
Studies show that long-term care staff members aren’t in it for the money. Because workers tend to be more motivated by recognition of their efforts than by remuneration, showing appreciation will reap great rewards.
- Start small by simply thanking the people around you for their efforts. Recognize triumphs, commitment to the team and attempts even if they don’t result in success. As leaders within the organization, your attention to appreciation can create a ripple effect as others model their behavior after you and start thanking their coworkers and subordinates.
- Make it a habit to recognize one person, unit or action in each morning report or department head meeting. By calling attention to positive behaviors, you provide a roadmap for your employees or coworkers regarding the kind of work you’d like to see. Ask coworkers to “tell on” their peers, and vary who receives acknowledgement so that the unsung heroes shine as much as the obvious go-getters. Use this powerful tool, for example, if you sense a new employee might be feeling anxious, commending their work in front of colleagues to generate a feeling of inclusion and welcome.
- Take appreciation a step further by establishing an official recognition program such as “Employee of the Month.” Rewards can be as simple as a good parking spot, a plaque on the wall or a gift certificate to a local restaurant.
2. REPAIR
In any establishment there are things that break down. The New York City subway system, for example, is over 100 years old and in constant need of repair. The Metropolitan Transit Authority moves station to station with complete renovations that transform the location from dingy and crumbling to bright and freshly tiled. A recent sign in a subway car, however, announced a change in its repair program: instead of complete overhauls while most stations languished in disrepair, they’d now be attending to the most urgent needs of all stations. If the MTA can use this triage approach, so can long-term care.
Posted by Dr. El - December 13, 2012 - Business Strategies, Engaging with families, Long-Term Living Magazine, Tips for gifts, visits
Here’s my latest article on Long-Term Living magazine online:
The holiday season is a time when family members are more likely than usual to visit their loved ones in long-term care facilities. Out-of-town relatives may be making their annual visit, or grandchildren off from school might be stopping by to see Grandma or Grandpa. Now’s your chance to roll out the red carpet and show families what nursing homes are really about—caring treatment of their loved ones, an engaged staff that considers family members part of the team and good customer service. Where to start taking advantage of this opportunity to shine? At the front desk…
1. Encourage staff to provide an extra-warm holiday welcome.
LTC staff members are used to the hustle, buzzers, equipment and jargon of facility life, but the environment can be jarring to occasional visitors. Counteract their expectations of a sterile setting by offering a cheerful hello from a holiday-themed lobby, providing directions to their loved ones that show personal knowledge of the resident (“Your aunt is probably at lunch on the first floor right now so you might want to check there before you go to her room.”) and suggesting guests have a look at the visitor’s information provided by the facility. This material can be displayed as informally as a stack of newsletters on the counter, or with the fanfare of a labeled magazine rack filled with the elements outlined below and complete with resident greeter.
2. Reach out to family members through the facility newsletter.
Have relatives sign up to receive the missive so they can be informed of events and happenings all year round—and create a facility newsletter if you haven’t already done so. It’s easy and inexpensive to offer an electronic version, so now is the time to capture those email addresses and save on printing and mailing costs. Deliver helpful information and news consistent with the mission of your facility at a realistic frequency that can be maintained by your staff. It’s much better to offer a quarterly or semi-annual publication that can be delivered regularly than to commit to a monthly contact and not be able to follow through.
3. Offer tips for families to make the most of their visits.
For more, visit LTL magazine online:
Posted by Dr. El - November 26, 2012 - Customer service, Long-Term Living Magazine, Medication issues
Here’s my latest article on Long-Term Living magazine online:
Reducing antipsychotic medications? Try these behavioral interventions
With the recent focus on reducing antipsychotics in long-term care and substituting behavioral interventions, facilities may be left wondering what interventions to use and how to implement them. Here are ideas on how to prevent, investigate and monitor agitation on your units and address staffing needs to ease the transition from antipsychotic medication.
PREVENTION: BORROW FROM THE PSYCHIATRIC HOSPITAL
In a psychiatric hospital, the focus is on creating an emotionally healing environment—a therapeutic milieu. In long-term care, the focus is on providing high-quality physical healthcare and the frequently neglected therapeutic milieu can contribute to resident agitation. Take some time to walk your units and evaluate the emotional environment. This is what residents, and especially those with dementia, are reacting to and small changes can make a big difference.
Evaluate and adjust the physical environment. Is it disturbingly bright or so dark that older eyes can’t see who’s approaching? Is it very loud, with excessive overhead paging, chair alarms and shouting staff and residents? Is it too cold or too warm? Make environmental changes so that an older version of you wouldn’t mind spending time in the day room.
Provide appropriate programming. Are residents crammed together in a small area for long periods of time, creating the sensation of being trapped? Is the main activity a blaring television set? A therapeutic milieu is all about engaging the residents in appropriate activities with a pleasant flow through the day. Pursuits for residents with dementia can include music, baking, tactile and visual stimulation, etc. Providing activities off the unit offers additional stimulation to those who can tolerate it and lessens crowding in the day room. It can also offer a healthy diversion for cognitively intact residents.
Calm residents before they get agitated. The time for staff to act is when interactions between residents start to become tense, rather than waiting until an argument has broken out. Interventions such as distraction, redirection and a face-saving move to another location can be remarkably effective. Attending to individuals at early signs of distress can prevent episodes of full-blown agitation.
Use customer service techniques. Well-trained staff can often prevent agitation from occurring. Units can be transformed by charge nurses who speak to residents and staff alike in calm, respectful tones, address needs immediately and expect the aides working with them to do the same.
Staffing recommendations:
- Train all your staff in customer service techniques.
- Offer special workshops for nurses, aides and recreation therapists on providing care and activities for residents with dementia.
- Consider hiring nurses with psychiatric experience who understand how to maintain a therapeutic milieu.
INVESTIGATE: PUT ON YOUR SHERLOCK HOLMES HAT
If a resident is agitated despite environmental changes, look for underlying causes. Residents with dementia are often unable to speak through words, so they use other methods. Sometimes it takes a bit of sleuthing to figure out what they’re saying.
For more, visit LTL magazine online:
For more details on behavioral interventions, download Dr. El’s FREE report: Stop Agitating the Residents!
Posted by Dr. El - November 3, 2012 - Long-Term Living Magazine, Savvy Guide reviews
How to help new residents adapt to nursing home life
November 1, 2012 by Patricia Sheehan, Editor-in-Chief
The nursing home can be an overwhelming and scary place for new residents and their families. There are so many fears and stigmas associated with nursing homes—even after spending a couple of years reporting on the industry I occasionally become anxious at the thought of someday spending time in one myself.And while facility staff may strive to allay new residents’ concerns upon admission, let’s face it, they are challenged with pressing demands on their time that compete with the important task of providing the critical reassurance and information residents require.There’s a great new resource that aims to meet this informational need for residents, families and providers alike. The Savvy Resident’s Guide, a book written by psychologist and Long-Term Living contributing writer Eleanor Feldman Barbera, covers just about every concern a resident might have, explaining how nursing homes work and how people can make the most of their stays. I encourage LTC providers to consider providing this book to residents and their families upon admission.
Posted by Dr. El - October 2, 2012 - Business Strategies, Communication, Customer service, Long-Term Living Magazine, Resident care, Resident education/Support groups
Here’s my latest article on Long-Term Living magazine online:
“Thanks, Doc, for telling me about this group!” Mr. Jones smiled and held up the magazine he’d gotten from the National Parkinson Foundation. “Except for that actor, I didn’t even know one person with Parkinson’s before I got my diagnosis—now I find out there are enough of them to have a whole Foundation!”“You feel better knowing you’re not alone,” the psychologist reflected.“Not only that,” he said, “but I’m learning a lot about Parkinson’s and how to handle it. I used to get so angry when I couldn’t do the things I used to do, but now I see it’s my illness. I’m gonna figure out how to deal with it,” he said with conviction.Like Mr. Jones, many residents enter long-term care with medical illnesses that are unfamiliar to them, sometimes years after their diagnoses. As discussed in the article 5 Reasons to Educate Residents About Their Illnesses, not only are properly educated residents more compliant with healthcare recommendations, but the coming baby boomers are going to demand information about their illnesses. Nursing homes that provide education for residents (and families) will be offering cutting-edge services that enhance the experience of their facilities and increase customer satisfaction.Here are seven simple methods to educate residents that are easy to implement and will help your facility stand apart from the crowd:
- Encourage discussion with medical staff upon admission and diagnosis. Part of the initial assessment of new residents should include asking them whether or not they know what their diagnoses are. Nurses and doctors can offer a brief explanation of unfamiliar terms and assess the need for more information, the length of time since diagnosis (the more recent the diagnosis, the more likely the resident will be in emotional distress and may benefit from mental health support), and the level of family involvement (involved family may need information too). Any new diagnoses after admission should be discussed with the physician and followed up as needed.
- Dispense fact sheets about illnesses. Every illness is Google-able. Chances are that your boomer residents and/or their family members will be researching their illnesses on their smartphones or laptops, but the details they’re obtaining may not be from reputable sources. By providing information from established medical sites, staff can direct residents to credible resources. The staff members also will have easy access to the information and can familiarize themselves with the illnesses and required care. Fact sheets could be in a binder available at the nursing stations for the staff to distribute or in a magazine rack accessible to the residents and visitors.
- Provide information about illness organizations and how they can join. Along with the basic details an illness fact sheet provides, residents can be offered information about disease-specific organizations. The mere knowledge of the existence of such groups can be helpful, since many residents feel alone with their illnesses, despite the fact that they may be sitting in the hallway next to another resident with the same disease. Privacy laws prevent staff members from sharing such similarities, and residents might not feel comfortable discussing their physical concerns with a neighbor on their floor. Illness-related societies can offer support, coping strategies, hope and perspectives that others are unable to provide. Joining such organizations can be an important step in regaining a sense of control over one’s life.
For more, visit LTL magazine online:
____________________
Now available on Amazon:
Everything You Wanted to Know About Your Nursing Home Stay
But Were Afraid to Ask
Posted by Dr. El - August 21, 2012 - Business Strategies, Communication, Customer service, Long-Term Living Magazine, Medication issues, Resident care, Resident education/Support groups
Here’s my latest article in Long-Term Living Magazine online:
5 reasons to educate residents about their illnesses
“How long have you had Parkinson’s?” the psychologist asked Mr. Jones during his initial evaluation.
“They just told me the diagnosis when I got here last week, but I suppose I’ve had it for a while.” He said it casually, but his hands were clenched and his voice held a note of tension.
“Did the doctor explain what it is or give you information about the Parkinson’s Foundation?”
“No. All I know is that it’s the same disease that young actor has—what’s his name?”
“Michael J. Fox.”
“Yeah, that’s the one.”
The psychologist assured the resident she’d bring him a pamphlet from the Parkinson’s Foundation the following week. It would work better, she thought to herself, if the medical staff provided the physical health information so she could follow up with the mental health aspects.
Residents often enter long-term care with surprisingly little knowledge about their conditions, whether they have a recent diagnosis or have been living with an illness for many years. This lack of information isn’t good for residents, families or facility staff.
Here are five reasons why we should teach our residents about the illnesses they live with:
1. Education leads to more active resident involvement in care.
When residents have information about their illnesses, they are more able to accurately report their symptoms to the medical team and to provide the type of information that improves treatment. A resident without knowledge is a passive recipient of medication and care; a resident with knowledge can partner with his or her medical team to address needs and find effective solutions. Joan, for instance, had multiple sclerosis and was keenly aware that the hot summer made it difficult for her to walk in rehab. She was able to work with her therapist to find more manageable activities so that she could continue with her rehab program during the summer months. Contrast this with Leon, who blamed himself for his MS symptoms, believed his difficulty walking was a personal failure, and was referred for psychotherapy when he stopped attending rehab. With encouragement and some psychoeducation about his illness, Leon was literally able to get back on his feet again.
2. Knowledge increases compliance.
Uneducated individuals are less likely to comply with treatment recommendations or may reject medications due to side effects without fully considering potential benefits. Individuals who understand why particular medications are given and how to cope with potential side effects are more likely to comply with treatment. They’re also more likely to have reasonable, informed objections for foregoing a particular course of treatment—reasons that can be readily understood and documented. For example, Lucille was initially resistant to the dialysis treatments that were recommended for her. Once she gathered information and spoke to some other residents in the dialysis program, she ultimately decided that its life-saving benefits were worth the time and discomfort of the treatments. Thomas, on the other hand, decided against dialysis and was able to explain and document his end-of-life wishes clearly, based on his knowledge of his illness.
3. Information reduces anxiety.
Posted by Dr. El - June 6, 2012 - Business Strategies, Long-Term Living Magazine, Motivating staff
Here’s my latest article in Long-Term Living Magazine online:
5 team building practices that will make your staff WANT to stay
According to a 2011 American Health Care Association study, the average nursing home turnover rate is 35 percent for all staff and 43 percent for CNAs. By contrast, Fortune magazine reports that the 100 best companies to work for in 2011 had a turnover rate of 3 percent or less. Clearly, most nursing homes are in need of staff retention strategies. One of these strategies is team building, which has a “long term positive relationship between employee morale and retention.” When it comes to building a team, forget corporate retreats and singing “Kumbaya” around the campfire. Here are five practical, easy-to-incorporate strategies you can use at your nursing stations starting today.
1. Develop a clearly communicated larger purpose for your organization.
Give people a reason to show up for work beyond their paycheck. If you were asked to fill in the “X” of the statement, “We do X here,” what would your answer be? Is your facility goal getting a great survey? While that may be energizing for you, it’s not likely to be motivating for most of your staff. Generate a vision that excites the team. For example, Signature Healthcare, which ranked in Modern Healthcare’s top 100 best places to work in 2009 and 2010, states that part of its mission is to “earn the trust of every resident, family and community we serve.” A staff member can use this barometer to make decisions about how to handle situations, i.e., “Is this going to earn trust?” A vision for a company or facility dedicated to addressing the mental health as well as the physical health of its residents could be, “We treat the whole person,” giving staff the impetus to care for both the physical illness and the emotional distress it causes. Elaborate upon ways in which your “X” is accomplished through your mission statement, employee training, staff recognition programs, and other communications.
2. Recognize staff members who further the organization’s values.
Whether or not your facility has developed a specific mission, there are certain qualities that stand out as desirable and create an environment more conducive to staff retention, such as teamwork, helping others and kindness. Staff recognition programs provide an opportunity to promote qualities that are valued within an organization. They are the “carrot” to the “stick” of disciplinary action. Schools use this technique when, for example, they discourage bullying by presenting their students with award certificates for “helping” or “caring.” Similarly, LTC facilities can offer kudos of varying types (certificates, gift certificates, parking spaces, free lunches, first choice of holiday schedule, etc.) for good customer service, going the extra mile for the team, helping a coworker care for a resident, and other valuable contributions. Employee recognition can be done on a facility-wide or unit-by-unit basis, allowing for great flexibility and the opportunity to institute this tool immediately. For example, a charge nurse inspired by this idea could ask in the next change-of-shift report: “Let’s try to encourage each other. Did anyone notice any good qualities about a coworker today?”
3. Help new employees integrate into the team.
Posted by Dr. El - March 29, 2012 - Business Strategies, Communication, Long-Term Living Magazine, Motivating staff
Here’s my latest article, on The Silo Effect, at Long-Term Living magazine’s online site:
The employees listened carefully to their boss as he outlined a new procedure.
“Any questions?”
None were raised, and the boss, pleased at the consensus, adjourned the meeting. But outside the conference room, the murmurs started.
How do they expect us to do that? Don’t they know that’s going to lead to this other problem? If they want that to happen, why didn’t they just do it this way? You and I both know that’ll never work, but I’m not going to be the one to say anything.
Me neither.
What is the Silo Effect?
The Silo Effect refers to a lack of information flowing between groups or parts of an organization. On a farm, silos prevent different grains from mixing. In an organization, the Silo Effect limits the interactions between members of different branches of the company, thus leading to reduced productivity.
Long-term care silos
Silos operate at various levels of long-term care. They can be found in the silent acquiescence of department head meetings, hospital transfers without complete documentation, care plan meetings where key players are missing, and nursing home admissions that neglect to provide residents and families with the information they need to become proactive members of the team.
In fact, our current healthcare system is one of silos: private insurers, Medicare, Medicaid, hospitals, nursing homes, home healthcare, regulators—all working independently, but connected, to haphazardly manage the nation’s healthcare.
For more, visit LTL mag: How to eliminate the silo effect in LTC organizations
