Category: McKnight’s Long-Term Care News
Posted by Dr. El - April 15, 2015 - Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The elevator opened up to the third floor of the skilled nursing facility. Wheelchair-bound residents lined the hall across from the nursing station, some silently watching the staff, some snoozing.
On the second floor of the nursing home, the physical layout was exactly the same but the atmosphere was completely different. Groups of two or three residents were chatting animatedly, commenting wryly on their observations of staff and laughing amongst themselves.
How do we get from Scenario A to Scenario B more often? Is it worth the effort?
The high cost of loneliness
A recent study showed that community-dwelling seniors visited their doctors more often when they were lonely — the trips to medical offices were an important but costly form of social interaction. Similarly, one might speculate that socially isolated residents request help from their nurses, aides and other workers due to feelings of loneliness in addition to addressing specific care needs.
Reducing loneliness among residents would, therefore, contribute to more staff time being available for medically necessary care.
Decreased turnover
The findings from another study suggest a connection between happier residents and staff retention. Researcher Barbara Parker-Bell, PsyD, LPC, ATR-BC, finds that “nurses consistently described the best and most satisfying aspects of dementia care as … the pleasure of seeing residents calm and engaged.”
I know from my own experience that it’s much more uplifting to step onto a unit with laughter than it is to work on a floor where the residents are depressed, lonely and withdrawn. And, of course, it’s better for the residents and their families.
Beyond ‘recreation’
Good therapeutic recreation programs are essential in reducing isolation, providing meaningful ways of spending time and in developing friendships. They’re an important step in reducing loneliness, but are also only one piece of the puzzle.
If all staff members consider the social aspects of the environment — one of the best selling features of life in LTC — we can create friendly, engaging interactions that build upon and extend formal recreation programs.
Challenges to interacting
For the entire article, visit:
Posted by Dr. El - April 1, 2015 - Communication, End of life, McKnight's Long-Term Care News, Resident care, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
As a psychologist observing the effects of medical interventions on the mental health of the long-term care resident, I often ask, “Is this aggressive procedure helping?”
Such a well-intended question can prompt the team to reconsider the course of treatment or to affirm that care is in line with the wishes of the resident and their family.
Conversely, I do what I can to encourage my residents to comply with medical recommendations. When a resident presents with end-stage renal disease (ESRD) and the inevitable recommendation of hemodialysis is given, I work with them to adjust to this turn of events.
That’s why I was surprised to read in Paula Span’s “New Old Age” article in the New York Times last week, “Learning to Say No to Dialysis,” that dialysis isn’t always the best course of treatment for older patients.
Span reports that while dialysis can be very successful for younger and healthier patients, about 40% of patients with ESRD over the age of 75 die within a year and only 19% survive over four years. One study found that 58% of nursing home residents died within a year. Meanwhile, 61% of patients in a Canadian study said they regretted starting dialysis.
What leads to regrets tend to be the following factors, which can contribute to feelings of depression among those on a renal program:
• Physical symptoms such as pain, fatigue, nausea and headaches
• The amount of time spent on dialysis
• Inability to travel
• Dietary restrictions
Span quotes nephrologist Dr. Alvin H. Moss, who notes, “Patients are told, ‘You have to go on dialysis or you’ll die,’ rather than, ‘You could have up to two years without the treatment, without the discomfort, with greater independence.’” I’ve been part of teams that have told residents the exact words of that first message.
Medical management
For older patients, particularly those with other health problems, Dr. Moss asserts that medical management might be a way for them to focus on extending their quality of life and avoiding the discomforts of dialysis. The American Society of Nephrology suggests discussing this alternative to dialysis with patients through a shared decision-making process, as noted in their Choosing Wisely guidelines.
Facilitating treatment discussions
For the entire article, visit:
Posted by Dr. El - March 24, 2015 - Business Strategies, McKnight's Long-Term Care News
Those who like the convenience of attending a conference without leaving their desks (and the fact that it’s free!) will be pleased to hear that McKnight’s is holding their online Expo tomorrow and Thursday on the following topics:
WOUND CARE TRACK: “The current science of pressure ulcer prevention (Or It’s Still Rock and Roll To Me)”
CAPITAL TRACK: “2015 seniors housing capital market trends — and influencing factors”
PAYMENT TRACK: “MDS 3.0 Update: Know the new requirements, or else”
QUALITY TRACK: “Ways to reduce rehospitalizations and attract partners”
TECHNOLOGY TRACK: “Using technology to track resident preferences and activities to drive quality improvement”
(After the last McKnight’s webinar on Wednesday, head over to my Senior Bullying webinar at 2pm ET sponsored by EmLogis — think of it as the Mental Health Track.)
You can earn 3 CEUs and visit the vendor booths, as well as chat with other conference attendees via your avatar.
Posted by Dr. El - March 18, 2015 - Dementia, McKnight's Long-Term Care News, Something Good About Nursing Homes
Here’s my latest article on McKnight’s Long-Term Care News:
When I learned about Neurocognitive Engagement Therapy for rehabilitation residents, I had the same reaction I did when I first heard about geriatric emergency rooms: Palm-smack to the forehead, “Why didn’t we think of this before?!”
Of course people with dementia aren’t going to do well in traditional rehabilitation settings. We’ve been putting them in large, over-stimulating rooms and asking them to accomplish tasks that are meaningless to them. No wonder they become agitated or withdrawn and are unable to engage in treatment.
Enter NET therapy. Using a $25,000 grant from the Alzheimer’s Foundation of America, Phoebe Ministries, in conjunction with various academic partners, developed and studied neurocognitive engagement therapy, which combines the best practices of dementia care with the tasks of occupational, physical and speech therapies.
The elements of NET Therapy
Like geriatric emergency rooms, one aspect of the NET model involves changing the physical environment so that it’s calming and more conducive to engagement in treatment, such as working one on one rather than in a group.
For the entire article, visit:
Posted by Dr. El - March 4, 2015 - Bullying/Senior bullying, Business Strategies, McKnight's Long-Term Care News, Resident education/Support groups
Here’s my latest article on McKnight’s Long-Term Care News:
Things were different when I was a kid. People regularly drove while intoxicated. The high school archery team practiced on the football field while the track team ran around the periphery. Children bullied their peers without anyone giving it much notice.
These days, drunk driving prohibitions abound, schools are no longer casual about teens with potential weapons, and children start learning about bullies in kindergarten.
When it comes to bullying in senior communities, though, we’re still behind the times.
What is senior bullying?
According to the American Psychological Association, “Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words or more subtle actions.
The bullied individual typically has trouble defending him or herself and does nothing to ‘cause’ the bullying.” Bullying that does not involve physical contact is sometimes referred to as “relational aggression.”
According to senior bullying expert Dr. Robin Bonifas at Arizona State University, 10% to 20% of elders in senior communities experience bullying.
Dr. Margaret Wylde of the ProMatura Group reports that senior bullying occurs in every independent living community studied in her 2014 report, “Make Them Feel at Home,” sponsored by the American Seniors Housing Association.
In that study, bullying fell into the category with the largest relationship to whether or not the community feels homelike. Study participants described problems such as “difficulties making friends, being lonely, not fitting in, not having common interests, bullying by cliques, and missing their friends.”
Wylde notes that increasing residents’ sense of being at home results in fewer departures from the independent living community and reduced staff turnover, leading to an estimated $52,242 in savings over the course of a year. (Far more than enough to fund a bullying prevention program!)
Increased media focus
Senior bullying is receiving increased attention in the mainstream media, with articles such as Paula Span’s New Old Age column, Mean Girls in Assisted Living and Jennifer Wiener’s Mean Girls in the Retirement Home. (“Mean girls” tend to engage in gossip, excluding others and establishing cliques, while male bullies are more likely to yell and threaten.)
Heightened media exposure for the issue increases the likelihood that potential residents and their adult children will be asking about bullying prevention when they’re searching for a senior living community.
Steps to reduce bullying
In order to address bullying in long-term care, several steps should be taken:
For the entire article, visit:
Posted by Dr. El - February 18, 2015 - Business Strategies, Communication, End of life, McKnight's Long-Term Care News, Talks/Radio shows
Here’s my latest article on McKnight’s Long-Term Care News:
Last week, I attended the MarcusEvans LTC and Senior Living CXO Summit in Los Angeles, where I delivered a keynote address on “Identifying and Repairing Communication Gaps in LTC.” It was a fascinating, energizing event, and not just because I was leaving the frigid temperatures of New York City to dine outdoors in Marina Del Rey.
Of course, I was all jazzed up to speak about my obsession, long-term care. Of the many communication gaps I mentioned that need repairing, the one that most people commented on afterward was the way we handle end-of-life care.
Perhaps the ample feedback reflected how we, as a country, are spending so much money on aggressive medical treatments that are unlikely to help those who are dying and that most people wouldn’t want if they knew what they entailed. Or perhaps it’s because the vast majority of the audience was not only professionals in the field but also had a relative in long-term care. They recognized the value of having a peaceful death both for the resident and for their family.
It was interesting to me that only a few of these C-suite attendees had heard of Atul Gawande, MD, whose recent book on end-of-life care, “Being Mortal: Medicine and What Matters in the End,” became the basis for a “Frontline” documentary that aired last week. Atul Gawande is all the rage in my circle.
I, on the other hand, was gobbling up new information about positioning care facilities to thrive over the long haul. The clinical and the financial sides of the business have a lot to teach each other.
One of the highlights for me was hearing Dr. Margaret Wylde of the ProMatura Group speak about what’s important to residents of senior living communities. I was so excited by her information that I leaped from my seat and shouted, “Yes! Yes! Right on, sister!” At least, that’s what I was doing on the inside, while my outside sat politely nodding in my gray business suit.
For the entire article, visit:
Posted by Dr. El - February 5, 2015 - Business Strategies, Communication, McKnight's Long-Term Care News
Here’s my latest article on McKnight’s Long-Term Care News:
In the TV show “Mad Men,” the Sterling Cooper advertising executives find out how consumers feel about the product they’re pitching by holding focus groups. They ask people who use their product what they like and don’t like about it, how they use it and what it means to them.
As a long-term care psychologist, one of my main tasks is to sit down and talk in-depth with residents on a regular basis. I’ve basically conducted 20 years of focus groups. The single most common comment I’ve heard from residents over the years: “I never thought I would end up in a place like this.”
While it’s probably not the case for people who entered swanky continuing care retirement communities of their own accord well in advance of a health crisis, many residents feel like it’s a personal failure to be in long-term care. They think if they’d done something different, or earned more money, or if they’d had children, or had a better relationship with their children, or if they had better children, or something, then they wouldn’t have “ended up” in a long-term care home.
As a psychologist, I assure them that they didn’t do anything wrong and neither did anyone else necessarily. I inform them that many of the nicest and best people I know are living in long-term care. Occasionally, I introduce one awesome person to another. In psychology terms, we call this “normalizing” the experience. It helps a lot.
Below are some ways in which you can allay the residents’ concerns that they have lost the game of life by being in your establishment:
• Include on your website stories of amazing residents. If that exemplary person can be there, potential residents will feel that it’s a club they might want to join too. Include not just individuals who have achieved a traditionally successful life (money, fame, education), but also those who have accomplished unusual feats (raised 11 children, sky-dived in their 70s) or who overcame poverty, prejudice, or disability to lead a good and decent life.
For the entire article, visit:
Posted by Dr. El - January 21, 2015 - Customer service, End of life, McKnight's Long-Term Care News, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
There are moments in life that engender important questions. When an individual is born, we ask, “Is it a boy or a girl?” When the person dies, we ask, “What happened?” In long-term care, we’re not around for the first question, but we often are for the second.
Though infrequently observed by those not involved with direct care, how someone dies is a very important part of the culture of the long-term care organization.
In “Remembering the Lost,” New Old Age blogger Paula Span reports on the typical experience of loss in LTC, where deaths are often barely acknowledged. She describes two alternative programs that offer a way to recognize individuals who have lived and died in LTC.
In “Better death notifications could improve CNA work experience, study suggests,” McKnight’s notes that how the deaths of residents are communicated to CNAs affects the way they feel about their work. The best way to find out, the study concludes, is to be told prior to beginning a work shift. The hardest way to learn of a death is to arrive at the resident’s room and find it emptied of belongings or filled with a new resident.
A front-line perspective
Like others performing direct care, I’ve had to cope with the loss of residents. I felt sucker-punched by the deaths that occurred early in my LTC career. My youth, inexperience, denial, and lack of training in issues around death made the demise of very ill or very old residents seem sudden and shocking.
I quickly got some training in thanatology (the study of death) and I’ve had many years of experience since then. I learned to protect my heart and love with a little cushion of distance around me.
Echoing the findings of the study referred to above, my worst experience by far was coming in to work to find the room empty of a beloved patient, the bed stripped and raised as high as possible after the mattress had been cleaned. By contrast, once an aide rushed to me the moment I got off the elevator to visit one of my patients, telling me she’d passed the night before. I thanked her profusely, hurried to the bathroom and cried.
My rituals around loss do still occasionally involve crying in the bathroom, but more often since I learned to protect my heart I look upward and say, “Rest in peace, John.” Or Mary. Or Viola. Sometimes I talk with other staff members who were close to the resident. Or I write about the person who died.
Creating better ways to address losses in LTC
My personal rituals were developed in the absence of formal, facility-sanctioned acknowledgement of the deaths of residents. As a shrink, I was aware of the need to get training and to recognize the personal impact of these losses.
I suspect that many new staff members don’t make it past the “sucker-punch” phase of losing residents. Instead, they quit, so that new staff members must be hired and trained. For ideas on how to reduce this likelihood, read Absenteeism and turnover in LTC? Death anxiety could be the cause.
Facilities can improve the experience of death and dying for the residents, staff and family by addressing various aspects of the process such as:
For the entire article, visit:
Posted by Dr. El - January 6, 2015 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, McKnight's Long-Term Care News, Motivating staff, Psychology Research Translated
Here’s my latest article on McKnight’s Long-Term Care News:
Standing by the salad bar in the newly opened restaurant, I recoiled at the sign that read, “Please don’t use your hands.” I suggested to the manager that the notice should instead advise diners to “Please use the serving spoons.” My recommendation for that short-lived establishment followed what’s known as “nudge principles.”
What are nudge principles?
Nudge principles use basic human tendencies to encourage people to engage in positive behavior. One aspect of nudge is to craft messages, like how to use the salad bar, in ways that are more likely to result in positive action.
Another aspect, according to Tori DeAngelis in Coaxing Better Behavior, is to harness “our less laudatory traits — short-sightedness, inertia, inflated optimism and our tendency to submit to peer pressure.”
Research shows people have a “default bias” which makes them more likely to choose the first option in front of them. Putting fresh fruit before the desserts in a cafeteria line would be one way of making positive use of this bias. Another is creating a default option that enrolls employees in a retirement account rather than requiring them to opt into the program.
Care must be taken to create good default options, though, or they can backfire. One poorly constructed automatic retirement account enrollment, for instance, resulted in more individuals contributing, but fewer dollars set aside overall. Why? The default choice set aside less money than what people might have chosen if they’d given it more thought.
Starting with the end result
Some “nudge” researchers identify the outcome they want to see and then look at what methods are most successful in achieving that outcome. In one study, the British government sent letters to delinquent taxpayers, saying, for example, “You are one of the few who have not paid us yet.” They altered the wording of the letters to see which phrasing would result in the greatest collection of outstanding funds — and retrieved an extra $15 million overall.
Applying nudge principles in LTC
For the entire article, visit:
Posted by Dr. El - December 22, 2014 - For Fun, Inspiration, McKnight's Long-Term Care News
Here’s my latest article on McKnight’s Long-Term Care News:
‘Twas the night before Christmas and all through long-term care,
Decorations sparkled and twinkled — no wall was bare.
The recreation department had concerts galore,
The residents enjoyed it — they clamored for more.
The maintenance guys put up outdoor lights,
Vendors sent cookies and other delights.
The nurses wore holiday tops and bright pins,
Each floor had menorahs and dreidels to spin.
Kwanzaa candles were set out next to the trees,
Poinsettias brightened the desk of Security.
IT staff donned elf hats, the business office did too,
Rehab wore red sweaters, with bells on their shoes,
Environmental services polished ’til the whole place gleamed,
Everyone had seasonal spirit, it seemed.
Outfits were chosen by residents with care,
Make-up and hairdos were all an affair.
Aides helped as needed with jewelry and ties,
To make sure “their people” looked fetching and wise.
For the entire article, visit:
