Category: McKnight’s Long-Term Care News

Dr. El’s McKnight’s column wins Azbee Award!

I’m excited to share with you that my McKnight’s column won the Gold award in the Upper Midwest Region of the 2014 ASBPE Awards of Excellence in the How-To/Tips/Service category.

My column, “The World According to Dr. El,” focuses on bringing psychological insights to long-term care for the Chicago-based McKnight’s Long-Term Care News magazine. According to The Association of Business Press Editors, the “Azbee Awards of Excellence program is one of the most competitive there is for business-to-business, trade, association, and professional publications. The awards recognize outstanding work by magazines, newsletters, and digital media — Web sites, e-newsletters, digital magazines, and blogs.”

What if psychologists ruled the (LTC) world… (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

What if psychologists ruled the (LTC) world…

In the medically focused setting of long-term care, psychologists are mindful of the emotional environment. While most psychologists almost exclusively address the mental health of the residents due to the current reimbursement system, we’re also aware of the interactions between staff members, families, the physical setting and the organizational culture.

Here are some of the important things psychologists might do to address the emotional climate of long-term care:

1. Every resident would be evaluated by the psychologist upon admission (just like other disciplines), because entry into long-term care can be very stressful.
2. Every staff member would have access to the counseling services of an Employee Assistance Program, because working in LTC can be very stressful.
3. Family members would be able to join regular educational groups so that they better understand the illness(es) of their loved one, how the treatment team works, and how to best manage their important role on the team.
4. Administrators, department heads, charge nurses and others in managerial roles would be given management training so that they’d have the skills they need to lead those on their teams, because chances are they didn’t learn management strategies in school.
5. Treatment teams would learn communication skills that enhance collaboration between disciplines and improve interactions with residents and families.
6. All staff members would be trained in non-pharmacological approaches to dementia care, because the porter needs to know what to do too.

For the entire article, visit:

What if psychologists ruled the (LTC) world…

Preventing burnout in long-term care (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

Preventing burnout in long-term care

In my recent post, “Stuff I won’t do for residents and why your staff shouldn’t either,” I wrote about the need for individual workers to set appropriate boundaries around caregiving in order to retain the ability to give without burning out. In this article, I examine more closely the symptoms of burnout and ways facilities can reduce its likelihood — which is particularly important given the link between burnout and turnover.

Employers find burnout reflected in high levels of absenteeism and tardiness, extended sick leave, and an increase in worker’s compensation claims. Employees might notice symptoms such as stress-related medical conditions (for example, ulcers or headaches), reduced job satisfaction, feelings of depression, anxiety, cynicism, boredom, discouragement and loss of compassion.

One study found that burned out staff were more likely to be accepting of resident abuse (Shinan-Altman and Cohen, 2009).

What is burnout?
In my research, I came across a number of definitions of burnout. Some definitions, like this early description by psychologist Herbert Freudenberger, focus on the role of the individual:

Burnout is “a state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that has failed to produce the expected reward.” People most likely to burn out are those who are the most “dedicated and committed to their positions, have poor work boundaries and who have an over excessive need to give.”

Ouch.

Other explanations of burnout focus on the environment, such as this one by Pines and Aronson (1988): Burnout is “a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations.”

It’s probable that most burnout is due to a combination of a stressful work environment and an individual’s difficulty balancing self-care with their commitment to their jobs.

Techniques to reduce burnout
The good news for management is that many of the causes of burnout can be addressed by the organization, whether they are due to the environment or rooted in the individual.

1. Training workers, including enhancing the initial orientation process and providing ongoing education programs that go beyond mandated courses, can address many factors that contribute to burnout. Studies suggest the following:

Orientation classes should provide clear job expectations and address ways to prioritize job tasks in order to reduce time pressures.
Managerial staff such as nurses and department heads would benefit from skills training to better help them supervise and manage their teams.
Team building efforts can improve relationships with coworkers and reduce professional isolation.
Training staff on how to manage aggressive behaviors reduces the stress of working with a verbally and physically aggressive population.

2. Scheduling issues are another area where management can make a significant impact on burnout through:

For the entire article, visit:

Preventing burnout in long-term care

Take this to the bank: How to reduce money stress for LTC residents (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

Take this to the bank: How to reduce money stress for LTC residents

It was noon at the nursing home and the staff was busy wheeling residents into the dining room. “Are you going to buy me lunch today?” an aide joked as she unlocked the brakes on Mr. Romano’s wheelchair. He smiled, but I could tell he was pained. He’d just spent his last psychotherapy session discussing his now-meager funds after a lifetime of earning and saving.

In my conversations with hundreds of long-term care residents over the years, I’ve found money to be an almost universally sore subject among them. Since money is a primary concern for most of us throughout our adult lives, it should come as no surprise that financial concerns continue to be a stressor for our residents even though they’re living in the mostly money-free society of LTC. The reasons for this financial tension vary, and with some adjustments we can reduce aspects of our residents’ financial distress.

Money stress sources and remedies

• Spending down: Residents who saved money during their lives and are now spending their savings to qualify for Medicaid are particularly sensitive to, shall we say, variations in care.

“This is what I’m paying for?” they’ll ask with incredulity at an unpalatable meal or an unpleasant interaction with a staff member. It’s a bitter pill to scrimp all one’s life and have to pay out of pocket for healthcare with savings, particularly when the lifelong free spender in the next bed is getting exactly the same care paid for by Medicare and Medicaid.

Remedy: While we can’t change the fact of the spend down (and it should go without saying that we provide the best service possible to every resident at all times regardless of their funding source), we as experts can offer suggestions for spending down that allow residents to make the most of this period.

o For example, elders might want to buy a television set, some extra clothes and other belongings they’ll be able to enjoy once they’ve qualified for Medicaid and don’t have as many funds to access. Perhaps they’d like to buy themselves flowers or fruit that arrives monthly for the next year so that they have some luxury in their lives when things get tight. New residents and families have never spent down before and they need our advice about what’s permissible and likely to make them happy in the years to come.

o Residents may be legally allowed a financial gift to a family member who can then use that money for them at a later point.

o Encourage seniors to put aside money for a burial fund, if needed, so that they don’t have to worry about this later in life. Money for burial isn’t counted toward the maximum amount residents are allowed to hold in their personal accounts.

• Personal Needs Allowance (PNA): Residents are entitled to a monthly PNA that allows them to buy things such as clothing, haircuts, special trips and other items not provided for by the facility. Unfortunately, when this amount — which varies by state — was determined back in 1980, no provision was made for inflation. In New York, the $50 PNA from 1980 is now worth $17.32. If the PNA had been adjusted for inflation, the resident would be getting $144.36 each month, which is a reasonable allotment that would permit people to buy the aforementioned goods and services, plus some takeout food or an occasional gift for their grandchildren. Managing personal needs on $50 a month in 2014 is beyond challenging. (For more on this, see the Money Issues anecdotes at My Better Nursing Home and the “Your Money” chapter of The Savvy Resident’s Guide.)

Remedy: Clearly, PNA levels should be adjusted for inflation, but for now we can help residents living on a very tight budget in several ways.

For the entire article, visit:

Take this to the bank: How to reduce money stress for LTC residents

For a humorous take on one resident’s efforts to manage her money, click on Aunt Sylvia Spends Down (http://youtu.be/5ZpdhO9HNmc) or watch below.

Dr. El’s McKnight’s column wins APEX award!

I’m pleased to share with you that my McKnight’s column,

“The World According to Dr. El,” is the winner of a 2014 APEX Award

for Publication Excellence in the Blog Content category!

My column can be found at McKnight’s: The World According to Dr. El

The psychology behind good customer service (and why it’s more important than you think) — McKnight’s LTC News

Here’s my latest article on McKnight’s Long-Term Care News:

The psychology behind good customer service (and why it’s more important than you think)

At the front desk, the workers were having an argument. Some residents watched the proceedings with interest and others with expressions of alarm. A waiting family member shifted from one leg to another and began sighing with exasperation as the loud conversation wore on without her presence being acknowledged.

We may talk about the term “customer service” and ask our staff members to avoid public arguments like the one above, but nevertheless, similar situations happen every day. Why does it matter so much? Using the model of the family as a guide, I discuss the psychological importance of good customer service in all our interactions.

With other staff members – Just as the relationship between parents forms the foundation of a family, our relationships with our coworkers are the foundation of good customer service.

o As shown in the above example, the residents observe how we treat one another. If our conversations are respectful and collegial, residents feel comfortable discussing concerns because they perceive their caregivers to be levelheaded and understanding. Angry, shaming interactions between staff members create an unsafe environment, making residents less likely to share information — including details that may affect medical care.

o Difficult interactions with coworkers are frequently transmitted to resident care. This is known in psychological terms as displacement. In the classic case, the boss yells at the father, who comes home and yells at his wife, who yells at the kid, who kicks the dog. If the nursing supervisor publicly criticizes the nurse who then chastises the aide, the residents are likely to be on the receiving end of the aide’s aggravation. Alternatively, if the nursing supervisor compliments the nurse who in turn praises the aide, the residents are more like to be met with a cheerful, upbeat caregiver.

o How senior staff members talk to subordinates is passed along to the next level of subordinates, not just through displacement, but also through modeling. Senior staffers are showing through example “how we handle things here.” When an administrator uses “teachable moments” to calmly point out what aspects of a crisis were managed well and what could be done differently for mismanaged parts, this becomes its own teachable moment in terms of how to provide constructive feedback.

For the entire article, visit:

The psychology behind good customer service (and why it’s more important than you think)

Implementing an employee recognition program: Tips for success (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

 Implementing an employee recognition program: Tips for success

One of my recent posts, Employee recognition programs: What works, focused on the benefits of recognition and key points in choosing a recognition program. Now I’d like to address how to implement your chosen employee recognition program so that it becomes an energizing and integral part of your organization, rather than a short-lived promotion that fizzles after its initial burst of enthusiasm.

Here are some tips to ensure a long, useful life for your recognition program:

1. Establish a budget — Most companies spend between 0.5% and 3% of their payroll budget on employee recognition, with the average being 2%. Decide whether your distribution will be centralized, department-specific, or a combination of the two. Human resource personnel most frequently direct the programs (55% in a 2013 WorldatWork study, with a variety of staff taking responsibility at the other 45% of companies studied).

2. Determine how success will be measured — There are many ways to gauge the results of your efforts, including employee and resident satisfaction surveys, the level of participation in the program, and turnover rates. It also may be useful to have goal-specific measures, such as “number of infections” for a program designed to improve infection control procedures.

3. Train management staff on basics — It’s essential for the success of your program to have buy-in from senior staff members. Educate them on general recognition strategies such as when and how to acknowledge employees for best effect and the importance of their role in the project.

4. Design the program and get feedback — While you may have decided the broad focus of your program, now is the time to get specific. Exactly how will your program work? Who is eligible? What rewards will be offered? Who will be offering them? Try to create a simple program to provide meaningful, desirable rewards that are distributed fairly. Get feedback from your team to ensure the feasibility of the ideas and to increase their support for the enterprise.

For the entire article, visit:

 Implementing an employee recognition program: Tips for success

The very anxious resident: A team approach (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

The very anxious resident: A team approach

“My mother was kicked out of her nursing home again,” my cousin told me. “They said they couldn’t handle her.” I phoned Cousin Belle’s new number in the afternoon.

“They didn’t give me my pain medication,” she said angrily. “They took away my walker and I need to use the bathroom. CAN SOMEBODY GET ME MY WALKER – I NEED TO USE THE BATHROOM!” She began sobbing. I heard another voice. “Did you hear what the man next to me just said?…You’re not a man?.. .I’m sorry, I can’t see…” Belle lost her vision several years ago, just like her father before her. “I helped people all my life,” she told her companion. Belle is a retired nurse.

She shouted again and I heard a staff member say, “Have some respect for the other residents.” Belle responded immediately, “Have some respect for me!”

“Let’s say the ‘Serenity Prayer,’” I suggested. “OK, let’s,” Belle agreed immediately. When we finished, she asked to say it again. She sounded calmer. “The woman next to me said it with me,” she remarked.

That story is about Cousin Belle, but it’s also the story of Gerry, Anna and a host of other residents I’ve seen over the years. Below are some suggestions for handling these challenging residents, coming from my perspective as a psychologist. I know there are many educated, experienced and compassionate people from other disciplines who will read this. If you have any additional tips, please add them in the comments section.

• Start afresh: If the current staff members are burned out and no longer responding well to the resident, it can be helpful to move the resident to a new unit or facility with a clean slate and fresh expectations. Notify the new team in advance so that they can prepare for the anxious resident and avoid repeating the same situation.
• Keep in close contact with the psychiatrist: The very anxious resident is likely to need medication for anxiety or depression, or at least to know that something is available if necessary. The early, frequent and regular attendance of the psychiatrist can reassure the resident and the team that an expert presence is guiding care.
• Give meds quickly: If residents are in pain or on a medication upon which they’ve become dependent, give the medication as soon as possible. Waiting will only increase their agitation and disturb other residents.
• Mollycoddle: A loud and anxious resident is likely to become louder and more anxious the longer they have to wait for their demands to be met. Just like with the medication, attend to their needs as soon as possible. Anxious people tend to be anxious because they feel out of control. Meeting their needs helps them feel more in control.
• Assign your most patient and compassionate aides: Satisfying a very anxious resident’s demands can be a never-ending task. Try to assign the type of person who will approach each call for assistance with a pleasant demeanor and not those who will let their displeasure be known with an unkind word or expression.

For the entire article, visit:

The very anxious resident: A team approach

In the wake of a nursing home double-homicide: How to meet mental health needs and prevent violence (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

 In the wake of a nursing home double-homicide: How to meet mental health needs and prevent violence

News of the recent double-homicide in a Houston nursing home arrived the morning I was to speak to a group gathered to address the needs of younger residents in long-term care. It didn’t escape anyone in the audience how serious this topic is — the alleged murderer is 56 years old and one of his two victims was 50 years old.

What can organizations do to respond to this terrible news and to reduce the chances that a similar situation could happen in their facilities? Plenty.

Calm fears

·      Soothe nerves by pointing out efforts your facility takes to address agitated residents and maintain the safety of the environment (for example, the security guard, video cameras, separating residents in conflict, etc.)

·      Minimize the news coverage of the event in common rooms. Residents who want to find out more information can read the newspaper or watch TV privately. It’s not helpful for most residents to listen to an anxiety-provoking rehash of information, especially when they’re unable to get up and leave the room.

Train staff

·      Train staff to recognize signs of distress and mental illness in residents and have a system in place that allows the information to be communicated effectively. Aides, for example, don’t have to make a mental health diagnosis; they just need to be able to recognize when a resident is behaving differently and communicate it to the nurse. Train nurses to recognize the importance of the information and to work with the team to assess the resident and intervene appropriately. Mental health issues should be addressed as seriously as physical health concerns and staff should have enough training so that they feel comfortable doing so.

·      Train your staff on how to defuse verbally and physically aggressive situations. Staff members without proper training often inadvertently precipitate conflict. (For more on this, download my free report, Stop Agitating the Residents, at MyBetterNursingHome.com.)

For the entire article, visit:

In the wake of a nursing home double-homicide: How to meet mental health needs and prevent violence

Battling depression: Advice on how to make seniors feel valued by others (McKnight’s LTC News)

Here’s my latest article on McKnight’s Long-Term Care News:

Battling depression: Advice on how to make seniors feel valued by others

Research shows that the rate of depression among elders in senior residences is 24% to 27%. It’s not that every fourth resident you greet in the hallway is depressed.

It’s that we should be more concerned about the people who aren’t in the hallway to greet.

“Depressive symptoms are expected to become a leading cause of the global burden of disease, second only to cardiovascular disease, by the year 2020,” according to Tracy Chippendale, PhD, OTR/L in her 2013 Clinical Gerontologist study.”

Depressed residents are less independent in their activities of daily living, have a decreased quality of life, and tend to use more medical services than peers who aren’t depressed.

Factors reducing depression

According to Chippendale, elders with more education, better self-rated health and more social support are less likely to be depressed. While we can’t necessarily change a person’s health or the level of education they’ve achieved, as senior care providers we can certainly offer opportunities for social support.

An important component of social support — beyond the number of connections in a person’s life — is how much the individual feels valued by others. For a retired elder who has completed raising her children and lost the value of a job and its contacts and income, mattering to others can come from family relationships, friendships, community service, and owning a pet, for example. Studies suggest that moving to a senior residence can reduce some of these opportunities to connect and to be of service.

Creating opportunities to ‘matter’

For the entire article, visit:

Battling depression: Advice on how to make seniors feel valued by others