Telemental health: Who, what, when, where, why you should use it (McKnight’s LTC News)

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

Telemental health: Who, what, when, where, why you should use it

Since I now Skype regularly with my 94-year old father-in-law and his wife, the concept of telemental health doesn’t seem as futuristic to me as it used to seem. I was shocked to discover, however, that the American Telemedicine Association (ATA) was established 20 years ago, with the first applications of telemedicine occurring over 40 years ago. Apparently, I’ve been behind the times.

According to the ATA, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.”

Telemental health, or telepsychology, as the American Psychological Association refers to it, is simply “the provision of psychological services using telecommunication technologies.” I turned to psychologist Dean Paret, PhD, senior vice president of clinical operations of Brighter Day Health, a provider of telemental health services in long-term care, to answer some of my questions about telemental health.

How telemental health works

According to Dr. Paret, telemental health includes not only psychiatric evaluations and medication management sessions, but psychotherapy as well. Providers use a two-way video system over a secure line to “visit” with LTC residents.

The equipment used includes a camera and a video screen that allows the clinician to see the resident and vice versa. The service is similar to Skype or Facetime, but it involves a secure, encrypted network that leaves nothing on the computer and is HIPAA-compliant. Brighter Day Health works with its facilities to set up the proper equipment. “The big challenge is the Internet speed,” Paret stated, “and the ATA has information on funding sources to upgrade rural systems.”

For the entire article, visit:

Telemental health: Who, what, when, where, why you should use it

Would you want to live in the LTC home where you work? (McKnight’s LTC News)

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

Would you want to live in the LTC home where you work?

I used to live in a fabulous old fourth-floor walk-up apartment in Manhattan. When I moved out of Manhattan to a borough of New York City for an elevator building with a laundry room in the basement, I made a conscious choice to pick a place I could live for the rest of my life if I had to. That ramp could come in handy if I need a wheelchair, I reasoned. And if worse comes to worse, I’ll move into a nursing home and blog from there.

A lot of residents tell me, “I never thought this (living in a nursing home) would happen to me.” After hundreds of these conversations, I have the opposite approach. I figure, “Why not me?”

But actually, I wouldn’t want to live in any of the nursing homes where I’ve worked. Sure, if I had to, I’d make do. I’d rabble-rouse and kvetch and roll to the administrator’s office if the situation called for it. I’m ready for a fight.

That was my thinking until last week when I toured the eldercare home of my dreams.

 For the entire article, visit:

Would you want to live in the LTC home where you work?

For more on what residents think about living in nursing homes, read The Savvy Resident’s Guide.

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‘Derek’ — a long-term care shrink’s view (McKnight’s LTC News)

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

‘Derek’ — a long-term care shrink’s view

I was very pleased when I heard there was a program about a long-term care facility on British television. Finally we’re getting our props — at least overseas.

“Derek” is the story of a simple but kind middle-aged man who works in a quiet assisted living home with an assortment of misfits who staff the place. The show is alternatively funny and sad and definitely worth watching, especially to see how our work is portrayed to the public.

 For the entire article, visit:

‘Derek’ — a long-term care shrink’s view

More about Ricky Gervais:

Ricky Gervais is not only the star of ‘Derek,’ he also wrote and directed it. Gervais’ past credits include his work on ‘The Office’ and ‘Extras,’ which he co-wrote and co-directed. He had lead roles in both programs. Below, Charlie Rose talks with Ricky Gervais about ‘Derek.’

Ricky Gervais on ‘Charlie Rose’

For more insider info on what it’s like to live and work in a nursing home, read The Savvy Resident’s Guide.

Care model for more than just medical condition needed in long-term care (McKnight’s LTC News)

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

Care model for more than just medical condition needed in long-term care

Of the most efficient countries for healthcare, the United States ranks second in healthcare costs per capita but 46th in efficiency (out of the 48 countries ranked!). The move from a biomedical to a biopsychosocial model of healthcare might be able to change that.

Consider the following scenario: Estelle’s fall at home sent her to the hospital. She was diagnosed with a hip fracture and diabetes and transferred to the nursing home for short-term rehab. A biomedical model would treat both conditions and send her home again. A biopsychosocial model would also address her need to make dietary changes, her fears of falling again, the alcoholism that contributed to both her diabetes and her fall, and her noncompliance with the rehab staff.

From biomedical to biopsychosocial

In her American Psychological Association presidential address, psychologist Suzanne Bennett Johnson discussed the change from a biomedical model of care to a biopsychosocial model of healthcare. The biomedical model of care that has “dominated Western medicine … for over 100 years” focuses solely on biologic factors to understand illness. It’s resulted in cures for infectious illnesses such as tuberculosis, pneumonia, and influenza, and increased life expectancy from 49 years in 1901 to 77 years in 2001. The biomedical model has been a great success in many respects.

As Johnson points out, however, “while infectious disease was the leading cause of death in 1900, today most Americans die of chronic disease: heart disease, cancer, chronic lower respiratory diseases, and stroke.”

Underlying these diseases are behaviors such as smoking, poor dietary habits, sedentary behavior, and substance abuse. In addition, she notes, “as many as 40% of medical patients are co-morbid for a mental health disorder and as many as 75% of seriously mentally ill patients are co-morbid for a physical health disorder.”

Implications for LTC

Clearly, in order to reduce chronic disease in this country (and to decrease medical costs), we need to address the behaviors – the psychological and social factors — underlying the diseases. But we work with elders, you might say, the damage caused by years of poor self-care has already been done! Perhaps.

But as a psychologist talking with seniors over the years, I’ve found that many of my lovely old dogs were ready for new tricks. We need to intervene, however, in certain key ways:

For the entire article, visit:

Care model for more than just medical condition needed in long-term care

McKnight’s Free Online Expo tomorrow, 9/10 at 11am ET

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 on the following topics:

• Enhancing relationships with key referral sources  – Tuesday September 10^th  11:00 AM
• Changes looming for the MDS 3.0  – Tuesday September 10^th  12:30pm
• Issues that keep operators awake at night  – Tuesday September 10^th  2:00 PM

You can earn 3 CEUs and visit the 12 vendor booths, as well as chat with other conference attendees via your avatar.

To register for the conference, visit McKnight’s Fall Expo

Same-sex couples: Are you and your staff prepared? Probably not (McKnight’s LTC News)

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

Same-sex couples: Are you and your staff prepared? Probably not

Last week, McKnight’s staff writer Tim Mullaney wrote about the new Medicare guidance that guarantees that same-sex married couples can live in the same nursing home. Perhaps, like many of our current opposite-sex married couples, they’ll share the same room or apartment. Is your staff prepared to offer them the same respectful service they’re providing for your male/female couples? Are you prepared to lead the way, regardless of your personal beliefs regarding homosexuality? I’ll bet you’re not.

Why do I say this? Maybe your religion denounces homosexuality, yet you strive to be open (and have your facility open) to people from all walks of life. You might take a “live and let live” approach.  But even if you are openly gay yourself and comfortable with your sexuality, chances are excellent that there are people on your staff who feel very uncomfortable with homosexuality and will need additional training in order to be able to successfully assist gay couples.

I say this because I worked with a well-meaning aide who, despite knowing nothing about my background really, repeatedly thought she had to try to “save” me through conversion to her (anti-gay) religion. As a psychologist, I could read and deflect her good intentions, but I doubt a gay couple under her care would feel the same way.

For the entire article, visit:

Same-sex couples: Are you and your staff prepared? Probably not

6 common problems a shrink on staff can solve (and your consultant can’t): McKnight’s LTC News

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

6 common problems a shrink on staff can solve (and your consultant can’t)

As a psychologist consulting in long-term care facilities, I was paid through Medicare, Medicaid, and/or private insurance for only one task: direct contact with residents. That’s it. I provided a lot more because it was needed, but that’s all I was paid for.

There was much more help that I didn’t offer, not only because I wasn’t paid for it, but also because the organization wasn’t structured to accept this type of assistance. The facilities’ needs were the kinds of things that made me sigh and shake my shrinky head in frustration. Oh, what we psychologists could do for you if we were on staff!

Here are some examples:

Problem #1: Admissions decisions

As your admissions department scrambles to fill beds and wonders whether the facility can manage a new resident with a psych history and a recent diagnosis of cancer, imagine if they could ask the opinion of the psychologist likely to be treating the resident. Now imagine if they could do this for every questionable admission. Psychologists could set up mental health services upon the new resident’s arrival and you would have the support necessary to meet the mental health needs of the residents under your care.

As the number of residents with behavioral issues increases, this psychological screening becomes an increasingly important element of providing good care and preventing time-consuming problems on your units after admission.

Problem #2: Team Communication

Watching two aides argue about giving care to a resident over said resident’s head or observing an essential piece of information get lost between shifts, I’ve fantasized about offering in-service training to eliminate these destructive behaviors. Not half-hour meetings sandwiched in between resident care, but real training that allows time for examples and practice as well as observation and feedback on the floors.

Real training provides the opportunity for staff to turn to the psychologist for guidance in handling the sticky interpersonal dynamics that are inevitable as people work in groups.  It also offers assistance in designing and implementing procedures that facilitate written and oral communication.

Problem #3:  Interacting with residents

Improperly trained staff members frequently escalate tense situations, cause unintended distress in residents, or miss cognitive changes that signal physical illness. They aren’t doing this on purpose — they just haven’t been taught how to handle such situations.

For the entire article, visit:

6 common problems a shrink on staff can solve (and your consultant can’t)

Suicide risk in LTC: Effective protocols may not be what you think (McKnight’s LTC News)

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

Suicide risk in LTC: Effective protocols may not be what you think

According to researchers, 11% to 43% of LTC residents have thoughts of suicide^1-3, with higher rates in larger facilities and in those with more staff turnover⁴. Other stressors include medical illness, the presence of a mood disorder such as depression, social isolation, and recent life stressors⁵ – factors that frequently affect our residents.

The MDS 3.0 requires that facilities ask residents questions regarding their risk of suicide. If a risk is identified, then effective protocols should be employed. In a June 2013 Annals of Long-Term Care review article, Challenges Associated with Managing Suicide Risk in Long-Term Care Facilities⁶, authors O’Riley, Nadorff, Conwell, and Edelstein offer alternatives to the procedures frequently in place in LTC settings – close observation or transfer to a psychiatric facility. These methods are often used unnecessarily, the authors note, due to staff fear of legal liability, concerns regarding their perceived competence in handling suicide risk, and the personal fear of losing a resident to suicide.

Essential for immediate risk

The authors argue that while close observation and hospitalization are essential when residents have the means, intent, and ability to end their lives at any moment (high risk situation), they’re ineffective in situations where there is a minimal or low risk of imminent death by suicide. For example, a resident may express thoughts of suicide but have no access to a means to do so or no ability to make use of an available means, making suicide very unlikely or virtually impossible. Other times a resident may have thoughts of suicide but no plans to do it any time soon. “If things get worse down the road,” they’ll sometimes say, “then I’m going to end it all.”

Ineffective for minimal risk

While a low or minimal risk should still be taken seriously, there is no evidence that it’s effective to put a resident on 15-minute checks or to send him or her to the psychiatric hospital.

For the entire article, visit:

Suicide risk in LTC: Effective protocols may not be what you think

1.Haight B K. Suicide risk in frail elderly people relocated to nursing homes. Geriatr Nurs.1995;16(3):104-107. 
2. Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry. 2009;25(8):843-849.
3. Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2-3):97-116.
4. Osgood NJ. Environmental factors in suicide in long-term care facilities. Suicide Life Threat Behav. 1992;22(1):98-106.
5. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451-468.
6. O’Riley A, Nadorff MR, Conwell Y, Edelstein B. Challenges associated with managing suicide risk in long-term care facilities. Annals of Long-Term Care. 2013;21(6):28-34.

Meeting boomer needs at LeadingAge Florida (McKnight’s LTC News)

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

Meeting boomer needs at LeadingAge Florida

“You do so much for seniors,” my friends tell me, having heard too many stories about the horrors of nursing homes. “Those places need more people like you.”

“Actually,” I respond, “there are lots of people like me out there trying to do the right thing for our elders.”

Nowhere was this more apparent than at the 50^th annual LeadingAge Florida convention this month, where I was speaking about the psychosocial needs of baby boomers. I was surrounded by people who, like me, were all jazzed up about long-term care and excited about the possibilities for improving services.

My talk about the needs of baby boomers generated an exciting exchange of ideas, with members of the audience sharing innovative best practices with each other.  Among the best practices mentioned:

• To address boomers’ need and expectation of being socially connected while in a long-term care setting, many of the Florida facilities have WiFi and use the Internet to help families stay connected.  Skype and other video chat services are available for care plan meetings as well.
• Individual preferences for music were met at one site through an iPod program that offered an iPod for each interested resident, complete with “their” music chosen from the thousands of songs in the home’s music library.
• Lending credence to my assertion that a strong resident council is the driving force of a good home, one CCRC reported that the dynamic and thriving resident council of their independent living facility generates innovative suggestions that the administration follows to make successful improvements.  For tips on how to rejuvenate a lackluster resident council, start here for the first in a 3-part blog series designed to create effective meetings that energize your community.

For the entire article, visit:

Meeting boomer needs at LeadingAge Florida

For more on boomer needs, read

10 anticipated psychosocial needs of baby boomers

Reducing Learned Helplessness in LTC (McKnight’s LTC News)

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

Reducing learned helplessness in LTC

Despite this, O’Connor points out, psychological services in LTC are often underutilized.  As I noted in my 2010 article, Improving the treatment of mental health issues in nursing homes, we can do more to identify residents who may benefit from psychological services and systematically refer them for treatment before problems become entrenched.

Learned helplessness

The University of Pittsburgh study reported that one of the helpful aspects of psychotherapy is the reduction of the learned helplessness often seen in depression. Learned helplessness comes about when a person believes that they have no control in a situation, even when they do….

Learned helplessness in LTC residents

There are many situations in long-term care that can lead to learned helplessness among our residents. Every time a call bell goes unanswered for too long, it leads residents to conclude that there’s no point in asking for help. When a staff member tells a resident she’ll follow through on a task and then doesn’t, that experience is reinforced.

For the entire article, visit:

Reducing learned helplessness in LTC

My book, The Savvy Resident’s Guide, is a great tool for reducing learned helplessness.  Please consider giving it to your residents or loved ones.