Category: McKnight’s Long-Term Care News
Posted by Dr. El - June 28, 2013 - Books/media of note, Boomers, Business Strategies, McKnight's Long-Term Care News, Resident care, Younger residents
Here’s my latest article at McKnight’s Long-Term Care News:
Young adults in long-term care: a new resource for caregivers
According to a 2010 NPR report, young adults have been one of the fastest growing long-term care populations over the past 10 years, with 14% of nursing home residents under the age of 65. Some live in facilities that have specialized in the care of younger residents and others are in settings where almost all the other residents are seniors.
Both scenarios pose challenges in terms of accommodating the unique physical, emotional, and recreational needs of younger adults — and the reactions of staff members to their young charges.
Having spoken with many young residents and their bewildered staffers over the years, I know firsthand how challenging interactions can be. I wrote about some of the psychological issues and remedies in my 2008 McKnight’s guest column, Young adults in long-term care: the canaries in the coal mine, where I argued that the problems arising with young adults now are precursors to those that will be endemic when the assertive baby boomers arrive at our doors — unless we adapt as providers.
Younger adult toolkit
Recognizing the need for facilities to be better prepared, the American Medical Directors Association has released a toolkit on “The Younger Adult in the Long Term Care Setting” as part of its LTC Information Series. I had the pleasure of working on this project, which covers a wide range of matters affecting young adults and provides recommendations for addressing them.
The guide is one of the few sources of information on this understudied population. If your facility has even one young or boomer resident that staff members consider “demanding” or “a problem,” you’ll find this report invaluable.
For the rest of the article, visit:
Posted by Dr. El - June 14, 2013 - Boomers, Business Strategies, Communication, Customer service, Engaging with families, McKnight's Long-Term Care News
Here’s my latest article at McKnight’s Long-Term Care News:
5 lessons long-term care providers can learn from Joan Lunden
Award-winning journalist and author Joan Lunden and I met recently to talk about eldercare issues. Joan’s mother is 94 years old and happy in a small care home after living for years in the community with home care.
Joan, a physician’s daughter, talks with family caregivers around the country as part of her mission to educate people about the challenges of eldercare.
The observations she shared in our conversation deserve attention from LTC providers looking to meet the needs of residents and their families. As a spokeswoman for family caregivers, her experience echoes that of millions of families across the country.
1. Help people choose the right level of care for their loved one.
The small care home was the third placement for Joan’s mother once she could no longer live in the community.
Lunden: When I finally moved my mother into a facility, I moved her into a place that would have been great for my mother 10 years ago. I moved the mother that was in my head. In reality, the beautiful dining room scared her because she didn’t recognize people, she was alone in her apartment when she started sundowning. The place terrified her. I had chosen the completely wrong facility.
As LTC providers, who recognize the toll it takes on elders and their family members to move from facility to facility, we can do more to help families find a placement that meets the needs of their loved one.
- We can strive to provide the family with a realistic assessment of needs and what a facility can offer.
- We can refer residents to other levels of care within our systems.
- We can build relationships with other facilities so that we refer potential residents to each other.
2. Assist families with the transition to parenting their parent
Joan points out that shifting the roles in the family can be very challenging.
Lunden: When you get to that life transition when you become the parent to your parent, it doesn’t feel natural because you’ve spent a lifetime learning to be a child to them and they have always been in that parental position. To all of a sudden have that role reversed is very disconcerting to a lot of people. It’s a hard one to accept. It often feels uncomfortable to tell your parent what they can do or can’t do.
Some families come to us having negotiated the shift in roles for years, but more often we find adult children and their loved ones struggling to find a way to handle dramatic role changes in the midst of a health crisis.
We can assist families with the role transition when we:
- Offer family education groups.
- Refer to counseling resources in the community.
- Recommend written resources such as David Solie’s book, “How to Say It to Seniors” which focuses on the communication challenges between adult children and their aging parents.
- Use our consulting psychologists to help the team with challenging family issues.
3. Provide an opportunity for staff to take a break
Joan offers a place for caregivers to recharge through her Camp Reveille.
Posted by Dr. El - May 17, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Customer service, McKnight's Long-Term Care News, Motivating staff, Something Good About Nursing Homes
Here’s my latest article at McKnight’s Long-Term Care News:
In long-term care we spend a lot of time focused on the physical health of those in our care. With increased emphasis on culture change and the update to the MDS (and hopefully as a result of this column), we’ve begun to address the mental health of our residents more adequately.
We do this not only by assessing the needs of individuals, but also by creating a healing emotional environment for all residents. It’s easier for our staff members to create an emotionally healing environment for residents when the work environment is psychologically healthy for them.
What makes a psychologically healthy workplace?
The American Psychological Association (APA) Center for Organizational Excellence recognizes five different elements that contribute to a healthy environment:
- Employee involvement includes efforts to involve employees in decision-making and give them more opportunity for autonomy.
- Work-life balance is a recognition that responsibilities outside work can impact on performance on the job, leading to programs that assist workers in managing childcare, eldercare, financial crises, etc.
- Employee growth and development focuses on offerings that provide employees with the opportunity for new skills and experiences such as coaching or mentoring, continuing education, tuition reimbursement, etc.
- Health and safety comprises programs that work to maximize employees’ physical and emotional health such as stress management programs, adequate insurance, healthy lifestyle motivators, safe practices training on the job, and Employee Assistance Programs (EAPs).
- Employee recognition includes ceremonies that acknowledge individual and group contributions to the organization, performance-based bonuses and pay increases, and acknowledgement of milestones.
The benefits of a psychologically healthy workplace
According to the APA Center for Organizational Excellence, which has been honoring exemplary company practices since 1999, having a healthy workplace isn’t just good for employees. A psychologically healthy environment can reduce staff turnover and absenteeism, improve performance, and enhance the quality of services provided.
Posted by Dr. El - May 3, 2013 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Communication, End of life, McKnight's Long-Term Care News, Motivating staff, Psychology Research Translated
Here’s my latest article at McKnight’s Long-Term Care News:
I started working in long-term care when I was in my early 30s and I was shocked at first when the residents died. I was used to falling in love with my patients — I consider it a prerequisite for psychotherapy. I wasn’t used to them dying on me.
In the years since, I’ve lost many, many people who have touched my heart, but I can still remember very clearly the ones who passed when I was new. In order to make it in LTC, I’ve protected myself by falling in love in a different way.
A recent New York Times article, “Is Giving The Secret of Getting Ahead?”, piqued my interest when it touched on the impact of death anxiety at work, suggesting that it could have an effect on absenteeism and turnover. Working with residents in LTC is all about coping with death, and facilities have huge problems with absenteeism and turnover —surely there was a connection. I raced through the article, located the research paper it mentioned, “The Hot and Cool of Death Awareness at Work,” and plowed through that too. What I read seemed very applicable to long-term care, so I’m going to present the gist of the research and ways to reduce absenteeism and turnover based on these ideas.
Mortality cues
In “The Hot and Cool of Death Awareness at Work,” authors Grant and Wade-Benzoni outline different types of work where mortality cues can be chronic or acute, internal or external to the job, and personal or vicarious. A firefighter, for example, is constantly in a work situation that threatens his life. This would be considered a chronic, internal, personal mortality cue. A nursing home employee would have a chronic, internal, vicarious mortality cue because they are repeatedly exposed to other people at work who are dealing with end-of-life issues.
Reactions to mortality cues
The authors state that there are two different reactions to being aware of death at work. A “hot” reaction leads to self-protection and “stress-related withdrawal behaviors” such as absenteeism, tardiness, and turnover. A “cool” reaction leads to prosocial behaviors such as helping, mentoring, and thinking of work in the context of contributing to society. They refer to the hot reaction as “death anxiety” and the cool reaction as “death reflection” and note that chronic exposure to mortality cues can shift a worker from death anxiety to death reflection.
This shift from death anxiety to death reflection describes my experience as I continued in long-term care. It also explains why some new workers bail out early and others persevere to become beacons of light in a challenging environment. In addition, the researchers propose that as we age, we become more likely to experience death reflection rather than anxiety. Younger workers, therefore, are more likely to withdraw from the nursing home environment.
Retaining new young workers
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Coping with Grief, for Staff Members: Conversation with grief expert Courtney Armstrong, LPC
Beloved residents decline and then die, their families stop visiting the nursing home — coming to terms with these losses is an unacknowledged challenge of our work. Especially helpful for training directors, new employees, or those struggling with a current loss either on or off the job, this 20-minute audio will help staff members:
- Understand their feelings
- Recognize symptoms of grief
- Identify coping skills
- Assist each other in creating a supportive community
Includes FREE:
- Signs of Grief checklist
- LovingKindness Meditation Sign suitable for posting at the nursing station
Instant Download: Only $7.99
Posted by Dr. El - April 17, 2013 - Dementia, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Resident care
Here’s my latest column at McKnight’s Long-Term Care News:
I was hoping not to have occasion to write another column about tragedy so soon, but the terrible events at the Boston Marathon have prompted another look at how we deal within our facilities with distressing news.
In my previous article, Helping Your LTC Community Cope in the Wake of Hurricane Sandy, I offer post-disaster recommendations that are applicable in this situation. In this column, I focus on the amount of information we provide to residents about distressing outside events.
Sandy Hook
An aide was the first person who informed me about the shootings at Sandy Hook Elementary School last December, calling me into the dining room to see the news broadcast. “Children,” she said, “just little children. This is awful.” The TV was filled with images of horror and the dining room was filled with residents, all of who were in wheelchairs or recliners and most of whom had dementia. They were more or less trapped in there, watching repetitive distressing reports of a vulnerable population being inexplicably attacked.
Many residents talked about the children in their psychotherapy sessions that week. Staff members stopped me in the halls to comment and to be heard and comforted by the psychologist. My daughter is six years old, the same age as most of the Sandy Hook victims. I was present at work as needed and at home I skimmed the headlines and tried not to read the details.
Posted by Dr. El - April 8, 2013 - Business Strategies, Communication, Customer service, Depression/Mental illness/Substance Abuse, Engaging with families, McKnight's Long-Term Care News, Resident care
Here’s my latest column at McKnight’s Long-Term Care News:
I have great respect for those who attend to the often complicated physical needs of our long-term care residents, but if your facility doesn’t have a solid social service department, it isn’t as good as it could be. Yes, the medical care is vital, but the social service department addresses many of the issues essential to resident satisfaction.
Market researcher Margaret A. Wylde, PhD, notes that the three most important elements of satisfaction with a long-term care community are the friendliness of staff, the degree to which residents feel the community is their home, and the opportunity they have to stay connected with the rest of the world.
In her 2010 McKnight’s Online Expo talk, she stated that it’s very satisfied residents who refer others to their communities.
Consider the multitude of tasks the average social worker performs:
· Helps the resident settle into the facility
· Handles roommates conflicts
· Facilitates room changes
· Assists with the purchase of new clothing
· Locates or arranges for reimbursement of lost clothing
· Facilitates the signing of financial forms
· Explains and establishes advance directives
Posted by Dr. El - March 26, 2013 - Business Strategies, Customer service, Dementia, McKnight's Long-Term Care News, Resident care
Here’s my latest column at McKnight’s Long-Term Care News:
Secrets to making your environment ’emotionally healing’
Back when I worked in psych, one of our most effective tools to improve mental health was maintaining a healing emotional environment, or therapeutic milieu. That’s why I was shocked when I first entered long-term care.
I couldn’t believe the din that faced me on the floors or the way some people spoke to the residents or the lack of coordination of care. In some ways, the settings are so similar —inpatient care, short- and long-term stays, family involvement, treatment teams, etc. — but the focus on physical versus mental health creates completely different atmospheres.
The reality is that even though our residents are entering LTC due to physical problems, their medical troubles impact their mental health and vice versa.
Posted by Dr. El - March 12, 2013 - Common Nursing Home Problems and How Psychologists Can Solve Them, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Resident care, Role of psychologists
I’m very pleased to announce the debut of my new column at McKnight’s Long-Term Care News. The World According to Dr. El is a twice monthly column that will address mental health issues in LTC.
Please visit and “Like” the page on McKnight’s to show your support for addressing the mental health concerns of all those involved with LTC.
Inside the mind of an LTC shrink
I sat in morning report as the nursing supervisor announced the arrival of a new resident. An 80-year old woman was taken to the hospital after a fall at home, where she received a below-knee amputation and contracted C. diff before being transferred to our facility.
I looked around the room and speculated about what each of my team members were thinking, imagining thought bubbles over their heads:
- The wound care nurse was wondering how the leg was healing.
- The rehab director was considering the chances an 80-year old woman might be able to manage on a prosthetic leg.
- The infection control specialist was mentally reviewing a checklist of infection control procedures that needed to be put in place.
- The social worker was hoping the woman lived in a ground-floor apartment.
What was I thinking about this new admission? I was worried she might be suffering from symptoms of Post-Traumatic Stress Disorder if she had been alone on the floor for any length of time after her fall.
I pondered how she might be handling the assault on her femininity of losing a leg. I wondered about the quality of her family supports and whether she’d consider attending the choir performance where one of the soloists was a glamorous amputee from the third floor.
Posted by Dr. El - October 31, 2012 - McKnight's Long-Term Care News, Savvy Guide reviews
I wanted to share with you this review of The Savvy Resident’s Guide from James Berklan, Editor of McKnight’s Long-Term Care News:
A savvy caregiver’s resource
James M. Berklan, McKnight’s Editor
If there is anyone who knows how to get inside the head of a troubled long-term care resident, it is Eleanor Feldman Barbera. Better than that is the fact that this talented nursing home psychologist is willing to share her insights.
She does so regularly with insightful guest articles for McKnight’s and her own My Better Nursing Home blog. But now she’s also become a book author. Set for official release on Monday, this is a publication primarily aimed at consumers, yet it can be an invaluable tool for caregivers as well.
Why? Barbera’s mission is to make the individual’s experience at your workplace (and hers) as pleasant as possible. This means smoothing the lines of communication and better understanding the thought processes between resident and caregiver.
“The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay But Were Afraid to Ask” is available online via Amazon. It’s worth taking a look here to learn about the special deals the author is offering to readers who invest the $13.99 for the 181-page paperback ($4.99 for the Kindle version). The add-ons are a bit dizzying, frankly, but in a good way. I think I added up at least $30 worth of professional audio interviews tossed in as a bonus if you buy during a certain period.
The book is composed in what has become a familiar Dr. El writing style. She excerpts discussions with residents to illustrate various points of emphasis, which is helpful to the potential resident, his or her family members and also caregivers. This often involves three different sets of ears, set to three different frequencies. Under Barbera’s light touch, however, they can tune in together.
Posted by Dr. El - October 10, 2012 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, McKnight's Long-Term Care News, Transitions in care
Here’s my latest guest post on McKnight’s Long-Term Care News:
Long-term care psychologists are a valuable resource for facilities looking to reduce their hospital readmission rates. As the only team member whose role it is to sit and talk with the residents for an extended period of time on a regular basis, psychologists are privy to a relationship that can help address root causes of readmission such as medication noncompliance and the recognition and timely reporting of symptoms, as well as follow-through with medical appointments after discharge.
Psychologists can:
1. Notice mental status changes before other staff members. Because interactions are based on extended conversations with residents, psychologists are frequently able to spot subtle alterations in cognition that wouldn’t be noticed during a med pass or routine caregiving.
2. Discover previously unreported symptoms. Due to the amount of time psychologists spend with the residents and the level of trust that develops in the psychotherapeutic relationship, residents often reveal important symptoms of their illnesses they might not share with medical staff.
3. Gather information from communication-challenged residents. Psychologists can gather info from residents who speak slowly or need to use communication devices and then share it with the team, saving staff time and providing important details.
For more, visit McKnight’s LTC News:
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For more on how nursing home psychologists can help those in LTC:
Free Audio: Interview by Psychotherapist Bill O’Hanlon
In this audio, mental health expert Bill O’Hanlon talks with Dr. El about the role of nursing home psychologists and how their work can transform facilities and improve the lives of residents, families, and staff members.
Free Download!
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Now available on Amazon:
Everything You Wanted to Know About Your Nursing Home Stay
But Were Afraid to Ask
