Category: McKnight’s Long-Term Care News
Posted by Dr. El - April 30, 2012 - Business Strategies, Customer service, McKnight's Long-Term Care News, Younger residents
Here’s my most recent article in McKnight’s Long-Term Care news online:
The “Single” Boom: Problems and Solutions for Long-Term Care
According to recent reports, one-third of the baby boomers who will be arriving at the doorstep of long-term care are unmarried. Many of them have no children. Just as our healthcare system relies on unpaid family caretakers, LTC relies on close family members who help our residents through their stays.
The demographic trends, however, suggest we need to prepare for increasing numbers of residents without close relatives.
Below are four ways we can expect this shift to impact our residents, and suggestions for how we can adapt to this change:
1. Lack of POAs, healthcare proxies or legal guardians
The Problem: Currently, most residents have someone available in their lives to make medical and legal decisions on their behalf. This trusted helper is able to collect the documents necessary to apply for Medicaid, for example, or to sell a home for the resident.
Typically, family members are informed of the need to sign or gather paperwork, and the nursing home awaits the documents. They generally arrive with or without further prompting, allowing for successful completion of the transactions.
In the absence of an involved family member, these essential activities are virtually impossible for a resident to accomplish independently from inside the nursing home, no matter how robust their condition. Residents, who often make a sudden trip from home to hospital to nursing home, generally don’t have important phone numbers, access to legal papers, Internet connectivity, or the wherewithal to make arrangements on their own, from afar, in the middle of a health crisis.
As we begin to see increasing numbers of elders in this situation, it will become apparent that what we are viewing is not an individual problem, but a systems problem.
The Solution: As a system, we’ll need more court-appointed powers of attorney, proxies and guardians available to our residents, as well as a greater emphasis on obtaining advance directives and community supports. Streamlining the process of obtaining these assistants will make life easier for everyone, and can be accomplished using some of the methods below:
• When assessing social supports upon admission, we can educate residents about the need for assistance in navigating their healthcare. It’s important to plant the seed early in admission because we can expect this idea to meet with resistance as residents struggle to maintain their independence. We can explain that obtaining helpers is not a reflection of a personal failing, but is unavoidable in a complicated healthcare system.
• We can offer increased independence via discussion of advance directives, which allow residents to make their own decisions regarding their healthcare.
• We can discuss with residents who among their family, church, and community members might be willing to assist them with their care and begin outreach toward potential helpers. Offering prepared pamphlets or other educational materials about what is involved in taking on a specific caregiving task will allay the concerns of those considering a helper role and reduce the burden on the social work staff communicating the information.
• Within our facilities, we can increase our connections to the local community. There we might find church volunteers, for example, who would be willing to take an active role in the lives of our residents, such as signing a back-up agreement for home healthcare or becoming a legal guardian.
• We can help residents create a personal caregiving team by connecting more distant relatives or friends who may be able to offer only limited assistance, but together meet the needs of the resident.
• We can increase the number and training of social workers in our centers, so they can take on the additional tasks required to address the above suggestions in a manner that enhances the reputation of the facility.
2. Lack of errand-runners
The Problem: A LTC facility often becomes the resident’s entire world, but not all of their needs can be met within the walls of the facility. A major and important function played by family members is that of procurer of outside items. Currently, residents rely on their family members to bring them home-cooked foods, clothing or items from the community, such as a favorite lotion or shampoo.
Residents without family or friends have come to rely on the kindness of strangers, like their roommate’s daughter, or the friendly aide who makes a grocery store run on her lunch break. This lack of control over formerly simple tasks leads to frustration and depression. Chores such as fixing a watchband become monumental in a nursing home. Using generic toothpaste instead of the brand enjoyed for 70 years can be a twice-daily reminder of lost independence.
Again, what appears to be an individual problem is actually a systems problem within each setting. An increase in the number of single residents will propel us to adjust the way we handle resident needs.
For more, visit McKnight’s Long-Term Care News online: The “Single” Boom: Problems and Solutions for Long-Term Care
Posted by Dr. El - June 4, 2010 - Business Strategies, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Role of psychologists
I wrote a guest post for McKnight’s Long Term Care News addressing how psychologists can help nursing home residents and when a referral for treatment might be appropriate.
“The recent Illinois legal decision to move mentally ill nursing home residents into smaller mental health settings is likely to prompt an industry-wide examination of the practice of accepting mentally ill residents into long-term care. If nursing home residents are lucky, it will also trigger an evaluation of how we treat mental health issues in nursing homes in general.”
Posted by Dr. El - December 18, 2008 - McKnight's Long-Term Care News, Technology
http://www.mcknights.com/Long-term-care-residents-can-benefit-from-the-Internet-too/article/123005
The Internet as Therapeutic Tool in LTC
On November 4th, 2008, McKnight’s reported on a study that Internet use stimulates the elderly brain. Perhaps you’re wondering what your residents would do on the Internet and whether or not it’s worth your time and investment to establish access for them. As a psychologist who has used the Internet extensively with LTC residents of all ages, I’ve found that every resident I’ve taken to the computer room has been thrilled to see what all the fuss is about and amazed at the possibilities offered to them. Below are a half dozen ways I’ve used the Internet with my residents. Given proper instruction, these interventions can be carried out by staff members, a resident’s family, volunteers, and/or the residents themselves.
1. Psychoeducation Regarding Illness
Often residents are given diagnoses, but little information about them, leaving them confused or upset, which sometimes results in noncompliance with medication and care. I often search for a resident’s illness with them on the computer, and discuss the symptoms and treatment, which enhances cooperation with medical staff. Some residents are more receptive to information coming from a “neutral” source than from their own caregivers, and most residents appreciate a print-out of information they can refer to over time. Posting a list of illnesses and the Web addresses of important sites near the computer would facilitate this process (eg; The American Diabetes Association, the Amputee Coalition of America, etc).
2. Support Regarding Illness
Most of the residents deal with their illnesses in isolation, when there are many avenues of support available to them on the Internet. Having the opportunity to “discuss” their concerns anonymously with peers can often be more effective than trying to generate a conversation between two or more residents at the nursing home, due to discomfort at revealing personal information. At strokenetwork.org, for example, stroke survivors can “meet” other survivors on-line and get information and emotional support, as can their caregivers. To find the appropriate support groups, enter the name of a particular illness and “support” into the browser window and look around from there. Another option: Look for a Yahoo group about the illness and sign up the resident after establishing a free email account through resources such as Yahoo or Google.
3. Connection with Family and Friends
Why should residents have to limit themselves to family visits or phone calls when most of the rest of the country is communicating via email or a social networking site such as Facebook or MySpace? I’ve established email accounts for octogenarians to help them keep up with the grands, and a free Facebook page would accomplish the same thing with a bit more zing.
4. Reminiscence
I once worked with a terminally ill 88-year old man who’d left Barbados in his thirties and had never realized his dream of seeing his country again. Imagine his expression as I entered “Barbados” into Google Images and up popped photos of the country he thought he’d never be able to see again. This intervention generated a flood of memories and a profound sense of relief and closure. Reminiscence could also be conducted in a group format, with connection to a large screen, so that residents should share with others information about their home countries or hometowns.
5. People Search
One of my favorite things to do with residents on-line is to find their long-lost friends and relatives. For example, through the Internet white pages, I helped one extremely lonely and depressed resident find a friend with whom he lost touch sixty years ago. They are now enjoying an exchange of letters and photos, and my patient has something else upon which to focus besides his poor health and lack of visitors.
6. Fun & Miscellany
Acting under the theory that doing something enjoyable will begin the upward spiral out of depression, I’ve occasionally brought a resident to the computer to listen to their kind of music (try shoutcast.com), to check out the latest fashions, or to see photos of famous movie stars (Google Images). Once a 97-year old Panamanian resident told me she’d felt unattractive all her life because she thought her lips were too big. “Oh, no,” I told her, “your lips are considered beautiful and the height of fashion.” She believed me after I clicked on Google Image photos of Angelina Jolie.
With access, instruction, assistance, and encouragement, I foresee residents of the future getting high school and college degrees on-line, learning languages, and participating more actively in the political process. To continue to the discussion, visit me at mybetternursinghome.blogspot.com or reach me at efeldmanbarbera@nyc.rr.com.
Posted by Dr. El - November 30, 2008 - Business Strategies, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Younger residents
http://www.mcknights.com/Young-adults-in-long-term-care-the-canaries-in-the-%20coal-mine/article/112345/
Young adults in long-term care
Eleanor Feldman Barbera, Ph.D.
July 3, 2008
Anne Marie Barnett, in her June 10, 2008 guest column, wrote about the disruptive effects of younger residents on long-term care facilities. As a psychologist who has worked with many younger residents over the years, I’d like to offer my perspective and some suggestions about how to create an environment in which younger residents can flourish and staff time can be devoted to care rather than to behavior problems. Today’s young residents are pointing out flaws in our system we need to address now before the baby boomers arrive. The generation of older adults who believe that “doctor knows best” will be gone, replaced by a cohort of residents who know and are ready to fight for their rights, just like our young people now. Setting up systems and programs for today’s young residents will prepare you for tomorrow’s boomers.
I find it helpful to differentiate between four general types of younger residents, as they require different approaches from the staff.
- Some of our younger residents arrive with illnesses with which they’ve been coping for years, such as MS or ALS. These residents need assistance adjusting to the facility, but are likely to be able to integrate into the existing programming with only modest changes.
- Many younger (and older) residents with serious mental illnesses have found their way into our system. They need regular psychiatric monitoring, but can often attend existing activities.
- Young adults who have been ill from birth are sometimes behavioral problems because they have been institutionalized from a very young age and know how to work the system. Other times they were exempted from the discipline of their able-bodied siblings. Placement in the nursing home is the first time they are expected to behave, and experience consequences, like everyone else. Intensive initial work will help them integrate into the environment.
- Young residents who have sudden onset of physical problems related to their lifestyle choices are generally the most difficult and time-consuming residents to work with. They require special programs and assistance with prior mental health and substance abuse issues, in addition to adjustment to their physical illnesses and loss of control over their lives.
Recommendations:
1. Strong psychology and psychiatry teams: Mental health staff should be considered a part of the treatment team rather than adjunct services. Efforts to increase visibility, understanding, and utilization of mental health services will ease the burden on nursing staff.
2. Early mental health referral: There is a critical period following the arrival of a new resident where they can be redirected onto a new, positive path or can be left to repeat the same negative patterns over again. Residents identified upon admission as having potential problems should be referred immediately, before resident/staff conflicts become entrenched.
3. Psychiatric nurses: The nursing home environment is remarkably similar to that of a psychiatric hospital, except that virtually all full time staff members aside from the social workers have no mental health training. Adding nurses, especially nursing supervisors, with psychiatric experience will improve use of techniques to reduce agitation and conflict.
4. Distinct recreational activities: Younger residents need activities geared toward their interests and without older adults. The most successful activities are likely to be ones chosen by the residents themselves and lead by the “coolest” member of recreation team. When your young residents have developed to the point of trustworthiness, they can run their own groups with staff as helpers. Activities which provide a showcase for the talents/expertise of various residents are likely to be successful among all age groups and provide an excellent forum for increasing connections among peers.
5. On campus support groups: Many of our young people would benefit from attendance at 12-Step meetings such as Alcoholics Anonymous or Nicotine Anonymous. If you have a large population of residents with a particular illness, an illness-specific support group can also be helpful. Providing space for such community groups allows the residents the opportunity to connect with positive peers in the community, reduces isolation, and increases the visibility of the nursing home. Most hospitals have 12-step meetings and other support groups on premises; nursing homes should too.
6. Peer-to-Peer Support: Residents who are successfully addressing their disabilities and/or addictions should be given the opportunity to assist newly arrived/disabled peers. One of the most devastating effects of illness and placement on younger people is the feeling of lack of usefulness. Providing peer support diminishes this feeling and creates meaning and purpose out of their experiences. Peer support can be facilitated by Recreation and/or Nursing staff.
7. Computers!!!: Our young people, and the coming boomers, need to have internet access. Lack of access increases their sense of isolation, frustration, and confinement. The Internet can be used for education regarding illnesses, contact with family and friends, and connection with peers with similar physical problems, among other benefits. Computers are essential to the mental health of the younger resident.
8. Effective Resident Councils: The resident council, used properly, can be an excellent tool for educating staff and determining which issues are most affecting resident satisfaction. Involving younger residents in the resident council provides a socially appropriate forum for their grievances. An effective resident council is one that is attended by alert, capable residents who see actions taken by the administration to address their concerns and who receive reasonable explanations if their concerns are not actionable.
9. Staff Training: Staff members require education specific to the needs of the younger resident. Training which focuses on dealing with behavior problems, understanding mental illness, resident/staff communication, and stress management can be conducted by the psychologist, psychiatrist, social workers, and psychiatric nurses.
10. Clear and Enforceable Policies: The challenge of providing care to acting out younger residents can be simplified by the creation of and adherence to policies for problematic behavior. Staff members need to know guidelines for handling resident intoxication and resident smoking, for example. Substance abusing residents, in particular, excel at “splitting” staff, creating conflicts between day and evening shifts and between weekend and weekday workers. Clear, consistently enforced policies will create a team that cannot be split.
The challenge of providing care for younger residents can be matched by its rewards. We can help our young people transform from angry, traumatized, and hostile individuals into happy, productive members of our nursing home communities. And, in the process, we can prepare ourselves for the coming wave of active, demanding baby boomers.
