Category: McKnight’s Long-Term Care News
Posted by Dr. El - December 18, 2018 - Communication, Customer service, McKnight's Long-Term Care News
Here’s my latest article on McKnight’s Long-Term Care News:
A study of interactions between families and healthcare providers published in the BMJ this month sparked my interest. It showed that improving communication between the two groups reduced harmful medical errors by 39%.
As if that vast reduction in medical errors weren’t enough, it was caused by harnessing the input of team members who don’t cost facilities a penny. In an era of intense financial pressures for the industry, free team members are a gift that shouldn’t be overlooked.
According to the researchers, the study “indicates that improving communication between families and healthcare providers doesn’t just feel good, it can help improve the safety and quality of care.”
Family strength
In Editor Jim Berklan’s excellent blog postlast month, he points out research that shows that families “don’t know what they’re talking about” when it comes to loved ones’ end-of-life care preferences. (If that’s so, we as experts should be facilitating Care Conversations.)
While family members may fall short on end-of-life wishes, they’re generally more expert than we are on their parents’ medical history and behavior. They know that their father didn’t react well to a particular medication when he took it at home or that Mom is “acting funny,” even if they don’t know why.
I myself have gone to the nursing station with the complaint that a resident is “off” somehow and been dismissed in my concerns, to the detriment of the resident’s health. Over the years, I’ve learned that I should phrase it as a “change in mental status” and to speak in a tone that conveys the depth of my experience and the seriousness of my observations, but basically I’m saying that the resident is “acting funny” and it seems physical, not psychological. I’ve detected sepsis, strokes and other emergencies this way.
If the nurses aren’t receptive to perhaps poorly-phrased information from psychologists, recreation therapists and other non-medical personnel, they may also be missing valuable information from families.
The BMJstudy shows how we can train staff to be more responsive to family input.
Family-centered rounds
For the entire article, visit:
Posted by Dr. El - December 7, 2018 - Business Strategies, Communication, Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I was recently required to take an online training module on burnout for physicians and allied professionals. It was the first time in 20-plus years that I’d received a formal message about self-care from any long-term care institution (aside from yearly staff appreciation barbecues and survey completion parties).
While I was impressed and grateful for the focus on caregiver well-being, a couple of points bothered me.
The questionnaire asked readers to select the phrase they most associated with provider burnout. There were options such as “workplace dissatisfaction” and “challenging patients.” I chose “changes in the healthcare system,” which triggered a pathway specific to that option.
I was guided through a series of vignettes discussing issues old-timers might have trouble with, such as adapting to the electronic medical record. Following the vignettes, helpful strategies were offered to manage stress.
Then came the part I found disturbing: The details of the “changes in the healthcare system” choice included “the emphasis on the healthcare experience of consumers” and “the shift from volume to value.” Let me explain why that irks me.
The experience of healthcare
Regarding consumer experience, most of my direct care team members and I have been very focused over the years on accommodating the needs of residents. It’s become more difficult, however, to maintain care quality and orderly surroundings in a healthcare environment where financial pressures have led to staff reductions and increased turnover amidst higher acuity residents.
Trying to deliver a decent customer experience without the necessary tools is part of the change in the healthcare system that induces my feelings of burnout — not the “new” attention to perceptions of consumers.
I’d be gratified to see a genuine, top-down focus on the healthcare experience of residents and their families — complete with Resident Experience Officers in every long-term care facility (sign me up!). Such an emphasis would realign resources with a mission of care that can stabilize staffing and sustain facilities over time.
Volume to value
“The shift from volume to value” stresses me in a different way.
Part of my role as a psychologist in the “volume” approach has been to aid residents in negotiating their illnesses and treatments.
If necessary, I could help them stop a lucrative but unwanted onslaught of painful medical interventions by fostering communication with their physicians and families.
For the entire article, visit:
Posted by Dr. El - November 12, 2018 - Business Strategies, Dementia, McKnight's Long-Term Care News, Motivating staff, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I headed to the 2018 LeadingAge convention last week looking for a fix of long-term care enthusiasm and that’s exactly what I got.
I met up with old colleagues, put faces to voices I’d spoken to for years and wandered through the expo hall catching snippets of conversations that might be exciting only to long-term care professionals.
PDPM
Armed with a large cup of black coffee, I attended an early morning seminar on the Patient-Directed Payment Model (PDPM), mostly so I’d know what everyone was freaking out about at work. “Are there any payment adjustments for residents with behavioral health problems?” I inquired of the speakers. “No,” came the reply.
Facilities will continue to have to manage residents with anxiety, substance abuse and other difficult and time-consuming behaviors without financial remuneration through PDPM. For those looking for immediate answers, consulting psychologists can be a good resource for staff training and local associations may be able to offer educational sessions on specific topics across facilities.
Team building
I participated in a session offered by Christopher Ridenhour, GFN entitled, “The Other Voice: Race, Class, Culture and the Other ‘Isms’ in Aging Services.”
“And you wonder why we have a staffing crisis,” he said, pointing out, for example, that attendees walking briskly through the conference hall without acknowledging one another were likely to be doing the same thing with their staff members back at home.
Ridenhour emphasized that all workers, regardless of their race, age or any other characteristic, want to be recognized and appreciated.
The session included practice exercises that highlighted commonalities between participants. I left with a new friend with whom I “LinkedIn” the next day. We were born in different countries, work in different LTC roles and have almost a decade between us, but given the directive to “tell each other your life story in thirty seconds,” we found the kind of common ground that any employer would want for their team members.
Montessori for staff
The theme of connection was echoed in a session offered by psychologist Cameron Camp, Ph.D., and his colleagues at the Center for Applied Research in Dementia on teaching Montessori techniques to staff members.
Posted by Dr. El - October 24, 2018 - Business Strategies, Customer service, McKnight's Long-Term Care News, Resident care, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
Long-term care success is about steady, reliable relationships. That’s my takeaway after attending two recent conferences that echo my experiences in the field.
The first event delivered the results thus far of an ongoing program that won a coveted grant from the Center for Medicare & Medicaid Services’ Center for Innovation. The OPTIMISTIC project is an effort of Indiana University and local partners, including the University of Indianapolis Center for Aging and Community. OPTIMISTIC is an acronym for Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care.
The model entails placing registered nurses in nursing facilities, as well as giving staff access to nurse practitioners. The nurses function as educational trainers and as resources for the team.
The consistent relationships with these nursing experts produced astounding results, including a 32.6% reduced relative risk of potentially avoidable hospitalizations and a net savings to Medicare of $3.4 million.
The second conference in which I participated was a National Readmission Collaborative event.
Keynote speaker Eric A. Coleman, M.D., discussed research on phone calls following up with patients after discharge from the hospital. While such contacts have been touted as an effective means of identifying and remedying precursors to hospital readmission, patients are often barraged with contacts from various service providers. These well-intentioned efforts thus become annoyances without real value to the patient and their family.
Having one consistent, informed care manager across the healthcare continuum proves more useful and effective, he reports.
As a psychologist, I’m not at all surprised.
For the entire article, visit:
Posted by Dr. El - October 10, 2018 - Communication, Customer service, McKnight's Long-Term Care News, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Observing the customary cacophony at the nursing station, I’d estimate that so-called “alarm fatigue” contributes to more than a few tragedies in long-term care.
Here’s one example that resulted in a lawsuit filing after a resident died when nursing staff ignored the alarm signaling that her ventilator had become disconnected.
That’s why I was so interested in a Stat news article “Anatomy of a Beep,” which focused on collaboration between Medtronic, a medical device company, and Yoko K. Sen, an ambient electronic musician. The feature describes how medical devices came to have the sounds that they do — “alarms that are easily confused and difficult to learn and don’t really tell us what’s wrong” — and efforts to create a more helpful and appealing healthcare soundscape.
While the Medtronic project is geared toward a hospital emergency department with its plethora of health monitors, long-term care operators hoping to avoid alarm-fatigue-related medical catastrophes might take note of their efforts.
Among the many sounds typically competing for the attention of nursing home staff members are ringing telephones, television sets, conversations among staff members, overhead pages, elders calling for help, chair alarms, escalating arguments between residents, completed tube-feed nutrition cycle indicators, noisy nebulizers and oxygen concentrators, exit door and elevator warnings, and call bell signals. Specialized units such as ventilator programs will blare additional alerts.
While some employees are fortunate enough to be able to move to a quieter unit to complete their duties, most must contend with a din they have limited power to change. Researchers have found that noisy healthcare environments can significantly increase workers’ level of distress.
Residents, unless they can independently ambulate, have virtually no ability to escape the hubbub, which can border on an abusive level of noise pollution and can negatively affect their perceptions of their stays. In addition, studies have shown that noise can disrupt sleep and increase the likelihood of delirium.
Consider taking a moment to listen to the soundscape of your facility. Stand by the nursing station, close your eyes and imagine that the sounds are the backdrop for your eight-hour workdays, or your life, 24/7.
Below are some adjustments that can enhance the aural environment:
For the entire article, visit:
Posted by Dr. El - October 7, 2018 - Anecdotes, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Personal Reflections, Role of psychologists, Something Good About Nursing Homes
Here’s my latest article on McKnight’s Long-Term Care News:
“No,” Diane said when I showed up at her door for our Thursday session. “I don’t want to talk to you. I’m too aggravated.” She turned her head and looked out the window for a moment.
“I’m surprised.” I replied. “We had such a nice conversation the last time. Plus, being aggravated is a perfect reason to talk to the psychologist.”
She looked back at me and sighed with exasperation, “Fine! Sit down. But I’m not going to be very good company.”
“You don’t have to be a star, baby, to be in my show.” I sang the refrain to the old song, mostly on tune.
She rolled her eyes. “They’re driving me crazy here,” she began, launching into an account of her recent fall on the way to the bathroom. “And now they won’t let me do anything by myself! They’re always yelling at me to wait for them, but then they don’t come when I call for them.”
It was the same tale I’d heard from two residents in my other facility that week.
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Maya was a frail woman in her late 70s who navigated around her room with a walker. She spent most of her time alone, crocheting colorful booties that she carefully tied onto the walker frame, which served as a display for her wares.
“Five dollars each,” she told me, when I commented on her handiwork. Her earnings, I learned several sessions later, were going to her disabled son, who came to the nursing home every few weeks to collect the money she’d made for him. “He’s a good boy,” she assured me.
Maya had been placed on the dementia unit, though she didn’t have dementia. Residents wandered in and out of her room, touching her yarn and the slippers. She yelled at them to stop, leading to chart notes saying she was agitated and eventually to a move to a different floor.
Once among residents more similar to herself and assigned to a consistent, experienced aide who took her under her wing, Maya’s mood and behavior improved considerably and we discussed concluding our sessions. I arrived for our last meeting with a $5 bill in hand and left with a beautifully crocheted pair of booties I didn’t need.
For the entire article, visit:
yarn in apile
Posted by Dr. El - September 19, 2018 - Business Strategies, McKnight's Long-Term Care News, Technology
Wednesday September 26, 2018
Earn 3 Free CEUs at 3 Free webinars
Once again, McKnight’s will host its annual Fall Online Expo, which is a chance to attend a conference without leaving your desk. Register for the conference in advance, and then log in to hear the talks, visit the vendors, and chat with the reps and attendees. This year’s topics are:
· TECHNOLOGY: Cyber threats and compliance challenges: Managing technology risk in aging services
· STAFFING: New strategies in staffing: Developing a partnership with your local university
· PAYMENT: Are you ready for the changes coming to MDS 3.0?
Posted by Dr. El - September 19, 2018 - Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Motivating staff, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
As a consulting psychologist, my official job is to provide psychological services to the residents of the nursing homes in which I work. Occasionally, though, I’m asked by a department head to informally assist a staff member in distress and, more frequently, a teammate comes to me for a referral for herself or a family member.
And then there are the times that I reach out to a coworker whom I see needs a hug, an acknowledgement or a few words of encouragement.
Based on a study reported in BMJ Open last month, it turns out that I’m not just being of service to my coworkers. I’m also helping to keep them on the job.
The study examined the way managers handle feelings of depression in their team members across 15 different countries. They looked at whether their reactions influenced absenteeism or presenteeism, which refers to attending work but with reduced productivity.
The researchers found that managers who acknowledged depression and actively offered help fostered greater presenteeism and less absenteeism.
The authors recommended that, given the prevalence and substantial costs of depression in the workplace1, attention be paid to developing policies and training that allow managers to better support employees who are experiencing depression. Training managers to recognize and attend to depressed workers makes it more likely that they’ll intervene before symptoms and productivity costs worsen.
Of particular interest given long-term care’s typical workforce is that the results of the study suggest that, “female individuals with low education and those in the middle age group (25–44) might need more support in the workplace.”
Interventions
Clearly, it’s not a good idea for managers to spontaneously hug all the coworkers they think might be depressed. (For the record, I approach only people I know relatively well and I always ask the person if they’d like a hug before hugging!)
Instead, consider these other ideas:
- At a minimum, add a section on recognizing employee depression to in-service trainings already in place for addressing depression in residents. Distribute an up-to-date list of local mental health providers at the end of the program for attendees who might want to access services on their own.
For the entire article, visit:
Posted by Dr. El - September 5, 2018 - Business Strategies, Depression/Mental illness/Substance Abuse, Engaging with families, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
In most of my long-term care career, I’ve witnessed short-term rehabilitation (STR) residents housed together, but occasionally facilities have scattered them throughout the building. I don’t know the reasoning behind dispersing residents, but from my perspective, dedicated rehab units work better.
My thinking is based on the fact that people entering rehab are almost invariably in the middle of a life crisis (see The stress of nursing home admission) – as are their family members – and that staff members are often stretched to the limits of their capacity to manage their responsibilities.
Keeping rehab residents together is better because:
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STR residents lodged together find a group of peers in the same situation as themselves, which can be enormously reassuring in anxiety-provoking times.
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Co-housing makes it more likely that STR residents will develop stress-reducing friendships and find a team of peers to support their progress in rehab. The ability to form friendships with peers is one of the major strengths and selling points of long-term care.
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Being around LTC residents can be alarming for STR residents, who usually have fears that they’ll “never get out.” Observing others being discharged upon completing rehab can ease their apprehension.
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STR residents, who are frequently younger and more cognitively intact, can feel isolated on LTC floors that have fewer people with whom to engage socially, and none in their particular situation. This increases their depression and anxiety.
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Family members can benefit greatly from talking with other families in similar situations. They’re much more likely to meet other families “in the trenches” on an STR unit. Yes, there are families on the long-term floors, but they’re in marathon mode while STR families are sprinting through a crisis that has reordered their lives.
For the entire article, visit:
Posted by Dr. El - August 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, Inspiration, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
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Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
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Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
For the entire article, visit:
