Category: McKnight’s Long-Term Care News
Posted by Dr. El - November 9, 2017 - Business Strategies, Communication, McKnight's Long-Term Care News, Resident education/Support groups, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
Ideas from an interview with Dr. Donna Corrado, Commissioner of the New York City Department for the Aging
Within long-term care, overcoming the problems caused by silos can lead to better care coordination, increased interdepartmental cooperation and reduced work redundancy.
My 1-on-1 interview with Donna Corrado, PhD, Commissioner of the New York City Department for the Aging, suggests there are also benefits to breaking down silos between public and private aging services.
Area Agencies on Aging (AAA)
There are 622 area groups in the National Association Area Agencies on Aging (n4a). According to its website, “the primary mission [of n4a] is to build the capacity of our members so they can help older adults and people with disabilities live with dignity and choices in their homes and communities for as long as possible.”
While n4a’s mission might seem diametrically opposed to the business interests of long-term care, this isn’t the case in a capitated model. When an organization offers a continuum of care with the goal of maintaining people outside of the hospital and at the least expensive level of care, then private and government (and personal) interests align.
My conversation with Dr. Corrado revealed ways of making the most of this alignment of interests, as well as ways to boost the census in long-term care.
AAA offerings
While NYC is the largest Area Agency on Aging in the country, each AAA has it’s own assortment of programs directed toward the needs of their community. There are core issues common everywhere.
Food insecurity is addressed through congregate meals in senior centers and through organizations like Citymeals on Wheels, which provides 8 million meals to New Yorkers Monday through Friday. At the National Readmission Prevention conference I wrote about last month, the speaker from Abbott Nutrition reported that proper nutrition resulted in a 28% decline in hospital readmissions over a six-month period.
Every community has a case management program that assesses individuals and offers home care services.
Senior centers (NYC has 270 of them!) can reduce the epidemic of loneliness and help identify health problems before they become medical emergencies. Funding for senior centers varies greatly, creating opportunities for collaboration.
For the entire article, visit:
Posted by Dr. El - October 25, 2017 - Business Strategies, Customer service, McKnight's Long-Term Care News, Transitions in care
Here’s my latest article on McKnight’s Long-Term Care News:
Long-term care providers have an opportunity to thrive with value-based care, escape cynicism and join the growing wave successful at avoiding readmissions.
Last week, I was part of a panel discussing readmission prevention at the National Readmission Prevention Collaborative’s C-Suite Invitational: New York Transformational Healthcare, which focused on Accountable Care Organizations, bundles and readmissions. The goal of the forum was identifying ways for providers at all ends of the healthcare continuum to prevent hospital readmissions and to thrive in a value-based care model.
Unlike fee-for-service care, which compensates providers for each procedure, value-based care pays for the episode of care, making it essential to coordinate between providers and to avoid unnecessary medical utilization. Efforts to avert hospitalization and readmission are paramount.
The conference offered several takeaways for skilled nursing facilities and other post-acute providers.
From hospital to post-acute provider
Presenters emphasized the importance of being part of a continuing care network rather than a stand-alone facility and of working closely with referral sources. Because crucial information is easily lost during care transitions, best practices suggest a “warm handoff” rather than an exchange of information on paper or via computer, meaning that providers have an actual conversation about care.
To facilitate this, both the referral source, such as the hospital, and the accepting organization, such as the nursing home, should have someone to collect and relay information. To reduce costs, this needn’t be a clinical role as long as the necessary details are conveyed. Communication can be streamlined using a “hotline” between the hospital and the post-acute provider so that phone calls can be made directly rather than routing through the emergency department.
The transition to home
Hospitals are being monitored for readmissions and may have several post-acute care options. The facility most likely to prevent rehospitalization after discharging residents is the one most likely to get referrals.
For the entire article, visit:
Posted by Dr. El - October 12, 2017 - Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Perhaps you’ve heard about the administrator who spent a week as a resident in his long-term care facility. After being roused from sleep daily to receive medications that could have been dispensed later in the day, he banned his physicians from unnecessarily prescribing meds during night hours.
That’s an excellent way of attending to sleep hygiene, an important and often overlooked aspect of wellbeing for residents and staff alike.
Sleep challenges of older adults
By the time residents arrive at our doors, their sleep is likely to be affected by influences such as illness and pain. In addition, there are changes in circadian rhythms as people age, leading to increased wakefulness earlier in the morning and fatigue earlier in the evening, according to an article in this month’s American Psychological Association’s Monitor on Psychology.
While we can’t alter some of these factors, as care providers we can become more attuned to the importance of sleep for our residents and train our teams to create environments that are more conducive to slumber.
Impact on care
Poor sleep is associated with cognitive and physical deficits. It can impair residents’ ability to participate in rehab and negatively affect their moods and their interactions with others, including the staff members there to help them (whose job is hard enough).
Residents who can’t sleep through the night due to elements within the control of the facility are not happy with this situation. They’re less satisfied with their stays and therefore less likely to recommend the facility to their friends and neighbors.
As illuminating as it would be, you needn’t sleep in your facility for a week to find out which staff training and policies will remedy the problem. The residents have told me what keeps them up at night and I’ve outlined a “sleep hygiene” training program based on that.
For the entire article, visit:
Posted by Dr. El - September 28, 2017 - Anecdotes, Business Strategies, Communication, Customer service, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
Both of my mothers-in-law live in long-term care communities in Florida. (I’ll keep the backstory about having two MILs a mystery.)
One MIL lives in a place that was excellent about how they communicated with family members before, during and after Hurricane Irma. The other MIL’s facility handled that aspect of care poorly.
At Bentley Village in Naples on the southwest coast of Florida, all 800 residents of the CCRC were evacuated in advance of the storm, even when everyone thought the hurricane was heading toward the East Coast. While not every organization can afford to evacuate their residents to plush hotels, all of them can afford to do what Bentley did next.
At the top of the home page of its website they placed a bright red banner instructing site visitors to click upon it for more information on Hurricane Irma. The following page contains continually updated reports on the progress the management is making toward assessing and repairing the damage to their homes, as well as an estimate of how long the process will take. A typical entry contains the date and time of the posting, the work that’s been done and what has yet to be accomplished.
They recently added photographs of the damage to the community. The photos clearly show even those most eager to return to their homes why they must wait.
In addition, there’s a list of locations where people are sheltering since residents from skilled nursing, assisted living and independent living were sent to different locales. A pet-friendly hotel was selected for independent living residents with animals.
When I discovered my MIL’s cell phone wasn’t working, I checked the website, got the phone number of the hotel where she was staying and was immediately connected to her room. She claimed they were “having a ball.”
Very reassuring.
For the entire article, visit:
Posted by Dr. El - September 13, 2017 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
I often speak with healthcare groups, giving psychological insights about a variety of issues within long-term care. Sometimes I address a C-suite audience; other times I train direct care staff.
I noticed during the course of these talks that some of the group exercises that generated excitement and intense discussion among direct care staff were met with relative restraint when presented to executives.
After pondering the discrepancy in reactions, I adjusted my talks accordingly and came to this conclusion: Healthcare executives and managers are very different from those they manage.
Understanding and utilizing these differences can facilitate leadership in a variety of ways.
How execs differ from direct care staff
We can consider the discrepancies between the two groups by looking at the traits generally exhibited by each. I’ve borrowed a tool from career counselors, who test their clients’ personality traits to determine what types of jobs best suit them.
One such test is the Myers-Briggs Type Indicator, which examines four different aspects of an individual’s personality as it relates to career choice. The summary below is from an article with a handy chart based on the book, “Do What You Are.”
For the entire article, visit:
Posted by Dr. El - August 31, 2017 - Communication, Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
By now it’s likely that you, your staff, the residents and their families have seen the incredibly disturbing photo of assisted living residents in Dickinson, TX, sitting in waist-high floodwaters.
Thankfully, all the older women in the picture have been rescued, but that image and others of the flood are undoubtedly causing concern in your community.
Vulnerable residents with no ability to remove themselves from similar situations may be experiencing anxiety, nightmares and/or agitation after seeing their peers immersed in water. Worried family members will want to know that their loved ones are safe from comparable disasters.
Staff members may be wondering what crisis procedures the facility has in place and if they’re sufficiently prepared to carry them out should the need arise (especially with their own families to worry about in an emergency).
Reassurance required
Just as the nation turns to its leaders for reassurance during difficult times, the members of your community will look to you to calm their fears. Now is the time to write a memo to your staff, post a notice in the lobby and add an article to the organization’s newsletter assuring people that there are plans in place for emergencies and that steps have been taken to ensure the safety of the elders entrusted to your care.
Review emergency plans
Review policies and procedures and train staff so that they feel comfortable carrying out these plans. Coordinate with other long-term care facilities so that there is reciprocity of staff and beds in emergency situations.
Posted by Dr. El - August 19, 2017 - Customer service, McKnight's Long-Term Care News, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Falls: A closer look
Part of my job as a geropsychologist is to conduct reviews of falls with my patients after they occur.
Through discussion with the resident, I analyze what happened and assess how they’re doing after what can be a traumatic event. Together, we identify ways they can prevent future falls.
This exercise can be very revealing not only about the particulars of a situation but also about why falls occur in general.
The trauma of falls
Falls can be traumatic for a number of reasons. Sometimes an individual is badly hurt in the event, leading to a hospitalization and/or a decline in their physical and mental condition.
Occasionally, a person isn’t found immediately, resulting in a period of time on the floor in pain with negative thoughts about themselves, staff, the facility and life in general. A spill can also trigger thoughts about similar past distressing episodes, such as a reminder of a fall at home that precipitated hospitalization and placement.
In addition, falls can decrease residents’ confidence in their physical abilities, leading them to become overly cautious in rehab and resulting in increased physical dependence.
Why residents fall
There are many reasons that people fall, including forgetting their inability to walk, dizziness due to medication side effects, pain and restlessness.
This 2014 article in Managed Healthcare Connect provides excellent examples of how to conduct a thorough “root cause analysis” and a discussion of many of the elements that contribute to falls and how to address them.
Falls are typically multifactorial, but my own experience with residents over the years — bearing in mind that I speak only with residents who are cognitively intact and able to benefit from psychological services — suggests one major cause of falls in this cohort: not getting help in a timely fashion.
For the entire article, visit:
Posted by Dr. El - August 4, 2017 - Books/media of note, McKnight's Long-Term Care News, Personal Reflections
Here’s my latest article on McKnight’s Long-Term Care News:
I was perusing The New York Times last week when I came upon an article about a play centering on my favorite topic — aging.
“Singing Beach,” by playwright Tina Howe, revolves around the drama that consumes a family when confronted with the need to place an elderly parent in a nursing home. Howe is 79 years old and lives with her 81-year old husband, who has been diagnosed with Alzheimer’s disease. She says the play was inspired by the care needs of her father years ago.
I enlisted a friend with similar interests to accompany me to the performance. “The director is a friend of mine,” I told her. “And I’m curious to see how long-term care is portrayed in the show.”
Howe, an Obie Award winner and two-time Pulitzer Prize finalist, notes that all the producers she’d initially approached turned down the script. Then, she encountered my director friend, Ari Laura Kreith, who found the subject in keeping with the mission of her company Theatre 167.
According to its website, Theatre 167 was “born in a community where 167 different languages are spoken” and it “creates, cultivates, and supports new work by artists of wide-ranging backgrounds, traditions, and beliefs” in order to provide “theatrical events that deepen and enhance our understanding of one another.”
Given our youth-obsessed culture and the paucity of “coming of old age” films and other media, this play certainly contributes a unique perspective and one that is, at the same time, universal. After all, among the 167 languages mentioned, each has speakers who are older adults and may one day be in need of long-term care.
For the entire article, visit:
Graphic image by Kelly Pooler, collage with Katsushika Hokusai’s The Great Wave
Posted by Dr. El - July 18, 2017 - Business Strategies, McKnight's Long-Term Care News, Technology
Here’s my latest article on McKnight’s Long-Term Care News:
I was at the nursing station the other day when some unusual cracking noises caused me to look up from my documentation. A very old, petite lady was sitting in her wheelchair popping bubble wrap. She wore th
e same contented expression that comes over virtually everyone popping a sheet of bubble wrap.
This low-tech soother was on my mind during my visit to New York City’s CE Week. CE, in this case, is not Continuing Education but Consumer Electronics.
In March, I wrote about attending Aging2.0, a tech conference geared toward elders. The CE Week NY isn’t specifically aging tech, but the 50+ set was invited by tech50+ and Senior Planet and I went to see what could be appropriated for people much older than 50.
I was thinking of the happy bubble-wrap popping elder when I came across FidgetTech, a table of high-tech “fidgets.” A fidget spinner is a small, flat plastic device with a central core that remains stable while the three-pronged body is spun in circles. Often marketed as a tool to help children maintain their focus, they’ve become a craze like yo-yos or Silly Bandz.
The display offered a wide variety of fidgets with various electronic capabilities (music! USB hubs!), but what stood out to me was the possibility of calming agitated elders with a basic, silent fidget that, unlike bubble wrap, wouldn’t disturb those around them. I liked the fidget that had “arms” filled with liquid and glitter so that when it stopped, the glitter settled in a slow, mesmerizing fashion. I could imagine a “Fidget Hour” mitigating the agitation that frequently occurs late in the day.
Farther down the exhibit hall, the Rapael Smart Glove display demonstrated virtual reality-based rehabilitation using a variety of computerized games and a plastic sensor “glove.”
(Think Wii for hand and arm rehabilitation.) In addition to the high-tech demonstration, they offered low-tech photocopies of a 2016 study published in the Journal of NeuroEngineering and Rehabilitation outlining the glove’s utility for post-stroke patients. The device would be a useful and impressive addition to rehabilitation services.
For the entire article, visit:
Posted by Dr. El - July 6, 2017 - Business Strategies, Customer service, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The team huddled around the nursing station talking in panicked whispers after the management meeting ended.
“How do they expect us to do that?” a young nurse wondered.
“Yeah,” an aide replied, “we’re stretched thin enough already!”
A more experienced worker piped up. “Don’t worry,” he said bluntly. “I’ve seen these ideas come and go. It’ll never happen.”
There was a collective sigh of relief and everybody went back to business as usual.
The scenario above illustrates some of the many ways organizations are resistant to change.
In this situation, the new procedure is viewed as a temporary fad not worth investing time and energy. The workers haven’t been consulted for their input prior to implementation, they fear that they won’t be able to handle the work and the benefits of doing so aren’t clear. In addition, the employees don’t trust their management to guide them through the process of change.
Think of how hard it is to adjust our own routines and then multiply that by, say, every employee, resident and family member. Then cube that number.
Speaking of adjusting personal routines, a few months ago I wrote that I was going to try to meditate daily this year. I haven’t.
Consider trying to make changes in the context of family life, such as going for a walk after dinner (a good idea that never happened) or eating healthy food (I do, she does, he doesn’t). Pushback and inertia can make it difficult for even the most well-intentioned modifications to take hold.
This is why it’s necessary to have a guide along the way for changes to take hold, whether it’s a friend to meet you at the gym or the Pioneer Network to help your organization navigate through the culture change process.
Full disclosure: While I don’t get paid to say this, as a psychologist I find that culture change principles are better for the mental health of the residents, staff and families. As a change agent, I know how important it is to enlist an agent of change.
For the entire article, visit:
