Category: Motivating staff

Racism and LTC

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

Racism and LTC

A friend of mine called me this week, upset about the racial tension making headlines in the news. We discussed what we could do as individuals to improve the situation.

“I called a friend of mine of a different race,” she said. “I told him we need to stay in touch right now, even if we’re busy.”

“My column this week is about the issue,” I responded. We talked about how differences are bridged in a healthcare environment.

In long-term care, we provide services to, and work with, individuals from backgrounds different than our own. Residents share rooms and break bread with types of people they may never have encountered more than superficially in their previous 80 years of life. Barriers recede when we come to know each other as people, yet it’s not always a smooth road.

Studies of racism in LTC

I’ve observed firsthand various culturally charged interactions — both positive and negative — and I wondered what types of racial challenges are common in long-term care.

I turned to the research to see what’s been studied formally and found that racism is observed in the following ways:

• Residents refusing care based on the racial or ethnic group of the caregiver, as noted in the New England Journal of Medicine article, “Dealing with Racist Patients.”

• Unpleasant work environments due to hearing racial remarks by family members or other workers, in “Racism Reported by Direct Care Workers in Long-Term Care Settings.”

• Nursing homes in areas with high poverty being more likely to close: “Why Medicaid’s Racism Drove Historically-Black Nursing Home Bankrupt.”

• The changing demographics of nursing homes due to people from minority groups having increased entrance to that level of care, but reduced access to privately paid home and community-based care such as assisted living: MedicareAdvocacy.org, “The Changing Demographics of Nursing Home Care: Greater Minority Access…Good News, Bad News.”

Increasing inclusion

While some of these problems are beyond the scope of any one LTC organization, there are ways in which the first two points can be addressed within our communities:

For the entire article, visit:

Racism and LTC

From abysmal to mediocre: Encouraging hand hygiene

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

From abysmal to mediocre: Encouraging hand hygiene

As a consultant in long-term care, I learned how to properly wash my hands by reading the hand hygiene poster hung above the sink at one of my first nursing homes.

I’ve gotten more diligent over the years (read: paranoid), making an effort to sanitize my hands as I move from room to room, but I wonder about those whose roles in long-term care don’t specifically emphasize infection control procedures.

While infection control is an integral part of training for most staff members, there are many other people in facilities — visitors, volunteers, vendors and residents, among others — who might not fully recognize the importance of hand washing to prevent the spread of infection.

In fact, a recent study suggests that even those who should know better don’t wash their hands as often as they should. Researchers found that doctors in a California hospital had a hand hygiene compliance rate of about 22% when they didn’t realize they were being observed and a rate of 57% when they recognized that the infection control staff was watching them.

The research paper is titled, “Hawthorne Effect in Hand Hygiene Compliance Rates,” referring to the change in behavior due to being observed. To me, however, the takeaway is that hand hygiene compliance rates range from being abysmal to mediocre. Clearly, this is an area that needs more attention.

A study presented at this month’s Association for Professionals in Infection Control and Epidemiology conference suggests a novel method of increasing hand-washing compliance.

Because prior research had found success in appealing to emotional motivators such as disgust in changing hand-washing behavior, investigators exposed subjects to unappealing photos of bacterial contamination. This visual exposure helped participants imagine the contamination on their own hands and increased their likelihood of hand washing by 11% to 46%.

We could call it the “Eww, Gross! Method.”

Other techniques suggested by infection control and other researchers to increase hand hygiene compliance are below:

• Publishing (in-house) rates of hand-washing observance for each unit to create a healthy sense of competition. The best team could be rewarded, perhaps with pizza or a special lotion to soothe frequently cleansed hands.

For the entire article, visit:

From abysmal to mediocre: Encouraging hand hygiene

Dr. El tries on the Genworth aging suit

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

Dr. El tries on the Genworth aging suit

I’d read about the Genworth R70i Aging Experience and when I discovered the exhibit was making a brief appearance near me at the Liberty Science Center in New Jersey, I headed over with my 9-year old assistant to see what it was all about.

The Aging Experience involves a high-tech suit designed to help younger people gain insight into the physical effects associated with aging. When I told residents I was going to age myself via the suit, reactions ranged from an incredulous, “Why in the world would you want to do that?!” to “Great! We can compare notes,” to, “Can they make a suit to make you feel twenty-five?”

My assistant and I arrived 15 minutes before the 11 a.m. demonstration so that I’d be dressed and ready. The Applied Minds staff, who partnered with Genworth on this project, took us into the back of a tech-filled room where they Velcroed various parts of the suit onto me, adding an extra 40 pounds strategically placed to mimic age-related weight gain.

This resulted in the constant thought throughout the half-hour presentation that it would be really nice to sit down.

The helmet included goggles and headphones, so that they could give me various disorders including glaucoma, macular degeneration, cataracts, age-related hearing loss, tinnitus and aphasia. I was finally able to see what one of my patients referred to when she said, “I have macular,” as if she was intimate enough with the condition to be on a first name basis.

After undergoing vision and hearing loss, I was faced with rheumatoid arthritis and hip problems that made walking on the treadmill a chore. Even without the additional physical challenges, trudging on the virtual beach was so difficult that I estimated a two-minute hike would be enough before it lost its pleasure – and I love walking on the beach.

The audience was able to observe my heart rate and perceptions on the screens behind me and then to try on goggles and headsets and experience the ailments themselves.

For the entire article, visit:

Dr. El tries on the Genworth aging suit

Growing Good

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

Growing Good

Woohoo! My first column of 2016.

Which was started during a bout of insomnia in the last week of 2015.

What did I do when sleep failed me? What electronics-addicted individuals often do in the middle of the night. I grabbed my computer, caught up on email, and headed over to Facebook to find out what my Friends had been up to.

There I discovered a post about a company founded by two brothers called Life is Good, which emerged from the standing request the founders’ mother had for them as children in a chaotic home environment: Tell me something good about your day.

This helped the brothers become “glass half full” kind of guys, the type of people who donate 10% of their profits to help children overcome adverse childhood experiences.

And what does a T-shirt company have to do with long-term care? Well…

What if we started off this brand new year asking ourselves and our coworkers, employees and residents to tell us something good?

What if we put time and thought into focusing on the positive — into growing the good — and reminding ourselves why we’re all here working with elders?

I predict we’ll have more productive staff, better functioning teams, and happier residents.

It’s not just me doing the predicting. The Positive Psychology Center, led by director Martin Seligman, Ph.D., describes positive psychology as “the scientific study of the strengths that enable individuals and communities to thrive.”

For the entire article, visit:

Growing Good

7 employee wellness ideas for the holidays (and beyond)

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

7 employee wellness ideas for the holidays (and beyond)

After a staff training on reducing burnout in long-term care last week, a look through the evaluation forms was illuminating. A significant number of attendees — mostly nursing aides, nurses, and environmental workers — wrote that the most valuable point they got from the training was how important it was to take time for themselves, even if it was for just a few minutes.

Apparently the 10-minute meditation we practiced using an app on my smartphone made a big impression on them. What struck me was how novel that experience was for them.

With frequent callouts and turnover rates troublingly high (50% for nurses and 51.5% for aides, according to a 2012 AHCA report), working short-staffed seems to be the rule rather than the exception. It means workers are being stretched ever thinner and being pulled in many directions by the needs of their residents.

With the holidays upon us, staff members have extra duties at home — gifts to purchase, parties to plan and attend, and special foods to cook.

By this time in December, your workers are probably maxed out.

This is a great opportunity to show that you’re thinking of them and that you recognize how stressful the holidays can be. It’s also a good way to prevent the staff burnout that leads to callouts, resignations and injuries.

For the entire article, visit:

7 employee wellness ideas for the holidays (and beyond)

The secret to LTC success? A focus on well-being

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

The secret to LTC success? A focus on well-being

Despite the diversity of the events I attended during my brief visit to the LeadingAge convention in Boston last week, a theme clearly emerged. The thread that ran through the varied offerings was well-being.

Retaining staff

In researcher and consultant Joanne L. Smikle, PhD’s talk on staff retention, rather than focusing on why employees are leaving, she looked instead at why they stay.

Based on her studies of long-term care organizations, she found that “if the leadership of the organization lacks passion, you will have trouble with retention and commitment.”

In healthy organizations, staff members “from the top of the house to the bottom of the house” stay because they can say, “I felt I mattered.” Experiences that contribute to that feeling: Recognizing staff in formal and informal ways, an open dialogue with staff rather than top-down communication, and a focus on the human elements enabling employees to make connections with each other, the residents and the families.

Dementia care

G. Allen Power, MD, FACP titled his presentation, “Enhancing well-being for people living with dementia,” so it wasn’t surprising that this was a central point in his talk.

He asserted that antipsychotics don’t work and don’t treat the true causes of the behaviors associated with dementia. Instead, he recommends focusing on the seven primary domains of well-being, which are part of the Eden Alternative model of care: identity, growth, autonomy, security, connectedness, meaning and joy.

In one instance, a resident who became agitated when he was prevented from leaving the building was allowed outside. The man looked at the cows in a nearby field and returned to spend the rest of the day calmly. The team, who subsequently learned that the resident had been a farmer whose daily routine included an early morning check on his animals, had given him not only autonomy, but had also affirmed his identity and added meaning and joy to his life. His agitation disappeared.

Keynote address

Atul Gawande, MD delivered a Monday morning keynote address. Author of the book “Being Mortal,” Dr. Gawande discussed ways in which to improve end of life treatment. He advocated for care that takes into account the desires of the patient and noted that there is more to living than extending the amount of time we live.

For the entire article, visit:

The secret to LTC success? A focus on well-being

Leonard Florence ALS unit entrance

How to find out why your staff is leaving

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

How to find out why your staff is leaving

During the Q&A section of my McKnight’s Fall Expo webinar “Letting them go with style,” the conversation turned toward why staff members are leaving their long-term care positions.
As I pointed out then, workers often give plausible but incomplete reasons for leaving their positions because they plan to work elsewhere in the industry and don’t want to burn any bridges. Others exit without giving notice. Without knowing the real reasons why employees leave, it’s difficult to make adjustments that will lessen turnover.

Challenging assumptions

Organizations sometimes disparage the departing employee rather than look at what might have contributed to their resignation. Psychologically speaking, this lessens the “narcissistic injury” of someone leaving. A narcissistic injury is one that hurts our sense of self. Rather than feel the pain of being rejected, we reject them.

A typical assumption is that there was something wrong with the resigning worker. For example, they weren’t dedicated enough, they didn’t appreciate the benefits of the organization, or they weren’t very good anyway (the “sour grapes” effect). This leads to the sweeping conclusion that you just can’t find good people these days.

Rejecting someone who has left us may help us get over failed romantic relationships, but it’s a missed opportunity in business, especially if our workers keep marching out the door in droves as they have a tendency to do in LTC.

For the entire article, visit:

How to find out why your staff is leaving

Behavioral health care — not drugs — for dementia

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

Behavioral health care — not drugs — for dementia

Antipsychotic medications have proved ineffective at reducing the symptoms associated with dementia. They also have serious side effects in older adults, including restlessness, dizziness, higher likelihood of falls and other problems that can contribute to an increased risk of death.

Behavioral health interventions, on the other hand, have no such side effects and have been found effective in reducing behaviors such as aggression, care refusal and wandering.

Employing behavioral health techniques with people with dementia becomes increasingly valuable as facilities in this country endeavor to follow the Centers for Medicare & Medicaid Services guidelines and reduce the use of antipsychotic medications.

Global efforts

Dementia care is a pressing issue around the world, and other countries have made headway in shifting from medication to behavioral interventions. Psychologist Paula E. Hartman-Stein, Ph.D., of The Center for Healthy Aging, writes about international programs that implement behavioral health methods in the September/October edition of The National Psychologist.

Dr. Hartman-Stein spoke with Cameron Camp, Ph.D., an expert who consults with long-term care facilities in the United States and abroad.

France

Dr. Camp reports that the French government pays nursing homes to train their staff in non-pharmacological approaches to dementia. The training includes various strategies, including Montessori techniques such as those described by Dr. Camp in his excellent book, “Hiding the Stranger in the Mirror,” and other publications.

Australia

Camp notes that Alzheimer’s Australia provides funding to train staff in behavioral health approaches. Its website, Alzheimer’s Australia Information for Health Professionals, offers helpful information and brief videos that explain the techniques used.

Canada

In Canada, the Canadian Foundation for Healthcare Improvement reports on the success “beyond the team’s expectations” of an effort to reduce antipsychotic medications and implement non-pharmacological approaches. The project saved $400,000 in six months across the Winnipeg region.

STAR-VA in the USA

Here in the United States, the Veterans Health Administration, less constrained by the fee-for-service psychotherapy model that plagues the rest of the country, utilizes staff psychologists and other behavioral health professionals in their Staff Training in Assisted Living Residences (STAR-VA) model.

For the entire article, visit:

Behavioral health care — not drugs — for dementia

Free Webinar 5/20 @2pm ET: 9 Ways to Improve the Effectiveness of your Social Work Department & Increase LTC Resident Satisfaction

Join Dr. El

Wednesday, May 20th

at 2pm Eastern Time (1pm Central Time)

for a

FREE Webinar on

9 Ways to Improve the Effectiveness of your Social Work Department

& Increase LTC Resident Satisfaction

sponsored by EmLogis

To register:

visit EmLogis Events

About the webinar:

Are your residents depressed, their families distressed, and your staff turnover rate higher than you’d like? Empower your long term care social service department to lead the way to change! Join LTC expert and psychologist Dr. Eleanor Feldman Barbera for a live webinar on Wednesday, May 20, 2015 at 1pm CDT | 2pm EDT as she discusses the importance of social workers and ways in which an effective department can transform your community.

What you will learn:

The most important factors contributing to resident satisfaction
The impact of social workers upon resident, family and staff satisfaction
9 easy-to-implement strategies to develop your social work department

Who should attend this webcast:

Administrators and assistant administrators
DONs, ADONs, social workers
Staff training coordinators
Human resource department staff

Free Webinar 2/25 @ 2pm ET: Motivating LTC Staff with “Nudge” Principles

Join Dr. El

Wednesday, February 25th

at 2pm Eastern Time (1pm Central Time)

for a

FREE Webinar on

Beyond Carrot and Stick: Motivating LTC Staff with “Nudge” Principles

sponsored by EmLogis

To register:

visit EmLogis Events

About the Webinar:

Employee recognition programs reward staff members for good behavior and discipline techniques (such as suspending staff members) discourage bad behavior. By using nudge principles in addition, organizations can develop unobtrusive methods to help staff do the right thing. Join psychologist Dr. Eleanor Feldman Barbera as she discusses nudge principles and how to use them to improve workflow and reduce conflict during a FREE webinar sponsored by EmLogis employee scheduling on Wednesday February 25th at 1pm central.

What you will learn:

What it means to use nudge principles with your staff
Three types of interventions employing this social psychology concept
How to harness nudge theory within your organization

Who should attend this webinar:

Administrators and assistant administrators
DONs, ADONs, department heads, nursing supervisors, and charge nurses
Staff training coordinators
Human resource department staff