Category: Psychology Research Translated
Posted by Dr. El - April 17, 2014 - Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Psychology Research Translated, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Research shows that the rate of depression among elders in senior residences is 24% to 27%. It’s not that every fourth resident you greet in the hallway is depressed.
It’s that we should be more concerned about the people who aren’t in the hallway to greet.
“Depressive symptoms are expected to become a leading cause of the global burden of disease, second only to cardiovascular disease, by the year 2020,” according to Tracy Chippendale, PhD, OTR/L in her 2013 Clinical Gerontologist study.”
Depressed residents are less independent in their activities of daily living, have a decreased quality of life, and tend to use more medical services than peers who aren’t depressed.
Factors reducing depression
According to Chippendale, elders with more education, better self-rated health and more social support are less likely to be depressed. While we can’t necessarily change a person’s health or the level of education they’ve achieved, as senior care providers we can certainly offer opportunities for social support.
An important component of social support — beyond the number of connections in a person’s life — is how much the individual feels valued by others. For a retired elder who has completed raising her children and lost the value of a job and its contacts and income, mattering to others can come from family relationships, friendships, community service, and owning a pet, for example. Studies suggest that moving to a senior residence can reduce some of these opportunities to connect and to be of service.
Creating opportunities to ‘matter’
For the entire article, visit:
Posted by Dr. El - February 7, 2014 - Business Strategies, McKnight's Long-Term Care News, Motivating staff, Psychology Research Translated
Here’s my latest article on McKnight’s Long-Term Care News:
“They keep giving me these new aides and they don’t know what they’re doing,” a disgruntled resident commented during a psychotherapy session.
“You’re not the first person to tell me that,” I replied, looking for a way to acknowledge her experience without criticizing either the facility or the new aides. “You have the honor of training them.”
“Yes, if they’d listen,” she said with an edge in her voice. “But it’s a lot of work.”
The turnover rate in long-term care is a significant problem, with rates ranging from 55% to 75% for nurses and aides and sometimes over 100% for aides alone. Having personally witnessed a great deal of turnover during my years in LTC, I was curious about why the rate is so high and what could be done about it. I turned to the research to find the answers.
Costs of turnover
I was dismayed by a study that suggested that the persistence of turnover over the years might be because nursing homes could save money by treating their staff like a never-ending supply of fast food workers and avoiding investment in training and retention practices.
To my great relief, I found data indicating that there are many costs associated with turnover, including increased hospital readmission rates, high employee replacement costs, loss of productivity, poorer quality of care, a decrease in staff and resident morale, increased work stress, job dissatisfaction, increased accident and absenteeism rates, increased overtime costs, and resident and family dissatisfaction. Aside from the moral reasons to reduce turnover, it’s also worthwhile on a strictly monetary basis. An estimate of the per-worker cost of turnover in the general U.S. economy is about 20% of the worker’s annual compensation amount.
Much of the literature looked at turnover in aides and nurses and while the findings weren’t always consistent between studies, the following factors were associated with job dissatisfaction and workers leaving their employers.
Factors associated with turnover
For the entire article, visit:
Posted by Dr. El - August 11, 2013 - Common Nursing Home Problems and How Psychologists Can Solve Them, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Psychology Research Translated, Resident care, Stress/Crisis management
Here’s my latest article at McKnight’s Long-Term Care News:
According to researchers, 11% to 43% of LTC residents have thoughts of suicide1-3, with higher rates in larger facilities and in those with more staff turnover4. Other stressors include medical illness, the presence of a mood disorder such as depression, social isolation, and recent life stressors5 – factors that frequently affect our residents.
The MDS 3.0 requires that facilities ask residents questions regarding their risk of suicide. If a risk is identified, then effective protocols should be employed. In a June 2013 Annals of Long-Term Care review article, Challenges Associated with Managing Suicide Risk in Long-Term Care Facilities6, authors O’Riley, Nadorff, Conwell, and Edelstein offer alternatives to the procedures frequently in place in LTC settings – close observation or transfer to a psychiatric facility. These methods are often used unnecessarily, the authors note, due to staff fear of legal liability, concerns regarding their perceived competence in handling suicide risk, and the personal fear of losing a resident to suicide.
Essential for immediate risk
The authors argue that while close observation and hospitalization are essential when residents have the means, intent, and ability to end their lives at any moment (high risk situation), they’re ineffective in situations where there is a minimal or low risk of imminent death by suicide. For example, a resident may express thoughts of suicide but have no access to a means to do so or no ability to make use of an available means, making suicide very unlikely or virtually impossible. Other times a resident may have thoughts of suicide but no plans to do it any time soon. “If things get worse down the road,” they’ll sometimes say, “then I’m going to end it all.”
Ineffective for minimal risk
While a low or minimal risk should still be taken seriously, there is no evidence that it’s effective to put a resident on 15-minute checks or to send him or her to the psychiatric hospital.
For the entire article, visit:
1.Haight B K. Suicide risk in frail elderly people relocated to nursing homes. Geriatr Nurs.1995;16(3):104-107.
2. Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry. 2009;25(8):843-849.
3. Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2-3):97-116.
4. Osgood NJ. Environmental factors in suicide in long-term care facilities. Suicide Life Threat Behav. 1992;22(1):98-106.
5. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451-468.
6. O’Riley A, Nadorff MR, Conwell Y, Edelstein B. Challenges associated with managing suicide risk in long-term care facilities. Annals of Long-Term Care. 2013;21(6):28-34.
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 - February 28, 2012 - Business Strategies, Common Nursing Home Problems and How Psychologists Can Solve Them, Long-Term Living Magazine, Psychology Research Translated, Role of psychologists
Check out my article, 4 Ways Psychology Can Improve Your Bottom Line, featured on Long-Term Living Magazine’s online site:
It’s common knowledge that mental health and physical health are connected, but are you aware that applying mental health concepts to your organization could save you money? Observe the four theories below and my hypothetical long-term care scenarios. Who knows, this could be you.
1. Take a tip on workplace behavior from industrial-organizational psychology.
The nurse searched through the file drawer for a Consultation Form, flipping through one torn, faded manila folder after another. “I don’t have time for this now!” she said to no one in particular, eyeing a stack of paperwork at the nursing station. “I’ll get it on the way back from lunch.”
But the afternoon brought a new admission, and the referral never occurred. This didn’t escape the notice of the state surveyors, who cited it as a deficiency. The missed referral also resulted in a downturn in the health of the resident, who required a readmission to the hospital. Her family later filed a lawsuit for negligence.
The nurse, visiting Starbucks while searching for a new job, watched the barista prepare her coffee drink. All his equipment was in reach and clearly labeled. With a few movements, her drink was set on the counter for pick up—the same way it’s done in every Starbucks everywhere. She sighed. If only that Consultation Form had been within reach….
Borrow franchise-like organization systems to streamline functioning, with standardized tools in standardized locations, facilitating movement of staff between facilities and from unit to unit, which cuts time spent on repetitive tasks. Five minutes per staff member spent searching for a pantry key, a syringe or some clean linens quickly adds up, even if they don’t contribute to a citation, hospital readmission or lawsuit. Get organized and save yourself a bundle.
For more, read 4 Ways Psychology Psychology Can Improve Your Bottom Line…
Posted by Dr. El - November 7, 2011 - Communication, Psychology Research Translated, Resident care
I read some helpful ideas on working with residents with dementia in the most recent Psychologists in Long-Term Care newsletter (Vol. 25, Issue 2-3). Psychologist Nancy Hoffman, PsyD, discusses research findings and her interview with Lucy Andrews, RN, MS, owner of At Your Service Homecare in Santa Rosa, California. The main points to consider:
- Agitation often reflects underlying physical needs such as thirst, hunger, or pain, or an undiagnosed infection such as a Urinary Tract Infection (UTI)
- Many LTC residents suffer from sensory deprivation, boredom, and loneliness
- Behavior interventions aim to treat to underlying needs that are causing inappropriate behavior
- We should provide positive attention when residents are calm so they don’t need to become agitated in order to gain attention
- It works better to distract agitated residents rather than to reason with them
- Soothing music, toys, gentle touch, or favorite personal items can be helpful coping tools for residents with dementia
- Asking closed questions is more effective than open-ended questions that can leave the resident struggling for an answer
- Reminiscence therapy focused on pleasant and meaningful experiences can address underlying emotional needs, as can therapeutic activities such as art, exercise, and music
What are you doing in your nursing home to help residents with dementia have a meaningful, agitation-free day?
Posted by Dr. El - August 17, 2011 - Communication, Customer service, Medication issues, Psychology Research Translated, Resident care
“Come on now, Vera, honey,” the nurse said in a high-pitched, sing-song voice, “be a good girl and take this nice candy.”
Vera swung her arm and knocked the tiny cups of pills to the floor.
In their 2009 study, Elderspeak Commnunication: Impact on Dementia Care, Kristine N. Williams, RN, PhD, and her colleagues report that resistiveness to care increases nursing home costs by 30%. They examined the way nursing staff speak to residents and its impact on the level of cooperation of residents with dementia. They found that residents became significantly more resistant to care when nursing staff used elements of elderspeak such as:
- simplistic vocabulary or grammar
- shortened sentences
- slowed speech
- elevated pitch or tone
- inappropriately intimate terms of endearment
- collective pronouns (“Are we ready for our bath?”)
- tag questions (“You want to get up now, don’t you?”)
They found that residents with dementia were more cooperative when spoken to in normal adult talk, and suggest the following research-based strategies in working with residents with dementia:
- normal talk
- reorientation
- distraction
- positive feedback
- memory aids
Posted by Dr. El - May 16, 2011 - Depression/Mental illness/Substance Abuse, Psychology Research Translated
“Excuse me,” I said to the lady sitting across from the nursing station. “We’ve been saying hello for a while. I’m Dr. Barbera, the psychologist. You’re Ms. Patel, right?”
“Yes, that’s right.” She looked up at me from her wheelchair and smiled. “Nice to meet you.”
“You too. Listen, I wanted to ask you a favor. It’s perfectly okay if you say no, because not everyone is comfortable with this, but I’m trying to find a place to meet in private with a neighbor of yours and her roommate is in her room. I was wondering if I might be able to sit and chat with her for a few minutes in your room, since you’re out here. We wouldn’t touch anything, we’d just sit and talk.”
“Oh absolutely, honey!” Her face lit up and she waved her good arm in the direction of her private room. “Any time. You don’t even have to ask.”
“Really? That’s very kind of you. Sometimes it’s hard to find a quiet space.” I don’t think I’d be quite so generous if the circumstances were reversed. On the other hand, perhaps other staff members would be using my room without permission, and I’d be so pleased someone had actually asked that I’d give them carte blanche. Maybe I’d be mellower in my older years…nah, I don’t think so. I’d want to be asked every time.
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A study in the October-December 2010 Clinical Gerontologist looked at “The Effect of Helping Behavior and Physical Activity on Mood State and Depressive Symptoms of Elderly People.” The participants lived in senior housing, had mild physical and cognitive disabilities, and had an average age of 78. The researchers found that “helping behavior was positively correlated with cheerfulness and vigor” and “negatively correlated with depressive symptoms.” In other words, helping others made these seniors feel happier, more energetic, and less depressed.
Would helping others benefit our residents, who tend to be older and more impaired? Yes! We just have to create opportunities for success. In this case, I:
- picked someone who was friendly, in a good mood, and whom I thought was likely to say yes without later resentment or suspiciousness
- asked a favor that didn’t cost anything
- gave the opportunity for an “easy out” by providing the words to say no: “not everyone is comfortable with this.”
How have you helped residents help others? What was their reaction?
Posted by Dr. El - June 8, 2010 - Dementia, Psychology Research Translated, Resident care
Recent psychology research* showed reduced levels of agitation in nursing home residents with dementia, some to the point of not being considered agitated at all.
This promising study used a structured yes/no list to find the types of activities the residents found pleasurable either now or in the past, such as listening to jazz music or spending time with family members. The researchers presented participants with paired choices of desirable objects, such as different colored balloons or fabric. They also examined the times and reasons the residents appeared to be agitated, such as an apparent need to “escape” during the busy change of shift.
One resident wandered and jiggled the doorknobs of the rooms of other residents when he was left alone. Giving him his preferred objects (jazz music on a CD walkman, purple fabric, etc) significantly reduced his agitation. The resident who became agitated during busy times needed to be presented with her preferred objects (a family photo album, a felt flower, etc) before she became agitated and difficult to engage, but she also showed a dramatic improvement in behavior.
While readers might not use all the elements of this study simultaneously, there are many aspects that can be incorporated into our daily routines.
For further information:
*Based on the research study,
Applications of Preference Assessment Procedures in Depression and Agitation Management in Elders with Dementia, by Leilani Feliciano, PhD, Mary E. Steers, MA, Alexandra Elite-Marcandonatou, LCSW, Maura McLane, MA, and Patricia A. Areán, PhD,
Clinical Gerontologist, 32:239-259, 2009.
What I’ll want to look at.
Posted by Dr. El - April 13, 2010 - Communication, Psychology Research Translated, Transitions in care
There’s an interesting article about stroke rehabilitation by Tori DeAngelis in the March 2010 issue of the Monitor on Psychology. In “
New help for stroke survivors,” she writes about research showing that a “transfer package” is an essential component in maintaining the gains of inpatient rehab once the patient returns home. The transfer package includes elements such as “behavioral contracts, progress diaries, phone calls with their therapists and physical restraint of the arm outside the training setting.”
I believe some of these elements could be easily generated by the nursing home rehab staff prior to departure, such as a behavioral contract, and others could be implemented through a stroke-oriented support group following discharge. Residents would benefit if nursing home staff helped connect them to online and in person support groups prior to discharge.
There are several organizations that provide information and support for stroke survivors. I’ve listed some of them below:
