Category: Resident education/Support groups

Using technology to improve care, reduce costs

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

Using technology to improve care, reduce costs

At Maimonides Medical Center, 24 frail older adults were taught to use laptops so that they could manage their health information from home. The technology facilitated communication between patients and providers and improved the quality of life of participants.

The program was a collaboration between the Department of Geriatrics at Maimonides and the Older Adults Technology Services (OATS), who trained the elders and installed the laptops in their homes. I met with OATS founder Tom Kamber, Ph.D., to follow up on our conversation earlier this year and to hear more about how technology can play a role in reducing costs and improving the quality of care for nursing home residents.

Kamber was enthusiastic about the Maimonides program, noting that the elders, with an average age of 85, were able to use the devices to manage information, communicate with the care team and explore areas of interest.

Fun, he emphasized, is crucial to success.

The desire to connect with the grands on Facebook is a more powerful motivator to learn new skills than is tracking blood sugar levels.

For facilities, particularly those working in healthcare systems focused on providing care at the lowest cost (i.e. in the community or in skilled nursing rather than in the hospital), the ability to remain virtually connected provides a host of benefits. Patients remain within the network, medical issues can be tracked and health crises can be averted before needing expensive hospitalizations. Tailored health information can be offered effortlessly, such as sending out post-surgery information videos at a scheduled time. Patient and family satisfaction increases, as does that of care providers who can quickly answer questions via email rather than return lengthy phone calls at the end of a long workday.

From a mental health standpoint, the program is a winner. Residents and their families are typically anxious about discharge and how to manage once they’re home. A virtual system reduces anxiety because it allows for easy access to medical professionals, offers continuity of care and averts costly, stressful and frequently debilitating hospitalizations.

For the entire article, visit:

Using technology to improve care, reduce costs

Tom Kamber,PhD
Executive Director, OATS
Older Adults Technology Services

Help in your backyard

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

Help in your backyard

Amy Gotwals, the Chief of Public Policy and External Affairs at the National Association of Area Agencies on Aging, kicked off the 28th Annual Aging Conference in New York City last week, held at the New York Academy of Medicine and filled with attendees providing community-based care for elders. Her rousing keynote outlined the vast care demands of the growing wave of elders and the importance of building healthcare partnerships.

Some of Gotwals’ statistics were startling despite knowledge of the impending “silver tsunami.” Some areas of the country are projected to see an increase in Alzheimer’s diagnoses of 50% to 80% by 2025. Family caregivers between 65 and 74 years old provide more than 30 hours of care per week; for those 75 and older, it’s more than 34 hours each week.

Statistics such as these point to ways in which long-term care organizations can position themselves to be relevant far into the future by offering, for instance, memory or respite care.

Gotwals reported that local Area Agencies on Aging (AAAs), of which there are 622 across the country, are increasingly contracting with healthcare organizations to provide services such as care transitions, nutritional services, home evaluations and evidence-based self-management for chronic diseases.

In one example, San Francisco’s Institute on Aging (IOA) partnered with a nonprofit, community-based housing agency and contracted with the Health Plan of San Mateo County to provide care management services that reduced monthly spending per member by nearly 50%.

While local organizations may not be as seasoned in business promotion, they’re experts in the needs of the local community and their established presence in the neighborhood can be a boon to long-term care organizations seeking to create new partnerships.

ElderTech

After hearing Gotwals’ opening remarks, I chose a breakout session on technology and design presented by Tom Kamber, Ph.D., founder and director of Older Adults Technology Services (OATS). His is a national organization that provides technology-based senior centers and collaborates with a wide range of institutions to address the tech needs of elders.

For the entire article, visit: Help in your backyard

Interview with the Commissioner of the NYC Dept of Aging (Silo-Busting)

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

Silo-busting

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:

Silo-busting

Correcting long-term care’s image problem

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

Correcting long-term care’s image problem

Long-term care has an image problem. For a variety of reasons, we aren’t associated with good times. There are things we can do to turn this around, though, starting with the perceptions of our residents.

Most people who come to live in a long-term care facility struggle with a sense of failure. This isn’t because of anything that occurred in their lives prior to placement, but because many people view living in a nursing home as a sign of a failed life.

The most common comment I’ve heard from new long-term residents over the years is, “I never thought I’d end up in a place like this.” Some add, “Where did I go wrong?”

There are good reasons for providers to address the inherent sense of failure many residents feel in LTC placement: It can increase customer satisfaction, improve morale among residents and staff, and reduce depression among residents, thereby lessening the need for antidepressants.

The role of the psychologist

Part of my job as a psychologist is to help residents recognize that living in a long-term care facility isn’t a failure. It’s not a reflection of a life poorly lived or necessarily indicative of difficulties in their relationships with their children or other loved ones.

I do this in several ways, depending on the person and the circumstances.

I start by telling residents that I regard it largely as a societal problem. We’ve made advances in healthcare that allow people to live longer with chronic illnesses, but we haven’t yet devoted the resources needed to help people manage successfully at home and to support their caregivers. Long-term care is often the best solution under the circumstances.

Sometimes offering that view is enough to make them feel better about the situation, but other times more is needed. For example, Marie was a new resident who’d worked as an aide in a psychiatric hospital. She was distressed about living in the nursing home and had become irritable and withdrawn. I took her to visit a well-adjusted resident, Linda, who’d been a coworker and a union representative at the same psych hospital. They talked about the old days for 20 minutes and never visited together again, but Marie had a new acceptance for placement — if the nursing home was good enough for Linda the union rep, it was good enough for her too.

As a neutral party, I can provide the perspective that families and facilities can’t, pointing out, for example, how hard family members have worked to keep them out of the facility for as long as they did, how their relationships can reset once someone else is in charge of hands-on caregiving, and the benefits of living in a communal environment with easy access to medical staff and activities.

Organizational component

Aside from referring residents for psychology services, facilities can address this aspect of their image problem in several ways:

For the entire article, visit:

Correcting long-term care’s image problem

6 steps to manage post-election reactions in LTC

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

6 steps to manage post-election reactions in LTC

The 2016 presidential election has revealed a deep rift in our country, and quite possibly in our long-term care facilities as well.

While some employees and residents are pleased about the election results, it’s likely that others in your community are considerable less so.

An informal survey of my fellow geropsychologists revealed the following situations occurring in their nursing homes:

• Staff arguments regarding politics.

• Anger in residents, some of whom are misdirecting their anger.

• Residents and staff members who are dismayed, distraught or depressed regarding the election results and the direction of the country.

• Residents reporting that staff members told them they voted for Trump but asked them to keep this secret because they don’t want their Clinton-supporting coworkers to know.

• Staff who openly voted for and are discussing their Trump votes with clients as a point of pride, without recognizing the impact on their disabled clients after Trump’s mocking of a disabled person.

• Transgender residents concerned they are going to be “outed” and will be refused the medication they’ve been taking for years to maintain their health.

• Aides and other staff (housekeeping, kitchen workers) crying in staff lounges out of fear that some of their family members might be deported and that they, too, would have to return to their country of origin because they wouldn’t be able to afford to stay here on their own. As they shared their fears with their respective residents, the possibility that their beloved aide might leave them added to the anxiety the resident might have already felt about the election results.

• Staff concerned about their jobs and the future of healthcare; residents fearful they will no longer be eligible for Medicaid if the laws change.

Certainly not every facility is experiencing such reactions — a psychologist working in a VA home indicated that the veterans seemed generally positive about the prospect of President Trump.

Another psychologist reported that a Romanian Holocaust survivor was pleased with Trump’s win because he’d feared the country was moving toward a socialist model he’d unhappily lived through previously.

With our diverse population of residents and staff members, however, it’s likely there are at least some people in our communities who are experiencing distress and would benefit from reassurance and support from those in charge.

Here are 6 ways to accomplish this:

1. If you haven’t already done so, send a memo requesting that staff members refrain from discussing politics, especially in front of residents.

2. Reiterate to staff members the corporate policies regarding discrimination and express a commitment to a fair and bias-free environment.

For the entire article, visit:

6 steps to manage post-election reactions in LTC

NYTimes: Too Old for Sex? Not at This Nursing Home

Food for thought in this New York Times article:

Too Old for Sex? Not at This Nursing Home

By WINNIE HU

JULY 12, 2016

When Audrey Davison met someone special at her nursing home, she wanted to love her man.

Her nurses and aides at the Hebrew Home at Riverdale did not try to stop her. On the contrary, she was allowed to stay over in her boyfriend’s room with the door shut under the Bronx home’s stated “sexual expression policy.” One aide even made the couple a “Do Not Disturb” sign to hang outside.

“I enjoyed it and he was a very good lover,” Ms. Davison, 85, said. “That was part of how close we were: physically touching and kissing.”

Ms. Davison is among a number of older Americans who are having intimate relationships well into their 70s and 80s, helped in some cases by Viagra and more tolerant societal attitudes toward sex outside marriage. These aging lovers have challenged traditional notions of growing old and, in some cases, raised logistical and legal issues for their families, caretakers and the institutions they call home.

Nursing homes in New York and across the country have increasingly broached the issue as part of a broader shift from institutional to individualized care, according to nursing home operators and their industry groups. Many have already loosened daily regimens to give residents more choice over, say, what time to bathe or what to eat for dinner. The next step for some is to allow residents the option of having sex, and to provide support for those who do.

For the entire article, visit:

Too Old for Sex? Not at This Nursing Home

Depression – AND its treatments – are fall risks

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

Depression – AND its treatments – are fall risks

Feeling “down” takes on a wicked double-meaning for some seniors. Even conscientious providers could be unaware of it, let alone know what to do about it.

As McKnight’s Staff Writer Emily Mongan points out in “Depression treatments may increase risk of falls in SNF residents, study shows,” a psychosocial treatment for depression increased the likelihood of resident falls. I spoke with Suzanne Meeks, Ph.D., first author of the study, to discuss the problem and the results of her research.

Meeks and her colleagues studied the impact of the Behavioral Activities Intervention (BE-ACTIV) on depressed nursing home residents. They determined that the risk of falls in the treatment group was six times that of the control group, a statistically significant number.

Meeks told me all treatments for depression, including medication and behavioral interventions, increase the chance of falls. When an individual is no longer depressed, he or she has more energy to stand and walk, thus creating more opportunities to fall. If depression has immobilized them for some time, deconditioning may exacerbate the problem.

Meeks points out that more than 81% of her research subjects in both treatment and control groups were receiving antidepressants, suggesting that the behavioral intervention activated the residents more than the medication.

It’s important to treat people for depression despite the increased risk for falls because, as Meeks states, “depression is a fall risk.” Other researchers have found that the risk of falls increases when an individual has more of the following risk factors: depressive symptoms, antidepressant use, high physiological fall risk, and poorer executive function. Any two of these risk factors increase the likelihood of a fall by 55%. Participants with three or four risk factors were 155% more likely to fall — 155%!

The BE-ACTIV intervention

The BE-ACTIV model was quite successful in reducing depression, Meeks and her colleagues found, as described in an earlier article about their work. Study subjects in the 10-week treatment group were encouraged and assisted to participate in pleasant activities such as regularly scheduled group programs, in-room crafts and self-care such as haircuts. Compared to the “treatment as usual” control group, BE-ACTIV was “superior … in moving residents to full remission from depression.”

For the entire article, visit:

Depression – AND its treatments – are fall risks

Dr. El’s subversive guide to culture change

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

Dr. El’s subversive guide to culture change

We often think of culture change as a formal process initiated by company leaders that involves setting organizational goals and moving employees in big and small ways toward those goals.

But culture change also can be a grassroots effort that shifts the dynamics between residents, staff and community, one unit at a time.

Altering expectations

As a psychologist, I’ve been trained to observe the interactions of groups of people. The current dynamics of many long-term care settings involve residents who are in the passive role of “recipients of care” while the staff members are in the active role of “providers of care.” The residents are frequently isolated from each other and from the community outside the facility. They feel bored and useless, leading to depression.

Leaders in the culture change movement, the Eden Alternative calls loneliness, helplessness and boredom the “three plagues” of long-term care. Its aim is to eliminate these plagues through transforming the culture of the facility. Another culture change resource, the Pioneer Network, refers to the need for elders to have, among other things, “purposeful living.”

These organizations and others offer tried-and-true paths to alter the dynamics of your facility, but not every setting is ready for them yet. If you’re working in a culture-change-resistant organization and find yourself yearning for a way to make a difference — today — consider the possibilities here.

Grassroots culture change ideas

• Purposeful pursuits such as knitting and crocheting

As part of a therapeutic recreation program, these crafts can dramatically shift the dynamics noted above, especially when the needlework has a point. (Sorry, I couldn’t resist!) Residents who are working together to make lap blankets for new residents or hats for premature infants change from being passive recipients of care to active providers of care for others within the facility and in the larger community. Industrious and engaged residents show workers that elders can contribute to the world despite their age and physical or mental limitations. (For more on this, see the Recreation audios on my website. For more on therapeutic knitting, visit stitchlinks.com.)

• An active welcoming committee

Entering long-term care is very stressful for newcomers and an effective welcoming committee is an excellent way for long-time residents to recognize their own value and share their expertise.

For the entire article, visit:

Dr. El’s subversive guide to culture change

Dr. El’s Shrinky LTC Fantasy

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

Dr. El’s Shrinky LTC Fantasy

I hung up the phone with the managed care case reviewer. The patient in question was in her late 50s, with multiple sclerosis and other physical problems that had unexpectedly interfered with her ability to return home or even to sit comfortably in a wheelchair. Bed-bound, she was irritable with the staff and distressed about the changes in her life, and in financial circumstances that had resulted in this new insurance coverage.

“You can see her for another 30 days,” the case reviewer told me. “After that, I’ll have to send it to a second level review.”

I sat at the desk in the administration office, hyperventilating. What else would need to happen to this resident in order to get more than a month of treatment? An amputation? The death of her only child?

I took my mind to a better place:

I was in my office at the rehabilitation and care center reviewing the psychology calendar for the month:

• This week I’d shadow the east wing staff and focus on team building.

• My weekly open office hours with the staff had several appointments already filled to discuss conflicts with coworkers, finding better ways to interact with a difficult resident, and how an otherwise excellent worker could get to work on time.

• The topic for the August family group meeting was set: How to partner with the staff.

• The monthly staff training topic was planned to coordinate: How to work with families. Other trainings I had in mind were on facing challenges such as aggressive residents, understanding mental illness, dementia without medication and team management of end-of-life care, in addition to handling work/life balance, reducing stress, time management, and coping with loss.

• The data collection for my research project was progressing nicely. Copies of my book, “The Savvy Resident’s Guide,” had been distributed to the recreation therapists, who were using them to run discussion groups with the residents based on chapter topics such as “Working with the staff” and “Making the most of rehabilitation.” Residents were being measured on acquired knowledge, level of anxiety, conflicts with staff and participation in rehab.

For the entire article, visit:

Dr. El’s Shrinky LTC Fantasy

Diabetes care: Take two betta fish and call me in a week

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

Diabetes care: Take two betta fish and call me in a week

More than 25% of the US population over the age of 65 years has diabetes¹ and the numbers are far higher for those in long-term care. (Approximately one third of nursing home residents have diabetes.²)
Diabetics often need to track their blood sugar level multiple times daily and administer medication. Uncontrolled diabetes can lead to a host of medical problems, including heart disease, neuropathy, and impaired vision and falls, and can result in hospitalizations and rehospitalizations.

While guidelines suggest that elders with comorbid health problems need less intensive glucose control than younger healthier people (who are more likely to benefit from years of strict control), many residents in our communities still need to keep track of their blood sugar daily.

We can borrow an idea from a recent study of children with diabetes to help empower our elders toward better self-care in our senior communities and more successful transitions home from skilled nursing care.

In an effort to test pairing twice daily glucose checks with pet care, researcher Olga T. Gupta, MD gave betta fish and tanks to children ages 10 to 17 years. The children were asked to feed their fish and check their blood sugar at the same time, and to review their glucose logs with their parents when they cleaned the fish tank each week. The results of this pilot study showed a small but significant improvement in glucose control.

We can adapt this study to seniors and simultaneously take advantage of the health benefits of pet ownership. Caring for a pet has been linked to fewer doctor visits, improvement in activities of daily living, reduced depression and better heart health, among other rewards. ³

For the entire article, visit:

Diabetes care: Take two betta fish and call me in a week