Category: Resident education/Support groups
Posted by Dr. El - September 22, 2011 - Communication, Customer service, Resident care, Resident education/Support groups
“Tired CNA” posted a comment on my blog, saying she wished there were something that could be done about alert residents who ring their call bells 30 times a day. And there is. Here are some suggestions:
- Residents who ring their call bells frequently are often anxious, needing what seems like constant reassurance. Quell their anxiety by visiting with them at the beginning of each shift, telling them who you are and when you’ll be by again next. Check in on them when it’s relatively convenient for you so they don’t have to call and interrupt you when it isn’t.
- Answering the call bell right away reduces resident anxiety and decreases the frequency of calling. Ring, answer, ring, answer, even if it’s to say that help will be there in ten minutes. Then show up in ten minutes.
- I used to wait tables and there’d always be that group of diners who would wait until I’d returned from one request to give me a second, and then a third when I returned from the second. I learned to ask “Is there anything else you need right now?” Try this.
- I provide “Call Bell Education” on the theory that the residents, most of whom have never been in a nursing home before, have no idea how much bell-ringing is considered “too frequent” by the staff (and some of them don’t use it when they should). It’s better to do this in a calm, informative manner when the residents first arrive rather than waiting until everybody is aggravated. As a CNA you could give them a ballpark figure of what’s considered reasonable during a shift, while assuring them that you’re there to meet their need for care. Part of the education process is helping them to identify when it’s important to let the staff know they require assistance (for example, they need oxygen or to be changed) and when it might be better to “group” requests (for example, if they want the window closed and the TV station switched, and meds are coming in ten minutes, they might as well wait for the nurse).
- If a resident continues to need a lot of assistance, consider moving them to a room closer to the nursing station, where staff members are more likely to pass by easily rather than having to walk all the way down the hall.
- Consider a referral to the psychologist. My residents know they will see me each week and can ask me for assistance with a wide variety of matters. This significantly reduces their anxiety. This week someone said to me, “I don’t know what I’d do without you. I really feel like you’re listening to me, taking my concerns seriously, and getting things done to fix them.” And I am. Include the psychologist on your team, and any other staff and family members you can enlist to improve the situation.
Posted by Dr. El - December 15, 2010 - Boomers, Depression/Mental illness/Substance Abuse, Resident education/Support groups, Technology, Younger residents
The saying in 12-Step programs such as Alcoholics Anonymous (AA) is that alcoholism is a three-fold disease: physical, mental, and spiritual. The only-half-kidding joke is that alcoholism is a three-fold disease: Thanksgiving, Christmas, and New Year’s. The holidays can be a particularly stressful time for nursing home residents as their celebrations have often changed significantly from those in the past. The loss of family members, the inability to get around independently, and the lack of opportunity and funds to shop for gifts can take their toll on residents who may have had trouble with the holidays even before they entered the nursing home.
In case you haven’t been persuaded by my previous arguments for holding AA meetings in nursing homes (or in case you’ve been persuaded but your administration hasn’t) there are also telephone meetings available to residents for the cost of a phone call. Callers can listen in, or share their story if they wish, in an anonymous environment. Below are links to the telephone meeting lists of several 12-Step programs.
Alcoholics Anonymous
Al-Anon (for family and friends of alcoholics)
Overeaters Anonymous
Nicotine Anonymous
Posted by Dr. El - June 30, 2010 - Communication, End of life, Resident education/Support groups
The Health Insurance Portability and Accountability Act (HIPAA) ensures that the personal information of our nursing home residents stays personal, but sometimes it’s taken too far. Well-meaning staff members, not wanting to violate HIPAA, are unsure whether or not to share news of a resident’s death with their friends in the nursing home, so they err on the side of caution. This leaves other residents wondering what happened, and, if they suspect a death occurred, they’re left with the unhappy knowledge that their own death could also pass unacknowledged.
Some members of Psychologists in Long Term Care recently discussed this and the consensus was that since someone’s death is a matter of public record, letting other residents know about it is not in violation of HIPAA. To follow up on this, I contacted the New York State Department of Health Nursing Home Hotline (888-201-4563) and they concurred: it’s okay to tell others that the person died, but not to give medical details.
Similarly, it’s within HIPAA guidelines to let a roommate know, for example, that their friend in the hospital should be returning to the nursing home soon, but not to discuss details of their health condition without the permission of the hospitalized resident or their family.
Part of creating more homelike nursing facilities is honoring the bonds created between residents. It’s important to share news, within the limits of HIPAA, of how friends and neighbors are faring, and it’s especially important to acknowledge the lives and deaths of those in our care.
Posted by Dr. El - May 17, 2010 - Boomers, Resident education/Support groups, Technology, Tips for gifts, visits
I recently saw a video showing a 99-year old woman reading and composing poetry on her new iPad, which brightened and enlarged the typeface enough that she could read again despite limited vision due to glaucoma. It got me thinking about apps our elders could use in the nursing home and upon discharge. Please add your ElderApp suggestions in the comments section.
- Kindle, for a treasure trove of books
- A Diabetes app (there are many), to track blood sugar and help plan meals upon discharge
- A Medication Tracker
- Pandora, for instant access to favorite music (for inspiration in Rehab, or to drown out the buzzers and overhead pages)
- Games, to keep the mind sharp and to play while waiting for all the things residents have to wait for
- A Voice Memo Recorder, to easily capture thoughts before they escape
- The 12 Step Companion, which includes the Alcoholics Anonymous Big Book and a meeting locator, to keep close to your program until all nursing home host AA meetings (for more on this, see Why Every Nursing Home Should Host AA Meetings)
Posted by Dr. El - October 20, 2009 - Boomers, Business Strategies, Communication, Customer service, Resident care, Resident education/Support groups, Technology
A recent study by the Phoenix Center looked at adults 55 and over, but not employed or in nursing homes, and found that Internet use decreased their level of depression by 20%. I’m not at all surprised by this, and I believe a similar decrease in depression levels would be observed in nursing home residents as well.
While residents are living together rather than isolated in their own homes, and therefore have more opportunities for socialization, there are still many people who don’t partake of the recreational activities offered for their enjoyment. Some residents never leave their rooms due to physical or psychological barriers, and some don’t like crowds. Other residents feel uncomfortable socializing because of the physical changes of illness, wish to pursue activities other than those available in the nursing home, or miss connecting with those outside the home. The Internet offers the opportunity for nursing home residents to transcend their physical illnesses, leave the boundaries of the facility, and connect with the world.
In an earlier post, I shared ways in which I use the Internet for therapeutic purposes, and I believe they’re worth repeating here:
1. Psychoeducation Regarding Illness:
Often residents are given diagnoses, but little information about them, leaving them confused or upset, which can result in noncompliance with medication and care. I search for a resident’s illness with them on the computer, and discuss the symptoms and treatment, which enhances cooperation with medical staff. Some residents are more receptive to information coming from a “neutral” source than from their own caregivers, and most residents appreciate a print-out of information they can refer to over time. Posting a list of illnesses and the Web addresses of important sites near the computer would facilitate this process (eg; The American Diabetes Association, the Amputee Coalition of America, etc).
2. Support Regarding Illness:
Most of the residents deal with their illnesses in isolation, when there are many avenues of support available to them on the Internet. Having the opportunity to “discuss” their concerns anonymously with peers can often be more effective than trying to generate a conversation between two or more residents at the nursing home, due to discomfort at revealing personal information. At strokenetwork.org, for example, stroke survivors can “meet” other survivors on-line and get information and emotional support, as can their caregivers. To find the appropriate support groups, enter the name of a particular illness and “support” into the browser window and look around from there. Another option: Look for a Yahoo group about the illness and sign up the resident after establishing a free email account through resources such as Yahoo or Google.
3. Connection with Family and Friends:
Why should residents have to limit themselves to family visits or phone calls when most of the rest of the country is communicating via email, Twitter, or a social networking site such as Facebook or MySpace? I’ve established email accounts for octogenarians to help them keep up with the grands, and a free Facebook page would accomplish the same thing with a bit more zing.
4. Reminiscence:
I once worked with a terminally ill 88-year old man who’d left Barbados in his thirties and had never realized his dream of seeing his country again. Imagine his expression as I entered “Barbados” into Google Images and up popped photos of the country he thought he’d never be able to see again. This intervention generated a flood of memories and a profound sense of relief and closure. Reminiscence could also be conducted in a group format, with connection to a large screen, so that residents should share with others information about their home countries or hometowns.
5. People Search:
One of my favorite things to do with residents on-line is to find their long-lost friends and relatives. For example, through the Internet white pages, I helped one extremely lonely and depressed resident find a friend with whom he lost touch sixty years ago. They are now enjoying an exchange of letters and photos, and my patient has something else upon which to focus besides his poor health and lack of visitors.
6. Fun & Miscellany:
Acting under the theory that doing something enjoyable will begin the upward spiral out of depression, I’ve occasionally brought a resident to the computer to listen to their kind of music (try shoutcast.com), to check out the latest fashions, or to see photos of famous movie stars (Google Images). Once a 97-year old Panamanian resident told me she’d felt unattractive all her life because she thought her lips were too big. “Oh, no,” I told her, “your lips are considered beautiful and the height of fashion.” She believed me after I clicked on Google Image photos of Angelina Jolie.
Do you have more therapeutic uses of the Internet? Please add them to the Comments section.
Posted by Dr. El - August 18, 2009 - Depression/Mental illness/Substance Abuse, Resident education/Support groups
Alcoholism is not just a problem of youth. According to an 8/17/09 report in the American Journal of Psychiatry, 14% of men and 3% of women age 65 and older admitted to binge drinking (5 drinks or more on one occasion within the last month). I frequently see residents with lifelong addiction problems in the nursing home, and often their sobriety began with their admission to the facility. Early sobriety, particularly when dictated by outside forces, can be very difficult, leaving residents vulnerable to the underlying depression they were self-medicating with alcohol. Many residents with long-term sobriety but no AA recovery have behavior problems that could be successfully addressed in the meetings, as do mentally ill residents with a dual diagnosis of substance abuse.
Hospitals, churches, and community centers around the country regularly host AA and other 12 Step meetings, but I’ve yet to hear of a nursing home that does. I think they all should, for the following reasons:
- AA meetings establish a positive peer group for potentially difficult residents.
- Residents take responsibility for their own behavior, reducing the need for staff monitoring.
- Residents have an additional source of support from the group and from each other.
- Residents have a way to connect with the outside world, reducing their sense of confinement.
- For residents expected to be discharged, a connection to AA meetings and community members in the nursing home facilitates their transition back to the community.
- Staff members have a resource to which they can direct their residents in need.
- Staff members, some of whom may suffer from alcoholism themselves or in their families, become aware of a source of support, even if they don’t attend meetings in the facility.
- The nursing home increases its visibility and potential referral base in the community.
- There is no charge for AA meetings; in fact, the meetings often pay a small rent for the meeting space.
- AA meetings are easy to establish. Just contact AA, let them know you have a meeting space to offer, and they will do the rest.
Posted by Dr. El - June 4, 2009 - Resident care, Resident education/Support groups
I asked some experienced nursing home residents if they had any advice they’d like to share with residents who were just arriving, in order to make their stay more pleasant. I was surprised by the diversity of their responses and the speed with which they gave them. Please add your suggestions to the comments section.
Find at least one person you trust to confide in
Attend recreational activities
Get a newspaper subscription and crossword puzzle books
Read the bible and pray a lot
Know your medication so you can double check what they’re giving you
Be friendly and polite
Make your room your own by decorating
Know that you’re not alone in thinking “I never thought I’d be in a place like this”
Read a lot of books
Accept where you are and remember, there are worse places you could be
Be as independent as possible
Don’t be afraid to try new recreational activities, because you might find something you really enjoy
Try to bring activities from your home life into your new life in the nursing home. For example, if you used to garden, bring plants into your room. If you used to do needlework, continue to do it.
Posted by Dr. El - May 28, 2009 - Resident education/Support groups, Something Good About Nursing Homes
“I told my daughter not to be so gloomy-doomy all the time. I’ll be all right.” — A recently-placed 89-year old woman
I laugh with the residents all the time. We laugh at their jokes and we laugh at the crazy things that happen in life and in a nursing home. Once I was working with Mary, a genteel woman who’d had a series of roommates, each with their own peculiarities. Her first roommate was a 100-year old lady with the mouth of a truck driver, then the promised quiet new roommate had a husband in attendance almost 24/7 whether or not his wife was in the room, and finally she had a lady who couldn’t hear a thing. Over the months, her tales took on a Candide-like quality. When she told me she’d been roused from sleep when her latest roommate had rolled her wheelchair toward the bathroom close to the foot of Mary’s bed, put her hand to the new hearing aid in her ear, and said loudly, “Testing, testing, 1, 2, 3, 4,” I burst out laughing, and Mary did too. “This would be great material for a stand-up comic,” I told her, “only it would have to be a nursing home resident, preferably in a wheelchair, so it would be a sit-down comic.” I’m still waiting for a resident with enough chutzpah to make the rounds of the nursing home entertainment circuit.
There are lots of opportunities for fun in a nursing home, from the formal activities scheduled by the recreation department, to sharing a laugh with some friends on the floor, to going out on a day pass with family.
Once one of my coworkers was a therapeutic recreation director who was in a wheelchair himself. He took the residents watertubing. Yes, watertubing. The adventurers transferred from their wheelchairs to a seat on top of a large rubber tube. One end of a rope was attached to the tube, and the other end was attached to a boat, which took off with the floating resident flying along behind it. I have never seen a more revved up group of residents returning from a trip.
Not too long ago, I learned of a company, Draisin, that makes tandem bicycles for people in wheelchairs. I showed the photo of one of the bikes to some residents, and almost half of my small sample (N=11) said they’d be willing to go for a ride if they had the opportunity. Not quite watertubing, but still a lot of fun.
WalkerWonder is a company that makes decorative walker bags and accessories for people to enliven their medical walkers. [Update: WalkerWonder appears to have closed, but check out HDSMedallion‘s beautiful carry-all bags for mobility devices.]
A man in the building where I live exchanged his dull wheelchair wheels for ones that flash colorful lights as they spin. I think it will take only one person in each nursing home for that to catch on.
I’ll end this post with a true nursing home joke: One day after a psychotherapy session, I was trying to wheel one of my patients to her table in the dining room, but another resident, a gentleman in his 90s, was in the way.
“Excuse me,” I said to him, but realizing he couldn’t hear me, I leaned forward and asked in a very loud voice, “Which Ear Is Your Good Ear, Mr. Schwartz?”
He looked at me and said enthusiastically, “Any year I’m alive!”
Posted by Dr. El - April 13, 2009 - Business Strategies, Customer service, Resident education/Support groups, Something Good About Nursing Homes, Technology
At the Center for Nursing and Rehabilitation (CNR) in Brooklyn, New York, Recreation Director Brenda Torres, has established computer stations with Internet connection in all the “neighborhoods,” as they call their units, and has several groups currently being run by the residents themselves. I believe both of these steps are essential for the emotional health of residents, but as they are all too rare in nursing homes, I asked Brenda if she’d share with us how she managed these accomplishments. She graciously agreed, and what follows is my interview with one of the most talented, dynamic, and creative people in the field. You can visit her at technohealer.com for more information about her work.
How long have you been a recreation therapist and why did you choose to work in nursing homes? I’ve been in Recreation over 19 years. I was a psych major and had been gifted in the arts and when I started working in adult day care, I was able to use my art and my psych background, as well as an exercise component. I work with both young and old folks through the intergenerational program at CNR. I don’t focus on age, I focus on abilities.
You’re a big advocate of the use of technology with the residents. What do you see as the benefits and how did you go about getting the administrative support and financial backing for this? Walking through the nursing home halls, I noticed there were a lot of bed-bound residents, and I wished there was a way to get the activities to the residents because they couldn’t get out to them. I had a vision of having a mobile computer unit, so I started Googling it. At the time, they only had a unit that was used for hospital paperwork, so I started to research adaptive devices. At about this time, you and I started talking about a particular young resident and how he would benefit from Internet access. Using your testimony about the need, and other paperwork such as photos of the computer unit and information about the cost, I put out a request for funding. Two and a half years later, the funding came through the CNR community advisory board, which had collected the money through community fundraisers. Now CNR has a mobile unit, which we call R2D2, that brings games and activities as well as Internet access to bed-bound residents, in addition to multiple computer stations throughout the nursing home.
Some of your residents run their own groups. Do you think this has been beneficial for the residents and group leaders? Currently I have a poetry group, a bible group, a collage art group, and a crochet group run by the residents. The President of the Resident Council is in charge of games. Another resident is in charge of R2D2’s “wife” Techno, whom we were able to purchase through additional funding, and other residents come to her to gain use of it. One of the main benefits of having the residents run their own groups is empowerment. It gives them self-worth, a sense of being part of a community, and it gives them purpose. Being empowered prolongs their life and makes them feel needed. Traditionally in a nursing home, people tend to feel like they don’t have a life, that they’re just there until the end, but it’s not true. These are individuals who are survivors, they planted the soil for the new leaders. If it wasn’t for them, we wouldn’t have Obama. They are the blueprints to our society.
How would you suggest a resident who wanted to start a group within their facility go about doing this? [I thought the residents were coming to Brenda to ask if they could run a group, but I learned it was Brenda who was approaching and encouraging the residents.] Before you start a group, look at the needs and skills of the residents and assess the skills of the potential leader. The challenge is how to address a possible leader. I share with them the notion that leisure should not be work, it should be a fulfillment of purpose. It can take time to nurture a potential leader. Display their gifts, show them they still have the ability, invite them to teach others. Help them to visually see the group. We have to take away the barriers, using visual guided imagery. It can be a process taking up to a year, highlighting abilities, and providing reassurance.
What kind of practical support do you offer them in terms of set-up, supplies, etc? We do help with supplies and bringing the residents to the group. A staff member stays with the group as needed, puts up fliers for recruitment, reminders of the group, etc. It can start out at 100% support and eventually over time it moves to 30% support.
Are there any changes you would like to see in long term care in general, from your perspective as a recreation therapist? Yes, many. There has to be change in all long term, because life is changing. The changes have to match our lives, like technology and aging baby boomers. We have to make society paint a picture of long term care in the future, because then it will be more acceptable to be in a nursing home and they will be ready for people like you and me. All the work I am doing is part of building my own home for the future.
Posted by Dr. El - March 24, 2009 - Anecdotes, Resident care, Resident education/Support groups
I was walking home from my writer’s group the other day, talking with a group member who’s a former emergency medical technician.
“It’s funny how the elderly get infantilized so much. I wonder why that is,” she commented.
“I think we do it to them. I didn’t realize it for a few years into working in nursing homes, but if you think about it, they don’t have to make their beds, they don’t have to cook meals, or go grocery shopping, or worry about paying their rent, or cleaning their homes. What do we leave them with? Nothing.”
“So, you think we should let them be more involved in those things?”
“No. I think they should be writing their congresspeople, knitting blankets for impoverished babies, raising money for breast cancer research, and even participating in the reelection of right-wing Republican candidates if that’s what they want to do, as long as someone else is doing the laundry.”
