Category: Resident/Family councils

Opening the door for ombudsmen

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

Opening the door for ombudsmen

Last week during a talk at the Pennsylvania Department of Aging 2017 Ombudsman Conference, audience members told me that they’re having difficulty speaking to administrators and other senior staff when they visit the facilities. In fact, some people reported that the administrators close their office doors when they find out the ombudsman is in the building!

While I can imagine from an administrator’s point of view that an unexpected interruption from someone complaining about problems is not exactly a welcome visit, perhaps there’s a way to shift the relationship to mutual advantage.

In fact, ombudsmen may be able to use their resources to help you solve problems within your facility.

Their role

Long-term care ombudsmen act as advocates for residents to address problems and to facilitate quality care. According to The National Long-Term Care Ombudsman Resource Center, ombudsmen promote “the development of citizen organizations, family councils and resident councils.” Ombudsmen and the councils can identify areas of potential improvement and, if properly guided, can offer solutions and assistance.

Local ombudsman’s offices have, for example, sponsored training programs on culture change and invited facility staff free of charge. Ombudsmen have arranged trips for staff to visit nearby Green Houses and provided free staff training on various resident care matters.

Pennsylvania’s Ombudsman Program is very active in promoting resident participation. Their ombudsman-trained PEERs (Pennsylvania’s Empowered Expert Residents) focus on improving the quality of life for residents. PEER efforts include initiating activities in which elders have the opportunity to assist others, such as a program making blankets for the homeless. That would make a nice mention during the prospective resident tour, don’t you think?

Ombudsman contact tips

While it’s likely that your ombudsman will be sharing resident complaints with you, it’s better to hear about these problems from them than from a state surveyor. Consider the following methods to improve your working relationship and to enhance resident care:

For the entire article, visit:

Opening the door for ombudsmen

3 surprising reasons to strengthen your resident council

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

3 surprising reasons to strengthen your resident council

When it comes to resident councils, it’s often thought that an active resident council might seem good in theory, but that it’s offset by the amount of staff time required to devote to the process and concern that something written in the meeting notes will trigger an inquiry by state surveyors.

This line of reasoning, while raising legitimate concerns that need to be managed, gives short shrift to the benefits of a strong resident council.

Resident councils can be awesome for your facility and here’s why:

1. Residents tell it like it is: You know those things your staff members see but don’t mention because they don’t want to rock the boat? Residents are far more likely to speak up than the average staff member because they’re not worried about losing their jobs.

Some of them are like my Aunt Bevy, who used to tell me, “Eleanor, I can say what I want. I’m an old lady.” Tap into this important source of info and find out what’s really working, and not, in your facility.

Residents will tell you what you need to know to make your facility shine enough to attract more residents.

2. Free labor: I hate to be so crass about it but let’s face it: While everyone else is running around your organization like lunatics because they’re short-staffed, your residents are sitting around hoping for something interesting to do. We have a pool of diverse, experienced, motivated and often bored individuals yearning to be put to good use.

Sure, they’ll need some help to overcome their physical limitations, but working together they can effectively address many seemingly intractable problems. Maybe they could raise money to contribute toward an herb garden for the patio or start a welcoming committee to reduce the isolation of new residents. Ask them what they want to do – it might be exactly what’s needed to revitalize demoralized staff members and energize your institution.

For the entire article, visit:

3 surprising reasons to strengthen your resident council

7 powerful ways to deliver family-centered care

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

7 powerful ways to deliver family-centered care

When families seek mental health treatment, it’s often because of a “problem child.” Family therapists consider this person to be the “identified patient” and recognize that the troubled individual is part of a family unit whose members all benefit from assistance.

By contrast, when a resident enters long-term care, we tend to focus solely on the needs of the resident, even though they’re almost always part of a family system that is being affected by their placement.
Oddly, we do this in spite of the fact that it’s frequently a family member who chooses the facility or community where the loved one will live.

If we consider that we’re admitting families rather than just the residents themselves, we’d recognize the need to provide family-centered care in addition to resident-centered care.

Instead, we repeatedly attend to the needs of families in a haphazard, reactive fashion. Those tense family meetings with the director of nursing and the administrator after the staff “mishandled” an interaction with a family member are more likely a lack of organizational attention to the needs of families and an absence of proper training than they are a reflection of staff error or of a “difficult” family.

Here are some ways to implement family-centered care:

1. Convey essential information to families about your facility or campus in a way that’s easy to access. If your website offers only platitudes about how you really care and then lists insurance options, you’re telling potential customers what you really care about and it isn’t them. Instead, turn your site into a 24/7 support kiosk, answering questions families commonly have about your community and helping them to be better caregivers and community members. Include, for example, information about their role in care plan meetings or how to help their loved one adjust to their new home. Add a list of resources they might want to consult. (My book, “The Savvy Resident’s Guide,” for example, is one way to offer information and soothe the frayed nerves of family members.)

2. Hold regular family meetings on topics that frequently affect them, such as caregiver stress, understanding dementia, and making the most of an off-campus pass (a great session to hold before the holiday season, hint, hint). Even though this may seem like yet another task to add to an already burdened staff, it will save time in the long run: Rather than answer the same questions individually, your staff can direct families to the meetings where questions can be discussed simultaneously and in depth.

3. Reach out to families during transitions in care, such as moving from an independent apartment to the care center in a continuing care retirement community.

For the entire article, visit:

7 powerful ways to deliver family-centered care

How to Create Nursing Home Family Councils

In Part One of the Family Council posts, Karlin Mbah of FRIA discusses the role of the Family Council in improving the nursing home environment. In today’s follow-up post, she addresses ways in which to organize families to create a Family Council. In addition to her suggestions, some of the tips I provided in my posts on Resident Council Meetings can be adapted for connecting with potentially interested families.

Overcoming Challenges to Family Council Organizing

The most frequent question asked by Family Councils is: how do we get more members?

FRIA on Nursing Home Family Councils

For Residents: Reclaiming the Resident Council

The Last Post in a Three-Part Series

In the first two posts, I outlined why most Resident Council Meetings fall short of their potential (Why Most Resident Council Meetings Are a Sham) and offered suggestions for nursing homes to improve them (How to Run Effective Resident Council Meetings). Today’s post is for the residents. Since most residents don’t have Internet access, I hope readers will print out a copy and pass it along to people they think might be interested.

Of all those involved in nursing home life, you, as residents, are in the unique position of not having to worry about being written up, fired, or cited by the State. There are no jobs to attend, no chores to be done, and no bills to be paid. You have free time and experience that can be put to good use. As my Aunt Bevy used to remark, “Eleanor, I can say what I want — I’m an old lady!” You are free in many ways from the constraints that prevent others from taking action.

I know some people worry about retaliation for speaking up. As a psychologist, I’d suggest taking a moment to consider whether that might be a “left-over” feeling from childhood experiences in your family. In a nursing home, there are many people and agencies there to protect you and your rights. The changes I’m suggesting are beneficial for the nursing home, which can advertise a strong and effective Resident Council and point to improvements as a result. The changes generally don’t cost much money, such as providing a computer, or they’re free, such as adding a week to the meal rotation or bringing in Twelve-Step Meetings like Alcoholics Anonymous, so there’s not a big burden to the administration. And, as you’ll see from my suggestions below, creating change takes teamwork, with a group of residents working together, rather than a single individual.

If you’ve ever attended a Resident Council Meeting, thought they could be better, but wasn’t sure what to do, try these steps:

Step One: Find Your Peers. Every nursing home I’ve ever worked in has many bright, capable residents wishing there were other bright, capable residents to talk to. You are not alone. Recreational activities are a great place to scout for potentially like-minded individuals. Attend groups such as the trivia or news programs, note who the more alert residents are, and ask the recreation staff to seat you next to them. On your floor, take a roll (or a stroll) down the hall, looking for neighbors who might be interested in conversation. Keep an open mind — those who might look on the outside to be quite disabled may surprise you.

Step Two: Start a Conversation. I once went to a conference on women’s networking and the speaker said that women were terrible at making contacts because they were waiting to be properly introduced. She recommended approaching someone sitting by themselves and making a comment like, “Hello. What do you think of this conference?” I’ve tried this and it works. Say something like, “What did you think of the lunch today?” Or the activity. Or how Obama is doing. Or even ask about the weather. The goal is to make a connection and see if the person is someone you can talk to.

Step Three: Work in Teams to Overcome Disability. Let’s say you and a friend have been talking about revamping the Resident Council Meetings, but you can’t move your wheelchair yourself and your friend can’t hear very well. This is a perfect opportunity for teamwork. Try sitting together in an activity or in the hallway on your floor, and approaching your peers together. The person who can get around can invite neighbors over to talk, and the person who can hear can do most of the talking. I once ran a group where a man who could see, but not write, helped a blind teacher compose a letter by setting her pen onto each new line of text.

Step Four: Discuss Your Plan. Ask the people you approach if they’ve ever been to a Resident Council Meeting, and see if they’d like to attend one with you. Let them know you’re hoping to get a large group of alert residents to attend at the same time, with the goal of working with the staff to create a strong, positive meeting. Find out whether they have any friends who might be interested, and if they’ll talk to them, or will let them know you’ll be coming by to speak with them.

Step Five: Enlist the Help of Residents on Other Floors. If each floor has a resident or two making connections, you can reach the whole nursing home. If you don’t know people in a particular area of the home, find a peer who can ambulate and have them locate an interested individual.

Step Six: Set a Target Date. To give enough time for grass-roots organizing, set a start date two or three months into the future.

Step Seven: Tell the Staff Leader. Let the staff leader of the Resident Council know that more people than usual might be expected at the target meeting. Tell the leader there’s interest in working with the staff to become more involved in the nursing home. Be diplomatic. This is the time to provide reassurance about your purpose, rather than to cause panic about a resident revolt. If it seems appropriate, ask your staff leader to read my first two blog posts on this subject.

Step Eight: Learn About Running Meetings. Spending time during the Resident Council Meetings, or even before you attend, to learn about group process will make your meetings more effective. Tap your resources, including the staff member running the meetings, residents with leadership experience, and Roberts Rules of Order. The Pennsylvania Long Term Care Ombudsman Program has a project in which they train residents to work with staff to advocate for themselves and to become members of the Resident Council.

Step Nine: Call for Elections. Elections are central to a Democratic process and can energize not only the Resident Council Meetings, but the entire nursing home. In one facility, residents campaigned for positions on the Resident Council by hanging up posters, giving talks about their ideas, and delivering flyers from room to room, glad-handing along the way. It was fun.

Step Ten: Be Creative. As residents, you have the power to call for change in a way that staff members can’t. Want to knit scarves for the homeless? Form an activity group. Want to buy some umbrellas for the patio? Have a bake sale. Want to elect, or re-elect, the next US President? Start a letter-writing campaign.

What do you want to do?

How to Run Effective Resident Council Meetings

Part Two of a Three-Part Series

(Part Three: For Residents: Reclaiming the Resident Council)

Resident Council Meetings, as I discussed in my previous post, Why Most Resident Council Meetings in Nursing Homes Are a Sham, often can be improved to become a powerful tool for change in nursing homes. Giving residents a true voice within their nursing home community creates meaning and purpose in their lives, and reduces depression and acting out behavior.

In the one nursing home I’ve observed with effective Resident Council Meetings, residents actively campaigned for positions on the Resident Council and were voted into office. Meetings were conducted by a charismatic and enthusiastic staff leader, and concerns were seriously considered and acted upon by the administration. The residents felt they had a place they could bring their ideas, and the entire nursing home was a dynamic, thriving environment.

For Resident Council Meetings like that, try these steps:

Step One: As part of the administration, decide how open you’ll be to suggestions for change from the residents. Is the nursing home willing to consider, for example, how to offer computer access to residents, if they request it, or to bring 12-Step meetings such as Alcoholics Anonymous into the facility? Or is the home more comfortable with smaller changes such as adding a week to the food rotation schedule to increase the variety of meals served? The group leader should be aware of how willing the administration is to work with the group in order to guide the meetings more effectively.

Step Two: Evaluate which person on staff would make the best group leader. A successful leader will be someone who is a strong resident advocate, has good rapport with both residents and other staff members, and either has the skill to run meetings or is willing to learn and practice.

Step Three: Recruit new group members. The staff leader and current resident attendees can, with the support of the facility, begin a community-wide campaign to “rehabilitate” the Resident Council Meetings. Speak privately with those residents who might be willing to attend improved meetings and get a commitment from them to give it a try. Ask them to talk to their friends in the home and then follow up with the friends. This process may take some time, so plan for the kick-off meeting to be a few months down the road, rather than the following month. Bring in many new, alert people at the same time, so the group is strong enough to encompass confused, off-topic, or quirky members.

Step Four: Educate the group members about how the meetings work, what types of issues can be addressed, and where other concerns can be brought. Spending group time discussing the process of the group is a worthwhile investment. For practical, rather than clinical, information on running groups, check out Robert’s Rules of Order.

Step Five: As group leader, utilize group therapy techniques, such as creating an emotionally safe environment for discussion and ensuring that as many members as possible get a chance to express their opinions. Care should be taken to avoid a few members dominating the group. Leaders might consider reading about group process if they don’t feel comfortable with their skills. My group therapy “bible” is The Theory and Practice of Group Psychotherapy, by Irvin D. Yalom, which, while geared toward psychotherapy, offers many techniques which would enhance Resident Council Meetings and many other group activities. If anyone reading this has other resources, please add them in the comments section.

Step Six: Like all well-run meetings, issues raised by the group members should be addressed and followed up either within the current meeting or in subsequent gatherings, with a recording secretary so that items aren’t lost.* If suggestions made by the group aren’t able to be realized, give reasonable explanations so members understand their requests were seriously considered. Use the wisdom of the group to find ways to make things happen while working within the constraints and realities of the nursing home system.

Effective Resident Council Meetings are within the grasp of all nursing homes. I welcome further suggestions about how to make the meetings work, and I’d especially like to hear from those who currently participate in successful meetings. What makes them successful? How did you go about the process of transformation? What types of issues are you now addressing in your groups?

*Here’s a question for readers: If surveyors read the meeting minutes, then nursing homes will be reluctant to list all the issues raised by the residents out of concern they will be pointing surveyors to potential deficiencies. Is it enough for facilities to show they’re in the process of addressing concerns, or that they have good reasons for not fulfilling certain resident requests? For those with effective Resident Council Meetings, how do you handle this? Are there any surveyors out there who can shed some light on this?

Part Three: For Residents: Reclaiming the Resident Council

Why Most Resident Council Meetings in Nursing Homes Are a Sham

The First of a Three-Part Series

(Part Two: How to Run Effective Resident Council Meetings; Part Three: For Residents: Reclaiming the Resident Council)

*If you don’t know what a Resident Council Meeting is, see the Prequel, posted earlier today.

I must confess, the only time I’ve actually been to a Resident Council Meeting was when I was invited to speak about psychological services. Aside from invitees, the only people allowed at the meetings are the residents and the staff person in charge of running the group. My information about them comes from the residents themselves and sometimes from the staff leader, who is often the Recreation or Social Work Director. With one notable exception, the consensus on Resident Council Meetings is that they are a sham.

Why are the meetings a sham? There are two answers to that question. The first has to do with group dynamics. Often, the residents attending the meetings are the “regulars” who attend all activities. They tend to be the most accommodating residents and the ones who are generally satisfied with nursing home life, so their observations about the nursing home are less often geared toward change. Members of the group may have varying levels of dementia, and varying levels of familiarity with organizational dynamics. A well-attended Resident Council Meeting can absorb confused or off-topic residents, but frequently there is not enough of a critical mass to do so. Astute, alert new residents attending the meetings for the first few times encounter an ineffective group and quickly decide not to continue. Contributing to the ineffectiveness of the meetings is the fact that the staff person assigned to run the meetings generally doesn’t have true support from the administration, so the complaints and suggestions of the group are not met with a resolution. This creates a disheartened leader and a demoralized, depressed, and sometimes acting-out resident population.

Why are the meetings a sham? The second answer is that the administration doesn’t realize and/or know how to utilize the potential power and value of the Resident Council Meetings. The residents are the eyes and ears of the nursing home. They see things the administration can’t possibly know about, but should. The residents have years of experience in jobs, families, and society. They know a thing or two about how things work and how they can be fixed. The current cohort of residents is, generally speaking, a congenial bunch, not accustomed to bucking the system. The upcoming cohort of residents, the first of the Baby Boomers, is used to promoting change, and they will. Look around facilities now, and the early arrivers can be seen, angry, demanding, and knocking on the doors of the administrators. They can see things aren’t as they should be, or could be. The administration can harness their experience and fervor for change by offering them an avenue to discuss concerns and to be part of the treatment team, not just in their own care, but in the overall quality of life offered at the facility. Empowering the residents leads to happier, more satisfied residents, families, and staff, and to a better nursing home.

Part Two: How to Run Effective Resident Council Meetings

Resident Council Meetings: What are they?

Prequel to a Three-Part Series

For those of you who don’t know what a Resident Council Meeting is, I offer this brief explanation. If you have additional information about the meetings, please add it to the comments section.

Each floor/unit/neighborhood of the nursing home has a resident who acts as the representative to whom others on the floor can bring their concerns. The representatives gather on a monthly basis to address the issues, and all residents of the facility are welcome. The meeting is conducted by a staff leader, often the Therapeutic Recreation or Social Work Director, and it’s closed to other staff members except by invitation. Problems addressed can range from the temperature of the water in the shower room, to issues around recreational programming, to staffing concerns. The goal is to give the residents a voice in the nursing home community.

Part One: Why Most Resident Council Meetings in Nursing Homes are a Sham

Part Two: How to Run Effective Resident Council Meetings

Part Three: For Residents: Reclaiming the Resident Council