Category: Stress/Crisis management

Getting ‘hygge’ with it, at the holidays and year-round

Getting ‘hygge’ with it, at the holidays and year-round

I know, I know, that’s not how the word is pronounced. But as soon as I read about the Danish concept of coziness, I got that darn Will Smith song (“Gettin Jiggy With It”) in my head and I can’t get it out.

Hygge (actually pronounced “hyoo-guh”) refers to the creation of a comforting, convivial environment. Think hot cocoa, warm blankets and crackling fireplaces, with loved ones.

It sounds so charming that I resolved to apply hygge to an upcoming vacation. I decided to mix local sightseeing with a few days saved for the pleasures of cooking, reading a book and watching movies with an occasional bowl of popcorn under a comforter with my family. And, of course, I considered how the idea could be applied to long-term care facilities.

Nursing homes, which could generally do with an increased focus on “home” over “nursing,” have many reasons and opportunities to add some hygge.

First and foremost is the chance to “flip the script” about being in a confined environment. Residents who have infrequent opportunities to get outside under the best of circumstances and even fewer chances during inclement weather, often feel depressed or resentful regarding their confinement. Practicing hygge offers a mental shift from a perception of restriction to one of comfort.

Holiday hygge

During the holidays, residents may observe peers going out for day passes and family members arriving for visits. For those without passes or visitors, using hygge concepts can ease their emotional pain in a kind, simple manner that emphasizes their belonging to a group.

While holiday activities such as seasonal movies and Christmas caroling are wonderful, a hygge approach would suggest adding periods of quieter comforts such as lap blankets, a fireplace video and a story read aloud. Some people might enjoy crocheting or drawing during this communal activity. If the kitchen sent up a batch of warm cookies, so much the better.

Staff hygge

Residents may not be the only ones less-than-thrilled about being at the facility on a holiday. While many staff members consider their LTC jobs a calling and are gracious about being of service to elders on Christmas or New Year’s Eve, others may be disgruntled with the holiday shift and may “leak” their emotions to their charges.

A hygge approach can soften staff resentment.

For the entire article, visit:

Getting ‘hygge’ with it, at the holidays and year-round

What if nursing homes had a ‘well-being budget’?

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

What if nursing homes had a ‘well-being budget’?

Last week, New Zealand passed the country’s first “well-being budget,” with billions in funding directed towards mental health, suicide prevention, addiction treatment and combatting poverty. This development had me considering what a “well-being budget” would look like in long-term care facilities.

Reducing financial hardship

Combating poverty in nursing homes would have to address adequately funding treatments so that facilities are bringing in enough money to cover the expense of services as well as to manage upkeep and comply with regulations. It’s difficult for a business to engender well-being when under the threat of insolvency.

At the same time, any effort to reduce poverty in long-term care would certainly require living wages and reasonable benefits for workers at all levels. That would make it more likely that facilities could attract and retain capable staff.

A well-being budget would also need to increase the Personal Needs Allowance (PNA) of residents to account for inflation. While a few states have provided modest increases in resident’s monthly allowances over the years — with Florida the trailblazer at $130 – most have remained the same for decades¹. In my state, New York, for example, the PNA was set at $50 in 1980. Adjusting for inflation would make New York’s PNA $155 in 2019, a more reasonable amount considering that residents are responsible for paying for their own clothes, haircuts, telephones and other personal items and have become impoverished in order to qualify for Medicaid. Sadly, however, it is still $50.

Worker well-being

To improve the mental health of those who live in nursing homes, my well-being initiative would first tend to the mental health of those who work in long-term care. If employees aren’t emotionally well-balanced, it’s much more difficult for their charges to be.

For the entire article, visit:

What if nursing homes had a ‘well-being budget’?

Self-care, team-care and an empty well

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

Self-care, team-care and an empty well

“How’s it going?” I asked Larry, one of the maintenance workers I chatted with from time to time. He didn’t have his usual smile and his wrist was in a brace from a repetitive stress injury.

“I’m tired,” he replied. “I’m real tired. I was supposed to be off today but Jules called in sick and we were already short one guy. Tomorrow will make seven days of work in a row.”

“You’ve got to take care of yourself,” I encouraged him.

“I know,” he said, “but they needed me.”

A few months after my encounter with Larry, I noticed that an excellent nurse had “lost her shine.” I stopped by her med cart to see why.

“My sister’s very sick,” Shirley told me, becoming tearful. “She lives in Haiti and I’m worried about her.”

“Oh no! Do you have any vacation time? Can you go see her?”

“I do, but I don’t know if the director of nursing will sign off on it. I guess I could try.”

I followed up with her the next week as if she’d been one of my patients.

“No,” Shirley said as I approached the nursing station, “I didn’t put in for the vacation time.”

She’d lost weight since the prior week and her expression had become grim. I regularly observed her completing paperwork and tending to the residents an hour after her shift was over.

“Let’s do it now,” I insisted. I stood at the desk while Shirley filled in the form requesting time off the following month. That weekend she had a heart attack.

I’ve met many Larrys and Shirleys over the years. If asked, they’ll work the extra shift because they’re the type of people who don’t like to say no. While it’s tempting for organizations to meet staffing needs with someone who always says yes, good managers recognize that such requests can push employees to the brink. Encouraging employees to engage in ongoing self-care and to recognize when they need to “refill the well” can reduce their chances of burnout and illness, leading to better workers, improved care and fewer missed shifts overall.

Self-care for healthcare workers is, according to one research paper, “a proactive and holistic approach to promoting personal health and well-being to support professional care of others.” Team-care — a concept I learned while researching this article — refers to coworkers supporting and encouraging the self-care efforts of their teammates.

When I asked after the well-being of Larry and Shirley, I was engaging in team-care. While I often informally check in with my coworkers, team-care is much more effective if it’s a consistent, leader-supported element of workplace culture.

There are many ways in which individuals can engage in self-care and be supported by facilities and coworkers in their efforts.

Self-care, team-care and an empty well

How to support depressed workers and reduce absenteeism

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

How to support depressed workers and reduce absenteeism

As a consulting psychologist, my official job is to provide psychological services to the residents of the nursing homes in which I work. Occasionally, though, I’m asked by a department head to informally assist a staff member in distress and, more frequently, a teammate comes to me for a referral for herself or a family member.

And then there are the times that I reach out to a coworker whom I see needs a hug, an acknowledgement or a few words of encouragement.

Based on a study reported in BMJ Open last month, it turns out that I’m not just being of service to my coworkers. I’m also helping to keep them on the job.

The study examined the way managers handle feelings of depression in their team members across 15 different countries. They looked at whether their reactions influenced absenteeism or presenteeism, which refers to attending work but with reduced productivity.

The researchers found that managers who acknowledged depression and actively offered help fostered greater presenteeism and less absenteeism.

The authors recommended that, given the prevalence and substantial costs of depression in the workplace1, attention be paid to developing policies and training that allow managers to better support employees who are experiencing depression. Training managers to recognize and attend to depressed workers makes it more likely that they’ll intervene before symptoms and productivity costs worsen.

Of particular interest given long-term care’s typical workforce is that the results of the study suggest that, “female individuals with low education and those in the middle age group (25–44) might need more support in the workplace.”

Interventions

Clearly, it’s not a good idea for managers to spontaneously hug all the coworkers they think might be depressed. (For the record, I approach only people I know relatively well and I always ask the person if they’d like a hug before hugging!)

Instead, consider these other ideas:

• At a minimum, add a section on recognizing employee depression to in-service trainings already in place for addressing depression in residents. Distribute an up-to-date list of local mental health providers at the end of the program for attendees who might want to access services on their own.

For the entire article, visit:

How to support depressed workers and reduce absenteeism

9 reasons why it’s better to congregate than disperse short-term rehab residents

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

9 reasons why it’s better to congregate than disperse short-term rehab residents

In most of my long-term care career, I’ve witnessed short-term rehabilitation (STR) residents housed together, but occasionally facilities have scattered them throughout the building. I don’t know the reasoning behind dispersing residents, but from my perspective, dedicated rehab units work better.

My thinking is based on the fact that people entering rehab are almost invariably in the middle of a life crisis (see The stress of nursing home admission)  – as are their family members – and that staff members are often stretched to the limits of their capacity to manage their responsibilities.

Keeping rehab residents together is better because:

1. STR residents lodged together find a group of peers in the same situation as themselves, which can be enormously reassuring in anxiety-provoking times.

2. Co-housing makes it more likely that STR residents will develop stress-reducing friendships and find a team of peers to support their progress in rehab. The ability to form friendships with peers is one of the major strengths and selling points of long-term care.

3. Being around LTC residents can be alarming for STR residents, who usually have fears that they’ll “never get out.” Observing others being discharged upon completing rehab can ease their apprehension.

4. STR residents, who are frequently younger and more cognitively intact, can feel isolated on LTC floors that have fewer people with whom to engage socially, and none in their particular situation. This increases their depression and anxiety.

5. Family members can benefit greatly from talking with other families in similar situations. They’re much more likely to meet other families “in the trenches” on an STR unit. Yes, there are families on the long-term floors, but they’re in marathon mode while STR families are sprinting through a crisis that has reordered their lives.

For the entire article, visit:

9 reasons why it’s better to congregate than disperse short-term rehab residents

Dr. El’s Theory of Angry Activities

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

Dr. El’s Theory of Angry Activities

“Scream as loud as you can,” I encouraged my companions before we plunged down the waterslide in our rubber raft at the water park on Independence Day. “There aren’t enough opportunities for yelling in everyday life. Let’s make the most of it while it’s socially acceptable.” The shouts of our foursome pierced the air as we flew down the steep slopes and then dissolved into laughter as we splashed to a halt at the bottom of the ride. “That was great!” we all agreed.

Our residents tend to be stressed out. At a minimum, they’ve suffered debilitating and often sudden physical losses, they’re living 24/7 in a communal environment and they have to rely for assistance on helpers they’re sharing with other people. Add to this unfamiliar food, financial stressors, physical separation from their homes and family and worries about the future.

Is there any one of us who wouldn’t be angry about something in that situation? Yet we as organizations strive to have units filled with residents without “behaviors.”

I’m not suggesting nightly “primal scream” sessions, but we could add into the rotation some activities where residents get to be “bad,” or at least aren’t expected to be so darn good all the time.

For example, I used to counsel a 100-year old woman, Claire, whose active life had slowed to a crawl due to age, arthritis and other maladies. She often let out her frustrations by making sarcastic comments to her aides and other residents, which led to conflicts.

To help her blow off steam, as we talked, we slowly set up dominoes in a circuitous row on a table. When the domino chain was completed, I’d give her the signal and she’d gently push the first domino over with one arthritic finger and watch with glee as the whole chain loudly self-destructed. On some days, Claire was particularly “bad” and didn’t wait for the signal. This activity allowed her to be “good” bad and her sarcasm diminished.

For the entire article, visit:

Dr. El’s Theory of Angry Activities

Vacation envy, or ‘How to get your groove back’

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

Vacation envy, or ‘How to get your groove back’

Perhaps, like me, you’ve recently had time off from work but the only break on the near horizon is a measly midweek Independence Day.

Or maybe, like a coworker of mine, you’ve scheduled your summer vacation for the last week of August and you’re holding down the fort for your coworkers in the middle of a heat wave, watching others return to work tan, energized and eager to show off their vacation photos.

Or possibly you’re just plain tired, exhibiting some of the symptoms below:

1.  Wondering if the work you do really makes a difference.

2.  Feeling overwhelmed by regulatory requirements.

3.  Noticing every unfilled sanitizer dispenser and every chip in the wood veneer furniture.

4.  Wanting to buy gifts for all the elders. (This is both a sign of and a contributor to fatigue)

5.  Considering lying down on one of the resident’s beds for an afternoon nap.

If you recognize any of these signs in yourself, it’s wise to take note and to take steps toward self-care. Our work is important and the attitude with which we complete our tasks matters. Especially in jobs where we care for others, we need to “fill the well,” as the saying goes, because it’s impossible to “pour from an empty cup.”

How to get your groove back

If your vacation break is behind you, or so far ahead that you wonder how you’re going to make it, try these ideas to re-energize and add zip to your workday.

1.  Complete your paperwork in a quiet corner of the nursing home patio.

2.  Take up a new hobby or rekindle an interest in an old one. Tennis, anyone?

3.  Take a mental health day, morning, or afternoon. For added mileage, don’t tell anyone at all.

For the entire article, visit:

Vacation envy, or ‘How to get your groove back’

Suicide prevention in the workplace: What employers need to know

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

Suicide prevention in the workplace: What employers need to know

With the high-profile deaths this month of designer Kate Spade and chef Anthony Bourdain, the crisis of suicide has been thrust into the spotlight. Suicide deaths in the United States have increased 25% between 1999 and 2016, with an estimated 45,000 occurring per year.

I’ve written about suicide prevention in older adults and protocols for managing suicidal residents before. This column focuses on what organizations can do to address employee suicide.

As I prepared for this article, I realized that we don’t hear much in the industry news outlets about suicide among our staff members. But that doesn’t mean it isn’t happening.

Research has shown that physicians are twice as likely to commit suicide as the general population, and while there is a notable lack of information about the suicide rates for nurses in the US, a report from the UK finds that “for females, the risk of suicide among health professionals was 24% higher than the female national average; this is largely explained by high suicide risk among female nurses.”

A suicide death in the small-town atmosphere of a nursing home can have a devastating ripple effect, deeply affecting other staff members, as well as residents and their families. It can be particularly difficult to absorb a suicide death in an environment where others are struggling to live, despite age and disability and where the job of workers is to keep people alive.

A death by suicide leaves those around the deceased wondering how they might have failed their coworkers and teammates. This feeling can be particularly acute among individuals who pride themselves as excellent caregivers — the kind of people who work in long-term care.

How employers can help

The Suicide Prevention Resource Center (SPRC) points out that it is not only more humane to create an organizational culture of physical and mental health, but it also leads to more productive employees. They suggest a comprehensive approach based on the following three elements to make workplaces more supportive to those who are struggling with depression.

For the entire article, visit:

Suicide prevention in the workplace: What employers need to know

Why it’s impossible to maintain prior levels of care quality, and what to do about it

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

Why it’s impossible to maintain prior levels of care quality,

and what to do about it

In Editorial Director John O’Connor’s April 16th column, he reported on a study from the Kaiser Family Foundation indicating that increasing numbers of new residents have dementia, are more physically ill and are more likely to be on psychoactive medications.

The study showed that there has been a shift away from long-term services and toward short-term rehab treatment. O’Connor noted the pressure that this puts upon facilities to provide high-quality care in the midst of the churn of residents.

There are many difficulties that can arise from this shift in pace and population, but I’ll focus here on the mental health aspects and their effects on nursing facilities.

One problem that occurs when the length of stay decreases is that the team has a shorter period in which to get to know their residents. They are less likely to notice subtle changes in behavior and mood and they have less time to make the type of personal connection that reassures residents.

Adding to this, the fact that many facilities are operating short of staff in an environment of high employee turnover creates a “perfect storm” of emotional neglect.

Residents enter long-term care facilities in distress. When I adapted the classic Holmes-Rahe Stress Inventory to the circumstances of nursing home admission, I found that residents are experiencing a level of stress considered to be a “life crisis” that puts them at a high risk for further health breakdown. Their families also tend to be in crisis.

Residents and their family members are likely to expect that when they enter long-term care, staff members will provide compassionate medical treatment. Instead, what they frequently find are stressed out nurses and overworked aides who have just enough time to dispense medications or to make up a bed, but none to sit and talk with an understandably anxious resident and their family members about what they can expect regarding their stay and their future.

Social workers — most of whom got into the field in order to provide such counsel — are now buried under a flood of admissions and discharges. They cannot offer emotional sustenance when they need to complete the paperwork on three new admissions and order a walker for the lady whose family wants to take her home tomorrow because her insurance coverage ran out.

It is impossible for direct care staff to provide the same level of service that they did prior to this change in acuity and length of stay. In turn, distress over providing suboptimal care contributes to staff turnover, exacerbating the problem.

For the entire article, visit:

Why it’s impossible to maintain prior levels of care quality,

and what to do about it

The importance of leadership in creating good deaths in LTC

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

The importance of leadership in creating good deaths in LTC

For the entire article, visit:

The importance of leadership in creating good deaths in LTC

Aging Insider Article