Category: Stress/Crisis management

Disaster communication: A tale of two mothers-in-law

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

Disaster communication: A tale of two mothers-in-law

Both of my mothers-in-law live in long-term care communities in Florida. (I’ll keep the backstory about having two MILs a mystery.)

One MIL lives in a place that was excellent about how they communicated with family members before, during and after Hurricane Irma. The other MIL’s facility handled that aspect of care poorly.

At Bentley Village in Naples on the southwest coast of Florida, all 800 residents of the CCRC were evacuated in advance of the storm, even when everyone thought the hurricane was heading toward the East Coast. While not every organization can afford to evacuate their residents to plush hotels, all of them can afford to do what Bentley did next.

At the top of the home page of its website they placed a bright red banner instructing site visitors to click upon it for more information on Hurricane Irma. The following page contains continually updated reports on the progress the management is making toward assessing and repairing the damage to their homes, as well as an estimate of how long the process will take. A typical entry contains the date and time of the posting, the work that’s been done and what has yet to be accomplished.

They recently added photographs of the damage to the community. The photos clearly show even those most eager to return to their homes why they must wait.

In addition, there’s a list of locations where people are sheltering since residents from skilled nursing, assisted living and independent living were sent to different locales. A pet-friendly hotel was selected for independent living residents with animals.

When I discovered my MIL’s cell phone wasn’t working, I checked the website, got the phone number of the hotel where she was staying and was immediately connected to her room. She claimed they were “having a ball.”

Very reassuring.

For the entire article, visit:

Disaster communication: A tale of two mothers-in-law

The “last day” protocol

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

The “last day” protocol

I waited outside the room until the rehab therapists finished talking to Jim, who’d been admitted to the nursing home the night before. I read over the basic info on his face sheet before my consult. Jim was an 87-year old widower with a long list of diagnoses, some very serious.

After a moment, the rehab people left and I sat across from him and introduced myself and explained my role as the psychologist.

“How are you handling all of this stress?” I asked.

“I’m dying,” he replied.

“You don’t think you’ve got much time left?”

“No.”

“Does that upset you?”

“No, not particularly.”

He seemed quite calm.

“Are you sleeping okay? Eating okay?” I proceeded to ask him all the questions I’m supposed to ask patients I meet for the first time. “What kind of work did you do?”

He quietly answered them all. After a while there was a knock on the door and his physician poked her head into the room. “Just give me a minute. I’ll finish up,” I assured her, and turned back to Jim.

“It’s one of us right after the other, isn’t it?” I commented. “Let’s stop here today and I’ll come back next week to see how you’re doing.”

He gave me a funny look and half-shrugged. The doctor knocked again and I rose to leave.

It wasn’t until I returned to work the following week, when I learned Jim had died, that I realized his look meant, “I told you. I’m dying. I won’t be here next week.”

In hindsight, I wished I’d asked Jim more specifically what he meant when he said he was dying. People sometimes make remarks like that to me in their first few days in the nursing home without meaning that they’re in the active dying process. If I’d realized I wouldn’t have more time with Jim, I would have abandoned my standard questions and focused more on being present with him.

I was even more distressed that Jim had spent his last day fielding interviews from well-meaning staff members determined to provide good care. He was patient and kind about it. I’m guessing he was a really pleasant man, maybe too nice for his own good. That might have been something we could have worked on in psychotherapy.

If I knew I was dying, I wouldn’t want to spend my last day answering the questions of strangers trying to provide services I knew I wouldn’t be around to receive. I hope I’d be more assertive than Jim about refusing care, but there must be a way to offer a better experience for a dying person than having to rely on their level of assertiveness when ill and faced with medical routines. Perhaps we could establish a “last day” protocol.

For the entire article, visit:

The “last day” protocol

The violent workplace

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

The violent workplace

Last week a nurse, aide and police chief were killed at an Ohio nursing home, along with the gunman, who died of a self-inflicted gunshot wound. While it’s impossible to prevent all tragic events, especially those involving an armed assailant entering the building despite an order of protection against him, there are ways to reduce the likelihood of workplace violence.

According to a 2014 Scientific American article, “Health-care workers experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S., according to data from the Bureau of Labor Statistics.”

The article goes on to discuss the institutional acceptance of violence against nurses, the lack of violence prevention training and the implication from management that the employees were responsible for the assaults against them.

While the Scientific American article focused on nurses in a hospital setting, a 2016 study of nursing staff in long-term care facilities finds that “65% of the participants had experienced workplace violence while 41% believed that management shows little or no concern for their safety.”

I’m reminded of the many times over the years that residents have hit, spit on and otherwise abused nursing staff, and a team meeting was convened or a resident transferred to the psych hospital only after assaulting the doctor. If we want to retain staff, we need to convey that the safety of each individual is important regardless of their stature within the organization.

We also might hypothesize that people who have grown up in homes without violence are unlikely to stay in positions where they feel endangered; similarly, the staff members who stay have some level of comfort with aggressive behavior, perhaps due to exposure to domestic violence as children.  Research on the “cycle of violence” indicates that childhood exposure increases the likelihood of violent relationships as an adult.

If that hypothesis is true, it becomes even more crucial for the facility to set the standard that violence is not “normal” and that the safety of those in their community is paramount.

For the entire article, visit:

The violent workplace

Vector illustration of the Dove of Peace

Remember to breathe

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

Remember to breathe

I was putting the finishing touches on my article for this week’s column when I paused to consider the headlines on McKnight’s right now.

“Don’t be worried about Medicaid funding, be very afraid,” advises Editorial Director John O’Connor.

Staff Writer Emily Mongan alerts readers with these articles: “Access to nursing homes would dim under Republican proposal, AGS warns” and “Medicare could be next on Trump’s chopping block, experts say.”

In “The LTC industry should be ashamed,” guest columnist Buffy Howard admonishes long-term care leadership because their treatment of nursing staff is leading caring professionals to leave the field.

Reduced funding, departing staff members, widespread uncertainty in the industry … even the most stalwart individuals might feel uneasy. I’ve postponed my earlier topic to consider what I could say as a psychologist to help.

Perhaps you’ve heard the tale about the boss who yells at the worker, who comes home and grouses at his wife, who is short-tempered with her child, who kicks the dog. Anxiety can spread like that too, from CEO to administrator to supervisor to charge nurse to aide to resident.

In order to better face whatever is ahead — and to avoid causing panic in those around us — we can make an effort to be serene and centered. Below are some tried and true calming techniques to help you remain levelheaded despite unnerving times.

For the entire article, visit:
Remember to breathe

10 ways to incorporate mood-boosting exercise into LTC

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

10 ways to incorporate mood-boosting exercise into LTC

Cold weather. An uncertain world. Rogue shrinks making the rest of us caring, diligent professionals look bad. I don’t know about you, but I need a mood lifter.

I came across an article that suggests that exercise of all kinds, even small movements, can make us feel less depressed. In “Get up and move. It may make you happier,” New York Times health writer Gretchen Reynolds notes that people in a University at Cambridge study “turned out to feel happier when they had been moving in the past quarter-hour than when they had been sitting or lying down, even though most of the time they were not engaged in rigorous activity.”

How can we incorporate more movement into our days across the spectrum of long-term care?

Personally, I purposely forego my car so I can walk to and from the subway and I take the stairs instead of the elevator whenever possible. I encounter surprisingly few coworkers doing the same, so perhaps that can be number one on this list of get-moving ideas:

1. Take the stairs.

2. Use public transportation. Sign up for or offer workers a transit tax exemption if a program, such as TransitChek in New York City, is available in your area.

3. Kill two birds with one stone by walking around the facility on rounds and checking in with staff members and residents.

4. Join or begin a lunchtime walking program. Find a buddy to add fun and accountability.

For the entire article, visit:

10 ways to incorporate mood-boosting exercise into LTC

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

Suicide prevention in older adults

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

Suicide prevention in older adults

In preparing for a webinar on suicide prevention, I came across startling statistics about suicide rates among older adults. Despite the concern we often hear about teen suicide, the rate for elders is even higher.

While older adults make up 12% of the U.S. population, they account for 18% of all suicide deaths. In 2014, the highest suicide rate in the U.S. population (19.3 per 100,000 people) was among people 85 years or older.

In addition, elder suicide may be under reported by 40% or more. Not counted are “silent suicides,” like deaths from overdoses, self-starvation or dehydration, and “accidents.”

Training staff to assess suicide

Given its prevalence, it’s important for long-term care staff members to know how to recognize and address suicidal thinking and behaviors.

As a psychologist who’s been assessing suicidality since my teen years as a peer counselor in college, I feel comfortable with the process. Most facility staff members, however, haven’t had extensive training and are understandably anxious about an issue that’s likely to be out of their area of expertise. This can lead to over-caution, such as unnecessary one-to-one observation, or to missing signs of distress.

Staff training programs should educate team members about factors increasing the likelihood of depression and thoughts of suicide. Many of these influences are prevalent in our elderly population, such as physical illness, pain, functional impairment, losses and social disconnectedness.

Make use of consulting psychologists by referring residents for evaluation after losses and a decline in condition such as a downgrade in diet from chopped to pureed food, a limb loss, a move from a wheelchair to a reclining chair or a death in the family.

Team communication and support

Virtually all workers know it’s necessary to inform the charge nurse and other personnel about direct statements such as “I want to kill myself,” but staff members should be trained to look for other warning signs of potential suicide, which include changes in grooming, loss of interest in previously appealing activities, giving away possessions and making statements like, “I won’t be needing any more appointments.”

For the entire article, visit:

Suicide prevention in older adults

Preventing Burnout in LTC: Free Webinar 7/17

Join Dr. El

Thursday, July 17th

at 2pm Eastern Time (1pm Central Time)

for a

 FREE Webinar on

Preventing Burnout in Long-Term Care

sponsored by EmLogis

To register:

visit EmLogis Events

Aunt Sylvia discusses burnout:  http://youtu.be/sIh274aoIF8?list=UUmfhLE_11Y9evQxu-dGxIXg

About the webinar:

Long-term care can be a stressful work environment, contributing to job dissatisfaction, turnover, injury and absenteeism. Join psychologist Dr. Eleanor Feldman Barbera as she discusses factors contributing to job burnout and offers practical, effective ways for managers and direct care staff to reduce and manage stress.

What you will learn:

Factors contributing to burnout in LTC
Strategies for managers that decrease work pressure among staff
Practical techniques to reduce stress for all staff members

Who should attend this webcast:

Administrators and assistant administrators
DONs, ADONs, and department heads
Staff training coordinators
Human resource department staff
All direct care staff

Preventing burnout in long-term care (McKnight’s LTC News)

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

Preventing burnout in long-term care

In my recent post, “Stuff I won’t do for residents and why your staff shouldn’t either,” I wrote about the need for individual workers to set appropriate boundaries around caregiving in order to retain the ability to give without burning out. In this article, I examine more closely the symptoms of burnout and ways facilities can reduce its likelihood — which is particularly important given the link between burnout and turnover.

Employers find burnout reflected in high levels of absenteeism and tardiness, extended sick leave, and an increase in worker’s compensation claims. Employees might notice symptoms such as stress-related medical conditions (for example, ulcers or headaches), reduced job satisfaction, feelings of depression, anxiety, cynicism, boredom, discouragement and loss of compassion.

One study found that burned out staff were more likely to be accepting of resident abuse (Shinan-Altman and Cohen, 2009).

What is burnout?
In my research, I came across a number of definitions of burnout. Some definitions, like this early description by psychologist Herbert Freudenberger, focus on the role of the individual:

Burnout is “a state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that has failed to produce the expected reward.” People most likely to burn out are those who are the most “dedicated and committed to their positions, have poor work boundaries and who have an over excessive need to give.”

Ouch.

Other explanations of burnout focus on the environment, such as this one by Pines and Aronson (1988): Burnout is “a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations.”

It’s probable that most burnout is due to a combination of a stressful work environment and an individual’s difficulty balancing self-care with their commitment to their jobs.

Techniques to reduce burnout
The good news for management is that many of the causes of burnout can be addressed by the organization, whether they are due to the environment or rooted in the individual.

1. Training workers, including enhancing the initial orientation process and providing ongoing education programs that go beyond mandated courses, can address many factors that contribute to burnout. Studies suggest the following:

Orientation classes should provide clear job expectations and address ways to prioritize job tasks in order to reduce time pressures.
Managerial staff such as nurses and department heads would benefit from skills training to better help them supervise and manage their teams.
Team building efforts can improve relationships with coworkers and reduce professional isolation.
Training staff on how to manage aggressive behaviors reduces the stress of working with a verbally and physically aggressive population.

2. Scheduling issues are another area where management can make a significant impact on burnout through:

For the entire article, visit:

Preventing burnout in long-term care

Stuff I won’t do for residents and why your staff shouldn’t either: Preventing burnout in LTC (McKnight’s LTC News)

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

Stuff I won’t do for residents and why your staff shouldn’t either: Preventing burnout in LTC

In my last post, I wrote about some of the many things I do for residents as a long-term care psychologist. The astute reader will note that most of the tasks were accomplished during work hours and within the facility. There’s a reason for that.

When I first started out as a shrink, I worked at the Manhattan Psychiatric Center, a setting similar to many nursing homes in that residents didn’t have access to stores and other amenities. “Next time you’re in the supermarket, will you get me some of that lotion I like?” “Can you buy me a new watch battery?”

The small requests were never-ending and because they were so small, I felt I couldn’t refuse.

And then there were the tasks I volunteered for because I could see the need and I was, you know, a nice person.

The breaking point came after I offered to darn a sweater with a small hole in the front. It was only after I got the sweater home that I discovered the large holes in the back. During the hours of mending — I didn’t want to go back on my word — I realized I had to set some limits on these “extras” or I’d quickly burn myself out on my chosen career.

Establishing limits

Knowing I was in this for the long haul, I created a personal “no errands” policy. The exceptions are endeavors that connect residents to their loved ones, such as obtaining and mailing out holiday cards. (And, I admit, I relish Internet searches for estranged family members.) On the occasions where I’m tempted to do something really special, I soul-search and sometimes consult with an advisor to determine if it’s something I’d do for any of my residents or if I’m going too far for one particular person. It’s important to be fair, especially in the “small-town” LTC environment.

Potential for burnout

For the entire article, visit:

Stuff I won’t do for residents and why your staff shouldn’t either: Preventing burnout in LTC

Staying in balance while leaning on each other