Category: Stress/Crisis management
Posted by Dr. El - August 11, 2013 - Common Nursing Home Problems and How Psychologists Can Solve Them, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Psychology Research Translated, Resident care, Stress/Crisis management
Here’s my latest article at McKnight’s Long-Term Care News:
According to researchers, 11% to 43% of LTC residents have thoughts of suicide1-3, with higher rates in larger facilities and in those with more staff turnover4. Other stressors include medical illness, the presence of a mood disorder such as depression, social isolation, and recent life stressors5 – factors that frequently affect our residents.
The MDS 3.0 requires that facilities ask residents questions regarding their risk of suicide. If a risk is identified, then effective protocols should be employed. In a June 2013 Annals of Long-Term Care review article, Challenges Associated with Managing Suicide Risk in Long-Term Care Facilities6, authors O’Riley, Nadorff, Conwell, and Edelstein offer alternatives to the procedures frequently in place in LTC settings – close observation or transfer to a psychiatric facility. These methods are often used unnecessarily, the authors note, due to staff fear of legal liability, concerns regarding their perceived competence in handling suicide risk, and the personal fear of losing a resident to suicide.
Essential for immediate risk
The authors argue that while close observation and hospitalization are essential when residents have the means, intent, and ability to end their lives at any moment (high risk situation), they’re ineffective in situations where there is a minimal or low risk of imminent death by suicide. For example, a resident may express thoughts of suicide but have no access to a means to do so or no ability to make use of an available means, making suicide very unlikely or virtually impossible. Other times a resident may have thoughts of suicide but no plans to do it any time soon. “If things get worse down the road,” they’ll sometimes say, “then I’m going to end it all.”
Ineffective for minimal risk
While a low or minimal risk should still be taken seriously, there is no evidence that it’s effective to put a resident on 15-minute checks or to send him or her to the psychiatric hospital.
For the entire article, visit:
1.Haight B K. Suicide risk in frail elderly people relocated to nursing homes. Geriatr Nurs.1995;16(3):104-107.
2. Malfent D, Wondrak T, Kapusta ND, Sonneck G. Suicidal ideation and its correlates among elderly in residential care homes. Int J Geriatr Psychiatry. 2009;25(8):843-849.
3. Ron P. Depression, hopelessness, and suicidal ideation among the elderly: a comparison between men and women living in nursing homes and in the community. J Gerontol Soc Work. 2004;43(2-3):97-116.
4. Osgood NJ. Environmental factors in suicide in long-term care facilities. Suicide Life Threat Behav. 1992;22(1):98-106.
5. Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatr Clin North Am. 2011;34(2):451-468.
6. O’Riley A, Nadorff MR, Conwell Y, Edelstein B. Challenges associated with managing suicide risk in long-term care facilities. Annals of Long-Term Care. 2013;21(6):28-34.
Posted by Dr. El - November 8, 2012 - Business Strategies, Stress/Crisis management
It’s been a challenging time here in New York, leading me to write this guest post for McKnight’s Long-Term Care News:
Helping your LTC community cope in the wake of Hurricane Sandy
In the aftermath of Hurricane Sandy, long-term care facilities may be wondering how to help their own residents, families, and staff members or those directly affected by this devastating storm.
1. Be aware of our own feelings: If we’re anxious ourselves, it’s unlikely we’re going to be of much assistance. We should take time to calm ourselves, or let others take on the task of reassuring residents, staff, and family members until we’re ready to do so.
2. Allow community members to express their concerns: Sometimes we don’t need to fix things, but can be more helpful acting as a sounding board. Often if we listen long enough, the speaker can get through the frightened feelings on his or her own.
3. Acknowledge feelings: It’s not uncommon to be fearful or anxious, which will diminish over time. Knowing this is normal can be comforting.
4. Emphasize safety procedures: Reviewing the safety procedures in the nursing home, such as backup generators, evacuation plans, and water pumps, can increase the sense of safety and control. If it seems necessary, separate group discussions can be offered for residents, staff, and family members.
5. Utilize spiritual supports: Natural disasters such as this reinforce the capriciousness of fate, and, for some people, may lead to questions of how this could have happened. Help them to understand it in terms of their spiritual beliefs.
Posted by Dr. El - June 26, 2012 - Books/media of note, Stress/Crisis management
This month’s Caring for the Ages magazine features an article by Joanne Kaldy on reducing the emotional distress of resident through disaster preparedness. Here’s my contribution:
During a disaster, staff might be surprised at how calm many residents actually are. “A lot of residents aren’t as upset as we think. We need to be careful not to think that everyone is distressed,” said Eleanor Feldman Barbera, PhD, a psychologist who consults in long-term care facilities in the New York City area. For some residents, a hurricane or a snowstorm isn’t as significant as a personal disaster such as a roommate’s death, Dr. Barbera said.
Other residents may not display their significant concern. “People might be in their rooms quietly freaking out,” Dr. Barbera said. Some cultures think it is inappropriate to express feelings, and men may feel that they should act strong and not show their emotions. “Count on aides who know the residents better than anyone,” she advised. “Have regular in-service programs about signs of trauma, and make sure [staff] know who to report their concerns to.”
For the full article, click this headline:
Posted by Dr. El - June 20, 2011 - Books/media of note, Common Nursing Home Problems and How Psychologists Can Solve Them, Stress/Crisis management
When nursing home residents are evacuated from their facilities after any type of disaster, they typically move to another nursing home rather than to a public shelter. They therefore miss the opportunity to speak with trained first responders who can help them address their emotional reactions to the experience.
Developed by psychologist Lisa M. Brown, PhD, and colleagues, the guidebook is based on the idea that, like medical first aid, anyone can be trained in psychological first aid techniques. The Psychological First Aid: Field Operations Guide for Nursing Homes provides training information specific to the needs of nursing home residents, including those with dementia.
The guidebook is an incredibly valuable resource, generously made available for FREE, and worth the click. A quick perusal of the table of contents will give you a sense of whether or not you and your staff members are prepared to help the residents in the event of a disaster.
Posted by Dr. El - August 30, 2010 - Depression/Mental illness/Substance Abuse, Resident care, Role of psychologists, Stress/Crisis management
In 1967, psychiatrists Holmes and Rahe created a scale that measures the stress levels of various life events, and found that people with stress levels over 300 are at high risk of illness. I’ve always considered a nursing home stay to be a very stressful experience, but applying the scale was illuminating.
I took the
Holmes and Rahe Stress Scale and modified it based on working with nursing home residents. For example, the Social Readjustment Rating Scale (SRRS) allots 65 points for a marital separation, but since moving away from one’s spouse to enter a facility isn’t a typical marital separation, I gave it 50 points. Nursing home residents aren’t technically imprisoned (63 points), but it is extremely confining, so I reduced that item to 50 points.
In my view, residents are not retired, but have started their jobs of working with the staff 24/7 in order to attend to the business of taking care of themselves, so I included many work-related items not usually considered the province of residents. This left me with the following items on the 43-item scale:
Marital Separation (50)
Imprisonment (50)
Personal Injury or Illness (53)
Business Readjustment (39)
Change in Financial State (38)
Change to a Different Line of Work (36)
Change in Responsibilities at Work (29)
Change in Living Conditions (25)
Revision of Personal Habits (24)
Change in Working Hours or Conditions (20)
Change in Residence (20)
Change in Recreation (19)
Change in Church Activities (19)
Change in Social Activities (18)
Change in Sleeping Habits (16)
Change in Eating Habits (15)
Grand Total: 471 points
471 points, on a scale that finds a high risk of illness at stress levels over 300 points. On the
updated SRRS, the total comes out much higher, with the person considered in a life crisis.
Upon admission to the nursing home, residents are required to see the dietician, dentist, social worker, and recreation therapist. A life crisis, and we have yet to require a psychological evaluation of the residents. Referrals are currently haphazard, and based on the psychological-mindedness of the nursing home staff.
Readers who feel they, their residents, or their loved ones might benefit from the assistance of a psychologist in coping with the magnitude of these life changes can suggest a referral for evaluation for a particular individual (until regulations catch up with the need).
Posted by Dr. El - March 30, 2009 - Stress/Crisis management
The shocking news of an assault on nursing home residents and staff is likely to cause fear and anxiety in members of our nursing home community. As a nursing home psychologist who was working in New York City in the aftermath of 9/11, I’d like to offer some suggestions regarding ways in which we can help our community members cope with this tragedy.
1. Be aware of our own feelings: If we’re anxious ourselves, it’s unlikely we’re going to be of much assistance. We should take time to calm ourselves, or let others take on the task of reassuring residents, staff, and family members until we’re ready to do so.
2. Allow community members to express their concerns: We don’t need to fix things, but can act as a sounding board. Often if we listen long enough, the speaker can get through the frightened feelings on his or her own.
3. Acknowledge feelings: It’s not uncommon to be fearful or anxious, which will diminish over time. Knowing this is normal can be comforting.
4. Emphasize safety procedures: Reviewing the safety procedures in the nursing home, such as a security guard, observant staff, alarms, and security cameras, can increase the sense of safety and control. If it seems necessary, separate group discussions can be offered for residents, staff, and family members.
5. Utilize spiritual supports: Tragedies such as this reinforce the capriciousness of fate, and, for some people, may lead to questions of how this could have happened. Help them to understand it in terms of their spiritual beliefs.
6. Anticipate increased efforts at control: For a brief period, we might expect to see our community members striving for control in other areas of their lives. For example, residents who usually feel some anxiety using the lift to get out of bed might find it more distressing and need increased reassurance. Staff members who are normally flexible about their work assignments might be less so, and family members might be more vocal about concerns for their loved ones. We need to be gentle with ourselves right now.
7. Be prepared for denial: Many people won’t mention the attack, or won’t feel it has any relation to them at all. Let them be. They’ll bring it up if and when they need to.
8. Observe for symptoms: You might notice increased depression or anxiety, rumination (repeatedly discussing the event), tearfulness, nightmares, insomnia, symptoms of Post Traumatic Stress Disorder such as exaggerated startle response, etc.
9. Use your mental health team members: If a resident is having difficulty in the aftermath of this attack, consider a referral to the psychologist and/or psychiatrist. Staff and family members who are distressed might be gently directed toward using their mental health benefits.
10. Provide the opportunity to be of assistance: Sending cards or taking up a collection for Pinelake Health and Rehab is a positive way to channel the energy of our community and show the power of human kindness in the face of tragedy.
According to McKnights.com, where this post is a guest column, donations can be made at the address below:
Carthage Crisis Assistance Fund
North Carolina Health Care Facilities Association
5109 Bur Oak Circle
Raleigh, NC 27612
Contributions may also be taken to any branch of Capital Bank
