Dr. Eleanor Barbera | My Better Nursing Home http://www.mybetternursinghome.com Tue, 19 Sep 2017 06:49:54 +0000 en-US hourly 1 https://wordpress.org/?v=4.8.2 You and your staff are very different: Use it to your advantage http://www.mybetternursinghome.com/you-and-your-staff-are-very-different-use-it-to-your-advantage/ http://www.mybetternursinghome.com/you-and-your-staff-are-very-different-use-it-to-your-advantage/#respond Wed, 13 Sep 2017 21:59:30 +0000 http://www.mybetternursinghome.com/?p=6501 You and your staff are very different: Use it to your advantage

I often speak with healthcare groups, giving psychological insights about a variety of issues within long-term care. Sometimes I address a C-suite audience; other times I train direct care staff.

I noticed during the course of these talks that some of the group exercises that generated excitement and intense discussion among direct care staff were met with relative restraint when presented to executives.

After pondering the discrepancy in reactions, I adjusted my talks accordingly and came to this conclusion: Healthcare executives and managers are very different from those they manage.

Understanding and utilizing these differences can facilitate leadership in a variety of ways.

How execs differ from direct care staff

We can consider the discrepancies between the two groups by looking at the traits generally exhibited by each. I’ve borrowed a tool from career counselors, who test their clients’ personality traits to determine what types of jobs best suit them.

One such test is the Myers-Briggs Type Indicator, which examines four different aspects of an individual’s personality as it relates to career choice. The summary below is from an article with a handy chart based on the book, “Do What You Are.”

For the entire article, visit:

You and your staff are very different: Use it to your advantage

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Calming fears of floods and other catastrophes http://www.mybetternursinghome.com/calming-fears-of-floods-and-other-catastrophes/ http://www.mybetternursinghome.com/calming-fears-of-floods-and-other-catastrophes/#respond Thu, 31 Aug 2017 09:32:42 +0000 http://www.mybetternursinghome.com/?p=6495 Here’s my latest article on McKnight’s Long-Term Care News:

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Calming fears of floods and other catastrophes

By now it’s likely that you, your staff, the residents and their families have seen the incredibly disturbing photo of assisted living residents in Dickinson, TX, sitting in waist-high floodwaters.

Thankfully, all the older women in the picture have been rescued, but that image and others of the flood are undoubtedly causing concern in your community.

Vulnerable residents with no ability to remove themselves from similar situations may be experiencing anxiety, nightmares and/or agitation after seeing their peers immersed in water. Worried family members will want to know that their loved ones are safe from comparable disasters.

Staff members may be wondering what crisis procedures the facility has in place and if they’re sufficiently prepared to carry them out should the need arise (especially with their own families to worry about in an emergency).

Reassurance required

Just as the nation turns to its leaders for reassurance during difficult times, the members of your community will look to you to calm their fears. Now is the time to write a memo to your staff, post a notice in the lobby and add an article to the organization’s newsletter assuring people that there are plans in place for emergencies and that steps have been taken to ensure the safety of the elders entrusted to your care.

Review emergency plans

Review policies and procedures and train staff so that they feel comfortable carrying out these plans. Coordinate with other long-term care facilities so that there is reciprocity of staff and beds in emergency situations.

For the entire article, visit:
Calming fears of floods and other catastrophes

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Falls: A closer look http://www.mybetternursinghome.com/falls-a-closer-look/ Sat, 19 Aug 2017 11:47:44 +0000 http://www.mybetternursinghome.com/?p=6493 Here’s my latest article on McKnight’s Long-Term Care News:

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Falls: A closer look

Part of my job as a geropsychologist is to conduct reviews of falls with my patients after they occur.

Through discussion with the resident, I analyze what happened and assess how they’re doing after what can be a traumatic event. Together, we identify ways they can prevent future falls.

This exercise can be very revealing not only about the particulars of a situation but also about why falls occur in general.

The trauma of falls

Falls can be traumatic for a number of reasons. Sometimes an individual is badly hurt in the event, leading to a hospitalization and/or a decline in their physical and mental condition.

Occasionally, a person isn’t found immediately, resulting in a period of time on the floor in pain with negative thoughts about themselves, staff, the facility and life in general. A spill can also trigger thoughts about similar past distressing episodes, such as a reminder of a fall at home that precipitated hospitalization and placement.

In addition, falls can decrease residents’ confidence in their physical abilities, leading them to become overly cautious in rehab and resulting in increased physical dependence.

Why residents fall

There are many reasons that people fall, including forgetting their inability to walk, dizziness due to medication side effects, pain and restlessness.

This 2014 article in Managed Healthcare Connect provides excellent examples of how to conduct a thorough “root cause analysis” and a discussion of many of the elements that contribute to falls and how to address them.

Falls are typically multifactorial, but my own experience with residents over the years — bearing in mind that I speak only with residents who are cognitively intact and able to benefit from psychological services — suggests one major cause of falls in this cohort: not getting help in a timely fashion.

For the entire article, visit:

Falls: A closer look

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The image of LTC in the arts http://www.mybetternursinghome.com/the-image-of-ltc-in-the-arts/ Fri, 04 Aug 2017 08:24:48 +0000 http://www.mybetternursinghome.com/?p=6490 Here’s my latest article on McKnight’s Long-Term Care News:

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The image of LTC in the arts

I was perusing The New York Times last week when I came upon an article about a play centering on my favorite topic — aging.
“Singing Beach,” by playwright Tina Howe, revolves around the drama that consumes a family when confronted with the need to place an elderly parent in a nursing home. Howe is 79 years old and lives with her 81-year old husband, who has been diagnosed with Alzheimer’s disease. She says the play was inspired by the care needs of her father years ago.

I enlisted a friend with similar interests to accompany me to the performance. “The director is a friend of mine,” I told her. “And I’m curious to see how long-term care is portrayed in the show.”

Howe, an Obie Award winner and two-time Pulitzer Prize finalist, notes that all the producers she’d initially approached turned down the script. Then, she encountered my director friend, Ari Laura Kreith, who found the subject in keeping with the mission of her company Theatre 167.

According to its website, Theatre 167 was “born in a community where 167 different languages are spoken” and it “creates, cultivates, and supports new work by artists of wide-ranging backgrounds, traditions, and beliefs” in order to provide “theatrical events that deepen and enhance our understanding of one another.”

Given our youth-obsessed culture and the paucity of “coming of old age” films and other media, this play certainly contributes a unique perspective and one that is, at the same time, universal. After all, among the 167 languages mentioned, each has speakers who are older adults and may one day be in need of long-term care.

For the entire article, visit:

The image of LTC in the arts

Graphic image by Kelly Pooler, collage with Katsushika Hokusai’s The Great Wave

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ElderTech: Ideas from a tech exhibit http://www.mybetternursinghome.com/eldertech-ideas-from-a-tech-exhibit/ Wed, 19 Jul 2017 02:48:22 +0000 http://www.mybetternursinghome.com/?p=6486 Here’s my latest article on McKnight’s Long-Term Care News:

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ElderTech: Ideas from a tech exhibit

I was at the nursing station the other day when some unusual cracking noises caused me to look up from my documentation. A very old, petite lady was sitting in her wheelchair popping bubble wrap. She wore th

e same contented expression that comes over virtually everyone popping a sheet of bubble wrap.

This low-tech soother was on my mind during my visit to New York City’s CE Week. CE, in this case, is not Continuing Education but Consumer Electronics.

In March, I wrote about attending Aging2.0, a tech conference geared toward elders. The CE Week NY isn’t specifically aging tech, but the 50+ set was invited by tech50+ and Senior Planet and I went to see what could be appropriated for people much older than 50.

I was thinking of the happy bubble-wrap popping elder when I came across FidgetTech, a table of high-tech “fidgets.” A fidget spinner is a small, flat plastic device with a central core that remains stable while the three-pronged body is spun in circles. Often marketed as a tool to help children maintain their focus, they’ve become a craze like yo-yos or Silly Bandz.

The display offered a wide variety of fidgets with various electronic capabilities (music! USB hubs!), but what stood out to me was the possibility of calming agitated elders with a basic, silent fidget that, unlike bubble wrap, wouldn’t disturb those around them. I liked the fidget that had “arms” filled with liquid and glitter so that when it stopped, the glitter settled in a slow, mesmerizing fashion. I could imagine a “Fidget Hour” mitigating the agitation that frequently occurs late in the day.

Farther down the exhibit hall, the Rapael Smart Glove display demonstrated virtual reality-based rehabilitation using a variety of computerized games and a plastic sensor “glove.”

(Think Wii for hand and arm rehabilitation.) In addition to the high-tech demonstration, they offered low-tech photocopies of a 2016 study published in the Journal of NeuroEngineering and Rehabilitation outlining the glove’s utility for post-stroke patients. The device would be a useful and impressive addition to rehabilitation services.

For the entire article, visit:

ElderTech: Ideas from a tech exhibit

 

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Why (culture) change is so hard and what to do about it http://www.mybetternursinghome.com/why-culture-change-is-so-hard-and-what-to-do-about-it/ Fri, 07 Jul 2017 01:18:50 +0000 http://www.mybetternursinghome.com/?p=6483 Here’s my latest article on McKnight’s Long-Term Care News:

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Why (culture) change is so hard and what to do about it

The team huddled around the nursing station talking in panicked whispers after the management meeting ended.

“How do they expect us to do that?” a young nurse wondered.

“Yeah,” an aide replied, “we’re stretched thin enough already!”

A more experienced worker piped up. “Don’t worry,” he said bluntly. “I’ve seen these ideas come and go. It’ll never happen.”

There was a collective sigh of relief and everybody went back to business as usual.

The scenario above illustrates some of the many ways organizations are resistant to change.

In this situation, the new procedure is viewed as a temporary fad not worth investing time and energy. The workers haven’t been consulted for their input prior to implementation, they fear that they won’t be able to handle the work and the benefits of doing so aren’t clear. In addition, the employees don’t trust their management to guide them through the process of change.

Think of how hard it is to adjust our own routines and then multiply that by, say, every employee, resident and family member. Then cube that number.

Speaking of adjusting personal routines, a few months ago I wrote that I was going to try to meditate daily this year. I haven’t.

Consider trying to make changes in the context of family life, such as going for a walk after dinner (a good idea that never happened) or eating healthy food (I do, she does, he doesn’t). Pushback and inertia can make it difficult for even the most well-intentioned modifications to take hold.

This is why it’s necessary to have a guide along the way for changes to take hold, whether it’s a friend to meet you at the gym or the Pioneer Network to help your organization navigate through the culture change process.

Full disclosure: While I don’t get paid to say this, as a psychologist I find that culture change principles are better for the mental health of the residents, staff and families. As a change agent, I know how important it is to enlist an agent of change.

For the entire article, visit:

Why (culture) change is so hard and what to do about it

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Promote your connections http://www.mybetternursinghome.com/promote-your-connections/ Thu, 22 Jun 2017 13:54:21 +0000 http://www.mybetternursinghome.com/?p=6480 Here’s my latest article on McKnight’s Long-Term Care News:

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Promote your connections 

One of the things that most brightens my workday is when I see long-term care residents hanging out together.

In particular, I’ve noticed two ladies who attend activities in tandem wearing dresses with hats and costume jewelry, a threesome of confused residents who sit near the nursing station laughing at jokes only they understand, and an African-American and a Caucasian octogenarian twosome who are amazed to be best friends since neither of them had a friend of the other race before.

Men gather for card games, guys group in the hallway offering wry observations on the behaviors of the staff and other residents, and rehab patients tell me how inspired they are by someone they meet lifting weights in physical therapy. Sometimes I’ll discover that the resident they mentioned is, in turn, inspired by them.

What long-term care offers, aside from medical help and safety, is the opportunity to connect with peers and to maintain a social life. One of our best selling points is the fact that folks can get to activities without needing a coat or umbrella. New residents are often surprised and reassured to learn that there are “transporters” who will bring them to and from daily recreation programs, all for free.

For the entire article, visit:

Promote your connections

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The “last day” protocol http://www.mybetternursinghome.com/the-last-day-protocol/ Thu, 08 Jun 2017 12:17:28 +0000 http://www.mybetternursinghome.com/?p=6477 Here’s my latest article on McKnight’s Long-Term Care News:

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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

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The violent workplace http://www.mybetternursinghome.com/the-violent-workplace/ http://www.mybetternursinghome.com/the-violent-workplace/#comments Thu, 25 May 2017 12:15:57 +0000 http://www.mybetternursinghome.com/?p=6468 Here’s my latest article on McKnight’s Long-Term Care News:

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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

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Opening the door for ombudsmen http://www.mybetternursinghome.com/opening-the-door-for-ombudsmen/ Thu, 11 May 2017 00:50:14 +0000 http://www.mybetternursinghome.com/?p=6461 Here’s my latest article on McKnight’s Long-Term Care News:

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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

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