Dr. Eleanor Barbera | My Better Nursing Home http://www.mybetternursinghome.com Wed, 19 Jul 2017 02:48:22 +0000 en-US hourly 1 https://wordpress.org/?v=4.8 ElderTech: Ideas from a tech exhibit http://www.mybetternursinghome.com/eldertech-ideas-from-a-tech-exhibit/ http://www.mybetternursinghome.com/eldertech-ideas-from-a-tech-exhibit/#respond 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/ http://www.mybetternursinghome.com/why-culture-change-is-so-hard-and-what-to-do-about-it/#respond 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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Insights on family-friendly care from Dr. El — the daughter of a new resident http://www.mybetternursinghome.com/insights-on-family-friendly-care-from-dr-el-the-daughter-of-a-new-resident/ Wed, 26 Apr 2017 12:52:54 +0000 http://www.mybetternursinghome.com/?p=6457 Here’s my latest article on McKnight’s Long-Term Care News:

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Insights on family-friendly care from Dr. El — the daughter of a new resident

Due to a series of unfortunate events, both of my previously independent parents were recently injured over the course of five weeks. In the past, I’d been the granddaughter, the niece and the daughter-in-law of someone in long-term care, but I’ve now taken on the very different role of daughter of a resident.

In between errands, trips to medical appointments and calls to the facility, I’ve been making mental notes of insights afforded me by my new perspective and that of my family members.

Here are some thoughts from someone who’s seen the long-term care world from both sides now:

• It’s worthwhile to have a pleasant and efficient receptionist. I don’t often call the facilities in which I work so it hasn’t affected me personally if the automated telephone system sends callers into a netherworld of options and hang-ups or if the receptionist is curt or bumbling.

As a family member, however, it’s tremendously reassuring to have a calm, competent individual answering questions and guiding me to the appropriate staff member.

• Visitor areas are scrutinized. While my general philosophy is that I’d much rather be in a place that focuses on emotional and physical comfort than on outward appearances, my visiting family members are definitely aware of disrepair, cleanliness levels and shabbiness.

For the entire article, visit:

Insights on family-friendly care from Dr. El — the daughter of a new resident

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On power, teamwork and communication http://www.mybetternursinghome.com/on-power-teamwork-and-communication/ Thu, 13 Apr 2017 13:08:21 +0000 http://www.mybetternursinghome.com/?p=6454 Here’s my latest article on McKnight’s Long-Term Care News:

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On power, teamwork and communication

Having enough of it at work, I tend to avoid drama in my entertainment choices unless it involves aliens or post-apocalyptic nonsense. My family and I are currently enjoying the creative spectacle of Project Runway “Teams” version from a few seasons ago. In it, the judges of the clothing design competition repeatedly make the point that “teams are only as strong as their weakest link.”

A significant part of the Project Runway teamwork challenges involve communication. Collaborators who take over the project and those don’t speak up can both get penalized by the judges. Similarly, teamwork within the long-term care setting heavily relies on communication. For the best healthcare outcomes, it’s essential for all team members to contribute their expertise.

An article in the American Psychological Association Monitor, however, suggests that people who feel powerful are more likely than those who don’t feel powerful to share “opinions that differed from the norm,” a important element of team interactions.

Further, the authors cite research that describes how “people who feel powerless are more likely to…behave in inhibited ways. People in positions of greater power, on the other hand, are more likely to…act in uninhibited ways.” A care team member who feels inhibited is less likely to speak up and contribute to a group discussion.

In the hierarchical world of LTC, administrators, nursing directors and medical directors have more perceived power than, say, charge nurses or recreation therapists, despite whatever layers of upper management and accountability exist.

In my conversations with aides and residents, there is consistent disagreement among them regarding who has the power. Aides will argue that the “Resident’s Bill of Rights” gives the residents control, while residents, waiting on aides for intimate care, feel that the aides are in charge. Both struggle to deal with the moods and behaviors of the other.

Family members can be considered a part of the team that wields power in the form of potential phone calls to senior staff, the ability to transfer their loved one to a different facility, a negative social media review or a lawsuit. At the same time, relatives are often overwhelmed by the new and unfamiliar situation and the shifting dynamics within their families and many feel powerless in relation to the staff members upon whom they depend for good care for their loved one.

The challenge for LTC is to empower all team members to overcome their “inhibitions,” so that they offer their expertise despite the imbalance of power and in perceptions of power.

For the entire article, visit:

On power, teamwork and communication

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Enthusiasm and ingenious inventions at the NYC Aging2.0 Global Startup Pitch Event http://www.mybetternursinghome.com/enthusiasm-and-ingenious-inventions-at-the-nyc-aging2-0-global-startup-pitch-event/ Fri, 31 Mar 2017 15:00:06 +0000 http://www.mybetternursinghome.com/?p=6445 Here’s my latest article on McKnight’s Long-Term Care News:

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Enthusiasm and ingenious inventions at the NYC Aging2.0 Global Startup Pitch Event

Perhaps, like me, you’ve heard of Aging2.0 but hadn’t had the opportunity to attend one of their events. When I discovered that they were holding a pitch session a subway ride away from my home, I jumped at the chance to be there. I was curious to see if any of the startups were promoting products to benefit elders in long-term care.

Here’s what I learned:

What’s Aging2.0?

According to their website, “Aging2.0 is a global innovation network on a mission to accelerate innovation to improve the lives of older adults around the world.” Moving beyond the development of medical products for seniors, Aging2.0 seeks to facilitate collaborations between senior care providers and entrepreneurs to create products and services that can be integrated into their businesses.

The scene

The event was held at the modern, tech-oriented community space of SeniorPlanet.org in Manhattan. (The tagline for SeniorPlanet.org is “Aging with Attitude.” One of their recent articles is titled, “Is it time for #OscarsSoYoung?”)
The large, windowed, ground floor room on West 25th Street was filled with the animated clamor of innovators munching on crudité and discussing products to better the lives of elders. The youngest attendees appeared to be twenty-somethings and the oldest participant was octogenarian and aging activist Muriel Beach, Chief Elder Officer and a judge for the event.

The format

Each inventor had several minutes to pitch their product and take questions from the four judges, who also included the CEO of 1-800-Wheelchair Joseph Piekarski, HealthTech Angel Investor Sacha Levy, and AARP’s Director of Market Innovation Jeffrey Makowka.

Aging2.0’s host Crispin Baynes kept things moving along swiftly and explained that the winner of the event would receive cash, mentorship and an international spotlight, going on to pitch at Aging2.0’s inaugural Americas Summit in Toronto on June 21, 2017.

The inventions

Nine people pitched their products, which were designed to assist elders with a wide variety of challenges.

For the entire article, visit:

Enthusiasm and ingenious inventions at the NYC Aging2.0 Global Startup Pitch Event

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Remember to breathe http://www.mybetternursinghome.com/remember-to-breathe/ Wed, 15 Mar 2017 02:34:29 +0000 http://www.mybetternursinghome.com/?p=6442 Here’s my latest article on McKnight’s Long-Term Care News:

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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

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