Dr. El - October 10, 2018 - Communication, Customer service, McKnight's Long-Term Care News, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
Observing the customary cacophony at the nursing station, I’d estimate that so-called “alarm fatigue” contributes to more than a few tragedies in long-term care.
Here’s one example that resulted in a lawsuit filing after a resident died when nursing staff ignored the alarm signaling that her ventilator had become disconnected.
That’s why I was so interested in a Stat news article “Anatomy of a Beep,” which focused on collaboration between Medtronic, a medical device company, and Yoko K. Sen, an ambient electronic musician. The feature describes how medical devices came to have the sounds that they do — “alarms that are easily confused and difficult to learn and don’t really tell us what’s wrong” — and efforts to create a more helpful and appealing healthcare soundscape.
While the Medtronic project is geared toward a hospital emergency department with its plethora of health monitors, long-term care operators hoping to avoid alarm-fatigue-related medical catastrophes might take note of their efforts.
Among the many sounds typically competing for the attention of nursing home staff members are ringing telephones, television sets, conversations among staff members, overhead pages, elders calling for help, chair alarms, escalating arguments between residents, completed tube-feed nutrition cycle indicators, noisy nebulizers and oxygen concentrators, exit door and elevator warnings, and call bell signals. Specialized units such as ventilator programs will blare additional alerts.
While some employees are fortunate enough to be able to move to a quieter unit to complete their duties, most must contend with a din they have limited power to change. Researchers have found that noisy healthcare environments can significantly increase workers’ level of distress.
Residents, unless they can independently ambulate, have virtually no ability to escape the hubbub, which can border on an abusive level of noise pollution and can negatively affect their perceptions of their stays. In addition, studies have shown that noise can disrupt sleep and increase the likelihood of delirium.
Consider taking a moment to listen to the soundscape of your facility. Stand by the nursing station, close your eyes and imagine that the sounds are the backdrop for your eight-hour workdays, or your life, 24/7.
Below are some adjustments that can enhance the aural environment:
For the entire article, visit:
Dr. El - October 7, 2018 - Anecdotes, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Personal Reflections, Role of psychologists, Something Good About Nursing Homes
Here’s my latest article on McKnight’s Long-Term Care News:
“No,” Diane said when I showed up at her door for our Thursday session. “I don’t want to talk to you. I’m too aggravated.” She turned her head and looked out the window for a moment.
“I’m surprised.” I replied. “We had such a nice conversation the last time. Plus, being aggravated is a perfect reason to talk to the psychologist.”
She looked back at me and sighed with exasperation, “Fine! Sit down. But I’m not going to be very good company.”
“You don’t have to be a star, baby, to be in my show.” I sang the refrain to the old song, mostly on tune.
She rolled her eyes. “They’re driving me crazy here,” she began, launching into an account of her recent fall on the way to the bathroom. “And now they won’t let me do anything by myself! They’re always yelling at me to wait for them, but then they don’t come when I call for them.”
It was the same tale I’d heard from two residents in my other facility that week.
********
Maya was a frail woman in her late 70s who navigated around her room with a walker. She spent most of her time alone, crocheting colorful booties that she carefully tied onto the walker frame, which served as a display for her wares.
“Five dollars each,” she told me, when I commented on her handiwork. Her earnings, I learned several sessions later, were going to her disabled son, who came to the nursing home every few weeks to collect the money she’d made for him. “He’s a good boy,” she assured me.
Maya had been placed on the dementia unit, though she didn’t have dementia. Residents wandered in and out of her room, touching her yarn and the slippers. She yelled at them to stop, leading to chart notes saying she was agitated and eventually to a move to a different floor.
Once among residents more similar to herself and assigned to a consistent, experienced aide who took her under her wing, Maya’s mood and behavior improved considerably and we discussed concluding our sessions. I arrived for our last meeting with a $5 bill in hand and left with a beautifully crocheted pair of booties I didn’t need.
For the entire article, visit:
yarn in apile
Dr. El - September 19, 2018 - Business Strategies, McKnight's Long-Term Care News, Technology
Wednesday September 26, 2018
Earn 3 Free CEUs at 3 Free webinars
Once again, McKnight’s will host its annual Fall Online Expo, which is a chance to attend a conference without leaving your desk. Register for the conference in advance, and then log in to hear the talks, visit the vendors, and chat with the reps and attendees. This year’s topics are:
· TECHNOLOGY: Cyber threats and compliance challenges: Managing technology risk in aging services
· STAFFING: New strategies in staffing: Developing a partnership with your local university
· PAYMENT: Are you ready for the changes coming to MDS 3.0?
Dr. El - September 19, 2018 - Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Motivating staff, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
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:
Dr. El - September 5, 2018 - Business Strategies, Depression/Mental illness/Substance Abuse, Engaging with families, McKnight's Long-Term Care News, Resident care, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
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:
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STR residents lodged together find a group of peers in the same situation as themselves, which can be enormously reassuring in anxiety-provoking times.
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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.
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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.
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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.
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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:
Dr. El - August 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, Inspiration, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
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Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
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Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
For the entire article, visit:
Dr. El - July 31, 2018 - Business Strategies, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I once rode down a crowded afternoon elevator with the CEO of a managed care company. “It must be 5:01,” he commented wryly. I heard a measure of scorn for his employees’ lack of dedication to the job. What I saw was a group of people fleeing from utterly uninspiring and unappreciated work.
Similarly, in long-term care facilities with high staff turnover, some may see an absence of commitment on the part of workers, while others recognize that there’s something wrong with the job and the way employees are being treated. If workers are fleeing for the private sector, it’s not because they have an intense desire to work at Burger King.
Managers are no doubt familiar with many ramifications of turnover, such as the time and expense of finding and training new hires, the overtime costs for filling in shifts and the need to engage expensive agency workers. It’s also recognized that staff become demoralized in a high-turnover environment and that the quality of care can suffer — two points worth considering in more depth.
When key employees depart — such as nursing supervisors, department heads and nurses — direct care staff may be hesitant to bring problems to new workers just settling in to their jobs. Without the ease that develops between team members over time, important information may not be relayed, glitches in the system aren’t identified and resolved, and problems can fester and multiply.
When staff retention is low, workers become burned out on meeting new team members. They don’t want to put in energy toward welcoming newbies because they know the likelihood is that the individual isn’t going to stick around. This exacerbates the problem because a new worker who doesn’t feel welcomed is less likely to remain with the job.
The impact on residents is profound. Residents are in a vulnerable position, reliant on others for their most personal needs. It’s difficult for them to adjust to being assisted with toileting and bathing by a familiar person, but an unpredictable rotation of strangers who are new to the work adds another level of stress to their lives. For residents with dementia, expect an increase in distress — and the kinds of behaviors that make new hires less likely to remain on the job.
Turnover begets more turnover.
Dr. El - July 29, 2018 - Books/media of note, Personal Reflections, Role of psychologists, Talks/Radio shows
NursingAssistantGuides.com, an educational site for certified nursing assistants, has a new podcast series featuring experts in the field of geriatrics and long-term care. The podcasts offer the chance for those considering or working toward becoming a nursing assistant to get insider information about the field. I was pleased to be interviewed by registered nurse Patricia Laramee about mental health and elder care for their most recent podcast.
To listen, click HERE and be sure to check out the other excellent podcasts on this page.
Patricia Laramee, RN of NursingAssistantGuides.com
Dr. El - July 19, 2018 - Depression/Mental illness/Substance Abuse, For Fun, For Recreation Staff, McKnight's Long-Term Care News, Resident care, Stress/Crisis management, Tips for gifts, visits
Here’s my latest article on McKnight’s Long-Term Care News:
“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 - July 5, 2018 - For Fun, Inspiration, McKnight's Long-Term Care News, Personal Reflections, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
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:
