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.
Here’s my latest article on McKnight’s Long-Term Care News:
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.
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.
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.
Denise B. Scott, president of Drive Consulting, posted an intriguing story on LinkedIn the other day about a Scottish supermarket that partners with Alzheimer Scotland to help those with memory loss.
The workers are trained to understand how to help people with dementia, and the supermarket offers a “relaxed checkout lane” for seniors and others who might need a little extra time when paying for goods at the register.
On senior citizen discount day, the store posts a sign at the entry to the cashier’s line designating it as the “relaxed checkout lane,” allowing customers in a rush to go elsewhere. Those on the relaxed lane can check out slowly, without the pressure of worrying that someone behind them will get irritated.
The concept is so simple, easy and kind that I decided to ask my local supermarket if they’d join in.
Long-term care has an image problem. For a variety of reasons, we aren’t associated with good times. There are things we can do to turn this around, though, starting with the perceptions of our residents.
Most people who come to live in a long-term care facility struggle with a sense of failure. This isn’t because of anything that occurred in their lives prior to placement, but because many people view living in a nursing home as a sign of a failed life.
The most common comment I’ve heard from new long-term residents over the years is, “I never thought I’d end up in a place like this.” Some add, “Where did I go wrong?”
There are good reasons for providers to address the inherent sense of failure many residents feel in LTC placement: It can increase customer satisfaction, improve morale among residents and staff, and reduce depression among residents, thereby lessening the need for antidepressants.
The role of the psychologist
Part of my job as a psychologist is to help residents recognize that living in a long-term care facility isn’t a failure. It’s not a reflection of a life poorly lived or necessarily indicative of difficulties in their relationships with their children or other loved ones.
I do this in several ways, depending on the person and the circumstances.
I start by telling residents that I regard it largely as a societal problem. We’ve made advances in healthcare that allow people to live longer with chronic illnesses, but we haven’t yet devoted the resources needed to help people manage successfully at home and to support their caregivers. Long-term care is often the best solution under the circumstances.
Sometimes offering that view is enough to make them feel better about the situation, but other times more is needed. For example, Marie was a new resident who’d worked as an aide in a psychiatric hospital. She was distressed about living in the nursing home and had become irritable and withdrawn. I took her to visit a well-adjusted resident, Linda, who’d been a coworker and a union representative at the same psych hospital. They talked about the old days for 20 minutes and never visited together again, but Marie had a new acceptance for placement — if the nursing home was good enough for Linda the union rep, it was good enough for her too.
As a neutral party, I can provide the perspective that families and facilities can’t, pointing out, for example, how hard family members have worked to keep them out of the facility for as long as they did, how their relationships can reset once someone else is in charge of hands-on caregiving, and the benefits of living in a communal environment with easy access to medical staff and activities.
Organizational component
Aside from referring residents for psychology services, facilities can address this aspect of their image problem in several ways:
In his Dec. 6 McKnight’s Senior Living column, Editorial Director John O’Connor reported on a senior living center in Jiangsu province in China that offers cash rewards to people who visit their loved ones. Ten visits in a two-month period led to the equivalent of about $10; thirty visits brought about $29.
The result? The number of residents receiving regular visitors jumped from 10% to about half, no doubt making a huge impact on the lives of the residents and on the culture of the facility.
While this “positive reinforcement” obviously can be very valuable — and I agree with O’Connor’s alternatives to cash such as gift cards or entry into a raffle for a local restaurant — there’s a lot we can do to make family visits inherently more rewarding.
When long-term care providers accept the role of teachers, we can add great value to our services and enhance the experiences of the families who come to us for assistance.
The reality is that many relatives have no idea how to best engage with their loved one in long-term care.
Visitors often ask questions in ways that lead to frustration or embarrassment rather than the heart-to-heart they’re seeking. A television blaring in the background can make it difficult to maintain a conversation. Family members trying to do the right thing by visiting are met with disappointment and frustration rather than joyful connection. When visits don’t go as hoped, it can create what feels like punishment instead of reward.
Take a moment to listen to the comments of the visitors on the way out the door this holiday season. Look at their expressions. Do people seem satisfied with their visits or can more be done to create a pleasant experience? Astute administrators and nursing directors might overhear remarks such as, “Dad didn’t hear a thing I was saying,” or, “She couldn’t remember anything. I didn’t know what to say to her.”
Family visits can be vastly improved with some basic tools and education. Here are some ideas for this year and next:
The Savvy Resident’s Guide can help set reasonable expectations for your new residents and families, leading them to view their stays in a more favorable light. To see how, download a FREE Kindle version between December 7-9th and take advantage of Holidays Savings of 20% off bulk orders of 25 or more copies through Friday, December 23rd. Use the code MCKNIGHTS at checkout.
It’s like giving people 24/7 access to an experienced nursing home shrink who tells it like it is with gentle humor and answers every question before it’s asked. Put a copy in every rehab room and watch your customer satisfaction reviews improve!
For more great resources, read my latest article on McKnight’s Long-Term Care News:
Over the past year, I’ve been involved with several exciting long-term care-related projects that I can now tell you about. In the spirit of the season, I wanted to spread some good cheer with them*, and also offer a gift.
The first is a book entitled “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic” by Robin P. Bonifas, to which I had the honor of contributing a chapter. This volume addresses the effects of bullying among seniors and outlines actions which facilities and communities can take to address the problem. It provides step-by-step assessment strategies and anti-bullying interventions that will increase staff awareness and improve day-to-day interactions.
In another publication, fellow geropsychologists Kelly O’Shea Carney and Margaret P. Norris have put their years of experience to paper in “Transforming Long-Term Care: Expanded Roles for Mental Health Professionals.” As I state in my review of their work, “The book will … appeal to long-term care policy strategists and facility managers looking for ways to reduce costs while improving care quality and staff turnover.” The book digs deeper into the Eldercare Method (which I earlier discussed here) and outlines ways in which long-term care can make better use of its consulting psychologists.
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And finally, I’d like to offer the opportunity to download — through this Friday — a free Kindle version of my book, “The Savvy Resident’s Guide: Everything You Wanted to Know About Your Nursing Home Stay But Were Afraid to Ask.” This large-print guidebook provides essential facility-friendly information in an entertaining format for residents and family members regarding how to make the most of their time in a nursing home. (If you like it as much as I think you will, order here by Dec. 23 for a 20% discount for purchases of 25 or more. Use the code MCKNIGHTS upon checkout.)
*Full disclosure: I do not benefit financially from mentioning the resources of my colleagues or from any purchases of their products.
When it comes to resident councils, it’s often thought that an active resident council might seem good in theory, but that it’s offset by the amount of staff time required to devote to the process and concern that something written in the meeting notes will trigger an inquiry by state surveyors.
This line of reasoning, while raising legitimate concerns that need to be managed, gives short shrift to the benefits of a strong resident council.
Resident councils can be awesome for your facility and here’s why:
1. Residents tell it like it is: You know those things your staff members see but don’t mention because they don’t want to rock the boat? Residents are far more likely to speak up than the average staff member because they’re not worried about losing their jobs.
Some of them are like my Aunt Bevy, who used to tell me, “Eleanor, I can say what I want. I’m an old lady.” Tap into this important source of info and find out what’s really working, and not, in your facility.
Residents will tell you what you need to know to make your facility shine enough to attract more residents.
2. Free labor: I hate to be so crass about it but let’s face it: While everyone else is running around your organization like lunatics because they’re short-staffed, your residents are sitting around hoping for something interesting to do. We have a pool of diverse, experienced, motivated and often bored individuals yearning to be put to good use.
Sure, they’ll need some help to overcome their physical limitations, but working together they can effectively address many seemingly intractable problems. Maybe they could raise money to contribute toward an herb garden for the patio or start a welcoming committee to reduce the isolation of new residents. Ask them what they want to do – it might be exactly what’s needed to revitalize demoralized staff members and energize your institution.
My mother has a knack for taking something awkward and, as she puts it, “turning it into a feature.”
For example, the previous owners of our family home placed the living room couch in front of a protruding radiator so that the sofa was oddly and obviously a foot away from the wall. By contrast, my mother had shelves installed above the radiator so that it became a pleasant focal point for books, photos and the stereo system.
I follow this line of thought with regard to the need for assistive devices such as canes, walkers, and eyeglasses. It’s possible to convert something unappealing yet necessary into an item that bestows confidence, evinces a sense of humor or becomes more useful.
Turning assistive devices into a feature creates a psychological shift for the wearer. It gives residents an element of control over mostly uncontrollable circumstances and allows them to retain their personal style in a situation that tends to strip them of their uniqueness despite our best efforts.
An organization providing the opportunity to purchase or design desirable devices can generate a change in their culture. Seeing residents sporting colorful walkers or personalized wheelchairs rather than standard equipment sends a message of individualized care and a zest for life despite disability.
In the spirit of giving your residents an emotional boost and taking the sting out of the need for assistive devices, your organization might try some of the following ideas (found through my handy search engine):
• Residents can purchase sophisticated walking canes featuring fancy handles or colorful shafts with a wide selection of items under $50. I know many residents who would find that an excellent use of their Personal Needs Allowance (PNA).
• Another company features a colorful range of walking canes for about $40 each. Choices include floral motifs, Irish themes, US military and biker inspired designs.
• With PNA funds being as limited as they are, a decorating event is a great addition to the recreation calendar. Help residents embellish canes or create personalized walker or wheelchair bags to carry their belongings using colorful duct tape, Velcro and other supplies, or sew a handy cup holder.
