6 common problems a shrink on staff can solve (and your consultant can't)
Eleanor Feldman Barbera, Ph.D.
As a psychologist consulting in long-term care facilities, I was paid through Medicare, Medicaid, and/or private insurance for only one task: direct contact with residents. That's it. I provided a lot more because it was needed, but that's all I was paid for.
There was much more help that I didn't offer, not only because I wasn't paid for it, but also because the organization wasn't structured to accept this type of assistance. The facilities' needs were the kinds of things that made me sigh and shake my shrinky head in frustration. Oh, what we psychologists could do for you if we were on staff!
Here are some examples:
Problem #1: Admissions decisions
As your admissions department scrambles to fill beds and wonders whether the facility can manage a new resident with a psych history and a recent diagnosis of cancer, imagine if they could ask the opinion of the psychologist likely to be treating the resident. Now imagine if they could do this for every questionable admission. Psychologists could set up mental health services upon the new resident's arrival and you would have the support necessary to meet the mental health needs of the residents under your care.
As the number of residents with behavioral issues increases, this psychological screening becomes an increasingly important element of providing good care and preventing time-consuming problems on your units after admission.
Problem #2: Team Communication
Watching two aides argue about giving care to a resident over said resident's head or observing an essential piece of information get lost between shifts, I've fantasized about offering in-service training to eliminate these destructive behaviors. Not half-hour meetings sandwiched in between resident care, but real training that allows time for examples and practice as well as observation and feedback on the floors.
Real training provides the opportunity for staff to turn to the psychologist for guidance in handling the sticky interpersonal dynamics that are inevitable as people work in groups. It also offers assistance in designing and implementing procedures that facilitate written and oral communication.
Problem #3: Interacting with residents
Improperly trained staff members frequently escalate tense situations, cause unintended distress in residents, or miss cognitive changes that signal physical illness. They aren't doing this on purpose — they just haven't been taught how to handle such situations.
Before graduate school, I worked in an aide-like capacity in a residential treatment center for adolescent girls with emotional and behavioral problems. We had half-day staff trainings on a regular basis and you could practically see the light bulbs turning on over our heads. We loved the workshops because they helped us understand how to handle the behaviors we were encountering. Your staff will love them too. And you'll appreciate the reduction in absenteeism, work injuries, and complaints from residents, staff, and family members.
Problem #4: Families
When was the last time your organization held a meeting for families of residents? When you held the meeting, did you feel it adequately addressed the issues you targeted or did one or two people hold the meeting hostage while they raised personal concerns better handled in a private conference?
You could be harnessing the training of your staff psychologist to run groups that address frequent family concerns and to identify future education needs. Not only would this be an appealing selling point as families tour your facility, this would free up the time of your social workers to focus on other important tasks.
Problem #5: Policy development
An intoxicated resident returns from a Friday evening at home. Another resident is caught smoking in his room. A family member brings in sweets to a loved one with diabetes. Two residents are found sharing an intimate moment in bed.
Does your facility have policies to address these situations or are your staff members left to wing it when the occasions arise? Are your staff members adequately trained in how to implement the policies or is it left for the administration to sort out on Monday? A staff psychologist can help you develop appropriate policies and train your workers so that they're able to follow procedures, even on the weekend.
Problem #6: Milieu troubles
“I hate to take showers because the water is too cold,” Felix informed me. His aide added, “He scratches and hits me at shower time.” The note in the maintenance log went unheeded. Meanwhile, the constant overhead paging rattled the nerves of residents and staff alike, and residents were crammed into the overheated day room to watch grim news stories all day.
Psychologists are trained to observe and adjust the environment to promote a positive atmosphere — if you let them. Fixing the heating system might be costly, but it may very well be less costly than providing worker's comp for aides who are out on preventable disability, treating skin problems that develop from less-than-adequate bathing, and training new staff members after the old ones quit in frustration.
Currently, psychological services are a valuable and essentially free resource for long-term care facilities because of the reimbursement model, but they are a resource that's available only to residents.
Forward-thinking facilities will recognize the expertise of their psychologists and harness their experience and training to solve common problems costing far more than the fee for having a psychologist on staff. Innovative facilities will have their psychologist design a quick research study to prove the cost-effectiveness of their services (and then email the results to me).
Eleanor Feldman Barbera, PhD, the author of The Savvy Resident's Guide, is an accomplished speaker and consultant with over 16 years of experience as a psychologist in long-term care. A long-time contributor to McKnight's publications, this blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.