Residents arrive at our doors, with sleep likely harmed by illness and pain, and changes in circadian rhythms. While we can't alter some of these factors, as care providers we can become more attuned to the importance of sleep for our residents and train our teams to create environments that are more conducive to slumber.
Both of my mothers-in-law live in long-term care communities in Florida. One lives in a place that was excellent about how they communicated with family members before, during and after Hurricane Irma. The other's facility handled that aspect of care poorly.
I often speak with healthcare groups, giving psychological insights about a variety of issues within long-term care. 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.
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. That image and others of the flood are undoubtedly causing concern in your community.
Speedy assistance should be the norm when falls occur, but the reality is that it's frequently a rarity. The staff is often stretched too thin. What can be done, aside from ensuring adequate staffing, is to reduce residents' anxiety, frustration and impatience.
Playwrights continue to do long-term care no favors, so providers need to continue to share stories of the good work they're doing. It's the way to help create a more realistic picture of LTC and the value we bring to people's lives.
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 the same contented expression that comes over virtually everyone popping a sheet of bubble wrap.
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!"
One of the things that most brightens my workday is when I see long-term care residents hanging out together.
I waited outside the room until the rehab therapists finished talking to Jim, who'd been admitted to the nursing home the night before.
It's impossible to prevent all tragic events at a long-term care facility, especially those involving an armed assailant entering the building despite an order of protection against him like in Ohio last week, but there are ways to reduce the likelihood of workplace violence.
I can imagine from an administrator's point of view that an unexpected interruption from an ombudsman complaining about problems is not exactly a welcome visit, but perhaps there's a way to shift the relationship to mutual advantage rather than keeping an office door closed.
Due to a series of unfortunate events, both of my previously independent parents were recently injured over the course of five weeks. Here are some thoughts from someone who's seen the long-term care world from both sides now.
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.
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.
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.
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 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.
Cold weather. An uncertain world. Rogue shrinks making the rest of us caring, diligent professionals look bad. I don't know about you, but I need a mood lifter.
It's easy to become overwhelmed and to have the information presented by a medical professional blur so that it sounds like a Charlie Brown cartoon teacher declaring, "Wa wa wa wa, wa wa wa wa wa wa." I recently learned of a promising program to teach families — particularly Hispanic families — about dementia.
Rather than resolve to do more than I can possibly accomplish, I prefer to view the beginning of the year as a time to examine the course I've been on and to make corrections as needed.
Many relatives have no idea how to best engage with their loved one in long-term care. When 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.
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 2016 presidential election has revealed a deep rift in our country, and quite possibly in our long-term care facilities as well.
In preparing for a webinar on suicide prevention, I came across startling statistics about suicide rates among older adults. Despite the concern we often hear about teen suicide, the rate for elders is even higher.
After reading a recent New York Times Opinion piece about the uses of lotteries to solve social problems, I began contemplating their potential application to long-term care. An element of fun might be a welcome addition to what's typically a very serious business.
Forget about worries of them eating up staff time or triggering something bad on surveys, resident councils can be awesome for your facility and here's why.
Once, when I worked for a managed care company, I rode down a packed elevator with the CEO, who commented drily on the crowd, saying, "It must be 5:01." What I thought, but did not say, was that there were reasons his staff members weren't staying more than a minute past the hour.
When I spoke about the challenges of staff turnover at the Louisiana Nursing Home Association convention last week, I asked the group, "If you were able to bring in the same salary you were currently making, would you want to have the job of an aide?"
Why are they keeping track of peanut butter and jelly sandwiches? I appreciate their concern that residents might have our lunches served late, but what about the tuna fish sandwiches? And the chicken? Doesn't it matter if those are served late as well?
I told residents that I was writing an article on advice from elders about how to live life and their responses were immediate and enthusiastic, as if they'd been waiting for someone to ask.
When it comes to 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.
Given the racial tensions in the news this week, I thought it would be a good time to reflect on interactions among races in long-term care. I've observed firsthand various culturally charged interactions — both positive and negative.
Reducing the costs of long-term care "super-utilizers" first requires recognizing them as such. Then proceed carefully, and with an investigative eye, to increase the likelihood of successfully meeting their needs and decreasing expenses.
I've become more diligent over the years (read: paranoid) about making an effort to sanitize my hands as I move from room to room. But I wonder about those whose roles in long-term care don't specifically emphasize infection control procedures.
Assistance in creating a "good death" is a fundamental task of any organization working with elders and may be addressed by a number of team members singly or in combination. Since these discussions are often easier said than done, I thought it might be helpful to share some of my experiences since I, as a geropsychologist, regularly discuss dying with residents and their families.
Feeling "down" takes on a wicked double-meaning for some seniors. Even conscientious providers could be unaware of it, let alone know what to do about it.
There is much that can be done to improve the quality of life for dialysis patients at your facility and showcase your facility as dialysis-friendly at the same time. Unfortunately, many providers are not doing all they can to help these people, or boost their own business operations, for that matter..
I had a chance the other day to see what it feels like to be 85 years old, thanks to a test drive of the Genworth R70i Aging Experience suit. Talk about being transported to another world. This is a pure empathy builder.
When it comes to dealing with residents who are hoarders, facilities are often caught between a rock and a hard place. Here's how to deal with it.
"Trudy's here!" exclaimed the resident I'd been speaking with, excusing herself for a moment to exchange a few dollars for a bottle of lotion. "She buys me the things I can't get here. She's a real lifesaver." It was a sentiment I heard echoed by many other residents.
Research now suggests there may be a solution for residents lacking sleep, experiencing depression or falls, or other certain conditions — and it involves no medication or side effects. The answer could be the use of light.
More quality initiatives are on the horizon for many providers, and they address a wide array of necessary topics. Here are a couple of experts' insights.
Wondering how an employee could possibly think posting a photo of a resident's behind to social media would be a reasonable action to take, I contacted a psychologist and social media expert.
Culture change can be portrayed as many things. One possibility often overlooked is its being a grassroots effort that shifts the dynamics between residents, staff and community, one unit at a time.
Placebos could be a better friend than you realize in the universal quest to reduce the number of medications that elderly patients receive. Don't believe me? Read on. (It won't hurt.)
In the wee hours of the night I recently discovered a Facebook post about a company founded by two brothers called Life is Good. It emerged from the standing request the founders' mother had for them as children in a chaotic home environment: Tell me something good about your day.
There are many givers in senior care facilities. Sometimes they don't even realize it themselves. This holiday season is a good time to recognize them — and the things that make smiles bright.
After a staff training on reducing burnout in long-term care last week, a look through the evaluation forms was illuminating. A significant number of attendees — mostly nursing aides, nurses, and environmental workers — wrote that the most valuable point they got from the training was how important it was to take time for themselves, even if it was for just a few minutes.
To get us in the spirit of gratitude for Thanksgiving, I've included a sample of grateful comments made by residents to their psychologists. The nice things they say can really make things better.
Despite the diversity of the events I attended during my brief visit to the LeadingAge convention in Boston last week, a theme clearly emerged. The thread that ran through the varied offerings was well-being
Some of the reasons employees leave are beyond our control. But many are not. Here's how to start figuring out how to stop the flow and reduce turnover.
There have been thousands of movies and TV shows about the exciting work of cops, lawyers, and hospitals, but long-term care? Fuhgeddaboutit! Until now.
For the treatments to help dementia patients, turn to behavioral health solutions, not antipsychotic drugs. Just like others around the world.
When a resident enters long-term care, we tend to focus solely on the needs of the resident, even though they're almost always part of a family system that is being affected by their placement. If we consider that we're admitting families rather than just the residents themselves, we'd recognize the need to provide family-centered care in addition to resident-centered care.
Given the stresses of caregiving and the complexities of human relationships, incivility happens. But considering the potential impact of rudeness on care, we need to do more to understand and prevent rudeness when we can. Here's how to start.
In the beginning of my long-term care career, I quickly recognized that in order to be of service in this environment, I needed to come to a spiritual understanding of how such nice people could be dealing with such difficult illnesses. This was important because psychology graduate school, much like med school classes, definitely had not focused on clients' spiritual needs.
I hung up the phone with the managed care case reviewer. The patient in question was in her late 50s, with multiple sclerosis and other physical problems that had left her bed-bound. What else would need to happen to get her more than a month of treatment? An amputation? The death of her only child?
These days, with organizations being penalized for rehospitalizations and closely monitored on clinical outcomes, it would probably be very worthwhile to provide a group of elders with some pet fish, food and a tank — along with their own self-care training before discharge or after diagnosis.
Residents and their families count on us to support them along the emotional and often frightening path of end-of-life care. We can help our residents have a "good" death and make the experience less painful for their families — and us, as LTC workers.
I believe leave-takings in long-term care are more important than in other settings and that the style of departure should be given more consideration.
Though it was close to 20 years ago, I'll never forget the reaction of one of my patients to losing both of her legs to diabetes. Residents like her make it quite clear that it is possible to be grateful and to live fully, despite disability.
A recent high-profile court case in Iowa highlighted the challenges that arise when considering capacity, sexual activity and the senior living environment. Long-term care psychologists met recently to sort the issues.
I've been fortunate enough to attend several senior living conventions recently and my enthusiasm for the experience has yet to diminish. You would feel the same way, and here's why.
My first-ever trip to Oklahoma for a speaking engagement recently included no fringed surries. But there was a bustling, well-run long-term conference, animated conversations with attendees, life-altering products in the expo hall and much, much more. Much more.
Reducing loneliness among facility residents has numerous benefits — for residents and staff. So why aren't we doing better at it? Here's what you need to know.
As a psychologist observing the effects of medical interventions on the mental health of the long-term care resident, I often ask, "Is this aggressive procedure helping?" As it turns out, so are others.
When I learned about Neurocognitive Engagement Therapy for rehabilitation residents, I had the same reaction I did when I first heard about geriatric emergency rooms: Palm-smack to the forehead, "Why didn't we think of this before?!"
We've come a long way with many psycho-social problem areas. Children, for example, start learning about bullies in kindergarten. When it comes to bullying in senior communities, though, we're still behind the times.
Last week, I delivered a keynote address on "Identifying and Repairing Communication Gaps in LTC" at an LTC and Senior Living Summit. It was a fascinating, energizing event, and not just because I was leaving the frigid temperatures of New York City to dine outdoors in Marina Del Rey.
If we address new residents' hidden concerns, we can better show them we understand and care about how they feel. We can enhance their experiences upon entering our organizations and can market our services in a way that relieves their anxiety.
How someone dies is a very important part of the culture of the long-term care organization. Odds are your community can improve its culture in this area.
We all can use practice harnessing "less laudatory traits," such as short-sightedness, inertia, inflated optimism and our tendency to submit to peer pressure. Especially for our work. Here's how.
It was the night before Christmas, Hanukkah was ending and Kwanzaa was right around the corner. The perfect time for a poem.
Jane Gross' recent post 'Seeing the Invisible Patient' in the "New Old Age" blog of the New York Times discusses how professionals often ignore the needs of caregivers of the elderly because they are focused on their identified patient. While the article centers on the burdens of caregivers in the community, it got me thinking about whether we're meeting the needs of families whose loved ones are in long-term care.
I owe a lot of my blessings to working in long-term care, and my LTC career is a blessing in itself. You might have some of these same feelings.
Transitions between care settings are getting more scrutiny than ever before. So thank goodness for new guidelines designed to help smooth them out. Still, we need all the help we can when it comes to improving communication among fellow caregivers. And I have proof.
If you, like me, completely missed the 2005 White House Conference on Aging (or if you weren't in the field at the time), it's fair to ask just what the heck it and does. And what it means for eldercare professionals. Read on for the answers and my take on it all.
There's nothing like the first time you get to meet people, attend education sessions and see the exhibit hall at the American Health Care Association, as I found out last week. If you weren't there, you missed a lot.
While conducting a training session last week in Montana, I was lucky enough to have a group of more than 100 staff members from various long-term care departments share some excellent suggestions on how to engage residents with dementia. They're too good to pass up.
From a psychological perspective, here are some ideas to prevent or reduce disagreements with residents and their family members over care, thereby decreasing the likelihood that a situation will result in legal action.
With the mandate to reduce the use of antipsychotics, many facilities are looking for alternative methods to address the behaviors often associated with dementia. There are several good resources available for training staff, including your consulting psychologist. Here's how he or she can help:
Like many, I'm taking some vacation time during the month of August. It got me thinking about the ways workers interact with residents when they take time off from their jobs. It's more important than you might first think.
According to the American Geriatrics Society, one in three adults over the age of 65 falls each year. Falls represent the leading cause of fatal and nonfatal injuries among older adults. You might be surprised to hear some of the contributing factors of falls and the psychology behind them. I also have advice on ways residents and staff can reduce the likelihood of falls.
While most psychologists almost exclusively address the mental health of nursing residents due to the current reimbursement system, we're also aware of the interactions between staff members, families, the physical setting and the organizational culture. Here are some of important things psychologists might do to address the emotional climate of long-term care.
In my recent post, "Stuff I won't do for residents and why your staff shouldn't either," I wrote about the need for individual workers to set appropriate boundaries around caregiving in order to retain the ability to give without burning out. In this article, I examine more closely the symptoms of burnout and ways facilities can reduce its likelihood — which is particularly important given the link between burnout and turnover.
In my conversations with hundreds of long-term care residents over the years, I've found money to be an almost universally sore subject among them. Financial concerns continue to be a stressor for our residents even though they're living in the mostly money-free society of LTC. With some adjustments we can — and should — reduce our residents' financial distress.
We may talk about the term "customer service" and ask our staff members to avoid public arguments in front of residents and family members. But nevertheless, volatile situations happen every day. It matters a lot, and here are the psychological implications why.
I recently focused on the benefits of recognition and key points in choosing a recognition program. Now I'd like to address how to implement your chosen employee recognition program so that it becomes an energizing and integral part of your organization, rather than a short-lived promotion that fizzles after its initial burst of enthusiasm.
I've developed a set of suggestions for working with "challenging," anxious residents, who can disrupt everyone around them. If caregivers don't have sound strategies like these, patients, caregivers and others will suffer.
News of the recent double-homicide in a Houston nursing home arrived the morning I was to speak to a group gathered to address the needs of younger residents in long-term care. It didn't escape anyone in the audience how serious this topic is. What can organizations do to respond to this terrible news and to reduce the chances that a similar situation could happen in their facilities? Plenty.
Senior living providers can design programs that increase the opportunities for residents to be valued within their communities and in the outside world. They have nothing to lose but high depression rates. Here are some ideas to start with.
Those of us in long-term care have undoubtedly witnessed incidents where residents become agitated and staff members don't have the tools to prevent or manage their distress. Unfortunately, psychologists — who could offer such tools — are largely limited in the current reimbursement model to providing individual services to cognitively intact residents.
In my last post, I discussed culture change and its positive impact on the mental health of the residents, particularly at Eden Alternative facilities. I recently also had the opportunity to tour a Green House, which I'd heard about but had never seen. I found this model turned everything I'd known about nursing homes upside down.
Culture change, the Eden Alternative, whatever you call it, things are moving in that direction. In my experience, the nursing home I worked in that was most attentive to the psychosocial needs of the residents was the one that was in the process of becoming an Eden Alternative home
Many, if not most, of the services offered in the nursing home can be provided through home-based care. What sets nursing homes and other long-term care sites apart is the opportunity for residents to socialize with each other with ease. Savvy facilities will make the most of promoting their recreation programs and facilitating connections among residents and their families.
The turnover rate in long-term care is a very significant problem, so I dug into the research about it. Some of the findings were shocking. Others were simply very disappointing. Here's what I found, and what can be done to improve conditions.
After Ms. Ryan's psychotherapy session, I stopped at the nursing station and asked the nurse for the name of her aide. The nurse pointed to a uniformed woman right next to me, who turned and asked me with hostility, "How do you know it was me?" Surprised, I responded, "I just wanted to tell you Ms. Ryan was really happy with how you did her hair today. She wanted me to thank you for her." The aide appeared stunned. The nurse commented, "We usually expect complaints, not compliments."
In my last post, I wrote about some of the many things I do for residents as a long-term care psychologist. The astute reader will note that most of the tasks were accomplished during work hours and within the facility. There's a reason for that.
Many of us in long-term care think of our jobs as a calling. We handle the day-to-day tasks and the business as usual but also get a lot of energy and joy out of taking our work one step further. Here are some actions I've taken that have enriched my patients and my role as a psychologist.