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.
I've heard many complaints about roommates from residents over the years. While some roommate difficulties need to be addressed on a situation-by-situation basis, most conflicts revolve around a few basic issues. Here's a handy guide to conflicts and potential resolutions to print out and give to staff.
"I hope Santa brings me a Sony DS," my 7-year-old told me the other day. I can tell you right now that Santa is NOT bringing her a video game player, but I didn't want to tell her that. So I did what I imagine most parents would do in that situation: I asked her what else she hoped Santa would bring. What does this have to do with long-term care? As it turns out, a lot.
The upcoming holidays are an ideal time to provide extra services that showcase your high level of care and make the seasons more pleasant for families and residents.
Since I now Skype regularly with my 94-year old father-in-law and his wife, the concept of telemental health doesn't seem as futuristic to me as it used to seem. I was shocked to discover, however, that the American Telemedicine Association (ATA) was established 20 years ago, with the first applications of telemedicine occurring over 40 years ago. Apparently, I've been behind the times.
I used to live in a fabulous old fourth-floor walk-up apartment in Manhattan. When I moved out of Manhattan to a borough of New York City for an elevator building with a laundry room in the basement, I made a conscious choice to pick a place I could live for the rest of my life if I had to. "That ramp could come in handy if I need a wheelchair, I reasoned. And if worse comes to worse, I'll move into a nursing home and blog from there."
I was very pleased when I heard there was a program about a long-term care facility on British television. Finally we're getting our props — at least overseas.
Of the most efficient countries for healthcare, the United States ranks second in healthcare costs per capita but 46th in efficiency (out of the 48 countries ranked!). The move from a biomedical to a biopsychosocial model of healthcare might be able to change that. Maybe you're already doing it without realizing it, in fact.
Last week, McKnight's staff writer Tim Mullaney wrote about the new Medicare guidance that guarantees that same-sex married couples can live in the same nursing home. Is your staff prepared to offer them the same respectful service as always, and are you prepared to lead, regardless of your personal beliefs? I'll bet you're not.
As a psychologist consulting in long-term care facilities, I provided a lot more than I was paid for, because it was needed. But 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.
According to researchers, 11% to 43% of LTC residents have thoughts of suicide, with higher rates in larger facilities and in those with more staff turnover. Other stressors include medical illness, the presence of a mood disorder such as depression, social isolation, and recent life stressors - factors that frequently affect our residents.
Social connections, individual preferences and strong resident councils are among the ideas for what makes a strong long-term care facility.
John O'Connor's recent post on the pain/depression cycle raised some interesting points about depression in long-term care. Reducing learned helplessness that is often seen in depression is something more providers need to be trying for.
Nearly one in seven nursing home residents is now under the age of 65, and the number could rise. That's creating challenges for caregiving staffs that could blossom into big problems — if caregivers don't adapt better. Luckily, there's help.
Award-winning journalist and author Joan Lunden has learned a lot from dealing with her 94-year-old mother's housing and care. Also a physician's daughter, she recently passed along to me some excellent tips for long-term care professionals, which I now pass along to you.
Someone posted a story I Liked on Facebook about an 85-year old woman who graduated from college and already had a job offer. "She's my new hero!" a Friend commented. That got me thinking about all the resident heroes I meet at work every day. They're the ones who help me along the journey to having the kind of life I can look back on without regrets when I'm in my nursing home room in my senior years.
I'm a big advocate of taking small steps in the direction of change. Perhaps your organization isn't in the position of being able to upgrade the health insurance package or to install an onsite gymnasium for staff members. But here are some manageable actions along the road to creating a psychologically healthy workplace.
I started working in long-term care when I was in my early 30s and I was shocked at first when the residents died. I was used to falling in love with my patients. In order to make it in LTC, I've protected myself by falling in love in a different way.