The World According to Dr. El

In the wake of a nursing home double-homicide: How to meet mental health needs and prevent violence

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Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

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 — the alleged murderer is 56 years old and one of his two victims was 50 years old.

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.

Calm fears

·      Soothe nerves by pointing out efforts your facility takes to address agitated residents and maintain the safety of the environment (for example, the security guard, video cameras, separating residents in conflict, etc.)

·      Minimize the news coverage of the event in common rooms. Residents who want to find out more information can read the newspaper or watch TV privately. It's not helpful for most residents to listen to an anxiety-provoking rehash of information, especially when they're unable to get up and leave the room.

Train staff

·      Train staff to recognize signs of distress and mental illness in residents and have a system in place that allows the information to be communicated effectively. Aides, for example, don't have to make a mental health diagnosis; they just need to be able to recognize when a resident is behaving differently and communicate it to the nurse. Train nurses to recognize the importance of the information and to work with the team to assess the resident and intervene appropriately. Mental health issues should be addressed as seriously as physical health concerns and staff should have enough training so that they feel comfortable doing so.

·      Train your staff on how to defuse verbally and physically aggressive situations. Staff members without proper training often inadvertently precipitate conflict. (For more on this, download my free report, Stop Agitating the Residents, at MyBetterNursingHome.com.)

·      Remember to include night shift and weekend staff on all trainings and to incorporate them into team meetings and staff communications. There are many more hours in the nights and weekends than when administrative staff are there. These workers see important aspects of care (such as sleeplessness and drunken late-night returns from home passes) and need to know how to handle challenges in the absence of the administrative staff.

Make use of mental health experts

·      Ensure that social workers, as the primary mental health team members, have enough time to get to know their residents and aren't inundated with admissions, discharges, and other administrative tasks.

·      Schedule psychiatrist visits on a regular and consistent basis. Distinguish urgent consults from routine follow-ups and attend to them immediately.

·      Refer residents to the psychologist upon admission if they have high-risk factors such as

o   History of depression or other mental health problems

o   Substance abuse history

o   Recent serious medical diagnosis, especially those that result in a decline in functioning such as a stroke or an amputation

o   Younger residents

·      If residents are having interpersonal conflicts, experience a decline in physical health, lose a friend or loved one, or have a change in demeanor or attitude, refer them to the psychologist.

·      It's best to offer psychological services to residents as soon as problems are noticed, especially interpersonal conflicts. Don't wait until the resident is angry with all the staff on the unit or vice versa.

·      If the resident doesn't need psychotherapy at the time of the assessment, at least he or she will know the service is available and that staff members care enough to offer it.

·      Referrals to mental health professionals are often more acceptable to potentially resistant residents if phrased as part of a standard procedure that's provided “because it can be stressful to be in a nursing home.”

Consider behavioral health rounds

·      Review procedures to ensure that adequate mental health support is offered to all residents and particularly to those with challenging behaviors. In addition to having psychiatrists and psychologists consulting in your facility and seeing individual residents, consider holding behavioral health rounds on a weekly basis. This allows the team to discuss difficult situations with the mental health consultants and to create a unified and consistent plan. Ensure that aides and other essential team members are present – those that know the resident best. If they can't be there, find a way for them to communicate their observations to the team.

·      For more on incorporating mental health tools in a team approach, read The Eldercare Method, which applies to residents of all ages.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an accomplished speaker and consultant with over 17 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.

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