Inside the mind of an LTC shrink
Eleanor Feldman Barbera, Ph.D.
Editor's Note: This is the debut of “The World According to Dr. El," a McKnight's blog from psychologist Eleanor Feldman Barbera. Look for updated posts regularly in this space.
I sat in morning report as the nursing supervisor announced the arrival of a new resident. An 80-year old woman was taken to the hospital after a fall at home, where she received a below-knee amputation and contracted C. diff before being transferred to our facility.
I looked around the room and speculated about what each of my team members were thinking, imagining thought bubbles over their heads:
- The wound care nurse was wondering how the leg was healing.
- The rehab director was considering the chances an 80-year old woman might be able to manage on a prosthetic leg.
- The infection control specialist was mentally reviewing a checklist of infection control procedures that needed to be put in place.
- The social worker was hoping the woman lived in a ground-floor apartment.
What was I thinking about this new admission? I was worried she might be suffering from symptoms of Post-Traumatic Stress Disorder if she had been alone on the floor for any length of time after her fall.
I pondered how she might be handling the assault on her femininity of losing a leg. I wondered about the quality of her family supports and whether she'd consider attending the choir performance where one of the soloists was a glamorous amputee from the third floor.
I hoped she had the grit and determination for rehab with a prosthesis or the spiritual strength to handle life with one leg, and that she would be willing to talk with me about the changes in her life.
Fortunately for the newly admitted lady, most of my colleagues have the concerns of their disciplines represented at care plan meetings and other formal discussions. The voice of mental health is a louder one now that MDS 3.0 requires asking residents themselves about their mood symptoms, but psychologists and psychiatrists are still most often consultants rather than formally on staff, and still most often consulted in reaction to an obvious problem rather than proactively to prevent problems. Their contributions are made through chart notes and conversations with staff members at the nursing stations, rather than at team meetings where decisions are being made.
And fortunately for those of you who recognize the impact of mental health upon, well, everything, McKnight's has decided to run a regular blog addressing mental health needs in long-term care.
You'll be able read the thought bubble over my head regularly as I tackle the mental health concerns not just of the residents, but also of the staff members who balance job and family to work in an emotionally challenging environment.
I'll be looking at ways to adjust programming to create mentally healthy facilities, offering suggestions to shift the role of family members from adversary to ally, and weighing in on the issues of the day. Please feel free to write with questions about how to handle sticky situations or improve any aspect of mental health care in long-term care.
The doctor of psychology is in.
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, her blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.