Dr. El

I had the pleasure of being interviewed recently by Susan Ryan, senior director of The Green House Project, for her Elevate Eldercare podcast. As I remarked to her, what could be better than talking with someone kind and knowledgeable about something I’ve been obsessed with for more than 20 years?

We spoke about the experiences that inform my thinking about long-term care, and we addressed topics such as the disconnect between mental and physical health, the moral injury and staff burnout exacerbated by the pandemic, and ways of better supporting staff, families and facilities in their efforts to provide quality care.

Readers can listen to the podcast here, and I’d like to expand in this column on some of the points discussed in the conversation.

First, let me call attention to the fact that there are not a lot of mental health professionals in long-term care; it’s first and foremost a medical setting.

The voices that we hear from regarding care tend to be physicians and nurses, and increasingly, nursing aides. On the business and policy side, we’re informed by CEOs, heads of trade organizations, healthcare economists and policymakers. Families and resident advocates have a place at the table. 

But there’s less often a mental health perspective on long-term care, especially from those embedded in nursing home teams.

Many of the problems facing LTC, however, can be mitigated by using a mental health lens: staff burnout, unappealing facility cultures, family distress, subpar end-of-life care, the increasing population of residents with severe mental illness, etc.

One of the subjects we addressed in the podcast, for instance, were my efforts to overcome post-traumatic stress disorder after working in the pandemic epicenter. Whenever I write or speak about this, someone tells me afterward, “I just realized I have PTSD,” or, “I feel seen. Thank you.” As facilities seek to address continued staff burnout, keep in mind that acknowledgment and witnessing are a vital part of how people heal from trauma and how they regain trust in leadership. 

Susan Ryan and I also discussed ways to overcome the information disconnect between leaders and employees, which can affect quality, cost of care and staff retention. Bridging the hierarchy and incorporating “worker voice” can lead to improved and streamlined processes.   

One of the techniques I mentioned was The Sleepover Project, where leaders spend a night in their facilities, interact with residents, staff and families, and see what’s happening on the front lines of their organization. A psychological question for any leader who hesitates to do this might be, “What am I afraid of?” 

This is a legitimate query that deserves exploration. Is it the amount of time it would take? The loss of control? Is there fear that the facility is so dreadful that one night would be unbearable? Is there a wish to avoid knowing that this is the case? 

Dig deep and then weigh these factors against the benefits of sleeping over, such as morale building and discovering needed changes that only leaders are in the position to make. For a facility to run successfully, it’s vital that there’s a flow of information from leaders to the front lines and vice versa. Develop as many ways as possible in which to communicate with and learn from employees. 

Our discussion touched on incorporating a psychological approach into working with teams and families with the goal of reducing turnover, family distress and problems with communication, with many suggestions offered. We also mentioned the limitations of a punitive approach to nursing home reform.

If the ideas on the Elevate Eldercare podcast intrigue you, note that I’ll be delving into some of them further in the free April 5 McKnight’s Long-Term Care News webinar, “Creating wellness, reducing costs: Targeting the emotional health of residents, staff and families.”

As the industry undergoes a period of change, I hope readers take opportunities to hear from direct care workers and to consider the benefits of better integrating mental health supports into every aspect of long-term care. 

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.