Dr. El

In my last blog post, “Boosting team resilience,” I briefly touched upon the need to recognize the pandemic-related trauma experienced by staff members and to better prepare for future catastrophes. 

The potential passage of the Build Back Better Act, with “roughly $150 billion to boost HCBS under Medicaid and $329 million in grant funding for recruiting, retaining and training long-term care workers,” as McKnight’s Danielle Brown reports, offers an opportunity to do just that.

In addition to the emotional distress caused by the pandemic, the reality is that we have ignored the mental health challenges of workers forever. The death of a beloved resident, the abusive family member, the staff conflict, the aggressive behavior of a resident with dementia – we have left workers to manage these situations and their emotional reactions largely on their own. It’s no wonder we have a turnover problem.

The pandemic has changed the way society discusses and seeks emotional support, with more openness about the value of mental healthcare and increased use of technologies such as telehealth. We can and should be participating in this cultural shift. With new funding streams, this is our chance.

Dr. El, you may be thinking, how can I pay attention to the emotions of my staff when my facility is (figuratively) on fire?

That’s where your psychologists come in. Yes, the quiet people who talk in private rooms with individual residents – because that’s all that has been financed – until now.  

The workforce investments of the BBB Act offer the opportunity to unchain your psychologists and partner with them to prepare grants for projects to train and retain workers, and to measure success. Psychologists have the education and experience to perform these functions. 

Grants could be used to establish mental health services within facilities that would treat not just the billable diagnoses of individual residents, but also address the concerns of workers, teams and family members. The mental health team could run support groups for new employees (improving retention), and for families (reducing time spent by other departments dealing with family dissatisfaction). 

The department could be called in to address disagreements between co-workers, or after the loss of a long-time resident or staff member. They would proactively assess the mental health requirements of the organization, creating programs and events as needed, and they would be available before, during and after crises, including future pandemics.

Psychologists could train workers as peer counselors and provide supervision for them. They could offer open office hours for drop-in consultations for supervisors, workers, families or residents.

In her Nov. 19 McKnight’s blog post, Martie Moore calls upon LTC leaders to address the vast amount of nursing turnover that occurs “because they became disenfranchised with their leaders. They reported that they felt they did not care, nor support them.”

Embedding mental health services into long-term care settings can attend to this problem not only by offering techniques to deal with staff conflict, difficult residents and challenging families, but also by providing the “personal development plans” Moore found was key in retaining healthcare workers. Using trained mental health professionals to work with staff members on these plans (which focus on what’s working on the job, what isn’t and what support is needed to resolve problems), can free LTC leadership to concentrate on putting out the perpetual “fires” of work in this field. It can reduce the number of fires needing attention.

Grant-funded studies would assess the costs and benefits of these mental health services. Based on my experience and reviews of related literature, expenses would be mitigated by reduced absenteeism and turnover, fewer lawsuits, increased treatment of physical conditions while early and more easily remedied, enhanced referrals by satisfied families to the facility, and decreased use of futile, painful and expensive medical treatments at end of life. Let’s get the data to show this.

As the bill makes its way through the Senate, it seems likely that some level of funding will come our way. Talk to your teams, staff psychologists, psychology service agencies and local university psychology departments to get a sense of what’s necessary and possible for your organization. 

Long-term care can and should move into the position of addressing the mental health needs of everyone involved in the care of elders. This is a huge part of what’s been missing and what needs to shift in our field for it to survive.

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.