Dr. El

As I stated in my last column, improving the emotional tenor of the facility can decrease staff turnover. In this piece, I’ll offer additional ideas to achieve that goal. 

Most organizations have a consulting psychologist on the team who can spearhead or contribute to the recommendations below. Psychologists are capable of far more than providing direct services to residents. 

Psychologists are in a unique position not only by virtue of their understanding of research and their extensive training in individual and group behavior, but also because they spend most of their time on the units, moving from floor to floor talking to residents, staff and family members. 

This allows them to see patterns from unit to unit and to observe interactions usually hidden from those in leadership positions. Their expertise can improve the functioning and atmosphere of the nursing home.

Staff support

Even under conditions where there are reasonably paid and sufficient staff, the nursing home is a stressful environment. As noted in this STAT first opinion piece, “We all need help working through grief and hardship,” staff members may be coping with their own personal losses while trying to care for others. Given COVID-19’s impact on long-term care facilities, virtually every worker is dealing with grief and a “minefield of triggers” on the job.

The authors suggest enhancing policies to provide “systematic supports and anticipatory guidance.” Psychological knowledge would be valuable in formulating these systemwide strategies. Employee assistance programs, support groups and psychologist open office hours are other means to help workers manage common stressors such as team conflicts, difficult residents and family problems.

In addition to direct emotional support, there are many other ways to mitigate stressors on the job.

Restructuring and education

As I wrote in “Post-pandemic population may require higher staffing levels,” the population of nursing home residents has changed. With the decrease in elective surgeries and the increase in avoidance of nursing home rehabs, the remaining residents are more likely to be a demanding mix of people who are unable to be managed at home due to medical acuity, behaviors and/or a lack of available, supportive family. There are also more residents with comorbid severe mental illness and medical problems.

Staff members are therefore required to simultaneously manage very different and urgent needs, such as a wheelchair-bound resident with dementia about to stand up from his chair, a recent admission with alarming vital signs, and a comparatively young woman with bipolar disorder loudly demanding immediate attention.

As part of ongoing staff training to address these and other common challenges, the psychologist can contribute expertise in behavior management, critical thinking skills, the understanding of mental illness and techniques to become more proactive than reactive on the units. 


Staff conflict is another frequent difficulty in the nursing home setting. Not only can psychological training be used to mitigate and prevent disagreements, but it can also be used to examine and change systems that are contributing to problems. 

For instance, in the example above with diverse resident needs, perhaps the solution is not just training staff members to be better at triaging care, but in establishing floors or neighborhoods that focus on particular types of residents. 

Psychological expertise can be useful in team building, making facility-wide transitions, and in training teams to work with specific populations. Especially if a nursing home has residents with severe mental illness, mental health experts should be used to educate staff and create systems that address the needs of this population, such as working on appropriate programming with activities professionals and engaging in behavioral rounds with the team.


Psychologists could run educational and support groups for families, participate in end-of-life planning discussions, and work with disgruntled family members, relieving much of the time spent by other professionals (and probably reducing litigation costs).


Psychologists can help review and adjust the onboarding process and the support given to new workers to increase the likelihood that newbies will become old-timers (directly reducing turnover).


The biggest challenge to harnessing psychological expertise outside of direct resident care is that there’s no payor source. My hope is that grants and studies for providing these services will show cost mitigation to lead more organizations to fund them or CMS to consider widening the scope of payable services for psychologists. 

The pandemic has revealed how broken our long-term care system is and how much need there is for mental health services. Fixing the former involves better utilization of the latter.

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.