Dr. El

Last week I flew from New York City to Indianapolis to speak at a conference on severe mental illness in long-term care. From there, I drove to Chicago to offer my thoughts about behavioral health at a risk management event.

It wasn’t exactly a world tour, but I did come away with some interesting observations regarding our field.

My first stop was the severe mental illness (SMI) conference organized by the Indiana State Department of Health. The goal of this event was to improve care for Indiana residents diagnosed with SMI. 

Nationally, rates of severe mental illness in LTC have doubled between 2000 and 20171. At 10%, Indiana has about an average number of SMI individuals, yet, with conferences like this, it’s leading the way in addressing this nationwide problem. 

After recognizing that the mental health pendulum went too far in the direction of deinstitutionalization, Indiana has also revamped its psychiatric hospital system and increased the number of beds available, including geropsychiatric beds. 

To see the number of residents with schizophrenia and bipolar disorder for your state, county and facility, create a map in one minute on LTCFocus.org, a fascinating, user-friendly Brown University website.

(By the way, I’m editing this article in my office on the rehab unit and a resident with bipolar disorder just stopped by for the third time this week — and it’s only Tuesday! As I was saying, it’s a national issue.)

One challenge that needs to be further addressed with regulators is how to comply with directives to avoid using individuals “for labor,” while at the same time allowing residents living with mental illness the opportunity to engage in meaningful, esteem-building activities. 

Conference attendees told me, for instance, about a resident who enjoyed pulling weeds in the garden, but surveyors perceived this as problematic. Perhaps having more guidance and flexibility around volunteerism would help.

On the three-and-a-half-hour drive from Indianapolis to Chicago, I saw two unusual sights. One was a wind farm, with miles and miles of spinning windmills as far as the eye could see. It was mesmerizing, though I pulled myself out of my reverie since I was driving 70 miles an hour down the highway. 

The other sight that was out of the ordinary, to me at least, was a bright yellow jeep convertible upholstered in fuzzy leopard-print seats. Clearly, I wasn’t in New York City.

Trauma-informed care concerns

My Chicago session was at the 2019 National Aging Services Risk Management conference hosted by Caring Communities, the Peace Church Risk Retention Group and ECRI Institute. It focused on enhancing behavioral healthcare in the older adult population, including a discussion of how to improve staff retention, teamwork and communication. 

One of the audience members asked for my advice about trauma-informed care. Readers who have seen my previous column, “What worries me about trauma-informed care,” know that I’m quite concerned about how this well-meaning focus on the mental health needs of residents will be implemented out in the field. 

I encouraged audience members to find ways of complying with the mandate in a manner that minimally disturbs residents and to follow up, if needed, with a swift referral to a mental health provider such as the consulting psychologist or social worker. 

Following this discussion, several professionals privately shared their own personal traumas and their alarm that someone in LTC might ask about these incidents when they were being admitted for their own care.

Given that even thinking about asking these questions of older adults is triggering for potential interviewers, I’m guessing we’ll be hearing more about these dilemmas as the implementation of trauma-informed care proceeds.

The McKnight’s tour

Although I’ve been writing this column for over six years, I’d never been to the office in Chicago where the “magic” happens, so I was excited to get a tour. There were certainly things you might expect to see at the McKnight’s office: a giant red McKnight’s logo on the wall, a table full of awards, lots of computers and copies of the print edition scattered about. 

Dr. El, you might be thinking to yourself, give us the inside scoop! What did you find out that we didn’t already suspect? 

Well, I did pass a journalist’s office with a pristine desk and I can tell you this tidbit: Editorial Director John O’Connor is very, very neat. I guess I shouldn’t have been surprised, given his uncanny ability to hone complex and thorny concepts to their essence.

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 and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com.