Dr. El

These days, mental health in long-term care is getting far more attention than it used to. After 25 years as a nursing home psychologist, it’s pretty exciting to see.

I perused the April print edition of McKnight’s Long-Term Care News and found articles on the impact of nurse stress on quality of care, the connection between nursing turnover and the emotional toll of the job, and the importance of mental health support for staff. 

Last week, McKnight’s Senior Editor Kimberly Marselas wrote about the increased attention being paid by CMS to mental health conditions, and on iCare’s Chris Wright: Seizing on skilled nursing’s behavioral health opportunities.

It’s my hope that this attention generates a shift in the way that psychology services are utilized and reimbursed. 

While it’s valuable to provide individual services for residents with identified mental health conditions, psychologists can and should do so much more.

The mental health challenges in nursing homes would be better served if psychologists were involved in programming, such as the STAR-VA model for dementia-related behaviors, or the Eldercare Method, developed by senior living consultant Kelly O’Shea Carney, Ph.D., ABPP to address the behavioral health needs of long-term care residents.

She and Margaret Norris, Ph.D., wrote “Transforming Long-Term Care: Expanded Roles for Mental Health Professionals,” which “shows how mental health practitioners can use their full range of skills to create systems that are more supportive and engaging for residents, while also providing the staff with greater opportunities for professional growth and meaning.”

As I’ve written about in the past, psychologists can be instrumental in a wide variety of currently problematic areas such as:

  • Staff training, including education on mental health basics and psychiatric illnesses, how to work with families, stress management techniques, and other issues that typically arise for staff in the nursing home setting.
  • Team building, which focuses on addressing the specific needs of units and departments, such as conflict resolution, communication skills, etc.
  • Morale boosting, utilizing psychologists’ training and awareness of the emotional climate of the facility to devise interventions that can improve facility culture, such as enhancing staff common areas or collaborating with the recreation department on activities that inspire community.
  • Improved onboarding, addressing often undiscussed but vitally important topics such as coping with the loss of residents or dealing with challenging families. 
  • Behavioral rounds, to assist staff with interventions to reduce problematic behaviors in residents or families.
  • Open office hours, where residents, workers and family members can drop in for a quick chat to address concerns and get direction for further services if needed.
  • Systems interventions where psychologists collaborate with facility leaders to streamline systems and resolve problems, often between departments, such as communication glitches or turf disputes. 
  • Group sessions for residents that cover topics such as how to make the most of rehab or psychoeducation about illnesses like diabetes, and which foster connections and reduce isolation.
  • Group sessions for families, to reduce their anxiety, increase their ability to manage their loved ones’ health challenges, improve their understanding of how to partner with the team, and to decrease the amount of staff time spent dealing with family concerns.
  • Family psychotherapy sessions, since admitting a loved one to a nursing home can be very distressing.
  • End-of-life support, because we should be experts in acknowledging when residents are nearing death and helping them, and their families and team members, cope with the process and with their grief.
  • Individual psychotherapy for residents because, yes, this is important too.

A few years ago, I got a referral for a very anxious 90-year-old rehab resident. She was initially extremely reluctant to speak with me but she eventually became a fan of psychotherapy. 

The morning before she was to return home, she called me over to her spot in the day room and told me, “I wish I’d talked to you when I was a young woman. The work you’re doing is so important, just as important as the cardiologist or the surgeon.” 

“I know,” I replied. 

Long-term care is like this woman, who could have benefitted from psychological services decades ago. 

I’m pleased that greater mental health awareness has entered the LTC zeitgeist and I’d like to think that columns like mine have contributed to this recognition. 

The work continues, but I wanted to let you know in advance that this is my penultimate “World According to Dr. El” column. More on that next time.

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, 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.