Back when I worked in psych, one of our most effective tools to improve mental health was maintaining a healing emotional environment, or therapeutic milieu. That’s why I was shocked when I first entered long-term care.
I couldn’t believe the din that faced me on the floors or the way some people spoke to the residents or the lack of coordination of care. In some ways, the settings are so similar —inpatient care, short- and long-term stays, family involvement, treatment teams, etc. — but the focus on physical versus mental health creates completely different atmospheres.
The reality is that even though our residents are entering LTC due to physical problems, their medical troubles impact their mental health and vice versa.
When I read a chart filled with medical diagnoses, I know it’s likely my prospective patient will spend much of our initial interview discussing the barrage of procedures he or she has undergone. A session or two later, the discussion will be about how the staff treats patients or how a difficult roommate situation should be handled.
My long-term residents will be frustrated by the lack of follow-through on medical tests or by the interpersonal dynamics on the floor. The vast majority of their concerns will stem from the lack of a therapeutic milieu.
The good news is that it really isn’t that difficult to create an emotionally healing environment. It doesn’t have to cost a lot of money or take all that much time. What it does take is recognizing there’s a problem and then dealing with it.
The first step is to simply walk onto your unit and listen. If you were ill enough to require long-term care, would what you hear make you feel better or worse? Look around. Is the atmosphere soothing or visually disturbing?
If you’ve identified any problems, then take the second step of reading about the therapeutic milieu. The article, The Nurses’ Role in Milieu Therapy, gives a good overview of the elements used in psychiatric settings, most of which can be easily adapted to long-term care.
Third, outline a plan of change and begin. Start training your staff to make each interaction therapeutic, to adjust the physical setting so that it’s more pleasant and less jarring. Have them set up policies for challenging behavior so that staff are proactive rather than reactive, and have them involve the entire facility in recreational activities that give purpose and meaning to life.
Then watch your community flourish.
Eleanor Feldman Barbera, PhD, the author of The Savvy Resident’s Guide, is an accomplished speaker and consultant with over 16 years of experience as a psychologist in long-term care. A long-time contributor to McKnight’s publications, this blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.