I watched with dismay as the nurse abruptly moved a table in front of a confused and agitated resident trying to leave the dining room. “Sit down!” she told him in a stern voice. “Dinner will be here in an hour!”
Those of us in long-term care have undoubtedly witnessed similar incidents where residents become agitated and staff members don’t have the tools to prevent or manage their distress. Psychologists — who could offer such tools — are largely limited in the current reimbursement model to providing individual services to cognitively intact residents.
Using mental health expertise
The Eldercare Method, developed by psychologist Kelly O’Shea Carney, PhD, CMC, executive director at the Phoebe Center for Excellence in Dementia Care in Pennsylvania, harnesses the training of mental health professionals to successfully address the gap between what’s known in the mental health world about how to handle challenging behaviors and how they’re often managed in long-term care.
The method uses interdisciplinary teams facilitated by mental health professionals (psychologists and licensed clinical social workers) to examine the causes of resident distress and to identify ways to prevent it. Team members include representatives from the nursing department and other direct care staff such as dietary, housekeeping, and aides.
The first step in the Eldercare Method is to assess the overall behavioral health needs of the facility and to establish training programs and annual service goals. This dramatically increases the focus on behavioral health as compared to facilities that provide behavioral health training sporadically, often after an incident occurs, missing the opportunity to prevent problems on an ongoing basis.
The interdisciplinary team, called the Community Care Team (CCT), “is responsible for collaborating on the development of behavioral plans, trainings and environmental and systems changes that will address the needs of the residents.” The CCT meetings occur weekly or every other week, straddling the change of shift in order to obtain information from as many staff members as possible. The Phoebe Center tries to incorporate the meetings into care planning and other already occurring events in order to streamline the workflow.
In our conversation, Dr. Carney gave an example of a confused resident who was combative in the mornings. Through the use of behavioral tracking, the team determined that incidents occurred at mid-morning. Further investigation revealed that the man had been a farmer and was used to waking early, going out to work in the field and returning for a large breakfast. The team changed him to a double portion at breakfast and the problem resolved. In another case, staff members shared the discovery that turning the television to ESPN during care calmed an elderly sports enthusiast.
Behavioral health consultation
As part of the program, psychologists spend half their days seeing patients under the traditional fee-for-service model and the other half providing consultation services paid by the facility. The chance for staff to consult on a regular basis with a mental health professional not only improves the care for individual residents, it provides the opportunity for “grass roots culture change.” Team members become more aware of how the environment and their own behaviors impact upon residents’ behavior. The model leads to increased collaboration and enhanced understanding of how each discipline contributes to patient care.
Positive financial impact
Carney reports the outcomes of the method are being studied in conjunction with Teta Barry, PhD, their academic partner from Penn State University. Results from early quality improvement data are promising, indicating a reduction in falls, decreased use of antipsychotic medication, reduced staff injuries, and reduced staff turnover. The positive outcomes more than make up for the cost of the services provided by the mental health professional.
If you would like more information on the Eldercare Method, contact Kelly O’Shea Carney, PhD at [email protected].
Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is an accomplished speaker and consultant with over 17 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.