The severe impact of COVID-19 on nursing homes has led to calls for change in the country’s approach to eldercare. In “The American Nursing Home is a Design Failure,” for instance, author Justin Davidson describes the nursing home as a “soul-sapping institution” and argues that we need to rethink the current system entirely.
In my opinion, part of returning the “soul” to LTC is expanding the use of psychology services.
Currently, psychological treatment is furnished in a manner similar to that of knee-replacement surgery — a billable service provided to an individual. Treatment may include consultations as needed with family and staff, but these meetings are adjuncts to the therapy and are focused on the care of the individual resident.
While providing treatment to residents is an essential service, it’s far from the only assistance that psychologists can and should be providing. We would make better use of psychological services to improve the long-term care system if we widened our view of who and what is in need of treatment.
Much of a psychologist’s time, for example, is spent discussing the interactions between residents and aides. The present structure allows for conversations with residents about how to handle interactions with aides, but not with aides on how to work with the residents. Ten residents might have the same complaint about one aide, but working with a specific aide to improve interactions with the residents isn’t a reimbursable service.
Psychologists can also greatly assist with “behavior rounds” to discuss residents with difficult or concerning behaviors such as agitation or treatment noncompliance, and work with groups of staff to enhance team functioning. Team dysfunction negatively affects care costs and quality.
Anyone who has been on the floors of a nursing home has undoubtedly witnessed more than one situation where a worker isn’t functioning at his or her best, whether it’s because of stress at home, a triggering interaction with a colleague or resident, or some other difficulty. Assisting staff members isn’t a paid service either, though many of them would benefit from either brief consultations or referrals to outside providers for more extensive help.
With losses from COVID-19, many LTC employees have experienced trauma that could be lessened by psychological support either individually or in groups. The new Coronavirus Commission for Safety and Quality in Nursing Homes has, as part of its mission, the goal of “improving the responsiveness of care delivery to meet the needs of residents.” Reducing staff burnout could be considered a component of this goal, since burned out staff members are less responsive to the needs of residents. The inclusion of a psychologist on the panel, Lisa M. Brown, Ph.D., ABPP, brings some hope that there will be efforts to address the emotional impact of the pandemic on staff.
Family members are frequently under as much stress as the residents being admitted for care. They invariably have their own emotional reactions to the illness and placement of a loved one. The current resident-focused treatment system isn’t designed to address this.
Without adequate emotional support, the grief and frustration felt by family members is often expressed as dissatisfaction with the services provided. Vital information about a resident’s health needs can be lost once an adversarial relationship family/facility relationship develops, and the dynamic can lead to an increased likelihood of lawsuits. It can also require a substantial amount of staff time to address family complaints that would be more effectively handled by attending to underlying emotional pain.
Additionally, unresolved guilt or grief on the part of family members can lead to futile and excessive medical treatments, adding expenses to the system.
At a minimum, not funding psychological counseling for families results in unnecessary distress for residents and their family members.
Psychologists are also trained to be attentive to the physical and emotional environment. They notice, for example, if residents are becoming agitated by overhead pages or excessive heat in the day room, or if team members seem down or stressed due to, say, the departure of a favorite coworker. They can offer nursing home leaders valuable strategies to enhance care quality and worker performance in a variety of areas.
Many residents say they don’t need a psychologist because they don’t know what a psychologist does. Once residents are in treatment, however, they discover that it can be life changing. As one patient said to me, “What you’re doing is just as important as blood pressure or surgery. I wish I had you years ago!”
Correspondingly, most long-term care organizations don’t think they need a psychologist on staff because they don’t know what a psychologist can do. If we could put long-term care systems into psychological treatment, I’m certain they’d find that they really needed it too.
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 at EleanorFeldmanBarbera.com.