Why it's impossible to maintain prior levels of care quality, and what to do about it

Residents and their family members are likely to expect that when they enter long-term care, staff members will provide compassionate medical treatment. Instead, what they frequently find are stressed out nurses and overworked aides.

The importance of leadership in creating good deaths in LTC

In one of the more disturbing encounters I've had in long-term care — in a 5-Star deficiency-free nursing home — I offered my condolences to an aide on the loss of a resident she'd cared for over a period of two years. I never expected the response I got.

Using technology to improve care, reduce costs

At Maimonides Medical Center, 24 frail older adults were taught to use laptops so that they could manage their health information from home. The technology facilitated communication between patients and providers and improved the quality of life of participants.

New perspectives on aging and healthcare

Three new books on aging and healthcare recently crossed my desk, each with completely different takes on our industry. Each has merit for anyone involved with senior care.

Taking teamwork to a deeper level

When we think of teamwork in long-term care, we envision a group of dedicated specialists reading notes from other disciplines, bouncing ideas off colleagues and convening care plan meetings. In reality, it is much more complex.

Enhancing quality of care through design

Incorporating the principles of accessible design into long-term care creates communities where inclusion and independence are emphasized. Good for those who do it.

Help in your backyard

Amy Gotwals, the Chief of Public Policy and External Affairs at the National Association of Area Agencies on Aging, kicked off the 28th Annual Aging Conference in New York City last week, held at the New York Academy of Medicine and filled with attendees providing community-based care for elders. Her rousing keynote outlined the vast care demands of the growing wave of elders and the importance of building healthcare partnerships.

Self-disclosure: What your staff needs to know about revealing personal information to residents

Disclosing your personal information can be a good way to establish a more intimate connection with residents but there also can be unintended and unwanted consequences to revealing such details.

4 ways to revamp work culture in the new year

Ahhh. A new year. It's time for a fresh start, the chance to take life in a different direction. Whatever our roles in long-term care, there are steps each of us can take to enhance the way we treat each other and to have a positive impact on workplace culture.

People in LTC who've inspired me in 2017

From the 102-year-old Hulk Hogan fan to the doting, selfless caregivers doing behind-the-scenes work, there are numerous people who inspired me in long-term care this year.

Elder love

I lost one of my two mothers-in-law last Monday, five weeks after she was diagnosed with pancreatic cancer. Audrey had filled a hole in my life left after the death of my beloved great-aunt many years ago.

Home, small home

Rebecca Priest, LNHA, LMSW, is presiding over one of the most exciting changes in long-term care to come down the pike since, well, Green Houses.


There are benefits to breaking down silos between public and private aging services.

Readmission prevention: The role of post-acute providers

Long-term care providers have an opportunity to thrive with value-based care, escape cynicism and join the growing wave successful at avoiding readmissions.

How do they sleep at night?

Residents arrive at our doors, with sleep likely harmed by illness and pain, and changes in circadian rhythms. While we can't alter some of these factors, as care providers we can become more attuned to the importance of sleep for our residents and train our teams to create environments that are more conducive to slumber.

Disaster communication: A tale of two mothers-in-law

Both of my mothers-in-law live in long-term care communities in Florida. One lives in a place that was excellent about how they communicated with family members before, during and after Hurricane Irma. The other's facility handled that aspect of care poorly.

You and your staff are very different: Use it to your advantage

I often speak with healthcare groups, giving psychological insights about a variety of issues within long-term care. After pondering the discrepancy in reactions, I adjusted my talks accordingly and came to this conclusion: Healthcare executives and managers are very different from those they manage.

Calming fears of floods and other catastrophes

By now it's likely that you, your staff, the residents and their families have seen the incredibly disturbing photo of assisted living residents in Dickinson, TX, sitting in waist-high floodwaters. That image and others of the flood are undoubtedly causing concern in your community.

Falls: A closer look

Speedy assistance should be the norm when falls occur, but the reality is that it's frequently a rarity. The staff is often stretched too thin. What can be done, aside from ensuring adequate staffing, is to reduce residents' anxiety, frustration and impatience.

The image of LTC in the arts

Playwrights continue to do long-term care no favors, so providers need to continue to share stories of the good work they're doing. It's the way to help create a more realistic picture of LTC and the value we bring to people's lives.

ElderTech: Ideas from a tech exhibit

I was at the nursing station the other day when some unusual cracking noises caused me to look up from my documentation. A very old, petite lady was sitting in her wheelchair popping bubble wrap. She wore the same contented expression that comes over virtually everyone popping a sheet of bubble wrap.

Why (culture) change is so hard and what to do about it

The team huddled around the nursing station talking in panicked whispers after the management meeting ended. "How do they expect us to do that?" a young nurse wondered. "Yeah," an aide replied, "we're stretched thin enough already!"

Promote your connections

One of the things that most brightens my workday is when I see long-term care residents hanging out together.

The "last day" protocol

I waited outside the room until the rehab therapists finished talking to Jim, who'd been admitted to the nursing home the night before.

The violent workplace

It's impossible to prevent all tragic events at a long-term care facility, especially those involving an armed assailant entering the building despite an order of protection against him like in Ohio last week, but there are ways to reduce the likelihood of workplace violence.

Opening the door for ombudsmen

I can imagine from an administrator's point of view that an unexpected interruption from an ombudsman complaining about problems is not exactly a welcome visit, but perhaps there's a way to shift the relationship to mutual advantage rather than keeping an office door closed.

Insights on family-friendly care from Dr. El — the daughter of a new resident

Due to a series of unfortunate events, both of my previously independent parents were recently injured over the course of five weeks. Here are some thoughts from someone who's seen the long-term care world from both sides now.

On power, teamwork and communication

Having enough of it at work, I tend to avoid drama in my entertainment choices unless it involves aliens or post-apocalyptic nonsense. My family and I are currently enjoying the creative spectacle of Project Runway "Teams" version from a few seasons ago.

Enthusiasm and ingenious inventions at the NYC Aging2.0 Global Startup Pitch Event

Moving beyond the development of medical products for seniors, Aging2.0 seeks to facilitate collaborations between senior care providers and entrepreneurs to create products and services that can be integrated into their businesses.

Remember to breathe

In order to better face whatever is ahead — and to avoid causing panic in those around us — we can make an effort to be serene and centered. Below are some tried and true calming techniques to help you remain levelheaded despite unnerving times.

Join me for the 'Relaxed Lane' challenge!

Denise B. Scott, president of Drive Consulting, posted an intriguing story on LinkedIn the other day about a Scottish supermarket that partners with Alzheimer Scotland to help those with memory loss. The concept is so simple, easy and kind that I decided to ask my local supermarket if they'd join in.

Correcting long-term care's image problem

Long-term care has an image problem. For a variety of reasons, we aren't associated with good times. There are things we can do to turn this around, though, starting with the perceptions of our residents.

10 ways to incorporate mood-boosting exercise into LTC

Cold weather. An uncertain world. Rogue shrinks making the rest of us caring, diligent professionals look bad. I don't know about you, but I need a mood lifter.

A 'novel-la' way to educate families about dementia

It's easy to become overwhelmed and to have the information presented by a medical professional blur so that it sounds like a Charlie Brown cartoon teacher declaring, "Wa wa wa wa, wa wa wa wa wa wa." I recently learned of a promising program to teach families — particularly Hispanic families — about dementia.

Successful New Year's resolutions, LTC-style

Rather than resolve to do more than I can possibly accomplish, I prefer to view the beginning of the year as a time to examine the course I've been on and to make corrections as needed.

Enhancing the value of LTC by making family visits more rewarding

Many relatives have no idea how to best engage with their loved one in long-term care. When care providers accept the role of teachers, we can add great value to our services and enhance the experiences of the families who come to us for assistance.

New LTC resources from some of the best

Over the past year, I've been involved with several exciting long-term care-related projects that I can now tell you about. In the spirit of the season, I wanted to spread some good cheer with them, and also offer a gift.

6 steps to manage post-election reactions in LTC

The 2016 presidential election has revealed a deep rift in our country, and quite possibly in our long-term care facilities as well.

Suicide prevention in older adults

In preparing for a webinar on suicide prevention, I came across startling statistics about suicide rates among older adults. Despite the concern we often hear about teen suicide, the rate for elders is even higher.

Playing the LTC lottery

After reading a recent New York Times Opinion piece about the uses of lotteries to solve social problems, I began contemplating their potential application to long-term care. An element of fun might be a welcome addition to what's typically a very serious business.

3 surprising reasons to strengthen your resident council

Forget about worries of them eating up staff time or triggering something bad on surveys, resident councils can be awesome for your facility and here's why.

4 ways to find out why your aides are leaving

Once, when I worked for a managed care company, I rode down a packed elevator with the CEO, who commented drily on the crowd, saying, "It must be 5:01." What I thought, but did not say, was that there were reasons his staff members weren't staying more than a minute past the hour.

To reduce staff turnover, lead with LTC strengths

When I spoke about the challenges of staff turnover at the Louisiana Nursing Home Association convention last week, I asked the group, "If you were able to bring in the same salary you were currently making, would you want to have the job of an aide?"

What's all this about PBJ?

Why are they keeping track of peanut butter and jelly sandwiches? I appreciate their concern that residents might have our lunches served late, but what about the tuna fish sandwiches? And the chicken? Doesn't it matter if those are served late as well?

Wisdom from elders

I told residents that I was writing an article on advice from elders about how to live life and their responses were immediate and enthusiastic, as if they'd been waiting for someone to ask.

'Healthwear' and other culture changes

When it comes to assistive devices such as canes, walkers, and eyeglasses, it's possible to convert something unappealing yet necessary into an item that bestows confidence, evinces a sense of humor or becomes more useful.

Racism and LTC

Given the racial tensions in the news this week, I thought it would be a good time to reflect on interactions among races in long-term care. I've observed firsthand various culturally charged interactions — both positive and negative.

Super-utilizers: LTC has them too

Reducing the costs of long-term care "super-utilizers" first requires recognizing them as such. Then proceed carefully, and with an investigative eye, to increase the likelihood of successfully meeting their needs and decreasing expenses.

From abysmal to mediocre: Encouraging hand hygiene

I've become more diligent over the years (read: paranoid) about making an effort to sanitize my hands as I move from room to room. But I wonder about those whose roles in long-term care don't specifically emphasize infection control procedures.

Full code: Discussing advance directives

Assistance in creating a "good death" is a fundamental task of any organization working with elders and may be addressed by a number of team members singly or in combination. Since these discussions are often easier said than done, I thought it might be helpful to share some of my experiences since I, as a geropsychologist, regularly discuss dying with residents and their families.

Depression - AND its treatments - are fall risks

Feeling "down" takes on a wicked double-meaning for some seniors. Even conscientious providers could be unaware of it, let alone know what to do about it.

Creating a dialysis-friendly facility

There is much that can be done to improve the quality of life for dialysis patients at your facility and showcase your facility as dialysis-friendly at the same time. Unfortunately, many providers are not doing all they can to help these people, or boost their own business operations, for that matter..

Dr. El tries on the Genworth aging suit

I had a chance the other day to see what it feels like to be 85 years old, thanks to a test drive of the Genworth R70i Aging Experience suit. Talk about being transported to another world. This is a pure empathy builder.

Help for hoarders, and those who care for them

When it comes to dealing with residents who are hoarders, facilities are often caught between a rock and a hard place. Here's how to deal with it.

Clone this woman. Steal this idea.

"Trudy's here!" exclaimed the resident I'd been speaking with, excusing herself for a moment to exchange a few dollars for a bottle of lotion. "She buys me the things I can't get here. She's a real lifesaver." It was a sentiment I heard echoed by many other residents.

Using light to improve sleep, reduce agitation

Research now suggests there may be a solution for residents lacking sleep, experiencing depression or falls, or other certain conditions — and it involves no medication or side effects. The answer could be the use of light.

Upcoming quality initiatives

More quality initiatives are on the horizon for many providers, and they address a wide array of necessary topics. Here are a couple of experts' insights.

'Just a picture of her butt' — an analysis

Wondering how an employee could possibly think posting a photo of a resident's behind to social media would be a reasonable action to take, I contacted a psychologist and social media expert.

Dr. El's subversive guide to culture change

Culture change can be portrayed as many things. One possibility often overlooked is its being a grassroots effort that shifts the dynamics between residents, staff and community, one unit at a time.

'Honest' placebos help without side-effects, expense

Placebos could be a better friend than you realize in the universal quest to reduce the number of medications that elderly patients receive. Don't believe me? Read on. (It won't hurt.)

Growing Good

In the wee hours of the night I recently discovered a Facebook post about a company founded by two brothers called Life is Good. It emerged from the standing request the founders' mother had for them as children in a chaotic home environment: Tell me something good about your day.

The Twelve Days of Christmas in LTC

There are many givers in senior care facilities. Sometimes they don't even realize it themselves. This holiday season is a good time to recognize them — and the things that make smiles bright.

7 employee wellness ideas for the holidays (and beyond)

After a staff training on reducing burnout in long-term care last week, a look through the evaluation forms was illuminating. A significant number of attendees — mostly nursing aides, nurses, and environmental workers — wrote that the most valuable point they got from the training was how important it was to take time for themselves, even if it was for just a few minutes.

Kind words from residents

To get us in the spirit of gratitude for Thanksgiving, I've included a sample of grateful comments made by residents to their psychologists. The nice things they say can really make things better.

The secret to LTC success? A focus on well-being

Despite the diversity of the events I attended during my brief visit to the LeadingAge convention in Boston last week, a theme clearly emerged. The thread that ran through the varied offerings was well-being

How to find out why your staff is leaving

Some of the reasons employees leave are beyond our control. But many are not. Here's how to start figuring out how to stop the flow and reduce turnover.

'The Adventures of The Geropsychologist'!

There have been thousands of movies and TV shows about the exciting work of cops, lawyers, and hospitals, but long-term care? Fuhgeddaboutit! Until now.

Behavioral health care — not drugs — for dementia

For the treatments to help dementia patients, turn to behavioral health solutions, not antipsychotic drugs. Just like others around the world.

7 powerful ways to deliver family-centered care

When a resident enters long-term care, we tend to focus solely on the needs of the resident, even though they're almost always part of a family system that is being affected by their placement. If we consider that we're admitting families rather than just the residents themselves, we'd recognize the need to provide family-centered care in addition to resident-centered care.

The high cost of rudeness

Given the stresses of caregiving and the complexities of human relationships, incivility happens. But considering the potential impact of rudeness on care, we need to do more to understand and prevent rudeness when we can. Here's how to start.

Spirituality in long-term care

In the beginning of my long-term care career, I quickly recognized that in order to be of service in this environment, I needed to come to a spiritual understanding of how such nice people could be dealing with such difficult illnesses. This was important because psychology graduate school, much like med school classes, definitely had not focused on clients' spiritual needs.

Dr. El's Shrinky LTC Fantasy

I hung up the phone with the managed care case reviewer. The patient in question was in her late 50s, with multiple sclerosis and other physical problems that had left her bed-bound. What else would need to happen to get her more than a month of treatment? An amputation? The death of her only child?

Diabetes care: Take two betta fish and call me in a week

These days, with organizations being penalized for rehospitalizations and closely monitored on clinical outcomes, it would probably be very worthwhile to provide a group of elders with some pet fish, food and a tank — along with their own self-care training before discharge or after diagnosis.

Creating better deaths in long-term care

Residents and their families count on us to support them along the emotional and often frightening path of end-of-life care. We can help our residents have a "good" death and make the experience less painful for their families — and us, as LTC workers.

The Goodbye Guide: Why and how to terminate tenderly in LTC

I believe leave-takings in long-term care are more important than in other settings and that the style of departure should be given more consideration.

Harnessing gratitude

Though it was close to 20 years ago, I'll never forget the reaction of one of my patients to losing both of her legs to diabetes. Residents like her make it quite clear that it is possible to be grateful and to live fully, despite disability.

Psychologists open up about LTC sex and dementia

A recent high-profile court case in Iowa highlighted the challenges that arise when considering capacity, sexual activity and the senior living environment. Long-term care psychologists met recently to sort the issues.

The many riches of senior living conferences

I've been fortunate enough to attend several senior living conventions recently and my enthusiasm for the experience has yet to diminish. You would feel the same way, and here's why.

'Okie El' rocks out, and then veges out

My first-ever trip to Oklahoma for a speaking engagement recently included no fringed surries. But there was a bustling, well-run long-term conference, animated conversations with attendees, life-altering products in the expo hall and much, much more. Much more.

Loneliness in LTC: Overcoming disability, creating connections

Reducing loneliness among facility residents has numerous benefits — for residents and staff. So why aren't we doing better at it? Here's what you need to know.

Dialysis: Gauging its need, and how to reduce its stress

As a psychologist observing the effects of medical interventions on the mental health of the long-term care resident, I often ask, "Is this aggressive procedure helping?" As it turns out, so are others.

NET Therapy: Dementia care best practices + Rehab = Success

When I learned about Neurocognitive Engagement Therapy for rehabilitation residents, I had the same reaction I did when I first heard about geriatric emergency rooms: Palm-smack to the forehead, "Why didn't we think of this before?!"

Senior bullying: How to recognize it, how to handle it

We've come a long way with many psycho-social problem areas. Children, for example, start learning about bullies in kindergarten. When it comes to bullying in senior communities, though, we're still behind the times.

Reflections after an LTC and senior living summit

Last week, I delivered a keynote address on "Identifying and Repairing Communication Gaps in LTC" at an LTC and Senior Living Summit. It was a fascinating, energizing event, and not just because I was leaving the frigid temperatures of New York City to dine outdoors in Marina Del Rey.

Addressing residents' deepest fear

If we address new residents' hidden concerns, we can better show them we understand and care about how they feel. We can enhance their experiences upon entering our organizations and can market our services in a way that relieves their anxiety.

6 ways to improve dealing with death in LTC

How someone dies is a very important part of the culture of the long-term care organization. Odds are your community can improve its culture in this area.

Use 'nudge principles' to prompt staff

We all can use practice harnessing "less laudatory traits," such as short-sightedness, inertia, inflated optimism and our tendency to submit to peer pressure. Especially for our work. Here's how.

'Twas the night before Christmas and all through LTC ...

It was the night before Christmas, Hanukkah was ending and Kwanzaa was right around the corner. The perfect time for a poem.

Seeing the 'invisible patient' in LTC

Jane Gross' recent post 'Seeing the Invisible Patient' in the "New Old Age" blog of the New York Times discusses how professionals often ignore the needs of caregivers of the elderly because they are focused on their identified patient. While the article centers on the burdens of caregivers in the community, it got me thinking about whether we're meeting the needs of families whose loved ones are in long-term care.

10 reasons I'm thankful to work in LTC

I owe a lot of my blessings to working in long-term care, and my LTC career is a blessing in itself. You might have some of these same feelings.

Working on how to communicate in facilities

Transitions between care settings are getting more scrutiny than ever before. So thank goodness for new guidelines designed to help smooth them out. Still, we need all the help we can when it comes to improving communication among fellow caregivers. And I have proof.

The White House Conference on Aging: Why it should matter to you

If you, like me, completely missed the 2005 White House Conference on Aging (or if you weren't in the field at the time), it's fair to ask just what the heck it and does. And what it means for eldercare professionals. Read on for the answers and my take on it all.

Dear Diary, Last week I attended my first AHCA convention ...

There's nothing like the first time you get to meet people, attend education sessions and see the exhibit hall at the American Health Care Association, as I found out last week. If you weren't there, you missed a lot.

Creative activities for residents with dementia

While conducting a training session last week in Montana, I was lucky enough to have a group of more than 100 staff members from various long-term care departments share some excellent suggestions on how to engage residents with dementia. They're too good to pass up.

Preventing difficult family situations

From a psychological perspective, here are some ideas to prevent or reduce disagreements with residents and their family members over care, thereby decreasing the likelihood that a situation will result in legal action.

Reducing antipsych meds: 5 ways psychologists can help

With the mandate to reduce the use of antipsychotics, many facilities are looking for alternative methods to address the behaviors often associated with dementia. There are several good resources available for training staff, including your consulting psychologist. Here's how he or she can help:

Taking vacations when residents can't do the same

Like many, I'm taking some vacation time during the month of August. It got me thinking about the ways workers interact with residents when they take time off from their jobs. It's more important than you might first think.

The psychology of falls in long-term care

According to the American Geriatrics Society, one in three adults over the age of 65 falls each year. Falls represent the leading cause of fatal and nonfatal injuries among older adults. You might be surprised to hear some of the contributing factors of falls and the psychology behind them. I also have advice on ways residents and staff can reduce the likelihood of falls.

What if psychologists ruled the (LTC) world...

While most psychologists almost exclusively address the mental health of nursing residents due to the current reimbursement system, we're also aware of the interactions between staff members, families, the physical setting and the organizational culture. Here are some of important things psychologists might do to address the emotional climate of long-term care.

Preventing burnout in long-term care

In my recent post, "Stuff I won't do for residents and why your staff shouldn't either," I wrote about the need for individual workers to set appropriate boundaries around caregiving in order to retain the ability to give without burning out. In this article, I examine more closely the symptoms of burnout and ways facilities can reduce its likelihood — which is particularly important given the link between burnout and turnover.