Category Archives: Compassionate Touch®

Person-centered programs

Innovation in long term care communities: early versus late adopters

Innovation in the long-term care setting can take many forms. It can be a novel technology, an inventive volunteer program, or an innovative training class. No matter what the offering is, the willingness to try something new to benefit elders in the long-term care setting is always worth attempting.

In exploring new, innovative projects in the long-term care setting, there can be two types of adopters: early and late. Those communities who are early adopters want to be the first to try something new. They are not afraid of risk or to make mistakes. They will test new approaches and identify ways to refine the process as needed, developing best practices to help build upon lessons learned.

Bringing a new, innovative project into the long-term care setting can also provide a competitive advantage by distinguishing a community as one that offers services that other communities do not. Elders, families, and staff will recognize the community’s commitment to trying new concepts and projects to enhance and improve resident care and quality of life.

The drawbacks in being an early adopter can include the emergence of unknown, unexpected costs to make changes and adaptations to test a new, unknown project. There are also risks involved, especially in the potential unknown effects on residents and staff of a new project. Additionally, the implementation of a new, untested project can affect the workload of employees who are likely already over-burdened while being asked to try a new project.

There are also benefits and drawbacks in being a late adopter. By adopting a project or idea late, the existing kinks likely have been worked out, making it easier to implement and potentially less costly to undertake. The benefits for implementing a project may be well known by the time a late adopter brings it to the community which may make the implementation process more worthwhile. Drawbacks to adopting late include the delay in providing elders with the benefits of an innovative program. Further, there may be more costs to elders that might have been avoided if the program had been attempted.

Despite the benefits and challenges in being an early or late adopter, there are some programs which are beneficial to adopt early. The National Partnership to Improve Dementia Care in Nursing Homes (Partnership) works to improve the quality of care for individuals with dementia who live in nursing homes. Part of the Partnership’s mission includes a focus on addressing the amount of antipsychotic medications individuals with dementia are prescribed. According to a memo from the Centers for Medicare & Medicaid Services’ Center for Clinical Standards and Quality/Quality, Safety & Oversight Group , from 2011 to 2018, there has been a national decrease of nearly 40 percent (38.9) in the number of nursing home residents receiving an antipsychotic medicine; however, more work can be done to reduce the use of antipsychotic medications in nursing homes.

As recently as December 2017, there were 1,500 nursing homes identified by the Partnership as late adopters, which are nursing homes with a sustained high or relatively unchanged rate of antipsychotic medication use, or their antipsychotic medication usage continued to be above average without a high percentage of schizophrenic elders in the nursing home.

In order to address these findings, the Centers for Medicaid and Medicare Services (CMS) is providing technical assistance and support to late adopters. There will be enhanced oversight and enforcement actions to support these nursing homes in addressing their high rate of antipsychotic medication use. These strategies will be useful in helping these nursing  homes implement the changes and strategies needed to address the rate of antipsychotic medication use.  The return on that investment of time and personnel to implement programs like those can be significant, in terms of improving elder care, which is always worth attempting, whether early or late.

Kathy Dreyer, Ph.D., is the Director of Strategic Projects at AGE-u-cate® Training Institute, which develops and delivers innovative research-based aging and dementia training programs such as Dementia Live® and Compassionate Touch®, for professional and family caregivers;  kathy.dreyer@ageucate.com

 

Specialized Dementia Training and Employee Turnover

 

Specialized Dementia Training can have a positive impact on reducing employee turnover.

The AGE-u-cate Training Institute received encouraging feedback from a client, and it is worthy of a share. A home health agency that utilizes Dementia Live for staff training reported that their employee turnover is decreasing. Furthermore, the turnover correlates with their implementation of  Dementia Live, a simulation training experience of what it might be like to have dementia.

This news made us curious about the connection between specialized dementia training and employee turnover.

PHI is an organization with a mission to promote quality care through quality jobs. PHI identifies staffing in long term care a national crisis and reports conservative estimates of turnover across the long-term care sector ranging from 45 to at least 66 percent. In addition, one in four nursing assistants and one in five home health aides report that they are actively looking for another job.

The Dementia Care Foundation (DCF), based in Darwin, MN, studied staff retention and turnover in those working with persons with dementia. The research premise is based on findings by Brodaty et al., 2003 that turnover is particularly challenging in dementia care.

Effectiveness of Specialized Training

Researchers with the DCF also cited findings from Chrzescijanksi, et al., 2007; Coogle et al., 2007 that specialized training has been shown to reduce staff turnover while simultaneously improving the quality of care.

Relationships with co-workers was the most significant factor contributing to employment exodus.  However,  findings also reveal a connection in turnover and the lack of specialized training.

The DCF also uncovered a relationship between dissatisfaction with training about managing dementia behaviors and how likely respondents were to leave their job within the year.

Specialized is the keyword. Training for staff working with persons with dementia needs to heighten understanding and empathy. In addition, it should equip staff with knowledge and skills to respond to and reduce difficult behavioral expressions.

Something else to ponder is if and how employee relationships improve with specialized dementia training.

The training philosophy behind  Dementia Live is that it is hard to care for someone that you don’t understand.  Lack of understanding leads to stress, burnout, and ultimately turnover.

In conclusion, consider investing in specialized dementia training as a strategy to reduce employee turnover.  In addition, the impact on employee relationships following specialized training would also be an interesting aspect to explore.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Find Time for Compassion

Care of frail elders is often reduced to the completion of tasks. Caregivers caught in the frenzy of tasks should make time to provide the compassionate part of care- expressive touch.

I’ve been contemplating the chronic state of lack of time that so many feel these days.   We allow ourselves to think that more time will permit exercise or completing that project.

Lack of time is   a reason given for the inability to incorporate expressive touch into the care we provide our frail elderly residents.  Rachelle  Blough Kowalczyk,  Memory Care & Life Enrichment Consultant touched on the need for care workers to slow down.

Nursing assistants don’t have time to sit with a resident because they are always called away.  Nurses  have too much paperwork and medications to pass, and Social Workers have too many meetings.

These are the reasons expressive touch is mostly absent from the care we provide to our residents, yet it is such a necessary component of quality of life.   Making time is a big culprit.

Making Compassion a Priority

Many seasoned nurses state that at one time, back and foot rubs were a part of the care protocols.  One such nurse challenged her nurse colleagues during training to find the time to offer expressive touch to their residents.

This  nurse shared her experience  working in a large ward in England where she cared for over 50 patients.   Paper charts and hand-counted pills didn’t stop her from offering back rubs.  It was good medicine,  and would help her patients heal and feel better.

There are eye-opening moments in most Compassionate Touch training sessions when the learners realize how little time it takes to offer expressive touch!

Finding time is possible.   Consider a pocket of time 10-20  minutes before the end of a shift (when the cell phones usually come out). Think about the rest time after lunch and offer a back rub prior to assisting a resident to bed.

Ancillary personnel can also engage in expressive touch with residents if trained properly.   To that end, work together as a multi-disciplinary team to find time to improve the quality of life for your residents,  and your staff.

For more information about spreading the power of compassionate touch to your community, visit http://www.ageucate.com.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

A Special Grandparent’s Day

Lessons from an old tree.

You might be wondering why a picture of an old tree? This tree caught my attention while on a walk through a nearby forest preserve. I studied its shape, holes, splinters, and ragged edges. I didn’t know then why it captivated me so, but it did.

This tree, such as it is, a shell of itself from long ago still stands. How miraculous is this? Despite the trauma over the years, damaging winds, hail, heavy snow and ice, it still stands. Indeed, time is stamped on this tree, and its roots are weaker and deteriorated.  But it stands proudly, majestically demonstrating its resilience and strength.

I’ll call her Matilda (my grandmother’s name). Imagine the experiences she lived through and the stories she could tell. If only we had the opportunity to learn from this wise old oak. I would love to know what this forest preserve was like 50 or maybe even 100 years ago.

I speculate that sometimes Matilda had to dig deep for water and call on strength to brace against the hard times. But, she also got to bask in the glory of the nourishing sun and gentle rains and was probably thankful for the good times.  Her wisdom is unmatched in the forest, I am sure.

Matilda likely housed many critters over the years and created a safe space for them to call home. How many different species did she encounter over time? Insects, rodents, mammals, birds, canines felines, all in various sizes, shapes, and colors. Some may have taken advantage of her, but hopefully, most treated her with kindness and respect.

A Little Extra for Grandparents Day

This tree personifies grandparents for me, and that’s why I admire it so much.  I think it is true that you don’t know what you had until it is gone.  Three of my grandparents didn’t see me graduate from high school, and the last, my grandfather, died when my daughter was six years old.  She has only a faint memory of him.

It’s not too late to extend Grandparent’s day.   I know I would if I could.

I attribute my love for working with and advocating for the welfare of older adults to the loving relationship I had with both sets of grandparents. The memories I have of them all fill my heart with that longing to have just one more conversation.

Grandparents deserve to be celebrated! Congress had this right in 1978 when Jimmy Carter signed the proclamation.

If you have the good fortune to have a living grandparent, learn all you can from your beautiful, wise tree.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.