What can I do when the family wants their loved one to have restraints?
ANSWER: As the experts in LTC, we know the dangers, both physical and emotional, of restraining a person. If the family were to ask that their loved one have medications we know would be harmful for the person, we have no problem explaining the reasons the medications can’t be given simply based on family requests. The same is true with restraints. It is our responsibility to explain the reasons why restraints are no longer an acceptable means of managing behaviors. Use the LTC federal laws and guidelines, the physical and emotional dangers of restraining a person, the assistance of the state QIO as well as articles written by LTC experts on the issue of restraints as aides to explaining your position against the use of these pieces of equipment.
What can I do when I can’t get a physician to prescribe pain medication for a resident?
ANSWER: This issue has a many pronged approach. First there is a long list of non-pharmacological pain management interventions that cam be utilized by the nursing home staff. These include-Heat -Cold -Massage -Exercise-PT -T.E.N.S. -Acupressure -Acupuncture-Aromatherapy -Biofeedback-Magnetic -Diversional activity-involvement in activities at which the resident can succeed.
Often the root cause of the pain has not been adequately assessed. For example, it can be as simple as pain caused by constant use of a wheeled chair, the most uncomfortable chair available. Changing seating might reduce the presence of pain.
With the elderly population, immobility of joints often leads to pain when the joint is moved. Consistent, active and passive range of motion exercises can reduce the pain caused by immobility.
Secondly, work with the medical director as the facility champion in educating other physicians in explaining the need for adequate pharmacological pain management. The work done by the American Medical Directors Association on pain management is an excellent reference to assist in this education.
How can I reduce the turnover in the direct care staff?
ANSWER: All research shows that more money, although often mentioned as the reason for leaving, is not the primary reason people work. All efforts must focus on making the staff member feel they are an integral part of the care of the residents. Respect for the input of the staff, utilization of their ideas in care planning, permanent assignments, empowering direct care staff in making their own schedules and providing tangible evidence of their value, such as providing personalized business cards, are just a few of the interventions that lead to feelings of belonging and importance.
What can I do when residents with dementia are upset after family visits?
ANSWER: As LTC experts it is vital that families and visitors are educated in communication techniques that will not increase anxiety in the resident with dementia. The missing skill for the resident is short term memory. Questions such as “What did you have for breakfast?”; “What did you do yesterday?” and the simple “how are you?” often increase the anxiety due to the compromised short term memory. Assisting families to utilize long term memory comments such as “I was thinking about that dog we had that had so many fleas we called him Scratchy,” can lead to a pleasant memory and allow the resident to succeed in the conversation. Using the phrase “I was thinking” takes the pressure off of the resident to “remember”. It allows the resident to become engaged in the conversation at their own cognitive ability level.