OKLAHOMA ASSOCIATION OF HOMES
AND
SERVICES FOR THE AGING
ANNUAL MEETING
MARCH 8, 2011
“CELEBRATE AGE….
EXPAND THE POSSIBILITIES”

Rita L. Spak
MS, CTRS, ACC, CDP www.spakconsulting.com

 Regulatory Compliance
 Marketing of Your Facility
 Efficient Use of Staff
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Measuring Quality of Life/Satisfaction
Community care measures that account for preferences, caregivers, and inadequate care access
Measures that account for care continuity and coordination
Addressing cultural and individual preferences
Focus of Quality of Care

 How many of you have placed a parent or loved one in a facility?
 How many of you were satisfied with the provided care?
 How many of you were dissatisfied with the provided care?
 Reasons

 SEC.483.15 QUALITY OF LIFE
 A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.
 PARTICIPATE IN RESIDENT AND FAMILY
GROUPS

 When a family group exists, the facility must listen to the views and act upon the grievances and recommendations of families concerning proposed policy and operational decisions affecting resident care and life in the facility.

 Family satisfaction
 Family complaints
 Provision of Care, Treatment and Services

Residents must be given sufficient information to make decisions and to take responsibility for selfmanagement activities related to their needs.
Residents and as appropriate, THEIR FAMILIES are educated to improve individual outcomes by promoting healthy behavior and appropriately involving residents in their care.

 7. Family Complaints
 24/7 visiting hours
 Interact with members of the community both inside and outside the facility

 Utilize MDS data
 Resident interviews
 Family interviews
 Record reviews

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Family’s role remains critical to resident’s well-being
 Educate them with important information

 Care planning
 Ways to keep family involved
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Become partners with staff and other providers
Monitor their loved one’s care
 Help their loved one stay emotionally healthy

 Family council
 Grief counseling
 Bereavement counseling
 Support groups
 Family input into care plan conference
 Family night
 Volunteer group or auxiliary

 Abt study
 Participant surveys
 Participant counsels
 Choices in your facility
 Handling complaints

 The onus is on the facility to prove to the family that they have the best interest on the loved one in mind.
 The decision making authority of residents and their families has increased
 Informed consents are frequently required for therapies, treatments, and overall care.

HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
 It is the responsibility of the staff and administration of the LTC facilities to support families through the difficult process of admission and in dealing with new roles after the admission.
 In the majority of instances, residents come from acute care hospitals and family members most often do not get the whole picture of the status of the resident

HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
 More than 50% of both spousal and nonspousal caregivers report participating in the physical care of the resident
 Managing money, arranging medical care and transportation, and providing social support are tasks families regularly perform

HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
 DIFFICULTY ARISES BY THE WAY FAMILY
INVOLVEMENT IS VIEWED BY
ADMINISTRATION AND STAFF.
 THE KEY IS WHETHER THE FAMILY IS
VIEWED AS INTEGRAL TO THE LTC
SYSTEM OR PERIPHERAL

HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
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WILL RESIDENT FAMILIES HAVE SERVICES
EXTENDED TO THEM?
WILL THE FAMILIES BE INCLUDED IN
ACTIVITIES AND EVENTS?
ARE RULES AND REGULATIONS OF THE
FACILITY MADE WITH THE FAMILY’S WELL-
BEING IN MIND?
IS COMMUNITY SUPPORT OF YOUR FACILITY
IMPORTANT?

HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
 RESEARCH SHOWS THAT FAMILY
MEMBERS CITED MORE PROBLEMS IN
CARE, INTERACTIONS WITH STAFF, AND
NURSING HOME CHARACTERISTICS--
ENVIRONMENT, STAFFING, WHEN
FACILITIES HAD LOW FAMILY
ORIENTATION.

HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
 When the facility was ranked high in family orientation, family members were more likely to mention the care was good or excellent and staff cooperated in problem-solving

 Often unrealistic if they do not have a comprehensive understanding of the geriatric syndromes that have been at work and which had led to placement.
 Unrealistic expectations of the intensity of one-to-one care that can be provided by the facility staff.

 Visit or call relative often
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Plan a day trip with the resident outside the facility
Personalize the resident’s space with photos, pictures and other memorabilia
 Bring a favorite food that the resident enjoys

 MIRROR THEIR REALITY
What are the losses to the resident?
What are the losses to the family?
What are the physical implications?
What are the emotional implications?
Influencing the relationship may be: distance from family, availability of family, gender of family, prior relationship between the family member and older adult and the functional ability of resident

 STRESS
 GUILT
 MY PARENTS WERE NEVER THERE FOR
ME
 PHYSICAL AND EMOTIONAL
IMPLICATIONS
 BAD PUBLICITY

 Meeting with department heads
 Letter realizing their importance as family members
 Family newsletter
 Assess family
 What can they contribute to facility
Staff training on family involvement
Designated contact person for family

OUR RESIDENTS SHOULD NOT
BE ISOLATED IN OUR FACILITIES.
THEY SHOULD STILL FUNCTION
WITHIN THE COMMUNITY AND
WITH THEIR FAMILIES

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 Families need to be aware of the specific policies
(restraints, dietary)
 Facilities should not accept residents if their staff is not capable of providing appropriate care for them
 If planning occurs prior the the admission, an enormous amount of time and effort can be saved by avoiding frustration from the resident’s families

 Relay daily updates about residents to their families
 Deliver info in a professional and compassionate manner
 Often confusion about grooming, bathing
 Report medication changes and test results

 Be realistic and do not fuel unrealistic family expectations
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Do not delay in reporting lack of progression or worsening of functional status
Do not say that they are being “ discharged ” from therapy

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Don’t misunderstand family dynamics
 Explain code status
 Review DNRs
 Explore spiritual needs

 Handle resident council complaints promptly
 Get family permission for photographs
 Get family permission for outings
 Resident autobiographies
 Shadow boxes
 Encourage families to bring in pets, plants and reading materials

 Handle food complaints promptly
 Ensure family is aware that they can bring in food items for resident

 Simple Pleasures
 Family Baskets
 Bedside Family Members
 Discharge Phone Calls

 Denial
 Over-involvement
 Anger
 Guilt or Shame
 Acceptance

 Despite 80-90% of the family caregivers reporting adequate satisfaction with the care in the placement facility, their depression and anxiety levels, which were already high as a community caregiver, did
NOT improve following placement
 The use of anti-anxiety medications among family members actually increased from 14.6% to 19% following placement
 50% of family members were at risk for clinical depression following placement

 ADVOCATE
Family caregivers need to be involved as advisors
Caregivers should be acknowledged as the experts about the resident, if not their illness
Training staff to sensitivity policies and practices can reduce caregiver stress and facilitate patient adjustment.
Administration support for programs is essential
Instill empowerment by providing families with information, skills and services

 INCLUDE
Average family will visit between 6 to 16 times per month
Offer services specifically for family members
Offer social activities for the staff, family and residents to promote positive relationship
Offer volunteer opportunities to the family

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Respecting the resident’s individuality and uniqueness
 Encouraging personal interaction with others
 Promoting access to the larger world through television, radio or newspapers
 Encouraging participation in games or group activities
 Encouraging expression of spiritual beliefs and practicies such as praying, reading the Bible, or listening to spiritual music

 68% are female
 Average age of the caregiver is 58
 Average education level is 14 years of schooling
 60% of caregivers work part-time or full-time
 36% of caregivers are daughters
 78% of caregivers drive themselves to the facility
 70% live within 10 miles

 50% of spousal caregivers visit daily
 45% of spousal caregivers visit weekly
 25% of non-spousal caregivers visit daily
 66% of non-spousal caregivers visit weekly
 The vast majority of caregivers visit their relatives on a regular basis

 Approximately 85 to 98% of residents receive visits
 Residents receive an average of two to three visits per week
 The average visit last from one to two hours
 40% of the visits occur in the afternoon

 INVOLVE
Offer support and educational workshops
Facilities can use the Rite Aid Giving Care For
Parents site at www.riteaid.com
as a great educational tool in learning more about the clinical, legal and financial concerns.
The educational videos are free.

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Participate in assessments and care planning
Be informed of residents’ rights
 Be notified within 24 hours of an accident resulting in injury, a significant change in the resident’s condition, a need to alter treatment significantly, or a decision to transfer the resident

 Immediate access to visit the resident at any time, subject, of course to the resident’s consent
 Be notified promptly if the resident is going to be moved to another room or if there is a change of roommate
 Participate in a family council and make recommendations and present grievances without retaliation

IDENTIFY AND BUILD ON
COMMUNICATION BEHAVIOR STYLES
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WITH WHAT FAMILY DO YOUR FIND IT
DIFFICULT TO COMMUNICATE?
DESCRIBE THE BEHAVIORS THAT CAUSE
PROBLEMS FOR YOUR?
NOTE HOW YOU GENERALLY RESPOND TO
THESE PROBLEMATIC BEHAVIORS
NOW LOOK AT YOURSELF.
IDENTIFY AT LEAST ONE BEHAVIOR THAT MAY
NEED MODIFYING.

 Facilities do not typically promote family education.
 All staff must understand the intense level of stress experienced by families at the time of placement
 Knowledge of the long-term care systems and understanding the nature of the common geriatric syndromes can aid families during this difficult period

 Body Language
 Tone of Voice
 Actual Words

 Assess Your Attitudes
 Manage Your Anger
 Respond Appropriately to Anger
 Conflict Management Strategies
 Communicate Through Conflict
 Build Successful Relationships

 Listening
 Acknowledging
 Accepting
 Avoid accusations
 State your position
 Propose compromise
 Suggest further discussion
 Follow up
 Be respectful

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Tact vs Skill
Skill is…ability, expertise; proficiency
Tact is….the skill of handling a difficult or delicate situation
 Self-image vs Self-Esteem
 Self image is the mental concept of the self that an individual identifies as a “picture, symbol” of oneself.

 Respects the needs of both individuals
 When you care enough to have the courage to be connected, creative resolutions result
 Appropriately and honestly expressing our views or feelings with another person while respecting the other person
 This is what I think
 This is what I feel
 This is how I see the situation

 Your behavior is your choice.
 How you choose to label an event and to respond to it are your decisions
 Always remember that anger and aggressive behavior can have a devastating impact on your immune system and long-term health

 POSITIVE RESPONSE
 EVENT/TRIGGER
 Increase in volume
 Focus on emotion
 Remarks about the person
 Decrease in volume
 Focus on facts
 Remarks about the situation

 Miscommunication
 Personality type
 Differing Values
 Opposing Objective
 Variance in Methodology

 Genuine empathy establishes a specific connection between people
 This connection brings with it an obligation to create the highest good of all

 Be a builder
 Focus on the positive
 Respect life
 Mind your ego
 Invest in a healthy attitude
 Focus on commonalities

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I feel…..
I believe…..
I accept……
I desire…..
I am……

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I feel…..
I believe…..
I accept…..
I desire…..
I am…..

Empathetic communication is the foundation of excellent resident care.
Poor communication contributes to suffering because it exacerbates the resident’s and families’ sense of isolation, helplessness and anxiety.
YOU are in a unique position to provide solace to residents and their families.