Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency • Survey
Landmark legislation for long term care, OBRA ’87, mandates that certified nursing facilities are to provide services so that each resident can “attain and maintain their highest practicable physical, mental, and psychosocial well-being.” Recent requirements in Phase 3 of the Requirements of Participation (RoP) for trauma informed care have spurred a focus on behavioral health and psychological well-being. It has been questioned whether the attention to behavioral health issues has kept pace with the attention to the quality of medical care that we’ve seen increase in SNFs.
The spectrum and caliber of emotions related to the current COVID-19 crisis with:
- frustration and
- irritability have
- heightened the stress level.
Resilient leadership with clear, calm and compassionate care and guidance is needed. In the turmoil and mayhem of figuring out how to slow the spread of the virus, how to prepare for and deal with new routines, it is crucial to look at how our patients, families, and staff are being affected. The fear cycle is contagious so strategies to mitigate the emotional impact of this pandemic should be considered.
There are no easy answers but Harmony Healthcare International (HHI) recommends the following:
- Facilitate Alternatives for Family Visits
Helping residents stay in touch with their loved ones and feel connected to their families can provide reassurance and reduce anxiety. Consider ways to use FaceTime or telephone apps, set up Skype on computers in a private area, assist with phone calls or other methods for communication and staying in touch. Think about ways families can record video or audio messages for residents, particularly those with dementia that can be played when they are worried. This option of repeated encouragement and support may assist with comforting residents.
- Create a Clear, Consistent Message
Have a uniform guideline and talking points for staff to control the message when communicating with residents and families. Generate a simple explanation that reassures them that the facility is following procedures based on the best science available. Consider limiting exposure to 24/7 news on TVs in common areas.
- Provide Appropriate Activities
Have a predictable routine that keeps residents engaged. Think out of the box and modify activities to meet infection control requirements. Maybe a sing-along can be done with a patient by their door and a recreational professional in the hallway or common area.
- Assess for New or Increased Behavior Issues
Look out for subtle changes and identify issues early. Be checking for spikes in depression, anxiety, paranoia, delusions, hallucinations, and delirium. Ask residents how they are doing and listen carefully, not only to their words but the feelings behind them and absorb what they are and are not saying. Think about the best response and your plan for addressing behaviors. Consider non-pharmacological approaches first and remember that jumping to an easy solution is not always the best one.
- Watch your Non-Verbal and Verbal Communication
Be aware of how our emotions, tone of voice, behavior, body language and words can affect your residents. Do your best to act calm when interacting with residents, families, and other staff. The duck on the pond who glides smoothly through the water appears serene and unruffled even when furiously paddling below the surface. Let’s try to do the same.
- Provide Person-Centered Care
Gear your conversations and interactions with each resident towards their preferences, being aware of their triggers, background, concerns, and interests. Use simple explanations for a cognitively impaired resident and avoid rushing through care activities. Your caring manner can shine through your eyes and gentle touch even if you are wearing a mask and other personal protective equipment. Think about music that your resident especially enjoys and how to incorporate that into their day.
- Say “YES”
Try to find ways to agree with a distressed resident. Validate their concern and try to accommodate some part of their request while complying with the changes in routines such as social distancing. Whenever possible keep things as consistent as you can. Familiar caregiving staff and routines can help minimize behavioral symptoms.
- Support Staff
Trauma and stress result in an impact on our biopsychosocial systems for all of us. Caring for ourselves and our colleagues is vital as you work together. Besides maintaining infection control procedures and providing medical treatments for our patients, take time to brainstorm on interventions and successful strategies for providing compassion and quality of life for your staff as well as your vulnerable patients. Maybe a huddle with staff at the start and end of the shift with an opportunity to share what was hard, what was good and to recount the joy in small moments would help? Working as a team during this unprecedented journey while celebrating the unsung heroes on the staff will make a difference.
The advice, "don’t be scared, be prepared”, is timely. Please let us know at Harmony Healthcare International (HH) how you are preparing, what has or hasn’t worked for you and how we can assist you.
Don't forget to register for our Freaky Friday Webinar this Friday, April 10th on Trauma-Informed Care!
Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have. You can contact us by clicking here. Looking to train your staff? Join us in person at one of our our upcoming Competency/Certification Courses. Click here to see the dates and locations.