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What is the most important element of successful teamwork in long-term care communities? The answer, although obvious, is easier said than done—Communication.

Teamwork Training

According to the AHRQ (Agency for Healthcare Research and Quality), effective communication is CRITICAL for efficient teamwork. Furthermore, research conducted by Salas E & Frush K. (2012) notes that developing communication skills for the purpose of teamwork can improve resident safety in long-term care communities. Therefore, teamwork training is well worth the effort!

In fact, teamwork training is not that complicated. Even a little shift in technique can make a huge impact!

The SBAR Technique

The SBAR technique (Situation, Background, Assessment, Recommendation) is a structured form of communication for healthcare professionals to discuss a resident’s condition. Consequently, the SBAR technique has been successfully applied in many different healthcare settings, which not only improves team communication, but also improves resident safety.

When you need to communicate with another team member, consider framing the conversation in the following format:

First things first, you want to identify yourself. Then, you will begin with the Situation by stating the problem. What is happening with the resident? Next you will communicate the clinical and personal (yes, personal) Background of the resident. Give pertinent information related to the situation. After that, you will provide your Assessment of the situation. What do you think the problem is? Finally, make your Recommendation. What action would you recommend? Describe what the resident needs and what you want. Also, make sure that you are speaking clearly and concisely. That way, it will prevent miscommunications and misinterpretations.

Below, you will see an example of how to properly use the SBAR technique to communicate information in long-term care communities.

Practice communicating in the SBAR technique with your team, and watch team communication challenges quickly dissolve!

RESOURCES:
https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module4/mod4-facguide.html
https://eklavyaparv.com/content/communication-skills/400-nursing-notes-and-sbar-technique

You knew where you stood with Ralph Shute because he would either meet you with a smile or call you a moron.

Above all else, he was a kind man with a purpose. Those who have met him, remember not only his generosity, but also moments that make you chuckle and shake your head.

If you couldn’t find him, he was probably at work. And rightfully so, as he had 11 children. With five girls and six boys, the man had many to provide for.

So where can you find Ralph?

Ralph would be gone before the kids woke up and home after bedtime—six days a week. He was a hardworking man who took pride in his work, working as a longshoreman for 45 years in Halifax, Nova Scotia. He was dedicated to his family, and his wife, Mary, who held it down at home.

On his day off, you would often find him working on the house, asking for “help”, although most times, he would end up just doing it himself. You would somehow find yourself holding a board steady for him, helpless, only for him to come and push you out of the way. He was a perfectionist and would marvel at the imperfections of his construction. “Hey! Come look at this—look at how f***ing crooked that is!”

Every summer, he would often take his family to the cottage and stay there for a month or so, commuting two hours to work each way. He loved taking the kids water-skiing, boating, and apple picking, despite catching the odd rotten apple in the thigh after getting caught in the crossfire of a rotten apple fight.

He spends his remaining years at the cottage, lakeside, with his wife Mary, tinkering around the cottage.

A man with a quiet interior and a depth that he kept to himself, Ralph Shute was no moron.

Music has become an increasingly popular therapeutic method in long-term care communities. But do you actually know the power of music? Do you know that music has a significant effect on seniors? Let’s dive deep into the music world.

What is Music Therapy

According to the Canadian Association of Music Therapists, “Music therapy is a discipline in which Certified Music Therapists (MTAs) use music purposefully within therapeutic relationships to support development, health, and well-being.”

Knowing this, music therapists can use music to address human needs in the following domains: cognitive, communicative, emotional, musical, physical, social, and spiritual.

Fun Facts about Music

Do you have any fun facts about music? We do.

To start, music helps seniors recall old memories. Why? Because strong emotions are often associated with music, and music can support seniors in retrieving these memories. When was the last time you listened to a song and it took you down memory lane?

Furthermore, when seniors receive one-on-one personal care, music may facilitate their cooperation with caregivers. Research at the Journal of Advanced Nursing found that listening to seniors’ favourite music while receiving care may help reduce care-resistant behaviours.

Finally, music not only helps elders resist loneliness, boredom and isolation, but also alleviates feelings of sorrow and abandonment. Therefore, music can provide additional companionship, especially for seniors with dementia or sensory issues.

So get out your blue suede shoes and put on a little Elvis. Besides person-centred care and communication, music can also play a prominent role in a resident’s day!

REFERENCES:
https://www.musictherapy.ca/about-camt-music-therapy/about-music-therapy/
https://musicheals.ca/music_therapy/long-term-care-music-therapy/
https://www.thehamletsatpenticton.com/benefits-of-music-therapy-for-seniors/
https://www.mcmasteroptimalaging.org/blog/detail/blog/2016/11/15/3-simple-ways-to-manage-challenging-behaviours-associated-with-dementia
Konno R., Kang H.S., Makimoto K. (2014). A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes. Journal of Advanced Nursing, 70(10), 2167-2180. doi: 10.1111/jan.12432

We’re in the long-term care and hospice care industry because we care about our seniors, however, do we, as care staff and caregivers, care enough about ourselves too?

Pros and Cons of Caregiving

Caregiving is rewarding, but also stressful. It is truly satisfying to provide assistance to another person in need, although at the same time, the emotional and physical stress of caregiving is prevalent, especially when caring for a loved one.

According to Lawton and his colleagues in the Journal of Gerontology (1991), caregivers may experience prolonged physical and emotional pain, which can lead to depression, anxiety, and other mental illnesses. Therefore, it is crucial for leaders to recognize pain when they see it, and help caregivers receive the mental health support they need to maintain their health and wellness.

Stress Looks Different On Everyone

What does pain and stress look like? Well, it’s different for everyone.

Some may constantly feel worried, depressed and overwhelmed, and therefore miss work or “check out” during the day. With others, you may see a loss of interest in activities they used to love, or notable weight gain or weight loss. Some people may be sleeping too much or too little but still feel exhausted during the day, while others will experience headaches or other physical pain that was not evident in the past. Of course one of the most common signs that someone is in pain or under a lot of stress is how easily they are to become annoyed or angry.

How do you respond to stress?

Let’s Talk About Mental Health

Mental Health needs to be a topic of discussion. Let’s start the conversation, and battle depression and anxiety in the workplace together. Together, we can provide resources for all, and help each other get the mental health treatment and support we deserve. Together, we are strong.

SOURCES:
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/caregiver-stress/art-20044784
https://www.apa.org/pi/about/publications/caregivers/faq/health-effects
Lawton, M.P., Moss, M., Kleban, M.H., Glicksman, A., & Rovine, M. (1991). A two-factor model of caregiving appraisal and psychological well-being. Journal of Gerontology, 46, 181-189. doi:10.1093/geronj/46.4.P181

Attention all care staff, caregivers and CareStory followers! You really care about residents’ wellness, and you have checked blood pressure nearly thousands of times for seniors…but how long has it been since you checked your own?

Studies at BMC Public Health have found that the prevalence of hypertension was significantly higher among caregivers than non-caregivers. Even some small adjustments can make a huge difference in your blood pressure readings. Here are some tips for you:

Drink Wine! — Just kidding. That’s not recommended, but it does pair nicely with a bubble bath on stressful days.
Shed a Couple of Pounds! — We promote body positivity here, however, studies at Harvard Health Publishing show that the most effective way to reduce elevated blood pressure is to lose weight.
Go with a DASH (Dietary Approaches to Stop Hypertension) Diet. — Choose food that is rich in potassium, calcium, magnesium, fibre and protein. Also, choose ingredients low in saturated fat and sodium
Exercise. — Aim for a half-hour exercise daily. It could be running, biking, dancing, or any activities you love.
Limit Alcohol Intake (so much for #1). — Drinking too much, too often, can increase blood pressure. Try to drink in moderation by limiting your intake to 1 drink or less per day.
Meditation. — Research at Harvard Health Publishing also found that stress hormones can constrict your blood vessels. Over time, stress can lead to chronic hypertension. Meditation techniques help to reduce stress and lower your blood pressure.

We need you! So please take care of yourselves.

REFERENCES:
https://www.health.harvard.edu/staying-healthy/6-simple-tips-to-reduce-your-blood-pressure
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303565/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340290/#:~:text=Results,27.6%25%2C%20respectively

As professionals in the long-term care industry, have you ever heard residents complain about their unpleasant experiences while receiving care? If the answer is yes, we have a question for you. Do you think the caregiving team was working as a unit? Today, CareStory is going to discuss team collaboration.

The Bad News

Based on research published at NCBI, if care staff don’t work smoothly as a team, the community will begin to notice challenges with day-to-day care as a result.

First of all, caregivers may unintentionally overlook symptoms, such as unmanaged pain, dietary issues, sleep patterns, etc. This not only decreases the level of trust between the resident, the family members, and the staff, but it also greatly reduces the resident’s quality of life. Another issue that will present itself due to poor team collaboration is that Nurses may mix up medication among different residents. This happens more than you think, and is a mistake that could cost someone their life. Perhaps the issue we are currently seeing the most of in communities is that residents are being ignored and experiencing limited companionship and interaction.

These scenarios are very real, and may potentially lead to conflicts between residents, their families and everyone else involved in their care.

The Good News

However, if your long-term care community does have challenges with team collaboration, there are things you can do to improve, and quickly at that.

The first thing you can do is learn more about the residents. Get to know their life stories. Even the process of discovery will personalize interactions. Next, administrative staff can set long-term and short-term goals for the team. It is also important to identify how all team members can work together and help each other accomplish these goals. Another thing you can do is set up and consistently update records of important information, such as milestones, setbacks, and achievements. Everything should be easily accessible and in one place so staying up-to-date is simplified. Finally, to improve communication between seniors, the caregiving team, and family members you can adopt CareStory (we had to say it) to make sure everyone is on the same page about everything that matters.

Just know, team collaboration is an ever-changing and ongoing journey that makes the world of difference in any long-term care community.

RESOURCES:
https://www.ncbi.nlm.nih.gov/books/NBK2665/

How to Help a Senior’s Caregiving Team Work Together

https://www.seniorsmatter.com/caregiver-team-planning/2492267/
https://www.aplaceformom.com/caregiver-resources/articles/caregiver-duties
https://www.agingcare.com/articles/create-a-care-team-in-5-steps-195525.htm
https://www.brynmawrterrace.org/sites/brynmawrterrace.org/files/LTCcommunication_Tips.pdf

Today, CareStory would like to take you into the senior story world and tell you the story of John Drake.

In Portland, Jamaica, you might know John Drake. So who is John Drake? John is a very well-respected businessman and visionary. In fact, he built the Drake legacy from the ground up.

Community Contributor

Passionate for law and politics, John had a lot to say. Because of these passions, John is deeply involved in his community, and he is also an active member of the church.

Moreover, John was very popular and a busy man, working, inspiring the community, and hosting social events. He spent time as a Justice of the Peace and enjoyed being a member of the Freemason Lodge.

Besides these activities, John also had a large appetite for life. He loved going to the horse races at Caymanas and watching cricket matches at Sabina Park.

Successful Investor and Provider

Everybody knew John as a hardworking man and a great provider. He invested in businesses and real estate and his driving force was to support his family.

John owned a number of businesses, such as a hardware store, bar, restaurant, etc. The 52-acre farm is his prized investment. There, you would see cows, pigs, turkeys, chickens, rabbits, ducks, geese, along with gardens, an abundance of fruit trees, and a farmhouse filled with love.

Inside, he raised five children with his wife Cynthia, who he loved and respected dearly. John met Cynthia in church, and married her in 1953 with just a single gold band. They made commitments to each other, and they were partners in every sense of the word.

John was known for his kindness and giving nature, along with his firm hand. Johnny Walker was his signature drink, and he could make a mean Rum Punch.

John spends his remaining years in Portland with his wife Cynthia. Currently, he is still active in the community and taking care of others. If you’re from Portland, you know the name Drake. And if you know the name Drake, you know a good man.

Long Term Care Staff Study - Part 1 - PSW

Introduction

Long-term care is in a state of crisis, but you may have known that already. Nothing new. Before COVID-19 made its mark on the world and the industry, the tragedies within long-term care finally fell under scrutiny. At least here in Ontario. Due to the actions of a few bad actors, now tried and convicted, and the resulting investigation, the relatively new Ministry of Long Term Care (MLTC) issued the request for an investigation into the staffing situation within the industry. In the span of 6 months, despite the 1st wave of COVID-19, a 50-page document was produced. We have taken the numbers and compared them to the source where ambiguous and condensed them into a visual guide. In this 1st part, we will be looking at the state of Personal Support Workers (PSWs). Part 2 will explore the state of Nurses as outlined in this study into long-term care in Ontario.

Staff Distribution

At first glance, the above data may seem promising, but it’s far from the truth. One staff member per resident may seem like a dream come true, everyone has one, and there are a few to spare. Where’s the problem? Why is everybody screaming that we need more PSWs? They make up 58% of the hired staff of a home?

Mental health and chronic conditions can’t wait 12-16 hours until a caregiver is back on shift. It can’t wait over the weekend or when a caregiver has to take time off. With less than half (PSWs, Practical Nurses, and Registered Nurses) working full time, you can be sure that 1 staff to 1 resident becomes 1 staff to 2 residents if we talk about 1 shift a day.

Despite being more than 1 hired staff per resident, despite there being more than 1 trained PSW in Ontario per resident in long-term care, residents still receive on average 2.3 hours of attention from a PSW in a 24h time period. This is on par because, when talking about long-term care PSW, it employs only half of all the PSWs in the province. Clearly, not the 1 to 1 days we are hoping for.

Long Term Care Staff Study - PSW Demographics

Demographics Unpacked

Although anecdotal, regarding demographics, many of the homes we work with also tell us that the first language of close to half of their caregivers is not English. This is not to say they lack fluency, but an indicator of them being 1st generation immigrants; this in part can be correlated with age and sex distribution. Healthcare and Education being female-dominated industries, both preferred choices of new immigrants who may lack the transferable work or educational experience, or Canadian accreditation may come at a higher cost than that of transition.

Long Term Care Staff Study - PSW Enrolment Programs

Enrollment

Although an attractive job for newcomers, and a position in high demand, there is not enough incentive to become a PSW. At the time of writing, we did not receive a number for the available enrollment positions across the province, but the long-term care study describes it as “consistent.” Across the years, a visible drop of students is visible from 8000 in 2016 to 6500 in 2019. Of note, the same document also mentions the industry losing on average 9000 PSWs/year as of 2011.

Long Term Care Staff Study - PSW Depletion

Drop out, burn out.

Caregiver job satisfaction is the leading cause of burnout and them fleeing the industry. The lack of attractive wages does not help the situation either.

Understandably, staffing can be the largest cost of a home. Hiring more people may mean that everyone gets fewer hours or a smaller hourly pay. It’s not fair.

Without a top-down reform, attractive salaries, and industry recognition, there are few options to go with. Among them is to invest in technologies that can better the lives of caregivers. Enhancing communication for everyone will result in a better environment to work in and better care outcomes. We’ve actually written about strategies a home can adopt to avoid staff burnout. Free online resources and working with as opposed to ‘around’ or ‘against’ the families is a great first step. You can read it here.

Download the infographic from here.

Lastly, if you wish to read the full study the infographic is based on, you can do so here.

Part 2 – Nurses coming in 2 weeks.

First off, if you did not know that the https://www.lgbtagingcenter.org/ exists… now you do, and you’re welcome. Furthermore the acronym has happened Intersex and Allies. Thus the current version is LGBTQIA+, double welcome.

Quick LGBT History.

So why is this important, you may ask. And it’s a fair question to ask. It’s 2021, most of us probably have that gay friend or relative and we know that they are ok people. We say this as we live in cities with active communities and neighborhoods. But it was not always like this. When it comes to long-term care, those who are now at the age where a nursing home or assisted living facility is something to consider still have fresh in their mind the events that lead to Pride from the 60s. Here I’m talking about the Stonewall riots, arguably the most significant event in the liberation movement across North America. The LGBT youngsters of the time, those struggling with their identity, or those born shortly after having memories of anti-gay legislation, violent discrimination, and the bloody clashes that happened in the summer of 1969.

Exactly one year after the riots, the first Pride event was hosted. With the aim to commemorate the events and show the community’s solidarity against oppression.

Aging

Yes, as fabulous as some of us may be, we still age. Often times with a dire need for additional care. And as mentioned above, the 2020 urbanite who has LGBTQI+ in their network may disregard one’s sexual preference and treat them like any other person. You know, like the intent behind the whole liberation movement. But now, think those aforementioned activists and rebels who were on the front line in 1969. The participants of the various initiatives shortly after. All these people harbor a strong distrust of government institutions, such as law and healthcare. Furthermore, legal recognition of same-sex couples is a recent development. They have been discriminated against by these systems for decades. Adoption laws did not recognize same-sex couples.

There is only one sad conclusion to be drawn. The aging LGBT community often ends being comprised of isolated, lonely, childless, and potentially impoverished individuals. The loneliness epidemic, which we wrote about in the past, is stronger felt by the aging LGBTQs.

Care

With the above in place, there is little to no support network for these individuals. This in turn makes care more challenging in some circumstances. Be it the embedded mistrust of the system, or the caregiver’s personal biases or expectations from LGBTQI+ individuals. Whatever the case, it remains important for the service provider/caregiver to educate themselves on the best practices to interact with individuals coming in with different backgrounds, histories, and trauma. When it comes to the LGBTQI+ there are plenty of resources on the internet to facilitate the institutional or individual’s educational process. On this topic, another great resource is The National LGBTQIA+ Health Education Center, specifically this practical guide.

The extra mile

If you’re reading this and know of people who are living relatively isolated lives be it at home or retirement homes, there are 2 ways you can improve their long-term well-being. The Advance Care Plan, and caregiver education.

The Advance Care Plan

This is the millennia of TikTok, YOLO, and Carpe Diem. But to Live Laugh Love long time, we need to take care of our future selves with some of the decisions we make today. The idea of an advance care plan is nothing new, it is something that gets missed. It simply implies writing down how we want to be cared for when and if we are no longer able to take care of ourselves. How do you want to be called? What are some of your favorite routines, music, shows? …when should they pull the plug?

We all die. Most of us will need some form of care before we get there. We should have a say on how that care is provided. And for members of a historically discriminated against group, such a plan will hold accountable those slower to change and ensure one’s wishes will be respected.

Caregiver Education

We’re getting there. Organizations such as the Registered Nurses’ Association of Ontario have dedicated interest groups to help bring awareness. But when it comes to personalized care, it’s also important to have some of the details of that Advance Care Plan or the input from the guardian/primary_caregiver at hand. Technology, such as CareStory, but not only, can help facilitate this. Consider what solutions would best help you, your home, your residents, your co-workers or your friends have a higher satisfaction when engaged in the care process.

Conclusion

Pride is a show of solidarity that was born out of a violent clash between the LGBT Comunity and the Police in New York in the 60s.
LGBTQ adults have experienced historic, systemic, discrimination. They are wary of trusting institutionalized care.
LGBTQ older adults are more likely to be alone and impoverished.
Awareness groups and professional organizations are making efforts to make the system more accessible and inclusive.
LGBTQIA+ individuals should consider the importance and creation of an Advance Care Plan.
Communicating care preferences directly or through proxy via technology such as CareStory will improve the quality of care one receives.

Caregiver Burnout, we all know it’s real.

An investigation into the state of long-term care in Ontario (Canada) revealed that caregiver burnout starts before they even get a job. That is to say, close to % of personal support worker students quit before completing the program. Furthermore, approx. 40% of those who do graduate decide to pursue something else right after graduation. But, as the investigation concluded mid-2020, the onset of COVID-19 created government incentives for enrolment.

Yet, that did not solve the immediate problem. COVID meant putting the homes in isolation or lockdown. Which, in turn, meant no volunteers, no agency workers in most cases, and most importantly, no family. Understandably, this put a lot of pressure on the homes. On the other hand, families felt powerless and grew more demanding of the home; all the while, the residents suffered in lonely isolation. Isolation has a solution we explore here.

Granted, COVID is a new problem. A problem that exacerbated old problems, like staff shortage and burnout, the negative, unintentional impact family can have on care and the impacts of isolation. All this is currently pushing the system to its limits, often having it fail tragically. Yet, how can we tackle some of the old problems? Luckily we have both old and new solutions, some of which unfortunately are not well known.

why caregivers burn out

Customer Service

This may come as a surprise, but in an attempt to provide person-centered care, caregivers devote 99% of their attention to the resident and only 1% to the family. Arguably, you may say that they should be giving residents 110% of their attention, and I understand where you’re coming from. But hear me out. The aim is to make everyone happy so caregivers have an easier time.

Ensuring that staff spent a bit more of their attention on families will give exponential returns in everyone’s satisfaction. Yes, everyone, not just families, staff, and residents as well. And it will take you one step further in reducing caregiver burnout.

You may think that the resident is your customer, and yes, they are. They should be the focus. But families are also your client. They are also your referral, your Google/Facebook/Yelp review. And with us millennials putting our loved ones in a home retirement or ALF. And boy, do we give those reviews a serious look. A generation of people grew up not knowing a time before Google. Think about it.

Positive Feedback Loops

Study after study has shown that having a positive relationship with the family results in more supportive and more involved families. Brushing families off or flat out disregarding them results in adversarial or competitive relationships with families. These negative interactions justify many caregivers’ burnout and jump ship for another home where the cycle repeats itself.

Caregivers need to volunteer feedback and information. Updating the families on the residents’ goings-on is an easy, low-cost activity that can greatly improve the families’ mood. The aforementioned studies point out that families suffer from feelings of guilt towards their loved ones put in care for the first few months, if not years. And it is important to show them that said loved ones are in good hands and treated with dignity.

As psychologists will tell you, we are more prone to notice the bad than the good. So it is imperative to point out the good, as the bad will not go on unnoticed. Caregivers communicating offers families a sense of security, a sense that they have made the right decision, and that you are a professional.

Use Technology

Do you know what professionals also do? They use everything at their disposal to be masters of their craft. Everything means technology. If you want to help caregivers from burning out, caregivers need to be upgraded. COVID made this clear. A drop-in visit resulted in a rise in Video Calls. A step in the right direction. But it’s still using existing, generalized technology. Technology that due to the lack of specialization results in extra work to keep a sense of normalcy. If you want to take control of caregiver time, give a good chunk of it back, and empower families, Video Calls are not the way. Video Calls have existing caregivers on stretched lines having to sit in place holding a tablet if you’re unfortunate and don’t have the tablet stands or something similar.

So what would a specialized solution look like? Well, shameless plug here, CareStory is one such solution. It has a feature dedicated to asynchronous video communication. It allows families and residents to interact via video but is delayed and influenced by times best suited for the caregivers. No timeslots that can run over and push back a whole day. This on top of instant access to family-provided information without having caregivers run to the nearest point of care or… uh… computer… in a nurse’s office. All that running is what burns staff out.

But your EMR platform may have other integrations that allow communication with families. Be it one way or both ways. If it can be put directly in the hands of caregivers, communication would greatly improve their quality of life and the quality of care they provide.

In Conclusion, to avoid Caregiver Burnout, you should

Treat family like (future) customers.
Encourage caregivers to speak to the families and provide care updates, unprompted.
Empower families with the use of technology so that they can support caregivers from afar, as opposed to stressing them out unintentionally.

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