Waugh Consulting

Long Term Care: THEN AND NOW

2011-09-07T12:47:00.007-04:00

Ever said, “Just give me back the good old days”? Let’s take a look at what was good about those old days.

The year is 1990. The “new” OBRA regulations had just gone into effect. Our world of long term care was reeling and we were very busy trying to get our hands around what were the items the surveyors would be asking. Sure, we had regulations, but we were pretty comfortable with them and had learned how to work with surveyors successfully.

We were giving good care with the knowledge we had at that time. Most of the elderly folks presented with physical limitations. Those limitations were in ambulation, transferring and eating and we knew how to help them.

Many nursing homes were small and family owned where everyone knew the residents and their families from their community. Often the owner and the staff were personal friends with the folks from the community. The care was truly focused on the person.

Times have changed...or have they?

Contact us today to receive a complimentary copy of Long Term Care practices still used today! Clearing out my VHS tapes and would like to see them used if you still have a VHS player!

REGULATIONS: The laws governing nursing homes haven’t changed since 1990. We have learned how to meet those requirements. We have learned how to support our practice with evidence-based information. I often hear caregivers agree that the regulations speak to the kind of care they want for themselves when and if they become “residents”.

KNOWLEDGE: Sure there are new techniques and new approaches that we have learned. But we now have computers where we can find information with the click of a key. We have education available from a much wider variety of sources to keep us “up to date”.

STAFF: As I travel the country I continue to find the vast majority of staff members do care deeply for those entrusted to their care. Yes, the facilities are now owned by big companies, but the staff are still from the community they serve; they still know the folks as the people from their community.

RESIDENTS: Sure, the physical acuity of our residents has increased drastically. The number of residents with cognitive loss has compounded the challenges we are now asked to meet. But they are still folks from our community. They still are seeking to be known as individuals.

WHAT HASN’T CHANGED? We are still people caring for people. The residents are still looking for someone to know them and provide care that meets their needs.

The “good” we talk about from the “old days” is the same now as it was back then. I believe if we focus on our service to the people we will find the exact things that were important “back then” are still the things that make the difference.

In the final analysis it’s not about focusing on meeting regulations but on meeting the needs of people. That focus worked back in 1990 and it works today.

Clearing out my stock of VHS tapes - so contact us today to receive a complimentary copy of Long Term Care practices still in use today.

KNOW IT ALL BEFORE YOU CALL

2011-04-06T10:49:00.005-04:00

The time to "know it all" before you consider readmitting a resident to the hospital is here.

I want to share with you a wonderful tool that will empower your nursing staff to effectively communicate with the physician regarding the resident's condition prior to the consideration of readmission.

A review of the new publication from AMDA entitled KNOW IT ALL BEFORE YOU CALL reveals a step by step approach to gathering the vital information the physician needs to determine their course of action. It provides an easy to follow list of data that needs to be provided during the nurse-physician collaboration.

If I ran the world (always keep hoping!) I would highly recommend a copy of this dynamic tool be available on every nursing station. As a fellow nurse, I appreciate the need to share appropriate, to the point resident information with the physician. It can reduce "call backs", frustration and most importantly decreases the time needed to explain the resident's medical status.

Simply click on the tile of this blog to be connected to the AMDA products page for this publication.

Knowledge is power and sharing it is rewarding to nurses, physicians and the resident.

Get your copy now!

ANOTHER CASE AGAINST ALARMS

2011-03-22T08:34:00.007-04:00

I am very concerned about the increase in the use of personal and bed alarms in long term care facilities. In my opinion, we have exchanged physical restraints for psychological restraints in the form of devices that emit an annoying noise when the resident moves.

We say they are valuable to "alert" us. That seems to fall in the category of staff convenience at best as the alarm serves as a means of notification of an incident rather than prevention of an incident.

What about the effect of the alarm on the resident? If it works at all to stop an action it does so by psychological intimidation. An archaic approach at best. Actually an approach that is not sanctioned even when working with possible criminals. Since we never use alarms on alert oriented residents, the problem is simply compounded by the resident's dementia.

So the bottom line is we take a person who already is having problems understanding their environment and make them buzz when they move.

Recently there was an interesting article discussing ALARM FATIGUE for hospital staff members. Take a moment to review the video and the article and then please consider the rampant use of these devices in the care of the elderly.

Simply click on the title of this blog to read the Boston Globe article on ALARM FATIGUE IN HOSPITALS.

FAMILY CAREGIVERS SEMINAR

2010-11-10T12:37:00.003-05:00

11/9/10 Diana was honored to be a part of a dynamic seminar hosted by Senior Independence Home Health & Hospice, Toledo, Ohio. Caring for a loved one with cognitive loss is demanding and often offers frustration to the caregivers. The family caregivers attending the seminar were pleased to learn a wide variety of techniques to increase the value of their conversations including 1) Never say "NO" and 2) Capture stories from the person's past that are enjoyable. Each participant received a copy of Diana's book I WAS THINKING and began completing it during the seminar.

Diana shared that knowing how to begin conversations makes all the difference in the outcome. Family members shared that although they had made some of the common mistakes in the past, such as starting a conversation with a short-term memory question, they felt ready to try a new approach. They left the seminar empowered to "give it another try."

TALK TO ME!

2010-10-11T17:21:00.008-04:00

Diana has presented this dynamic and fun seminar across the USA to scores of long term care professionals.

As expected, Diana offered many practical and immediately useable tips to assist staff members in talking with each other. When communication is effective the quality of the resident care skyrockets! The basis of person-centered care is grounded in successful staff to staff communication.

Although each recommendation is priceless (just ask Diana!), here are a few that Diana would suggest you commit to memory:

1. When you see a behavior, don't play amateur psychologist. Your first thought needs to be "I don't know what they are thinking". Then stating the behavior you see allows the other person to tell you what they are thinking.

2. Success in dealing with a negative co-worker requires the implementation of a simple 5 step approach.

3. Talking behind a co-workers back is acceptable ONLY AFTER you have first told the person that you plan to talk behind their back!

4. Be a role model for the negative person, by eliminating negative talk in your communication.

5. When giving another person directions, assure they got your message by stating "Could you please repeat back to me what I told you to make sure I GOT IT RIGHT." Not "to see if YOU got it right."

What would you do if....

1. A co-worker says "We never have enough linen."

Diana suggests that you assist the person in gathering facts to support their position prior to taking the issue forward to the person who can truly assist you.

2. A co-worker gives you information and requests your assistance.

Diana suggests that you follow-up after the issue is solved you value their involvement and to demonstrate that you cared about their efforts.

Diana's DVD TALK TO ME! is entertaining but oh so valuable in teaching additional simple and effective communication techniques.

Want to ask Diana a specific question? Visit her CONTACT US page and ask away!

VISITS WITH VALUE!

2010-10-11T14:56:00.014-04:00

Diana Waugh has presented the VISITS WITH VAUE program more than 35 times to over 3000 enthusiastic long term care providers in 13 states.

One of her rewarding events was when she traveled with the Alzheimer's Association of the Great Plains speaking at four locations across Nebraska and Wyoming to over 150 family members and 240 long term care healthcare professionals.

She was also interviewed by Cathy Blythe of KFOR in Lincoln, NE. It was energetic and helpful. Here's the link to listen to a portion of that interview.

As expected, Diana offered many practical and immediately useable tips to assist staff members in teaching residents' families and friends how to have successful conversations with their loved one with cognitive loss. Maintaining a calm contented atmosphere during visits leads to increased resident and family satisfaction.

Although each recommendation is priceless (just ask Diana!) here are a few that Diana would suggest that you commit to memory:

1. Empower families by explaining that short-term memory questions often lead to increased anxiety for the resident.

2. Encourage families to refrain from the use of the words "NO" and "DO YOU REMEMBER?"

3. Help families explore the remaining strengths their loved one possesses. Often the focus is on what's missing not on what strengths the resident still exhibits.

4. Teach families through demonstration of successful conversation techniques utilizing the resident's long term memories.

5. Assist family members with their homework to capture the stories and likes of their loved one.

What Would You Do if....

1. A resident continues to ask for their husband who is deceased.

Diana would suggest you teach them to say "Tell me the neatest thing about your husband." Reminiscing with good memories about their loved one will fill their five minute concentration span with pleasant memories while the hope is they will leave the topic contented.

2. A family is distressed because their mother doesn't remember the new grand child.

Diana suggests that you use the phrase "I was thinking about my new grand child, Tommy." If their mother recalls the child they will join in the conversation. If not, the story belongs to the family member and does not demand that their mother "remember."

Diana's DVD VISITS WITH VALUE gives additional tips as you demonstrate your knowledge as a dementia expert with family members.

Want to ask Diana a specific question? Visit her CONTACT US page and ask away!

HEY HELP ME HERE!

2010-10-05T11:26:00.026-04:00

Diana believes that the key to behavior and falls management lies in the ability to determine the resident's motivation for their actions. Only when healthcare providers understand that motivation and then see their role as assisting the resident to reach their goal will success in reducing challenging behaviors be realized.

As expected, Diana offered many practical and immediately useable tips for behavior management as it relates to quality care for residents in long term care facilities.

Although each recommendation is priceless (just ask Diana!) here are a few that Diana would suggest that you commit to memory:

1. ALL BEHAVIOR IS MOTIVATED.

2. A fall is nothing more than the result of a motivated behavior.

3. Unless and until the staff focus in on "Why they are getting up", managing falls and challenging behaviors will continue to be seen as a failure to staff members.

4. The five hundred pound gorilla in the room is the percentage of residents in a facility with Cognitive Loss. The national average is approximately 80%. There is no diagnosis, syndrome or symptom that affects any where near that many residents. Long term care staff members must become dementia experts if care is to meet the unique needs of this population.

5. Knowing a resident’s cognitive functional age is vital. Two standardized and validated tests are: ALLEN COGNITIVE LEVELS www.allen-cognitive-network.org and RCCT www.clocktestrcct.com. For more information on these tests, please visit these two websites.

6. Freedom from the use of both physical and psychological restraints as devices to manage a resident behavior will occur only when there is a facility policy in place requiring that these devices are not utilized. By having such a policy in place a precident will be set to focus on the resident's need rather than using external devices to change an internal motivation.

7. With the "no devices" policy in place, the staff must determine the resident's motivation for moving and then HELP THEM REACH THEIR GOAL, not to stop them - which has been the practice.

What Would You Do For These Residents?

1. A resident likes to sit on the floor instead of sitting in a chair. She does not have cognitive loss. There is a faction at the facility that believes she should not sit on the floor and have instituted restraining shoulder harnesses to keep her sitting in a chair instead.

Diana suggests let her sit on the floor! Care plan it. Have a Physical Therapist perform an assessment on her ability to get on the floor and then get back up to determine where she will need help. Then outline a plan to help her to meet her goal successfully.

Diana's DVD HEY HELP ME HERE! will provide you with other alternatives.

2. A resident gets very upset when we try to bath her. Currently we have quite a "battle" with her. Not only is it challenging for her, it is very challenging for staff.

Diana suggests several alternatives. Consider rinse-less soap; changing the words you use from "shower" to "bath"; reducing bathing from a total bath to washing body areas that cause odors such as hair and perineum; involving her is an activity where she gets "dirty" such as kneading bread or replanting a plant.

Diana's DVD BATHING MADE EASY can give you additional possible interventions.

Want to ask Diana a specific question? Visit her Contact Us page and ask away!

Falls in Nursing Home Residents

2010-08-16T16:42:00.006-04:00

The single biggest challenge facing nursing home staff is the management of resident falls. Over the years we have tried using restraints to STOP residents from moving. It didn't work--they fought to get out of the restraint, fell and often suffered serious injuries. Injuries that we were trying to prevent through the use of the restraint. We are currently trying to make them "buzz when they move" with the use of personal alarms - it's not working! We erroneously think that we can manage their behavior with the addition of an external, negative stimulus when they move.

It is true that CMS has taken a very firm stand against the use of physical restraints. The use of restraints is captured on the MDS and reviewed by CMS with the resulting emphasis on reducing restraint use to less than 3% nationally by 2011. You will see data stating that that national goal has been met. It is true that the use of physical restraints has been reduced.

However, the use of alarms is sky rocketing. Unfortunately their use is NOT captured on any government document and therefore has not surfaced as a national "area of concern". The negative effects FOR THE RESIDENT as a psychological restraint are just starting to be discussed.

I think the saddest aspect of this approach is these devices are used with residents who already have lost some or all of their cognitive functionality. Not only have they lose their ability to think clearly but their dignity is drastically reduced with this attempt to "help" them.

The answer to mitigating falls lies in understanding the person's motivation for moving. After all, if they didn't move, they wouldn't fall! Unless and until we focus on determining the person's reason for moving AND then use our skills to help them meet their need, not STOP them as we have done in the past, we will continue to be unsuccessful in managing falls.

My approach is truly centered on the person. I work with caregivers across our nation to increase assessments that focus on WHO the person is as a social being. Only when we know who they are, not simply their medical challenges, will we be able to address the motivation that prompted the behaviors that lead to a fall. However, once the person is put into the picture, we have more tools than we can ever imagine to capture their attention, redirect their attention, manage (not control) their behaviors and begin to realize success in reducing falls by addressing the motivation to move.

I stand ready to talk with you as you work toward a truly restraint free environment in which residents aren't physically or psychologically restrained while providing days with purpose and less falls, for those entrusted to our care.

Please feel free to enlist my help via this blog as you address the biggest challenge we face in long term care - residents who fall.

Open for Discussions!

2010-08-02T17:37:00.004-04:00

LET'S GET STARTED!

As Waugh Consulting steps into the 21st century, we are proud to announce our new blog! It is our goal to assist caregivers, both professionals and family caregivers, as they work with elderly clients.

First we'd like to share the beliefs that drive our work:

VALUE
A life with purpose.

VISION
Commitment to educate staff and caregivers to the level of expert in long term care.

MISSION
In fulfillment of this vision we are accessible nationally to provide:
seminars presented in a straightforward yet humorous manner while offering innovative solutions with creative ideas for ongoing improvement educational materials that are reality based and immediately usable individual consultation with both professional and family member caregivers dealing with elders with cognitive loss.

Whether you are a professional caregiver working in a setting serving the elderly, or you are a family caregiver dealing with a elderly loved one, we stand ready to discuss challenges and concerns with you.

Please feel free to use our blog to post questions, thoughts and/or concerns and we'll share our knowledge and expertise for your consideration.

Here's to working together to address the challenges we face.