Transcript Rita Spak Fostering Participant and Family Relations SS

OKLAHOMA ASSOCIATION OF HOMES
AND
SERVICES FOR THE AGING
ANNUAL MEETING
MARCH 8, 2011
“CELEBRATE AGE….
EXPAND THE POSSIBILITIES”
FOSTERING
PARTICIPANT AND
FAMILY RELATIONS
Rita L. Spak
MS, CTRS, ACC, CDP
www.spakconsulting.com
IMPORTANCE
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Regulatory Compliance
Marketing of Your Facility
Efficient Use of Staff
Benefits
to resident
HISTORIC BARRIERS
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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
PARTICIPANT SURVEY
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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?
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Reasons
OBRA
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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
FAMILY GROUPS
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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.
JOINT COMMISSION
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Family satisfaction
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Family complaints
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Provision of Care, Treatment and Services
Standard PC.6.10
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.
JOINT COMMISSION
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7. Family Complaints
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24/7 visiting hours
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Interact with members of the community both
inside and outside the facility
NEW SURVEY PROCESS
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Utilize MDS data
Resident interviews
Family interviews
Record reviews
BE PROACTIVE
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Family’s role remains
critical to resident’s
well-being
Educate them with
important information
EDUCATE FAMILY
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Care planning
Ways to keep family involved
Become partners with staff and other
providers
Monitor their loved one’s care
Help their loved one stay emotionally healthy
FAMILY GROUPS
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Family council
Grief counseling
Bereavement counseling
Support groups
Family input into care plan conference
Family night
Volunteer group or auxiliary
PARTICIPANT SATISFACTION
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Abt study
Participant surveys
Participant counsels
Choices in your facility
Handling complaints
FAMILY COMMUNICATION
IN LTC
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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??
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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??
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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??
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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 WELLBEING IN MIND?
IS COMMUNITY SUPPORT OF YOUR FACILITY
IMPORTANT?
HOW DOES YOUR FACILITY VIEW FAMILY
INVOLVEMENT??
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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??
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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
FAMILY EXPECTATIONS
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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.
ENCOURAGE FAMILY TO:
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Visit or call relative often
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
PRIOR TO ADMISSION
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
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SYMPTOMS OF DEPRESSION
AND ANXIETY FOR HOME
CAREGIVERS
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STRESS
GUILT
MY PARENTS WERE NEVER THERE FOR
ME
PHYSICAL AND EMOTIONAL
IMPLICATIONS
BAD PUBLICITY
FACILITY ORIENTATION
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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
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OUR RESIDENTS SHOULD NOT
BE ISOLATED IN OUR FACILITIES.
THEY SHOULD STILL FUNCTION
WITHIN THE COMMUNITY AND
WITH THEIR FAMILIES
YOUR PERSONNEL
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A common
barrier to
improving Quality
of Life
ADMINISTRATION
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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
NURSING
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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
REHAB PROFESSIONALS
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Be realistic and do not fuel unrealistic family
expectations
Do not delay in reporting lack of progression
or worsening of functional status
Do not say that they are being “discharged”
from therapy
SOCIAL SERVICES
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Don’t misunderstand family dynamics
Explain code status
Review DNRs
Explore spiritual needs
ACTIVITY SERVICES
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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
DIETARY
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Handle food complaints promptly
Ensure family is aware that they can bring in
food items for resident
STATE OF THE ART
PROGRAMS FOR FAMILY
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Simple Pleasures
Family Baskets
Bedside Family Members
Discharge Phone Calls
STAGES OF GRIEF
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Denial
Over-involvement
Anger
Guilt or Shame
Acceptance
FAMILY ANXIETY
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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
WHILE THEY ARE AT THE
FACILITY
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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
WHILE THEY ARE AT THE
FACILITY
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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FAMILIES HELP BY:
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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
FAMILY CAREGIVER
DEMOGRAPHICS
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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
FAMILY VISITS
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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
FAMILY VISITS
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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
WHILE THEY ARE AT THE
FACILITY
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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RIGHTS OF FAMILY MEMBERS
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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
FAMILY RIGHTS continued
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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.
FAMILY EDUCATION
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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
COMMUNICATION SKILLS
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Body Language
Tone of Voice
Actual Words
CONFLICT RESOLUTION
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Assess Your Attitudes
Manage Your Anger
Respond Appropriately to Anger
Conflict Management Strategies
Communicate Through Conflict
Build Successful Relationships
CONSTRUCTIVE BEHAVIOR
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Listening
Acknowledging
Accepting
Avoid accusations
State your position
Propose compromise
Suggest further discussion
Follow up
Be respectful
ASSESS YOUR ATTITUDES
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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.
ASSERTIVE BEHAVIOR
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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
ANGER MANAGEMENT AND
STRESS
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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
MAINTAIN COMPOSURE
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EVENT/TRIGGER
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POSITIVE RESPONSE
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Increase in volume
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Decrease in volume
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Focus on emotion
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Focus on facts
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Remarks about the
person
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Remarks about the
situation
ROOTS OF CONFLICT
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Miscommunication
Personality type
Differing Values
Opposing Objective
Variance in Methodology
EMPATHY
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Genuine empathy establishes a specific
connection between people
This connection brings with it an obligation to
create the highest good of all
BUILDING SUCCESSFUL
RELATIONSHIPS
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Be a builder
Focus on the positive
Respect life
Mind your ego
Invest in a healthy attitude
Focus on commonalities
In my relationship with
families….
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I feel…..
I believe…..
I accept……
I desire…..
I am……
IN MY RELATIONSHIP WITH
PARTICIPANTS…
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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.