For most families, entry into a nursing home is like being teleported onto a strange new planet. The arrival is often swift and unanticipated, and the customs are foreign and frequently unnerving. Think back to your first days in long-term care, subtract your training, add a sick loved one and consider from that vantage point what services you can offer to improve the experience of anxious family members. Here are five ideas to get you started:
1. Provide essential information up front.
Your admissions packet probably includes the basics already, such as a copy of the residents’ rights and information on how to finance a nursing home stay and how to file a grievance. Consider going beyond the essentials to provide helpful details such as the names of the nurses, aides, doctors and social workers, and the fact that, for example, nurses wear white and aides wear blue and what the difference is in their roles in the facility. Anticipate the need for other information such as the location of the business office or how the discharge process works.
2. Offer emotional support via family meetings.
Nursing home entry is an extremely stressful event in the life of a family. Family members may consider nursing home placement to be “the beginning of the end” and be experiencing anticipatory grief as they look toward losing their loved one, even though the loss might be many years away. Most families are negotiating the added life tasks of trying to decide what’s best for Mom and perhaps selling a home or dispersing a lifetime of possessions. Family disagreements are common. Nursing homes that offer supportive and informative sessions run by the social worker or psychologist, with community referrals as needed, are more likely to be viewed with gratitude for meeting this unspoken need than to become targets of misplace anxiety and rage. Examples of meeting topics could include “understanding dementia,” “supporting your loved one during nursing home placement” and “coping with changing family dynamics.” In addition, offering information on illnesses such diabetes, provided by a knowledgeable staff member or by a local representative of an organization such as the American Diabetes Association, can improve the compliance of families with residents’ special diets and reduce conflict with staff (and residents) around this issue.
3. Support the family council.
A well-run family council can become an asset to a facility by providing the opportunity for experienced family members to assist newbies going through the process of adjusting to placement of a loved one in a nursing home. Family councils can identify problem areas within your organization and suggest improvements, thus keeping your facility ahead of the customer service curve—and your competitors. They often recognize staff members for their good work, arrange joint activities for families, friends, and residents, and may also be able to raise funds for needed items you can’t otherwise obtain. Facilities can show support for family councils through promotion of their existence, providing a meeting location (and perhaps some snacks and beverages), taking their concerns seriously, and showing up for invitations to participate in the proceedings.
4. Listen deeply and act on feedback.
Whether or not you have a family council, your families are constantly offering feedback to your staff. Listen to each concern for the possibility that it reflects an underlying systems problem. For example, a complaint to an aide about a dirty curtain dividing a semi-private room may be a signal that it’s time to review the facility-wide curtain-cleaning schedule. Provide a way for the line staff to safely communicate the info to management, such as an anonymous suggestion box or kudos rather than criticism for identifying problems. It is far more reassuring to family members to receive thanks for bringing concerns to staff attention and to let them know how the problem was resolved, than it is for them to hear a staff member say, “I’ll tell the nurse” and leave them wondering whether the information was ever communicated.
5. Train staff on customer service with families.
Does the following scenario play out at your nursing stations?
A family member approaches the desk and tries to make eye contact with any of the several staff members sitting behind the desk. They continue writing notes and talking to each other.
“Excuse me,” the family member says hopefully.
The nurse walks away from the nursing station.
The dietician keeps writing.
The consultant looks up and says, “I’m a consultant.”
Turn this situation around by offering your staff customer service training specifically geared toward working with family members. Role-play potentially challenging situations (e.g. errors in care, decline in health, etc.)so that your staff is prepared to handle strong emotions and to put family members at ease. After training, family members approaching the nursing station will be greeted with a friendly smile and the warm question, “How can I help you?”
Eleanor Feldman Barbera, PhD, is a speaker and consultant on psychological issues in long-term care, and author of the forthcoming book, The Savvy Resident's Guide: Everything You Wanted to Know About Your Nursing Home Stay, But Were Afraid to Ask. For more information, visit Dr. Barbera's website, www.mybetternursinghome.com.