If at first you don’t succeed…well, you know the rest: Try, try again!
How often do we ask residents to join us for exercise class or another activity, have them say “no”, and we say “ok” and move on to the next person. Then after a few “no thank-you’s” from them, we give up asking altogether. The thing is, with older adults—especially those with cognitive decline—we need to keep asking.
Why do residents refuse to participate in activities? Some reasons to consider:
They are in pain
They are depressed
They are intimidated by large groups or new people
They are afraid they won’t be able to keep up with the activity
They don’t understand what you are asking them to do
They are afraid of falling
They have poor hearing or eyesight
They are incontinent and don’t want to go too far from the bathroom
And the list goes on.
Consider these possible reasons and how you can address them. Also, remember that residents often mirror your attitude, so if you appear enthusiastic about having them join you, they will likely feel that enthusiasm too. If you ask them in a way that seems like you don’t care whether they come or not, then that’s how they may feel. They may feel that they’re not worth the trouble.
In any event, whether a person has said no to you 5 times or 500 times, don’t give up! The 501st time may be the one where they decide to come—if only to stop your nagging. And that 501st time can change their life. We’ve seen it happen.
We hope you are all enjoying your 4th of July holiday weekend!
With COVID-19, care providers need to wear masks and other PPE (personal protective equipment) that prevent spread of the disease – but masks can also cause communication challenges, particularly for older adults living with dementia. This 20-minute video shows simple, effective ways to communicate while wearing a mask.
Experts share practical tips to use body positioning, speech modification, gestures, communication boards and modified PPE to ease communication and help older adults feel understood and supported while everyone stays safe. We encourage you to share this video during your next staff meeting or huddle. Consider breaking it down to smaller sections if only have 5 minutes at a time.
First off, we hope all of you who are nursing assistants had a wonderful Nursing Assistant Appreciation Week and that your residents and fellow staff helped you feel appreciated, valued and loved! These have been very difficult months for all of us, but your commitment to your work and the residents you serve while putting your own health at risk makes you heroes in our eyes.
We know you miss your volunteers too. As facilities begin to reopen in some states, you may be able to bring back some volunteers who test negative for COVID or have already had the virus. (Check your local and state policies first.) If allowed, consider asking a few volunteers to help take residents outside for walks. Many residents would probably enjoy a walk outside to enjoy the sunshine and fresh air. This can help them maintain or regain some of the strength they may have lost while being isolated with limited access to physical activity and also provide a companion to talk to for a while. We also hope you are able to find ways to have outdoor visits with family members when permitted and encourage you to send us pictures or descriptions of creative ways you are making this happen!
As long term care communities slowly reopen to visitors, keep in mind that meeting outdoors is likely the safer for your residents and their visitors, and the warmer June weather will help with this!
The American Health Care Association (AHCA) suggests opening outdoor courtyards to residents and visitors. If your facility doesn’t have a courtyard, consider using outdoor open spaces around the building such as parking lots or grassy areas under trees. Remember that all visitors, residents, and employees should practice social distancing and wear masks. You likely will need to limit the number of people permitted in courtyards and place visual cues in outdoor spaces to guide social distancing, such as lines and the ground and chairs spaced apart with tables in between them.
Be sure to consult your local and state guidance when developing new approaches. You can read the full statement by AHCA below with additional ideas:
For some residents, it may take some extra effort from staff to motivate them to go outside again. Here’s a brief video with some tips by Dr. Elizabeth Galik on how to motivate residents to go outside:
These are challenging times to be sure. Not only are you and your staff working on the front lines during a global pandemic that disproportionately affects your residents, we are also in the midst of a national crisis as we face the injustice and racism that still exists throughout the country and within its systems. The anxiety and exhaustion from the past few months of fighting COVID-19, coupled with the sadness, anger and frustration that many are now feeling can have an enormous impact on the mental health of your nurses, nursing assistants, administrative staff, and others on your team. Here are some resources to help:
The Maryland COVID-19 Crisis Support Program is offering free mental health support for frontline workers. It is a new program that provides free, confidential mental health support to employees of Maryland’s long-term healthcare facilities impacted by the coronavirus outbreak. What’s different about this program is that in addition to individual counseling, there is also group support available for specific workgroups/teams/shifts. Facilitated wellness and stress management discussions are open to all employees. Services will be provided virtually by licensed mental health clinicians provided by the Workplace Trauma Center (WTC). Read the details.
Support and referral line of Pennsylvania: If you’re feeling scared, overwhelmed, or anxious, there are community-based resources available if you live in Pennsylvania, through the Support and Referral Helpline at 1-855-284-2492. Support is offered to anyone struggling with anxiety issues because of the pandemic. They are not licensed counselors but can refer you to counselors in the area, including those who can help with issues such as unemployment.
Learn more about Philadelphia area resources by clicking on the link below:
Since most of us, and certainly your residents, have spent the last few months limiting our travels to home, work, and essential visits to a grocery store, we could sure use a change of scenery! These simple, one-minute movement videos by Kay Vannorman from Brilliant Aging showcase the beautiful scenery and wildlife of Montana, Hawaii and Yellowstone National Park.
Staff can use iPads to show these quick videos to residents in their room and practice them while doing ADLs and before meals, or as a small group activity outside. The website has other free resources that you may find helpful as well…take a look!
We have a few tips and a tool to share with you this week. First off…Mask Hacks! Are you sore behind your ears from wearing a mask 8 to 12 hours a day? Well, nurse.org has some simple and creative ways to help make those masks more comfortable. Give one (or two!) of these ideas a try and send us pics:
And Dailycaring.com highlighted a recent article that offers some great stress relief advice (this tidbit writer has tried it, and it works J) Here it is in a nutshell from www.dailycaring.com:
This 10 minute exercise gives stress relief for caregivers
When we’re exhausted, stressed, and starting down a negative emotional spiral, it can be easy to overlook the things that are going right.
Dr. Mann’s simple stress relief exercise has 6 questions:
What experiences, no matter how small or simple, gave you pleasure?
What praise and feedback did you receive?
What were the moments of pure good fortune?
What were your achievements, however small?
What made you feel grateful?
How did you express kindness?
When you’re feeling down or in need of a boost, jot down answers to these questions in a notebook or journal. (If you don’t feel like writing, review answers that you’ve previously written…but that means you need to do it at least once!)
The exercise is based on scientific research that shows that taking some time to reflect in these ways can help you slowly shift your mindset and eventually find more happiness in your life. And because of the way our memories work, a bad mood caused by one bad event can cause you to think about other causes of stress and unhappiness.
Finally, you may remember when we shared with you a “My Story” page, where you and staff could note the preferences and life story highlights of residents to help you better care for them. Well we’ve created a “COVID-19” version (see below) which allows you to note resident preferences that can be key during this crisis, especially when residents are socially isolated and you may have staff changes. Feel free to edit as you wish, and let us know what you think!
We’d like to shine a light on long term care community staff and residents who are doing great things during this COVID-19 crisis!
This week, we give a special shout out to Sherry Stick, the Fitness & Aquatics Coordinator at Carroll Lutheran Village, who has recorded some wonderful exercise videos that her residents love, and that they can do in their rooms. One video uses exercise bands, and the other video includes range of motion exercises. Click on the YouTube links below to watch:
Carroll Lutheran Village also received some positive media attention when Vivian Myers, a 104-year-old resident, recovered from COVID-19 and walked with her walker back to her old room in the health center! She had a staff member with her and another following behind in the wheelchair. Baltimore’s local CBS station covered Vivian’s story:
Nurses and other health officials lined the hallways as Myers left the rehab wing where she recovered. “Excitement. We all waited until everybody had time to stop, and we were cheering her on,” said Tara West, one of her nurses. “And I was like ‘Come on, you got to walk.’ She was like, ‘alright!’”
And walk she did, showing that residents and staff all have the potential to be resilient! Keep up the great work!
Would you like to share a story about a hero or heroes in your community? Please email us and we’ll share it in a tidbit!
Have a great week!
Sherry Stick, instructor at Carroll Lutheran Village, demonstrates range of motion exercises in her wellness video.
Music has enormous power. It can motivate. It can soothe. It can make you smile, and move you to tears. It is more accessible now than ever before, and we aren’t using it enough in long term care.
We have seen first-hand how simply turning off the television in a common area and turning on some lively music can completely change the mood of residents. Some songs just make you want to move, and having older adults do just that instead of sitting still for hours on end can have a huge impact on their physical and emotional health. Try turning on some music ten minutes before each meal and asking staff and residents to dance, or clap, or march, or wave their arms!
Music can also be helpful when a resident is anxious and/or resisting care. Try playing soft, calming music while helping a resident with morning care and bathing. Ask a resident’s loved ones to donate an old smartphone or I-pod and load it with the person’s favorite songs or type of music. If they like to wear headphones, ask their loved ones to bring in several inexpensive pairs (discount stores carry these for as little as $4 or $5).
Music can help bring back fond memories and lead to wonderful discussions about them. You might be surprised at how many people with memory loss can still remember the words of their favorite songs from their younger years. Patriotic songs can be especially moving for people of the “greatest generation”, and popular songs from old movies and show tunes are fun to hear too.
Keep in mind that music can be overstimulating for some people with cognitive impairment, so be mindful of this and observe the reactions of residents when music is playing.