Thursday, April 20, 2017

Tips for Improving Caregiver Communication In ALFs and NHs

When making assisted living facility (ALF) and nursing home (NH) placements for loved ones, families relinquish their roles as primary caregivers, entrusting that role to institutional staff.  Staff must realize, however, that some family caregivers will still remain actively involved with their loved one’s care.
The last thing an ALF/NH administrator wants to hear is how his or her facility is developing a reputation as one where caregiver concerns about their loved ones are ignored by an uncaring staff. This is a sure way for bad PR to raise its ugly face in community discussions as well as possibly lead to negative facility reviews online. This is especially harmful if such perceptions are formed as a result of the actions—or inactions—of just one or a few staff members who do not do their jobs properly or who fail to respond to caregiver communications in a timely fashion. All staff must be on mission, not just most staff.
One of the institution’s goals should always be to provide as much appropriate information to caregivers as possible in a timely manner. Caregivers should always be informed whenever there are significant changes in their loved one’s health, behavior, or routine practices. In addition, should there be a problem, inform the concerned caregiver immediately—don’t wait for either the problem to escalate or for the caregiver to find out before being informed. Caregivers should also be informed should there be a significant program or staffing change.
Below are some detailed examples of and strategies for effective communication.
Report on resident/patient behaviors
Family caregivers should be informed whenever there are significant changes in a resident’s daily routines, health, or behavior. For example, I can recall when I noted significant changes in my wife’s sleeping and eating habits. When I brought my concerns to the attention of administrators, I was told that those habits had changed several weeks ago. Excuse me? Why wasn’t I informed of those changes instead of being left to discover them by myself?
One easy way for supervisors to communicate effectively with concerned caregivers may be to do something similar to what many teachers do for concerned parents. Many teachers send home a weekly check-off sheet noting relative behaviors; the teacher places a check mark or “x” in each box to indicate satisfactory or unsatisfactory progress. In a matter of a few seconds, the teacher can briefly communicate with parents, who can then follow up if more information is desired. ALF/NH supervisors could issue similar brief weekly check-off forms for caregivers who want to be kept informed about changes in sleeping, eating, socializing habits, or one or two other areas.
Hold informal get-togethers with family caregivers
Provide coffee and cookies and invite all concerned caregivers to meet with you and your top administrative staff two or three times each year. Such settings allow you to share information about significant changes that are coming or have recently been implemented. These do not have to be lengthy meetings, just long enough for you to inform caregivers, highlight institutional or staff accomplishments, listen to any suggestions for change, and receive valuable feedback on existing practices. 
Announce personnel and program changes
Family caregivers should always be informed whenever there are significant changes in personnel working with their loved ones. I often saw new faces in my wife’s dementia unit, but I was never told about those changes and never given the names of new personnel, making it much more difficult for me to discuss concerns with superiors. Similarly, program time changes often affected my ability to visit with my wife; a simple heads-up about a time change in programs would have enabled me to avoid any problems. Obviously, advance notice cannot always be given. However, very often, advance notice can easily be given, it just isn’t done.
Issue an informative, monthly newsletter
ALFs and NHs routinely provide monthly calendars of events and daily activities for their dementia residents, but few provide names of staff members or phone numbers/email addresses for administrative staff, which would help to facilitate communication with concerned caregivers. A monthly newsletter could also highlight differences in institutional practice for dementia residents as compared with other residents. For example, for the entire first year my wife was in her ALF, I would see the daily menu posted in the ALF dining room and assumed my wife was given those same meal choices each day. Only through observation at meal times did I discover that dementia residents didn’t choose their meals as did other residents. Any practice in the dementia unit—or other units—that is at variance with overall ALF practices could be clearly stated in such a newsletter, along with other helpful information for caregivers to know.

Published in Annals of Long-Term Care, April 20, 2017.  Access online only at:

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