Making LTC Facilities More Resident and Caregiver Friendly

All long-term care (LTC) institutional caregivers should seek to work closely with family caregivers/ advocates to further what should be a common dual mission: to provide the best possible care for each resident while making life easier for their caregivers/advocates. One way to accomplish this mission is for LTC administrators to place themselves in the shoes of concerned caregivers/advocates.
  
How does one do that? As a former caregiver/advocate for my late wife, an Alzheimer disease (AD) resident in lockdown units in both an assisted living facility (ALF) and a nursing home for 3 years, I would suggest simply asking caregivers and advocates for their opinions.

In those 3 years, never once was I asked this simple question: what can our facility do to improve upon how we are providing care for your loved one, and what can we do to make life easier for you?  In other words, what can we do make our facility more resident- and caregiver-friendly? Not shy by nature, I offered my suggestions even though I was never asked! At a certain point, I requested bi-weekly meetings with the chief administrator to discuss my concerns. Usually the follow-up was very good because the administrator, familiar with my published writing, feared I was going to write an article for publication detailing the problems at that facility! But I discovered that some caregivers/advocates refrain from voicing opinions and suggestions for change due to fear of “adverse treatment” of their loved ones if they complained. 

Dementia residents often may be unable to provide valuable feedback, but their caregivers/advocates can do so, either through written survey forms or through scheduled occasional meetings with administrators.

When I was a classroom teacher, I asked my students to complete a “report card” on me at the end of each school year. Names were optional; most questions were simple ratings, but some questions were open ended. Later on, when I worked as a principal, I also asked all of my teachers to complete a “report card” on me at the end of each year. ​Such feedback was extremely valuable, leading to improvement in either my teaching plans or administrative policies. I would suggest that LTC administrators also seek feedback from their caregiver/advocates.

What kind of feedback? I would divide such feedback into 2 categories: general and specific.  Generic categories would include many of the same items included on the checklist* I used when initially checking out ALFs. Not all of those checklist items would be appropriate for a survey after admittance, but feedback on many of those items would be valuable.  
Generic categories on my checklist included ratings or comments on items such as:

• First impressions (“clean, cheerful, well maintained?”)
• Common areas (“Garden/walking paths?”)
• Resident care (“Does staff monitor personal hygiene, eg, bathing, oral care?”)

But there were many more categories. With my personal caregiver/advocate experience, I can think of other generic questions to ask about availability of visitor parking, special dining facilities for caregivers/advocates to use for a resident birthday party, etc. 

Specific categories would be about issues that LTC administrators may only be able to learn about with feedback from caregivers/advocates. Perhaps the best way to obtain such specific feedback is to simply ask one question:

• Are there any policies and practices which you feel can be improved upon to provide better care for residents and/or make life easier for caregiver/advocates?

Had I ever been asked this question, I would have responded with such questions as:

• Why do caregiver/advocates coming to visit their loved ones in your lockdown dementia unit sometimes have to wait several minutes before someone unlocks the door?  
• Would providing remote openers to unit personnel be helpful, so when a caregiver presses a buzzer to enter, personnel occupied with other residents could simply click on their remote opener? 
• Could you provide a key code pad by the locked unit entrance with the code posted to allow caregivers/advocates to open locked doors by themselves?
• Why doesn’t your parking lot snow removal contract result in more frequent periodic snow removals in a timely manner, so caregiver/advocates have available safe places to park, and walk, when coming to visit their loved ones on a snowy day?
• Why is the music volume on lounge speakers so loud that it disturbs caregivers meeting there with loved ones? Can separate lounge volume controls be installed?
• Why are outside chairs, tables, and benches not cleaned periodically each day of bird droppings and pollen? Why aren’t seat cushions on wrought iron chairs set out each morning unless it is raining, or bad weather is imminent?
• Your facility has a special lounge where snacks, coffee, and juice are available to residents and visiting caregivers/advocates, but juice and coffee machines do not seem to be replenished periodically on a regular schedule or fixed quickly if reported as broken.  Why? 

Any LTC facility can be improved if suggestions for improvement are sought from the caregivers/advocates who visit their loved ones—the ones who are intimately acquainted with the services provided and personnel. In addition to possible facility improvement due to evaluative feedback, administrators may also see more referrals from clients who appreciate the fact that their feedback was valued.

*My checklist appeared as a companion resource to my article, “Advising Alzheimer’s Caregivers About Assisted Living” in the January 14 issue of ALTC. Readers can also read that checklist on Dr. Vann’s website,www.allansvann.blogspot.com.

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Dr Vann writes a monthly Commentary blog column for the Annals of Long-Term Care journal, one of the brands housed on the Managed Health Care Connect website. He has also written frequently for caregiver magazines, other medical journals, and major newspapers. After his wife, Clare, was diagnosed with early onset Alzheimer’s disease, Dr Vann made it a point to increase public awareness of Alzheimer’s and to help fellow caregivers. You can read more than 90 of his other articles about Alzheimer's at www.allansvann.blogspot.com. If you would like Dr Vann to respond to questions or comments about this article, please email him directly at acvann@optonline.net.

Published in Annals of Long-Term Care, April 25, 2018.  Access online only only at 
https://www.managedhealthcareconnect.com/blog/making-ltc-facilities-more-resident-and-caregiver-friendly