Long-Term Care Survey Alert

This approach to death and dying creates a positive, supportive environment.

For long-term care staff, chronic stress and loss can lead to compassion fatigue and a lackluster performance. Your facility can, however, take steps to help caregivers avoid this common pitfall so they can continue to provide empathetic, effective care.

Making the investment in that effort reaps "huge rewards," says David Farrell, a long-term care administrator with California-based SNF Management. "Occupancy goes up, satisfaction goes, up profits go up, and the clinical issues go better."

Management can reduce daily stress by making the staffing schedule predictable. "It's very stressful," says Farrell, "for frontline caregivers not to know how many residents they will be taking care of, who they will be working with, what days they will have off, etc." Farrell's facility has "consistent assignments in place. And assignments are on the master monthly schedule so everyone knows where they are working and whom they are taking care of."

How the facility administration addresses death and dying can make a big difference in how caregivers cope with this reality in long-term care. "Most nursing homes ignore and hide death," says Farrell. "They put the [deceased] resident on a gurney and move them out the back door quickly."

By contrast, "the most progressive nursing homes put a ceremonial blanket over the body and pray and march the body out the front door so people acknowledge the person," Farrell relays. "They call staff at home who cared for the person and let them know that Mabel passed away. They put a notice next to the time clock that Mabel passed away so people aren't surprised by it." And "they have policies that no one will die alone."

Farrell also believes that facilities that bring in hospice and use music at end of life, such as harps, as well as providing single rooms for people in the end stages of life, can help reduce stress for staff related to a resident's dying process.

Resource: For a free article from Eli's Hospice Insider on the benefits of including music therapy in hospice, e-mail the editor at KarenL@inhealthcare.com.

2 more supportive ideas: To help caregivers with grief over a resident's death, facilities can provide coverage for CNAs to attend a memorial service or have the social worker lead a remembrance service on the unit, suggests Steven Littlehale, MS, GCNS-BC, chief clinical officer for PointRight Inc. in Lexington, Mass. Also, "if someone on staff is dealing with the loss of a special resident, they might need to pull back a little and find [rotating] assignments helpful." 

Invite Staff, Residents, Families to Nondenominational Services

In Littlehale's volunteer work helping provide non-denominational spiritual services in an assisted living facility, he's found that staff members who attend the services also find solace and support. Say the service focuses on "honoring our mothers," he says.The elders attending the service may be remembering their mothers whereas sometimes younger staff may be experiencing issues with their mothers or their mothers may be ill or have died recently, he says. Littlehale finds that the elderly residents can help provide support to the caregivers in such cases. After all, elders have a great deal of experience living through the Great Depression and wars, he points out. They have often dealt with numerous losses, as well, including spouses, children, and friends, he adds.

Novel idea: "Wouldn't it be amazing if facilities provided resident/ staff integrated support groups that focus on issues such as dealing with chronic illness ... or personal loss?" Littlehale asks.