Goal: To promote spinal mobility by stretching the mid thoracic spine, neck and chest muscles.

Benefits:  Improving your spinal mobility will help reduce the risk of back, shoulder and neck pain.  Your ability to twist and turn will improve and make daily task such as showering, getting out of a car, and changing direction when walking easier.  Improving your spinal range of motion may also reduce the risk of joint pain related to the spine, neck, and shoulders.

To do: Start by lying on your left side with your knees bent and brought up to waist level. (as demonstrated in the picture).  Next you will turn your head to the right while opening up your arm and torso to the right, in the meantime, keep your knees together as demonstrated in the picture.  If this stretch is to strong, try placing a pillow under your arm, shoulder and neck to be more comfortable.  Try holding this stretch from 30 seconds to 1 minute.  Repeat on the other side. This is a great stretch to do at the end of the day while lying in bed and relaxing for the evening.

This information is not intended to take the place of any advice given to you by your healthcare professional(s). If you experience chronic lower back pain or other physical pain, please consult with you physician or medical professional.  There may be other underlying issues that should be evaluated prior to exercise.

Kaleb Roudabush, NSCA-CPT
Wellness Coordinator

It’s hard to truly appreciate how busy a care provider is during each shift without looking at their entire day.  Take just five minutes and sit and watch someone who is juggling between patients, collecting insurance information, verifying patient ID, or going from one room to the next delivering medications.  My recent observation has been a hurried group of professionals trying to get to each scheduled service, knowing that even a small delay will impact the rest of their day.  Not only will it impact their day, but their patients’ day as well. 

I transitioned from clinical practice into healthcare management about twenty-five years ago and it seems that there has been continual pressure to do more with less, increase efficiencies.  Sadly, with this what we have typically seen is loss of personalization.  Don’t get me wrong, I don’t mean that care is not individualized, because that is not what I’m talking about.  I’m talking about person-centered care, that swinging pendulum is now bringing us back to what is important to patients, personally.  It has become a mandate from CMS.

Person-centered care is not just about giving people whatever they want. It is about taking into consideration individual values, social situations, family dynamics, and needs; seeing the person as an individual, and working together to develop appropriate plan of care. In part, this represents informed decision making, sharing the decisions with the patients and/or families. It is as much about the way professionals and patients think about care and their relationships as the actual services available.

Being able to meet patient’s needs in a manner that best suits them requires change on the caregiver’s part. It requires the caregivers to slow down and consider the aspects of a person’s life that are important, to begin to partner with patients as we have not traditionally done in the past.   This requires the focus to be on the patient’s preferences and facilities that have fully implemented have seen benefits via the patient satisfaction surveys.  Some practitioners are calling this a paradigm shift.  The challenge to see things from the patient perspective has never been greater. 

Back in the sixties, Joni Mitchell had a big hit writing “I’ve looked at life from both sides now”.   Challenge yourself to take the time to observe a patient as they go through your healthcare system and understand what their experience is like as they get services.  Try to truly get the perspective of the patient.  It surprised me when I did this and found that the majority of caregivers I encountered were rushed.  They were often times task oriented and focus was completion of those tasks.  This leads to depersonalization.  Do take time to look at care from the patient’s perspective.  Both sides.

Lisa Chadwick
Director of Safety and Risk Management

Art is defined as having various branches of creativity, through painting, music, literature, dance and crafts.  Just about everything can be viewed as art.  Certain activities are recognized as an art, even if it does not involve painting or creating something from scratch.  There are so many benefits to the power of art, it is amazing we do not see and do more of it!

• Reduces stress, anxiety and depression. How does this work, simply by being a distraction?  It gives your brain a chance to stop thinking about the things that may be bringing you down or is negative in life.  Ruminating on negative thoughts is one of the leading causes of depression.  Art is an opportunity to break these cycles of rumination, helping you to clear your mind.
• Boost self-confidence, creative thinking and self-esteem. Anytime that you must figure out how to form or create something new, the brain is required to use neurons that it normally would not use.  As you continue to see successful outcomes, this leads to better confidence and self-esteem.
• Improves connectivity and plasticity of the brain. This is because anytime you must be use out of the box thinking, your brain must create new neuronal pathways to support this. As a result, new brain cells develop along with new connections in the brain.  It is thought that intelligence has to due the number of connections the brain has, not the size.  This is why individuals who seem to have answers to multiple issues seem intelligent, it’s because they have multiple things that created new neurological pathways.
• Art increases empathy and tolerance. When looking at art, it provides pleasure.  This pleasure is a result of dopamine being released when looking at art or completing an art project.  These feel good hormones help use cope and understand others better.
• Though the list goes on, the last one I am going to share; are improves quality of life for those with dementia. Dementia mainly thought of as a memory problem, there are other issues such as agitation, aggression, depression, anxiety and insomnia. Creating art engages the left and right hemispheres of the brain along with other neurological activities.  This in turn can calm dementia patients down, along with making them feel better.

Looking for some inspiration?  Visit our Pinterest page to see fun and functional ways you can practice in your community!

This information is not intended to take the place of any advice given to you by your healthcare professional(s).

Kaleb Roudabush
Wellness Coordinator

Phase 3 of the implementation schedule for the Mega Rule go into effect in November of this year. Phase 2 and 3 require facilities to demonstrate staff competencies and skill sets based on resident population, as well as providing training to remediate identified knowledge gaps.   Part of these Requirements include Trauma Informed Care (TIC).  This in an introductory discussion about how these changes will impact care delivery in the future.

Historically speaking, populations that have been served by staff experienced with treating traumatic issues include youth and children.  Lifelong impact of trauma during developmental periods has been well documented.  Secondly, trauma care treatment has been focused on our military, PTSD is a prominent diagnosis that focuses on impact trauma will have in daily life. 

Recent discussions within the Geriatric Care Provider Organizations have included impact of trauma in elderly and benefits of receiving care that focuses on behavioral health and/or post traumatic stress disorders.  With the increase in awareness of the benefits coupled with drive to ensure person centered care is being delivered comes the need to increase the educational exposure for staff caring for the aging populations.

 A potentially traumatic event is one that will affect your daily life.  Take for example how a devastating weather event, destructive tornado, hurricane, or flood may have had significant impact on someone’s life and their current reaction to severe weather.  Per Leading Age “A majority of us- somewhere between 55% and 90% by some measures- have experienced at least one traumatic event.”   Examples of traumatic experiences could include experiencing or witnessing domestic and sexual violence, car, train, plan crashes, combat, becoming a refugee, homelessness, medical trauma, violent crime, discrimination, and numerous other potentially harmful life events.

The mere thoughts of 90% of our population having exposure to a traumatic event is staggering.  Knowing that situations occur in everyday life that may trigger those memories and affect patient responses is imperative to assist with care.  As caregivers, how we react when those memories are triggered may make all the difference in the world to the patient’s ability to actively participate in care.

Many times, in older adults when those memories are triggered it may result in responses by the elder that could be easily misdiagnosed.  Behaviors such as irritability, argumentative and confusion, could lead to medication prescriptions that are not necessarily appropriate.  Treating behavior instead of underlying cause.  It is increasingly important that employees in LTC environment are aware of trauma informed care principles to keep those at risk safe.

Start off by defining trauma and look at the components of trauma.

Trauma:  Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

The Three E’s of Trauma: The Three E’s of Trauma are event(s), experience of event(s) and effect.

EVENTS — can include actual or extreme threat of harm, or severe, life-threatening neglect for a child. Events can occur once or repeatedly over time.

EXPERIENCE — how the individual experiences an event helps determine if it is a traumatic event. Does recall of the event disrupt normal behavior?  Does recall of the event trigger feelings of humiliation, shame, guilt? Is there a Cultural component that is affected? Has there been social or psychological support in the past?

EFFECT — adverse effects can occur immediately or after a delay and can have a range of duration. Individuals may not recognize the connection between traumatic events and their effects.

Adverse effects include:

• Inability to cope with normal stresses of daily living
• Inability to trust and benefit from relationships
• Cognitive difficulties — memory, attention, thinking, self-regulation, controlling the expression of emotions
• Hypervigilance / hyperarousal, numbing, avoidance

The first step towards being able to provide adequate trauma-informed care is a basic understanding.  We’ve provided you with facts regarding trauma and how patients may present if actively dealing with traumatic situations.  Let’s next look at how to effectively deal with patients experiencing trauma associated symptoms.

TRAUMA-INFORMED: What does this mean?

With basic understanding of trauma, next we’ll focus on recognition that past trauma may never have been dealt with and that triggering behaviors may be misinterpreted many ways.  Providing a fully integrated Trauma-Informed program will assist in preventing re-traumatization to individual.

The trauma informed approach can be broken down into four components.  All employees must be able to have a working knowledge of the following components.

The Four R’s.

Realization:  All employees realize that trauma can affect individuals, families, organizations, and communities. Individual behaviors may be coping strategies used to survive adversity and overwhelming circumstances both past and present.

Recognition:  All employees can recognize the signs of trauma and have access to trauma screening and assessment tools.

Responding:  With increased awareness of specific resident experiences, all employees can provide care using trauma informed approaches.

Resisting:  Understanding the impact of creating a potentially toxic environment by using devices such as restraints or seclusion with residents who have a trauma history.

Alison Mitchell, MA, MSW and Len Kay, Ph.D., DSW of the University of Maine Center on Aging have developed core principles outlining guidance for trauma-informed care.  We will review the three core principles in detail.

Principle 1: The impact of adversity is not a choice.  The old adage of “what doesn’t kill you makes you stronger” is not necessarily true.  Even one acute traumatic experience, sometimes called a single incident trauma, can change the brain in harmful ways.  In addition, your genetic makeup plays a part in how you deal with stressful situations.  The genetic makeup you inherit makes some of us more likely than others to experience difficult events as traumas that, in turn, produce health-damaging traumatic stress.

Principle 2: Understanding adversity helps us make sense out of behavior. Without understanding that prior adverse events may manifest as behaviors in the elderly population, the likelihood of going undetected and possibly treated incorrectly goes up.

Principle 3: Prior adversity is not destiny.  The ability of the human brain to continue to learn and grow lasts throughout life, this is known as neuroplasticity.  In a safe and supportive setting, elderly patients can learn new coping mechanisms and how to deal constructively with adversity.

Identify the Presence of Prior Trauma and Triggers

What then, is the best approach to teach staff?  How might we adjust our daily tasks to ensure that patients are thoroughly assessed and screened for prior trauma and staff respond appropriately?  It must start with an assessment that will ferret out history of trauma.  Lisa M Brown, PhD Director of Trauma Program at Palo Alto University suggests using questions such as:

“some patients have told me about difficult experiences they had during their lifetimes, such as being threatened or ___.  Has anything like that ever happened to you?”

Opening that vein of communication will help get a better understanding and begin to allow you to incorporate strategies in daily care.  Always validate the response: “That must have been very frightening”.  Make certain that you respond with a response that normalizes the event: “You are not alone.”  “Many people have had these experiences and may feel angry, embarrassed, fearful, etc.”

It’s inappropriate to probe the patient for details at this point.  You should not respond by questioning the patient “if that really happened” or if they are in some way responsible for the incident.  Helpful, trauma-informed care individuals will validate the incident back with the patient.

Only three questions, the briefest screen ever was introduced by Gabriella Grant of the CA Center of Excellence for Trauma-Informed Care.

• Do you feel safe speaking with me today? If not, what would help you feel safer?
• Do you feel safe being here/living here today? If not, how can we help you feel safer?
• Did you feel safe at home as a child? If not, how does that affect you today?

If you are unable to ascertain that there is a history of trauma the best approach is to assume there is.  Using specific therapeutic interactions, the answer may become clearer and direct care based on responses.  Gabriella Grant also recommends specific responses, such as recognizing bravery for coming forward with troublesome information, recognizing the disclosure was difficult, redirect the elder to the present if trauma occurred in early life.  You must also be aware of reporting responsibilities, if this is new information to your care team, ensure it is reported up through the supervisory system where mandated State reporting can occur if applicable.

Understanding what triggers memories of traumatic event is helpful to prevent re-traumatization. Triggering the memory is not always easily identifiable. It could be a scent, a sound, something seen, or felt.  The act of revisiting the incident could stimulate the patient to react in manner that feels as if the incident/insult is fresh.  The goal is helping the patient understand what stimulates and then preventing triggers.

De-escalation techniques should be focused on ensuring the patient is safe from injury.  Staff need to understand that often the patient’s response to the memory will bring back memories of the time and place and may require assistance to bring the patient back (psychologically and emotionally) to the here and now.  As with all patient care, this requires individual plan of treatment and approach.  As, what may work with one individual may not with another.  For continuity, it is best to keep a written plan to address de-escalation techniques and share with the treatment team.

Organizations should be ensuring that your team has an understanding how exposure to prior trauma can affect patients later in life.  Putting these concepts into practice will help position your organization to successfully address patients who may be affected by trauma.  Provision of trauma-informed care starts with understanding and effectively assessing for it’s presence.  Organizations that invest in leadership who will champion this initiative will successfully be able to address the patient’s needs. 

Source:

Leading Age Maryland; Foundations of Trauma-Informed Care: An Introductory Primer

The shoulder is a complex body part that consists of 3 bones, 3 joints, bursa, cartilage, numerous ligaments, tendons, and muscles. In the United States in 2015 there were over 100,000 workplace injuries involving the shoulder. Over 66% of those injuries were a sprain, strain, or tear. Some common injuries include rotator cuff tear, tendonitis, dislocation, and impingement. These are called Musculoskeletal Disorders (MSDs), injuries that are commonly caused by repetitive work, forceful exertions (such as lifting, pushing, or pulling something heavy), working in an awkward position, using tools that vibrate, and contact stress like working with a part of your body against a hard or sharp object.

What Are the Signs of MSDs?
1. Decreased range of motion
2. Deformity
3. Decreased grip strength
4. Loss of muscle function

What are the Symptoms of MSDs?

• Pain
• Tingling
• Cramping
• Numbness
• Burning
• Stiffness

How Do You Prevent MSD Shoulder Injuries?

• Stretch and warm up before beginning your work day.
• Minimize any reaching, lifting, pulling, or pushing below your knuckles and above your shoulders, or “Strike Zone”.
• Avoid working in an uncomfortable or awkward position, such as holding a phone to your ear with your shoulder.
• DO NOT make sudden movements, such as twisting or jerking, while moving an object.
• Ensure you take your break and rest. Your body needs downtime to recover and repair itself.
• If possible, break up or stagger tasks that use the same body part to prevent overuse.
• Complete a hazard assessment to identify where there is potential for someone to develop a shoulder injury.

Ask Yourself
1. Is there a better way to do this process?
2. Are there tools or equipment to help you move an object or assist in your job? Are they in good working order? Are
they readily available?
3. Can the work area physically be changed or improved to reduce hazardous behavior like overhead reaching or lifting?
4. Has this task brought about previous shoulder injuries? If so, where were they? What can we change to prevent these
injuries in the future?

Sources: medlineplus.gov, orthoinfo.aaos.org, www.osha.gov, www.bls.gov

Lisa Chadwick
Director of Safety and Risk Management

A fact, prior to the industrialization of America, retirement was not normal.  Retirement is an artifact of the Great Depression, this was a result of government and industry urging older people to retire so younger more abled-bodied individuals could work.¹ As the practice of retirement grew, it become widely accepted that most workers would retire. Later, the social security system was established; Americans viewed retirement as a fact of life, whether their life’s work was fulfilling or frustrating.  Children of the Depression, to a large extent, began to think of retirement as a duty to be planned for.¹ Employers started to express more on pensions and matching funds of 401(k) along with retirement accounts to be competitive at hiring the best work force. This was a way to help employees view retirement not as an abrupt end to their productive life but an entitlement that is carefully protected.¹

So how does retirement tie into wellness?  Many ways, in fact retirement can either be your demise or new beginning of life!  Harvard public health looked at the rates of heart attack and stroke in both male and females after retirement.  Among 5,422 individuals, those who retired were 40% more likely to have a heart attack or stroke than those who were still working.  The increase was more pronounced during the first year of retirement and leveled off after that.²

What is going on here, why would retirement increase the risk of mortality or negatively affect someone’s heath?  Many factors such as increase stress, in fact retirement is 10^th on the list of 43 most stressful events in life!² Other factors such as the social structure of co-workers or colleagues.  For some, work may have been an escape hatch for those with unhappy home life or on the flip side work may have been positive and it is no longer available due to age limitations for that job?   Having all that extra time after retirement can be hard for individuals to restructure.  This is why living in a retirement community has so many benefits.  Research shows that seniors who live in retirement communities are more independent than those who age in their own home.   Especially one that offers physical therapy for quick recovery along with wellness programs with various activities. 

Today it is expected that someone retiring at 65 will live another 20 years or more!  With that in mind, find a job or volunteer, learn new things, play variety of games such as cards, golf, shuffleboard, bocce ball and make new friends this summer!  We are never to old to play, we only get old when we don’t play!

Reference(s):

• Insel, P. M. (2010). Baby Boomers: Redefining Age and Retirement. In W. T. Roth (Ed.), Core Concepts in Health (p. 693). New York: McGraw-Hill .
• Skerrett, P. J. (2012, December 10). Is retirement good good for health or bad for it? Retrieved from http://www.health.harvard.edu/blog/is-retirement-good-for-health-or-bad-for-it-201212105625

Kaleb Roudabush
Wellness Coordinator

I recently listened to a podcast discussing the importance of the patient experience.  It was an enlightening discussion about collaboration across the healthcare continuum focusing on how to improve the health of our citizens.

The United States healthcare delivery system is the most costly in the world.  Projections indicate that by 2020 healthcare costs will account for 20% of our GNP.  Despite the cost of the American healthcare system, other countries outperform us.   

Because demands on medical and social services are being challenged by the aging populations, as evidenced by increased longevity and chronic health problems, the Institute for Healthcare Improvement has developed triple aim framework to optimize health system performance.  It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which they call the “Triple Aim”:

• Improved health of populations
• Improving per capita cost of healthcare
• Improved patient experiences

Definition of patient experience is explained by the University of TN Dr. Niederhauser as “The sum of all interactions shaped by organizations culture that influences patient perceptions across the continuum of care.”  Forward thinking organizations have begun focusing on committing to addressing and improving the patient experience.  

 The culture of an organization represents: what type of organization, who they are, how they act, what they value, and think is important.   Culture defines expected behaviors of the employees. 

Here is an example of one facility that committed to do “one thing different” each day that may positively affect the patient’s experience with healthcare.  In this situation, a non-clinical person, who initially did not feel part of the care team routinely changed the way he communicated with patients.  Each day this person purposefully put his hand on the patient’s shoulder and offered a sincere greeting.  Ultimately, this small gesture had a profound affect on the patient’s experience which in turn resulted in increased trust and increased value of the patient’s experience.  This is a win-win situation as it was accompanied by a bonus of increased employee satisfaction from witnessing the positive outcome.

The way that care providers communicate with patients is not a new topic.  We’ve seen numerous programs and facilities prescribe to various tactics to assist in personalizing and improving the patient experience.  There has been much success publicized by the Studer AIDET program as well.

With this, CMS is promoting programming focused on value vs volume and quality vs quantity in the post-acute care world.  Patient Centered Care has been in the forefront of the healthcare journals for quite some time and the expectation that it will be provided is well established.  Individuals can assist by keeping patients more actively involved in their own healthcare, education, involve fully in decision making, include patients and family during rounding, preferably on a daily routine.  This ties hand in hand with Trauma Informed Care.  Care providers need to understand how previous experiences will affect a patient’s reaction to similar or “triggered” situations. 

Challenges that continue to face health care providers include continuity of care across the continuum of all healthcare services.  From the patient perspective, a poor experience in one area may affect the perception of entire episode of care. 

What does “the whole is greater than the sum of its parts” mean?

This saying is credited to the Greek philosopher Aristotle. The concept has been used to explain many ideas, including:  Synergy, where people working together can achieve more than they can by working separately (e.g. in an organization or a team)

The whole is greater than the sum of its parts.  Do your part and commit to understand what it takes to improve the patient experience.  Look at processes to ensure they are patient centric NOT healthcare provider centric.  Make time to create the human connection necessary to improve the patient experience. Great quality care requires partnerships to transform patient experiences.  Improved patient experience will improve outcomes, patient safety, and lower utilization of unnecessary care.

Resources:

WUOT Health Connections: How Can We Improve the Patient Experience?
https://www.wuot.org/people/brandon-hollingsworth

IHI Triple Aim Initiative:
www.ihi.org/engage/initiatives/TripleAim

AIDET Patient Communication:
https://www.studergroup.com/aidet

Lisa Chadwick

Goal: To get you outside and enjoying spring weather!     

Benefits: There are many benefits to walking.  Walking is not only good for heart health but also good for boosting immunity.  Walking will help maintain your strength and endurance which can help you bounce back from an event of being sick.  Walking can be done anytime of the day either by yourself or with others.  Walking the hall is another great way to stay active during inclement weather.  Contrary to popular belief, walking can ease arthritic aches and pains.  Just try doing short trips to see what feels best for you, in time you will build stamina and be more able to walk longer distances.  

To do: First off, you want to start of with a comfortable pair of sneakers.  Yes, there are other types of shoes such as toe shoes and bare foot shoes, however if this is your first time starting a walking program; I would recommend looking into a quality pair of shoes fitted for your foot.  Someone who specializes in understanding gait can set you up with the right pair of shoes to decrease risk of injury.   Once fitted, pick a distance and time yourself.  Once you decrease time, increase the distance and repeat.  As your pace increases, your cardiovascular system and body’s ability to utilize oxygen is improving!  Nothing beats a healthy heart!!!     

This information is not intended to take the place of any advice given to you by your healthcare professional(s). If you experience chronic lower back pain or other physical pain, please consult with you physician or medical professional.  There may be other underlying issues that should be evaluated prior to exercise.

Kaleb Roudabush
Wellness Coordinator