Case Management Society of America

Features

Engaging Your LTC Residents

Top Tips to Connect, Interview and Educate

(Tips also work for patients in any setting!)

By Edward Leigh, MA

Create great experiences and you will have very satisfied residents; their family members will be very happy, too! As an added bonus, enthusiastic residents and their family members will become your organization’s biggest supporters, since they will tell everyone about their great experiences.

The first part of this article will focus on residents who do not have any type of cognitive impairment. The last section of the article will focus on effectively communicating with residents who have dementia.

STRONG OPENING

The first few moments set the tone for the resident experience; what happens in the first minute makes or breaks the experience.

Sequence of events for seeing a NEW resident (in chronological order):

  • Use resident’s preferred name. In your first meeting, ask the resident how he or she would like to be addressed. Record the preferred name, and always use that name. Be cautious with nicknames; just because a resident wants to be addressed as “Barbara” does not necessarily mean she likes being called “Barb.” Through interviews with thousands of LTC residents and patients, many report an intense dislike of being called “Honey” or “Sweetie.” The resident told you the name he or she prefers; stick with that name. Also, if you feel your colleagues may have pronunciation issues with the name, note in the records how the name is pronounced.
  • State your name and role. For example, you can say, “I am Mary Smith. I am a case manager.” Upon first meeting the resident, state both your first AND last names.
  • Meet the guests. If possible, ask the resident to introduce you so you can learn relationships (e.g., “This is my daughter, Carol.”). Repeat the name after meeting (e.g., “Hello Carol, a pleasure to meet you.”). Remind them to feel free to add information and ask questions. It is vital to establish a great relationship with the resident’s guests. The guests must also have great experiences.
  • Signpost. This communication term means to inform people of what’s coming next (i.e., providing direction). Explaining to residents what will be happening relieves their anxiety. For example, you can say, “Today, we’ll first
    talk about your treatment, then discuss activities, etc.”

EMOTIONAL ELEMENT

We connect with each other through emotion, not information. We provide information to residents; however, this does not mean we have connected with them on an emotional level. We have to connect with residents on an emotional level to convince them of the importance of compliance. This makes sense; if we feel connected with people, we tend to follow their advice.

  • Start with empathy. In non-emergency situations, address the psychosocial before the medical issues. Empathize before you educate. Put yourself in their shoes. People are fearful and they feel a loss of control. Those two factors alone can turn a sweet, kind person into a hostile nightmare. Residents want someone to listen to them; the correct use of empathy tells them you are present and that you care. Reflect back what you feel they are experiencing. This could be as simple as stating, “This must be very stressful for you.”
  • Use “I” language, not “You” language. Directly state, “I want to help you.” For example, if a resident is angry about taking a certain medication, state, “I know you have concerns about this medication; however, this medication will help you feel better. I want you to feel better.” This statement is much more effective than saying, “You have to take this medication.”
  • Angry residents. First use empathy, such as by stating, “I know this is very frustrating for you.” DO NOT say, “Calm down.” These two words make people even angrier. Angry people want to talk and saying “calm down” implies keeping quiet. Saying “calm down” has the opposite effect.

EFFECTIVE INTERVIEWING TECHNIQUES

The interview portion of the resident experience is when the professional(s) gather information. These strategies will help you gather information while simultaneously creating an excellent resident experience.

  • Start with a general question. For example, you can say, “Tell me how you are doing today.” BEFORE asking any details of the first issue, ask the resident, “What else?” There may be no other issues; however, asking this question in the beginning will help avoid the dreaded late-occurring “Oh by the way” issues.
  • Mute Yourself. Once you begin the information-gathering phase, DO NOT interrupt. Give the resident one to two minutes to fully tell you his or her story and then ask for details.
  • Caution with “Why” questions. Using the word “why” can often be seen as judgmental and should be avoided. Removing why questions creates a more comfortable experience for residents, rather than putting them on the defensive. Convert “why questions” to “what questions.”
    For example:

“Why” question: “Why didn’t you tell us you needed help going to the bathroom?”

“What” question: “What was the reason you didn’t tell us you needed help going to
the bathroom?”

  • Too many issues and not enough time. If the resident has multiple issues and there is not sufficient time to discuss everything, this situation has to be handled delicately to retain an excellent resident experience. Do not say, “I don’t have time to discuss all those items.” Instead, use an “I wish” statement, such as by stating, “I wish we had time to discuss everything that is going on. How about if we discuss these two issues and plan a time to discuss the other items? How does that sound?”

EDUCATE WITH IMPACT

This section focuses on educating the resident. Traditionally, the beginning of the meeting involves the resident giving you information — telling you his or her story. As the meeting progresses, the tables are turned and you are the one giving the information. This opportunity is when you provide education to the resident regarding his or her plan. There are several strategies you can employ to educate your residents. It is important to remember that you know the information, but your resident may be hearing it for the first time.

  • Blend in real-life stories. Telling stories of other residents who have been successful with certain treatments can be a major selling point for a resident who feels ambivalent. Information tells them, stories sell them.
  • Avoid medical jargon. Use everyday language instead of medical terms. This may sound obvious, but in my work with LTC facilities, hospitals and practices, I often hear jargon used without proper explanations. I read about one patient who complained that her doctor called her an “idiot.” He actually used the term, “idiopathic.” Avoid describing test results as negative/positive or unremarkable/insignificant. Residents are often confused by these terms. Some residents unfamiliar with the terms may find the jargon offensive! Some people may feel you are personally calling them unremarkable and insignificant.
  • Sketch a diagram. Hand-drawn sketches are very effective, and residents feel special that you did this just for them. Of course, pre-printed charts and graphs and also effective.
  • Effectively use brochures. Provide written information for the resident. Just before giving the brochure to the resident, briefly review key sections with him or her. Keep a pen or highlighter nearby; you may want to mark certain parts of the brochure. Taking a moment to review key points in the brochure has a dramatic impact as opposed to simply handing the resident a brochure.
  • Teach back. There are serious problems associated with the question, “Do you understand?” Just because residents say, “Yes,” does not mean they truly understand. How can you be sure they understand? Use the “teach back” method! Teach back is a powerful communication tool to assess a resident’s understanding. After you share new information with the resident and family members, the resident (or family member) is asked to “teach back” what he or she just heard, verbally or in the form of a demonstration. This allows the professional to correct misunderstandings and provide additional information, if necessary. Don’t simply tell a resident, “Repeat back what I just said!” That comment will put them on the spot and cause anxiety. They will feel like a school kid who was just told they are having a pop quiz. A better approach would be to say, “I have given you a lot of information and just to make sure you understand everything, I would like you to tell me what you heard.”
  • Chunk and Check. Instead of giving people a huge amount of information at one time, break the information into manageable units (“chunks”). After giving a “chunk” of information, “check” in with them to be sure of their understanding. This strategy helps residents who feel overwhelmed with too much information.

POWERFUL CLOSE

Many of the issues we face near the end of the meeting could be avoided by following all the steps we previously discussed, such as asking, “What else?” early on to avoid late-occurring “Oh by the way” issues from surfacing.

  • Repeat! Restate key pieces of information. Repetition leads to retention. Residents are under stress, and they do not remember information very well.

General closing elements includes:

  • Ask the open question, “What questions do you have?” (DO NOT ask the closed question, “Do you have any questions?”)
  • Summarize the discussion and confirm understanding with the resident and
    family members.
  • Signpost (explain future plans).
  • Use the resident’s name (and the family member names, if you can recall).
  • Close with a partnership statement, such as, “I know this is happening to you, but we will face it together.” or “We will be with you every step of the way.”

 

BONUS SECTION: ENGAGING RESIDENTS WITH DEMENTIA

All healthcare professionals must be skilled at effectively communicating with residents who have dementia. Some professionals may erroneously assume that only those employed in long-term care and other, similar places need these skills. However, residents with dementia visit medical practices, acute care hospitals and other healthcare centers.

  • Go along to get along. When a resident with dementia says something that is factually incorrect, intuitively, it may seem completely appropriate to correct the untrue statement. However, trying to correct residents may cause them to become agitated. If a resident with dementia states he or she just attended the senior prom, you can say, “Sounds like you enjoyed high school. I also want you to enjoy walking around; tell me about your foot that has been bothering you.” In other words, don’t correct, redirect.
  • Get their attention. Be sure you have their attention before beginning to speak. Always approach the person from the front, never from behind, which can startle people. Identify yourself, and call residents by their by preferred name.
  • Be at their level. Move your head to be at the same level as their head. Bend your knees or sit down to reach their level. Do not stand or hover over them — it is intimidating and scary. They can’t focus on you and what you are saying if they are focused on their fear.
  • Look carefully at non-verbal behaviors. As a resident’s dementia advances, his or her verbal skills diminish. A resident may be in pain and not able to verbally express his or her physical symptoms. Look carefully at facial expressions and gestures. For example, do they grimace when moving their arms?
  • Keep it simple. Give one-step directions. If you must ask multiple questions, ask only one question at a time. Use short, simple, and familiar words. Speak at a slightly slower rate, pausing frequently to give the person time to process what you are saying. Identify people and things by name, rather than saying he/she or him/her.
  • Turn negatives into positives. Instead of saying, “Don’t do that,” say, “Let’s try this.” Here is another example: Say, “Let’s go here” instead of “Don’t go there.”
  • Avoid asking, “Do you know who I am?” Outside of a mental status examination, this question often causes the resident to become frustrated. A friendly introduction, even if you have worked with the resident for an extended period of time, is best, such as this statement: “Hello Mary. I am Barbara Jones, your case manager.”
  • Memory loss does not mean a complete lack of all cognitive functioning. Residents may have memory loss, but many people in the early and mid stage of the dementia can still process information very efficiently.

In summary, the strategies and skills in this article will transform your resident relationships. Your residents will love you!

Edward Leigh, MA, is the Founder & Director of The Center for Healthcare Communication. The Center focuses on dramatically improving communication with patients and residents. Edward has a master’s degree in health education and has just completed the book Engaging Your Patients. He has appeared on multiple national television programs, including The Today Show and The Oprah Winfrey Network. Edward recently spoke at the Arizona CMSA Chapter’s Annual Conference. He can be reached at: info@CommunicatingWithPatients.com.