The severe impact of COVID-19 on nursing homes has led to calls for change in the country’s approach to eldercare. In “The American Nursing Home is a Design Failure,” for instance, author Justin Davidson describes the nursing home as a “soul-sapping institution” and argues that we need to rethink the current system entirely.
In my opinion, part of returning the “soul” to LTC is expanding the use of psychology services.
Currently, psychological treatment is furnished in a manner similar to that of knee-replacement surgery — a billable service provided to an individual. Treatment may include consultations as needed with family and staff, but these meetings are adjuncts to the therapy and are focused on the care of the individual resident.
While providing treatment to residents is an essential service, it’s far from the only assistance that psychologists can and should be providing. We would make better use of psychological services to improve the long-term care system if we widened our view of who and what is in need of treatment.
Much of a psychologist’s time, for example, is spent discussing the interactions between residents and aides. The present structure allows for conversations with residents about how to handle interactions with aides, but not with aides on how to work with the residents. Ten residents might have the same complaint about one aide, but working with a specific aide to improve interactions with the residents isn’t a reimbursable service.
Psychologists can also greatly assist with “behavior rounds” to discuss residents with difficult or concerning behaviors such as agitation or treatment noncompliance, and work with groups of staff to enhance team functioning. Team dysfunction negatively affects care costs and quality.