Correcting long-term care's image problem
Dr. Eleanor Feldman Barbera
Long-term care has an image problem. For a variety of reasons, we aren't associated with good times. There are things we can do to turn this around, though, starting with the perceptions of our residents.
Most people who come to live in a long-term care facility struggle with a sense of failure. This isn't because of anything that occurred in their lives prior to placement, but because many people view living in a nursing home as a sign of a failed life.
The most common comment I've heard from new long-term residents over the years is, “I never thought I'd end up in a place like this.” Some add, “Where did I go wrong?”
There are good reasons for providers to address the inherent sense of failure many residents feel in LTC placement: It can increase customer satisfaction, improve morale among residents and staff, and reduce depression among residents, thereby lessening the need for antidepressants.
The role of the psychologist
Part of my job as a psychologist is to help residents recognize that living in a long-term care facility isn't a failure. It's not a reflection of a life poorly lived or necessarily indicative of difficulties in their relationships with their children or other loved ones.
I do this in several ways, depending on the person and the circumstances.
I start by telling residents that I regard it largely as a societal problem. We've made advances in healthcare that allow people to live longer with chronic illnesses, but we haven't yet devoted the resources needed to help people manage successfully at home and to support their caregivers. Long-term care is often the best solution under the circumstances.
Sometimes offering that view is enough to make them feel better about the situation, but other times more is needed. For example, Marie was a new resident who'd worked as an aide in a psychiatric hospital. She was distressed about living in the nursing home and had become irritable and withdrawn. I took her to visit a well-adjusted resident, Linda, who'd been a coworker and a union representative at the same psych hospital. They talked about the old days for 20 minutes and never visited together again, but Marie had a new acceptance for placement — if the nursing home was good enough for Linda the union rep, it was good enough for her too.
As a neutral party, I can provide the perspective that families and facilities can't, pointing out, for example, how hard family members have worked to keep them out of the facility for as long as they did, how their relationships can reset once someone else is in charge of hands-on caregiving, and the benefits of living in a communal environment with easy access to medical staff and activities.
Aside from referring residents for psychology services, facilities can address this aspect of their image problem in several ways:
• Acknowledge upon admittance or in admissions material that some new residents feel hesitant at first but come to have friends and busy lives. Addressing these feelings helps new residents recognize that these are normal sentiments to have and reassures them that the feelings will fade with time. It's one of the points made in my book, “The Savvy Resident's Guide.”
• Make use of a resident welcoming committee that can assume the role that Linda did for Marie in the earlier example. Sure, we can say as staff members that our facility is a good place to be, but when they hear it from other residents it's much more believable.
• Introduce residents to others who share their interests, using recreational activities and other communal events to connect. For instance, aides cleverly sat Diane, a new hearing impaired resident who was distraught about placement, at the lunch table next to Pat, a political junkie despite her blindness, and the two inspired each other with their determination to remain involved in life despite impairments.
Living in long-term care isn't a low self-esteem, Woody Allen scenario of not wanting to belong to a club that would have them as members. It's about helping new residents see that people who belong to the long-term care club are valuable, successful and making the most of this phase in their lives.
Eleanor Feldman Barbera, Ph.D., author of “The Savvy Resident's Guide,” is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Gold Medal blogger in the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with more than 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.