Dr. El

Centers for Medicare & Medicaid Services directives ask facilities to be more attentive to behavioral health issues such resident depression and trauma, and to manage dementia and other behavioral problems while reducing or eliminating psychotropic medications. Providers wondering how to accomplish this tall order might consider turning to a generally overlooked resource — their residents.

Don’t get me wrong. I firmly believe that past traumas, long-standing mental health problems, and depression and anxiety triggered by the tumult of admission should be addressed by mental health professionals such as consulting psychologists like me. 

Just as firmly, however, I know that positive connections between residents can alleviate many of the problems associated with physical decline and institutional living. 

Shared friendships can give meaning, purpose and joy to the lives of elders, including those with advanced dementia. I know I’m not the only one in the field who has witnessed nonsensical conversations between two confused elders who delight in each other’s presence — and the challenges that come when one of the pair departs. 

Moreover, just this week McKnight’s wrote about a study reporting on the success of a peer mentoring program between residents. The “Java Mentorship” offered residents weekly training sessions incorporating 26 different modules, including “how to be a mentor” and “how to support someone who’s grieving.” When they completed the educational program, the trainees visited with other residents who were socially isolated. At the conclusion of the program, the mentors — mostly women about 80 years old — showed significantly reduced feelings of depression and loneliness.

If implementing this type of formal peer mentorship program isn’t right for your organization, staff members can assist in fostering connections between residents in many other ways. 

Here are nine simple but effective ideas to get started:

  1. Encourage aides to seat like-minded residents with similar abilities near each other in the dayroom and at the same dining table at mealtimes.
  2. Foster a supportive environment in the rehab room so that residents cheer on each other’s accomplishments and make “rehab buddies.”
  3. Train staff to be aware of hearing impairments and to seat potential friends next to someone’s “good” ear.
  4. Use dayroom time to create feelings of camaraderie between residents, such as CNA-led discussions of local events or old times. Teaching aides to positively engage residents can make their jobs more interesting and rewarding and can reduce the clamor in communal areas.
  5. Recommend that family members facilitate friendships between their loved ones and peers who have similar interests and/or speak the same language. 
  6. Assist residents and their families in finding kindred spirits by asking if it’s OK to reveal that they’re both from Baltimore, for example, or that they share a fondness for baseball or cats.
  7. Develop a recreation schedule that includes many activities that help residents get to know one another, rather than relying on those where residents are passive participants. For instance, a game that has members disclose their favorite food or place to visit will facilitate connections more than a movie where they are audience members.
  8. Offer the option for residents to host their own activities, with help from staff members as needed. A resident with a loud voice and good reading skills could hold an informal current events group, or a spiritually-inclined individual could start a bible-study group.
  9. Collaborate on pro-social activities, such as knitting hats for premature infants or for those undergoing cancer treatment, with residents assisting each other to complete the necessary tasks.

There are many instances in long-term care where a mental health professional is required to address behavioral health concerns. At the same time, friendships between residents can ease distress and help a facility become a beloved community. 

My goal for most long-term residents is for them to become so busy with productive activities and relationships that they no longer have the time or need for my services.

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 Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com.