The elevator opened up to the third floor of the skilled nursing facility. Wheelchair-bound residents lined the hall across from the nursing station, some silently watching the staff, some snoozing.

On the second floor of the nursing home, the physical layout was exactly the same but the atmosphere was completely different. Groups of two or three residents were chatting animatedly, commenting wryly on their observations of staff and laughing amongst themselves.

How do we get from Scenario A to Scenario B more often? Is it worth the effort?

The high cost of loneliness

A recent study showed that community-dwelling seniors visited their doctors more often when they were lonely — the trips to medical offices were an important but costly form of social interaction. Similarly, one might speculate that socially isolated residents request help from their nurses, aides and other workers due to feelings of loneliness in addition to addressing specific care needs.

Reducing loneliness among residents would, therefore, contribute to more staff time being available for medically necessary care.

Decreased turnover

The findings from another study suggest a connection between happier residents and staff retention. Researcher Barbara Parker-Bell, PsyD, LPC, ATR-BC, finds that “nurses consistently described the best and most satisfying aspects of dementia care as … the pleasure of seeing residents calm and engaged.”

I know from my own experience that it’s much more uplifting to step onto a unit with laughter than it is to work on a floor where the residents are depressed, lonely and withdrawn. And, of course, it’s better for the residents and their families.

Beyond ‘recreation’

Good therapeutic recreation programs are essential in reducing isolation, providing meaningful ways of spending time and in developing friendships. They’re an important step in reducing loneliness, but are also only one piece of the puzzle.

If all staff members consider the social aspects of the environment — one of the best selling features of life in LTC — we can create friendly, engaging interactions that build upon and extend formal recreation programs.

Challenges to interacting

The physical and/or cognitive impairments that lead to long-term care frequently alter aspects of social interaction that we take for granted.

You or I, as able-bodied people living in the community, might run into a neighbor on the street, talk for a few minutes and walk on, perhaps making a plan to get together at a future date. These aspects of socialization are dramatically different for impaired residents, especially for those who aren’t able to move about freely on their own.

Staff members can recognize and assist residents in overcoming these challenges:

The inability to ambulate on one’s own means that people can’t go sit by friends or potential friends and can’t move away from others when the conversation concludes.

• Staff can help by seating people next to friends or potential friends.

• Residents can be taught strategies to end conversations. For example, one woman I knew used to pretend to fall asleep when she was done talking. Other people use a concluding sentence such as, “Nice talking to you,” before looking in the other direction. It takes finesse in order to graciously end an exchange while still seated next to a neighbor.

Low speaking voices can prevent friendships from blossoming.

• Nearby staff members can repeat or rephrase the comments on the quiet resident’s behalf, thereby facilitating the conversation.

• Another option is to seat “quiet talkers” by others with good hearing.

Poor hearing can similarly thwart engagement.

• Seat those who are hard of hearing with people who can speak loudly.

• Position residents so that their “good ear” is by their neighbors.

• Be sure hearing aids with functioning batteries are part of the daily routine.

Shyness or “courtesy” can unnecessarily limit relationships:

• Sometimes elders don’t engage with each other because they haven’t been “properly introduced.” Staff members can assist by making introductions.

• Connections can be encouraged by sharing mildly disclosing information, such as, “Did you know you were both from South Carolina?” or “Jim’s a baseball fan just like you.”

Language barriers can make socializing difficult for those who don’t speak the same language.

• After physical needs, the next criteria for room placement should be the presence of other residents and/or staff members who speak the same language.

• Consider dining room seating based on language so that residents have the opportunity to interact with those who can understand them.

When staff members focus on the potential for social engagement, they get to know the residents better. They think about the activities residents might like to attend, and with whom. They help to make that happen, getting them out of bed on time and making sure they have their meds. They seat like-minded individuals together.

We can all work with the recreation staff to reduce the loneliness of residents and create joyful experiences that make it a pleasure to come to work and live in LTC.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at