Eleanor Feldman Barbera, Ph.D.

According to a 2010 NPR report, young adults have been one of the fastest growing long-term care populations over the past 10 years, with 14% of nursing home residents under the age of 65. Some live in facilities that have specialized in the care of younger residents and others are in settings where almost all the other residents are seniors.

Both scenarios pose challenges in terms of accommodating the unique physical, emotional, and recreational needs of younger adults — and the reactions of staff members to their young charges. 

Having spoken with many young residents and their bewildered staffers over the years, I know firsthand how challenging interactions can be. I wrote about some of the psychological issues and remedies in my 2008 McKnight’s guest column, Young adults in long-term care: the canaries in the coal mine, where I argued that the problems arising with young adults now are precursors to those that will be endemic when the assertive baby boomers arrive at our doors — unless we adapt as providers. 

Younger adult toolkit


Recognizing the need for facilities to be better prepared, the American Medical Directors Association has released a toolkit on “The Younger Adult in the Long Term Care Setting” as part of its LTC Information Series.  I had the pleasure of working on this project, which covers a wide range of matters affecting young adults and provides recommendations for addressing them.

The guide is one of the few sources of information on this understudied population. If your facility has even one young or boomer resident that staff members consider “demanding” or “a problem,” you’ll find this report invaluable.

The “Younger Adult in the Long Term Care Setting” addresses issues such as:

  • Identifying cohort or generational differences
  • Creating age-appropriate activities
  • Training staff to care for younger residents
  • Facilitating appropriate relationships between residents and staff
  • Establishing practical facility policies
  • Developing a cohesive team

The toolkit provides more details about the different groups of younger residents I identified in my 2008 McKnight’s guest column (ill from birth, through “capricious fate” such as MS, through “lifestyle misfortune” such as a drug overdose, and those with mental illness). It addresses each group’s distinct needs and the varying reactions of family and staff members to the young adult depending on the cause of their illness. The guide also provides numerous case studies and offers a list of references and additional resources your facility may find helpful.



As part of my training as a psychologist, I studied family systems theory. The theory suggests that the person in the family who has the difficulty is considered the “identified patient,” but they’re not necessarily the only one with the problem. Similarly, younger residents will often be seen as “the one with the problem” when they point out flaws in the system, such as uneven enforcement of policies or a lack of customer service. In fact, the dissatisfied young adult is doing you the favor of identifying trouble spots in your system before the boomers arrive.


The “problem” isn’t the resident or the staff member who has difficulty with the resident.  The trouble is with the approach. It’s important for the team as a whole to understand the dynamics involved in treating young residents and to work together to provide the best care. It’s essential for the administration to have policies in place that support team functioning.

Whether your facility is struggling to meet the demands of young residents now or anticipating the arrival of the baby boomers, the toolkit is a step toward addressing their concerns.

It suggests an informed, cohesive and creative approach that allows all residents to flourish. That’s good for the young adults who may remain in our facilities for years, the baby boomers who will challenge the status quo, and the staff members who manage care on a day-to-day basis. It’s also good for any business to have a well-functioning team that adapts to the needs of all residents.

Eleanor Feldman Barbera, PhD, the author of The Savvy Resident’s Guide, is an accomplished speaker and consultant with over 16 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.