Real names and toilet seats: Keys to resident happiness

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Tim Mullaney
Tim Mullaney

Feel like you need to renovate your building to boost resident satisfaction? Here's a tip: Make sure your staff knows the names of all the residents first.

It turns out that long-term care residents might not put stock in how “homelike” a building is, but caring staff members really make a difference, according to surprising findings from a study out of St. Catherine University in St. Paul, MN.

The assisted living residents who were interviewed generally agreed that the facility would never be like a private home, and “soft imitations” of “home living” were not even very desirable, study author Courtney J. Wright wrote. The residents all said that a safe environment and caring staff were the major factors in their sense of wellbeing. All eight participants specifically said that staff members calling them by name was a sign of caring.

I reported on these findings for McKnight's last week. Since then, I've been prompted to reflect on them a few times.

First, I read “The Real Nurse Jackie” blog from last Tuesday, about how workers refer to residents. As Nurse Jackie put it, residents should not be “Bed A” or “Bed B,” but “Mrs. Jones in Room 318.”

“I know I've blogged about this before, but you can never bring this point home enough,” she wrote. “It's about relationships, not about heads in the beds.”

From my office here at McKnight's, calling residents by name seems like a no-brainer. But Nurse Jackie's blog got me thinking that this must be a more persistent, challenging issue than I had imagined. I began to recall my days teaching college students and coaching middle school tennis. There were only about a dozen students in my classes and maybe 20 on the tennis team, but it took me a long time to get names down. In the meantime, I might think of a student as “Cardinals cap in the back row,” and I might even call out “hustle, green!” to a team member in green shoes.

I began to see how hard it might be to call residents by name in a facility with scores of beds and perhaps with lots of new faces in rehab on a regular basis. So I did a little experiment. I Googled “how to learn names quickly.” I got a bunch of sites with tips and tricks for teachers. When I Googled “how to learn patient names quickly” I got very different results, mostly about dementia and drugs used to treat it.

The Google results suggest that learning names might be ignored in healthcare training. If this is true, having a session in which some seasoned workers share their strategies could make a difference. (And if you've got some tips for how to learn resident names quickly, please share them in the comments!)

I also recommend checking out a New York Times article from Sunday: “Bracing for the Falls of an Aging Nation.” It provides some concrete examples of just how tricky it can be to balance a homelike atmosphere with safety and security, and powerfully illustrates why residents come down on the side of safety.

For instance, it focuses on a continuing care retirement community that replaced white toilet seats with black ones. This met with resistance from residents' families, who said the black seats were too “institutional.” But the online version of the Times article includes a video that shows how an aging person with compromised vision might see the white seat versus the black seat. Then the video shows how someone with yellowing vision might see them, and finally how someone with cataracts and with glaucoma might see them.

As you can guess, the “homelike” white seat disappears into a general haze, while the “institutional” black seat remains visible. It's easy to, well, see why a resident would be more likely to fall, and would feel much less confident, in a bathroom with the white seat.

Note that it was the residents' family members who protested the black seats. And in the study out of Minnesota, none of the assisted living residents showed much interest in decorating their apartments with belongings from their previous homes; those types of belongings mostly had been brought over by family members, they said.

Obviously, long-term care operators should not abandon more homelike settings based on one small study and a New York Times article. But the study and article provide some food for thought as providers keep trying to create buildings that both are safe and look great in glossy marketing materials, and that meet Mrs. Jones' needs and desires, as well as those of her family members.

Tim Mullaney is McKnight's Senior Staff Writer. Follow him @TimMullaneyLTC.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.