Crystal Wallace knows a thing or two about making older adults happy. As former director of the Benjamin Rose Institute on Aging’s adult day program in Cleveland, it was part of her job to do just that. So when it was time for her mother-in-law to choose a long-term care facility, she knew to guide her to a place where, among other factors, she’d always have company.
For the most part, the transition has been successful. “She still wishes she could be at home,” Wallace says of her mother-in-law, “but she understands the need for the skilled care.”
[See: Beyond Bingo: Innovative Activities at Today’s Nursing Homes.]
Not all older adults are so content with their nursing homes or other long-term care facilities, nearly 16,000 of which U.S. News rates based on safety, health inspections, staffing and more. Family members notice. “They’re concerned that [the older adults] don’t seem happy or they don’t seem as happy as they want them to be,” says Holly Harmon, a registered nurse and senior director of clinical services at the American Health Care Association. “The question is, ‘What’s going on? Why don’t they seem happy? Why aren’t they out and about throughout the facility?'”
The answer can be complicated, but here are a few possibilities — and how family members can address them:
1. Mom is still adjusting.
Whether you’re headed to college or shacking up with a romantic partner, moving is stressful. Now consider moving reluctantly due to declining health, as many incoming long-term care residents do. “It’s a big change, and it takes time to develop that sense of, ‘This is my new home,'” Harmon says.
One way to help ease the transition is to bring small reminders of the past — such as a photo album or one of the person’s favorite movies — into his or her new residence to spark richer conversations with staff members. “There are things that seem so small that actually are often the most meaningful interactions that occur,” Harmon says.
You may also be able to bring items like plants, a favorite chair or even a pet; anything that makes the environment more homelike can be helpful, suggests research by Dr. Bill Thomas, a geriatrician who created the Green House Project, an approach to long-term care that replaces traditional nursing homes with small, homey environments.
Some facilities also aim to help residents take pride and ownership in the space by involving them in daily operations — inviting them to join a committee tasked with planning the dining room renovation, for example; some residents even get satisfaction out of helping with chores like the laundry, Harmon says. “More and more,” she says, “nursing homes are sort of structuring their activity programming to invite residents to participate in the day-to-day.”
[See: The Best Ways for Nursing Home Residents to Stay Active.]
2. Dad is lacking satisfying social interaction.
Being the new kid is hard; being the new senior can be harder. “If they have cognitive changes, it makes it more difficult to develop a friendship network because those kinds of interactive skills … may no longer be there,” says Harvey Sterns, a psychologist who directs the Institute for Life-Span Development and Gerontology at the University of Akron in Ohio. Subtract friends and spouses, and loneliness becomes a real health threat in long-term care facilities, research suggests.
But well-run facilities will address that reality head on by, for example, assigning staff members to eat at dinner tables with residents to facilitate conversation or by working with “senior companion volunteers” who can get to know new residents on a more intimate level. “Sometimes someone who’s not sociable will open up to someone one-on-one a lot quicker,” Wallace says.
The key is understanding the difference between real loneliness and someone who is content with more alone time — a distinction adult children don’t always make. “When we were just living at home, we had an opinion of what our parents liked or didn’t like — that changes, just like for us,” Harmon says. “We all grow and develop and change.” That’s why it’s important to talk to your loved one about what’s most meaningful to them and ask the staff how he or she is behaving when you’re not around. “Raise concerns and raise them right away,” Harmon says.
3. Your loved one has untreated physical or mental health conditions.
Declining physical or mental health, or both, is often the reason older adults enter long-term care. But a sudden or unexplained change in disposition may mean that those issues aren’t being appropriately identified or treated. “It could be a sign of an infection brewing, an advancement to the next stage of dementia or Alzheimer’s,” says Harmon, adding that it could also be a change in medication, death of a close friend, change of staff or sentimental time of year. “The list is kind of endless.”
To get to the bottom of the problem, don’t jump to conclusions, and instead talk to your loved one and his or her care team. “If staff aren’t responding in a caring or concerned manner, or if there is a lack of follow-up or follow through, particularly repeatedly, that’s a significant concern,” Harmon says.
[See: 7 Red Flags to Watch for When Choosing a Nursing Home.]
Sometimes, feelings of depression and powerlessness may be related to a lack of choices — be it where and when to eat, which activities to participate in or simply reluctance to enter long-term care at all. “One of the things that’s really important over the next decade is finding ways of keeping them in their homes longer, keeping them as independent as possible as long as possible and, when they do need assistance, providing it in ways that give them life satisfaction at the same time,” says Sterns, adding that most people perceive themselves as five to 15 years younger than they are. “The idea of the ‘sick old person’ model needs to be replaced with an alternative; my emphasis is on choice-making.”
To an extent, older adults can make an empowering choice themselves by shifting their own view of aging. Research by Yale psychologist Becca Levy suggests that endorsing negative stereotypes of aging is actually linked to Alzheimer’s risk, a lack of resilience after stressful events and other physical and cognitive declines. “It’s actually a negative self-fulfilling prophecy,” Sterns says. But by expecting the later years of your life to be among the best, you can create a positive self-fulfilling prophecy, too.
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Why Is Mom Unhappy at the Nursing Home? originally appeared on usnews.com
