While taking a break during a day of training in a facility, a staff member wheeled a resident to a nearby aviary to watch the birds. The employee sat in a chair across from me and began talking about a variety of things including my haircut. We sat behind the resident so her back faced us. Another staff member stopped to chat. She also commented on my haircut. I watched the resident uncomfortably because she was not included in our conversation. I stood up and walked around the wheelchair to face her. I introduced myself and asked about her day. She commented immediately about how much she liked my hair and we continued to have a lovely conversation. The staff did not mean to exclude her but frequently, we have a hard time understanding the similarities that exist between our residents and us. The idea of exclusion, invisibility and being treated differently would upset many of us.
We are comfortable tending to the clinical, activities of daily living and concerns of our residents. Many staff members also have great success engaging residents while they provide care. During those in-between moments though, fewer of us (at all levels of the organization) remember that interaction and inclusion, even during the simplest of conversations, is critical to a resident’s quality of life.
It is no surprise that research reveals independence, self-determination and maintaining one’s identity as the components of life that our residents fight to keep. Wouldn’t we do the same? People who move into a nursing home experience different types of changes which they feel to a greater or lesser degree is stressful. The change in social status, the impact on autonomy, the feeling of having no place to call home, the change in social contacts, and the reduction of habitual activities…endanger the people’s identity which they had before. (E. J. Porter and J. F. Clinton, “Adjusting to the nursing home," Western Journal of Nursing Research, vol. 14, no. 4, pp. 464–481, 1992.)
We work hard to provide opportunities for self-determination through the offering of choices that conform to the regulatory requirements and what we perceive as feasible in our facility environments. Options like time to bathe, time to get up, choices in food and clothing and the people our residents want to socialize with are among the choices familiar to us. But what about individualized choices that are unique to each of our residents?
One of the activities in my session called Cultivating Resident Engagement asks participants to take part in an exercise about Bud, a make-believe resident, who is a doctor and lives in a facility. Bud has dementia and is angry and agitated. He yells and hits. I ask the group to consider why Bud behaves this way. We walk through a root cause analysis and determine that he has lost control of his life which contributes to his behavior. I ask for examples of ways to give Bud back his independence and self-determination. Most people suggest giving Bud choices about when he would like to eat his meals or bathe. Occasionally someone will suggest that we call him "Doctor" or give him a lab coat and a make-believe chart to review. These ideas give Bud back some control in ways that are important to him. Offering him choices like meal or bath times fulfills the idea of self-determination but doesn’t necessarily support the identity he seeks.
As we contemplate a quality life focused on independence, self-determination and identity, consider:
- Putting your point of view aside and thinking about the way in which a resident identifies him or herself even if you can’t understand or agree with it. This broader look may give you clues about how to interact.
- Identifying behavior as an emotion or the expression of an unmet need. This way of thinking opens possibilities to empathize and broadens our toolbelt of interactions.
- Sometimes staff will tell me that we need to behave towards residents in the same way that we treat children. The older people who live with us are mature adults living with physical and/or cognitive losses. Valuing them as adults will earn their respect and trust and help them reclaim what they have lost.
- Finding ways to value the stories, ideas and thoughts of residents engages them more fully in their lives. I met a man living in a facility who was an engineer. He had some ideas about how the laundry might function better. His concept could be the very strategy that fixes the issue.