By Toni Lynn Davis, MHA, CNHA, FACHCA
CEO and President Green Hill Inc.
“Loneliness is the pain that people feel when they want but can’t have companionship,” says Dr. Bill Thomas, Founder of the Green House® Homes Project, and a Harvard MD generally considered one of the leading philosophers of person-centered elder care.
Loneliness presents a growing quality of life, longevity of life, physical and mental healthcare challenge in long-term care settings for our elders. The same is true for those elders who are cared for, or care for themselves, at home.
One would assume loneliness to be more pervasive for elders at home due to a lesser ability to get out in the community and the succession of work and family responsibilities. Yet, a 2011 Norwegian study of skilled nursing centers found that 56% of their patients felt lonely. Even as nursing care residents are continually surrounded by care givers, nurses, other elders and staff. Loneliness has been found in studies to lead to depression, and a decrease level of physical, and mental health that causes an increase in the use of medical services and prescriptions.
Have you ever felt lonely in a crowded room? Just because there are lots of people around and lots of activities to do does not mean the participants are not lonely. There is a difference between loneliness and being alone that can most often be traced to structured versus chosen activities and socialization. One can be alone and not lonely if they are engaged in an activity that interests them and therefore are content. One will not be lonely in a group if they are with people with whom they have a personal connection.
One answer to loneliness in long-term care settings like Green Hill, Inc., is Person Centered Care. Person Centered Care is where all staff who interact with an elder engage in personal relationship building with that elder based on mutual respect, interests and experiences. Open dialogue and conversation between the parties is necessary. Asking questions of the elder, about their lives and experiences and sharing ones own, builds that relationship. Participating in activities that the elder enjoys, sharing meals together all creates the kind of care relationship that staves off loneliness.
Technology has been found to be another solution to loneliness and works in long-term and home care settings. Technologies like laptop computers, Ipads and mobile phones engage and excite elders, making connections and friendships with past, current and new people of interest to them easy and immediate. Access to communications platforms like Facebook, Instagram and other websites make seeing the world, places one has been, and photos of family and friends available at the touch of a mouse. Daily interaction with friends and family who may be far away through emails and Skype keep elders feeling connected to their families. Even on-line access to music and movies from the past can bring comfort and joy to an elder who might feel lonely.
Moving to a long-term care community is an incredibly stressful life event. Learning as much as you can about an elder at intake goes a long way to making sure they are comfortable with new people in their new surroundings. Giving your elders choices in the construct of their days, and choices about their daily activities will keep them engaged socially, and not hasten a helpless existence that can lead to depression. Encouraging that their rooms are filled with their own belongings and that their familiar routines of sleeping and waking, television, eating times and favorite foods are provided to them will help them adjust more easily and bond more readily with others.
At Green Hill we provide Person Centered Care at every level of service. Our staff is trained in interpersonal communication techniques and is encouraged to take time to speak with and engage our residents. Elders choose their activities and participate in decision making on how they are executed. They enjoy holiday activities that welcome family and friends. Elders volunteer in the community and participate in inter-generational activities. Children always bring so much joy to our residents and our staff is encouraged to bring their children to events. Computers and computer classes are available to all able residents and the weekly happy hour is a highlight of the social calendar. Residents also have ample ‘down time’ where they can enjoy the company of others in one of our light filled sitting rooms, work on a puzzle with a friend in the library, or watch a movie on the big screen TV in the living room. In our Green House Homes the elders dine with their caregivers, may participate in food preparation, enjoy activities with staff and housemates in their own living room and can relax on the patio to enjoy nature and fresh air. If they desire time alone they are free to hang out in their private bedrooms in a comfortable chair surrounded by their own belongings with a book, music or television, at their leisure.
Empowering elders to have choice in their lives at every phase of their abilities as they live fully during the last chapter of their lives, is the most valuable gift we can provide, and one that will encourage a rich and comfortable experience filled with friends and a sense of belonging each day at Green Hill. Loneliness in the long-term care setting can be eliminated by person-to-person connections and by providing elders with the tools to stay engaged in their greater world.