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Elder’s Family Learning Initiative: Relating to Other Residents and Families, Pt. 2

Robison Jewish Health Center frontResidents moving into lower levels of care than nursing facilities usually have more time to adjust to the idea and adapt to the community, more choice and more privacy once they are settled. But all long-term care settings are communal by nature and the interactions in them may be difficult for some residents to manage. Residents who are simply shy and reluctant to initiate conversation may need some assistance in meeting other residents prior to moving to a retirement or assisted living setting. Families who are moving a resident from another geographical area should seek to make connections and introductions prior to the move.

Residents moving into a facility in their own community are likely to know someone there and should be offered the opportunity to contact that resident prior to the move. In the least, families should attempt to take the resident to a meal at the facility prior to the move in order to introduce the most communal aspect of the environment within the safe confines of family accompaniment. Residents who have had difficult relationships throughout life will not improve in personality with age. They are likely to experience difficult interactions with other residents in long-term care facilities. The family should consider smaller settings or even foster care as the stimulation of the larger assisted living environment may exacerbate personality tendencies like irritability, impatience, and intolerance. Some families choose in-home care for this reason.

Illness and cognitive impairment can also exacerbate undesirable personality traits and inhibit the restraints and discretion that people would normally impose on their behavior and communication. The person who was somewhat sarcastic and impatient earlier in life may be perceived as cruel and thoughtless in a communal setting.

Gossip is a poisonous form of communication and interaction that is endemic in long term care facilities. Perceived knowledge of the details of the community’s life is considered to be powerful and, as in the larger community, is often distorted until it is unrecognizable from the actual event. Supervisors and family members should encourage staff and residents to refrain from any discussion about others in the community beyond expressing support and hope for recovery.

When a resident first settles into an assisted living or residential care community, the family may want to spend considerable time with her to ensure that her needs are met, to allay anxiety about being alone, and to offer support as she attends gatherings, receives care, meets her neighbors, and learns to negotiate the new environment. As the residents begins to become familiar with the new setting, family can slowly reduce the amount of time spent.

The time family members spend in a nursing setting depends on the nature of the condition, length of stay, and the impact on family of the stress already experienced prior to admission. If a resident is admitted to a nursing facility from a hospital, is doing well, and is anxious to discharge to home as soon as possible, one family member at least should be preparing for that discharge. If several members are available, the one least involved with the discharge can spend time with the resident when care and rehabilitation are not being provided. If a resident is not recovering and is not expected to leave in the near future, the family should set up visit times to provide companionship and begin to regain their own health and routines in order to cope with future stressors.

Elder’s Family Learning Initiative: Relating to Other Residents and Families, Pt. 1

Robison Jewish Health Center frontLong term care facilities are, by the nature of their services and structure, communities. While it is possible for people living in a retirement setting, receiving no services and requiring no interaction with fellow residents, to avoid all but voluntary contact, it is more likely that residents in long-term care facilities will have more daily contact with people other than family members than they have ever had in their previous lives.

Assisted living residents may have their own apartments but they are eating with others and living in large complexes as opposed to the private homes they may have inhabited in the past. In foster care and nursing facilities, quarters are even closer and many residents share a room with another resident.

There can be tense and uncomfortable situations for residents and their families related to lack of privacy and unavoidable contact and interaction in these settings. In nursing facilities, families will often have very little time or choice in arranging discharge from a hospital. They may assume that since the resident had a private room in the hospital that she will also have one in the nursing facility. If this is a critical issue for that resident’s recovery and well-being, and it can be, it is important to state this to the discharge planner in the hospital and make it the top priority when speaking to admissions coordinators at the nursing facility.

Many facilities have a number of private rooms but many others have few. If privacy is more important than the reputation of the facility for rehabilitation or other care, make that clear from the beginning to everyone involved in the arrangements. It should also be noted that skilled care reimbursed by insurance, including Medicare, does not offer payment to nursing facilities for private rooms. Facilities cannot allow families to pay extra for such privileges. Only residents paying privately for intermediate or custodial care can be charged for private rooms and facilities may be reluctant to offer those rooms to short-term residents whose stay is reimbursed at a flat rate.

While a private room may not be possible, facilities should be expected to attempt to match a new resident with an appropriate roommate. No person recovering from a hospital stay should have to endure noise or inappropriate behavior, and if this occurs, families should approach the social services designee or the administrator and ask for a transfer for the resident. If the resident in a nursing facility is sharing a room, the facility is required to ensure privacy by using curtains to create separation, asking visitors to leave when personal care is being offered, and creating quiet time and space for rest and sleep. If at all possible, prior to admission or actually choosing the facility, the family should ask to see the room and ask about the roommate’s routines and personality. In most situations new residents and families get along well with the roommates and their families and even establish new relationships. These all depend on courtesy and mutual respect for privacy and dignity along with some tolerance for the different expectations and routines of others. Such behaviors are not always easy to maintain in the middle of a crisis when families are already under stress. It is always best to request assistance from the staff in difficult interpersonal situations.