Residents 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.