|Understanding the Transition to Life
in a Nursing Home
the median age of Americans continues its upward spiral, more
and more seniors will find themselves faced with entering
a nursing home at some point in their lives. This is a major
life event and if the new resident and their family are not
prepared for this possibility, it can be a major life trauma
as well. It is important for the nursing home staff to understand
the many losses the resident faces as they enter the facility
and the possible reactions they may have because of this life-changing
Facts About Nursing Home Admissions
- About 5% of seniors live in a long term care facility
at any given time.
- One-third of all Americans will require nursing
home care at some time in their lives
- More women than men reside in nursing homes
- One-half of the people entering nursing homes will
remain there for the balance of their lives
Entering a nursing home means that the resident
has a condition that signifies the loss of their good health.
This condition may also prevent the resident from being able
to care for himself or herself, making them dependent on others
for some of their most basic needs.
Once the decision is made that the resident will
not be able to return to the community, the apartment or home
in which they lived will be lost. So often the task of sorting
through the resi-dent's possessions is the responsibility
of the children and the resident is not included. Precious
items that represent a lifetime of memories are scattered
throughout the family and sold or given away to strangers.
The house where the resident and his/her spouse raised their
children is sold so that the funds can pay for the cost of
their long term care. The possibility of providing an inheritance
for their children and grandchildren fades. The resident will
no longer have a place to call their own, to decorate for
the holidays, to invite others over for a visit, or to sit
in the shade of the oak tree they planted forty years ago
when the house was brand new. What little they can take must
fit in a small space, often shared with a stranger.
and changes in the roles that the residents may assume within
the nursing home, can cause them to develop a poor self-image.
The roles that the resident had in the community
-- mother, wife, neighbor, aunt, brother, community leader,
gardener, woodworker, grandfather, etc. -- provided them with
fulfillment and recognition. There is a status attached to
these roles. When a resident enters a nursing home, some of
the major roles are lost and there are changes to others that
can greatly affect the way the resident views himself or herself.
The loss of these roles can have a negative affect on the
The cost of long term care can quickly drain the
resident's assets. Their life-savings is used primarily for
the continuing care and often it is their children who write
the checks each month from their parent's account. Sometimes
the resident relinquishes control over their finances so they
don't really know how much money remains. Often they are fixated
on "paying their own way" and feel guilty about
spending anything on themselves or giving gifts to their children
and grandchildren on special occasions. Running out of funds
and having to apply for public assistance can be devastating
for this generation.
Visiting someone in a nursing home can be an uncomfortable
experience. The same relatives and friends that visited the
resident in their home are often intimidated by the sights,
sounds, and environment within the nursing home and stop visiting
as time goes on. Sometimes the lack of private space in which
to visit puts up barriers -- the resident's room with inadequate
seating, the presence of a roommate, a lounge with residents
and staff coming and going, overhead paging, etc.
Residents do not enjoy the same freedom as they
did when they lived in the community. For the sake of organization
and efficiency, or mandated by the regulations, meals are
served at specific times, activities are offered as scheduled,
rooms are cleaned on specific days, assistance with bathing
is scheduled, rehabilitation is scheduled. There are numerous
rules and policies and procedures to follow -- visiting hours,
which side of the hallway to walk down, where to sit in the
dining room, who your roommate will be, etc. Even the resident's
doctor visits and lab work are scheduled based on regulations.
The more dependent the resident, the less control they have.
Since most residents in long term care are elderly,
they have experienced many losses before admission. These
losses include the loss of employment due to retirement; the
loss of loved ones through death; the loss of their youthful
appearance and stamina; the loss or decline in their senses
such as hearing loss, cataracts, etc.; the loss of mental
"sharpness," and the loss of unrestricted function.
The more input the resident has into the choice
for placement in a long term care facility the better. Often
this is not the case as a result of a catastrophic health
problem that has hindered the resident's ability to continue
to care for themselves. Adjusting to life in a nursing home
can be challenging and the residents can exhibit many different
behaviors and emotional reactions to their placement.
When living in the community the resident had many
options to address their anger. They could go out with a friend
and talk about what was making them angry and together they
could come up with a solution. They could go for a walk, weed
the garden, stroll along the beach, go for a drive in the
country, etc. and ponder the situation. These options may
not be available to residents in a nursing home. It is understandable
for the resident to feel angry about the changes in their
life and the many losses they have just experienced.
Depending on how the resident chooses to vent their
anger is the key to how they will be perceived in the future.
The resident may throw items on the floor, refuse to cooperate,
criticize staff, the food, and the facility. When a resident
is obstinate and "acting out" staff may label them
as a trouble-maker, uncooperative, chronic complainer, etc.,
instead of finding out what is troubling them and helping
them work through it.
The grieving and sadness connected with admission
to a nursing home can cause the resident to feel depressed.
They may begin to sleep a lot more, refuse to participate
in the activities related to their past interests, "pick"
at their meals, have insomnia, demonstrate increased dependence,
openly express feelings of hopelessness, and refuse treatment.
Life in a nursing home and coping with their many
losses may intimidate and overwhelm the resident to the point
where they cease to do things that they are still capable
of doing. They may become dependent on their family or staff
to make their decisions for them. They may look to nursing
to help them eat, bathe, dress, etc., yet they are still capable
of doing this for themselves. They may ask their family to
write the checks for their bills, send a birthday card to
their grandchild, write a letter for them, etc. instead of
them making the effort to continue doing these things.
may learn that engaging in negative behaviors, becoming increasingly
dependent, and constantly complaining about small issues can
get the staff's attention and service.
Some residents may cope with the situation by choosing
to deny it exists. Residents with a terminal disease sometimes
make plans for the next year, even though the likelihood of
them being alive at that time is very slim. Others may tell
everyone that they are going home soon, when in reality there
is no longer a "home" to go to. Some refuse to have
anything to do with their finances, so that they don't know
"for sure" what their financial status is.
Giving explanations or excuses is another way of
dealing with life in a long term care facility. Residents
may make excuses for the infrequent visits of their family.
They may tell others that their loved ones are very busy with
their own lives, they live too far a way to visit so often,
they have problems of their own, etc.
Emotional turmoil can make residents agitated and
anxious. This may result in yelling, resisting care, and other
inappropriate behavior. Sometimes residents who are demanding,
complain about being ill, yell, etc. receive faster service
and more attention than those who are polite, calm, and healthy.
The residents realize this and sometimes resort to negative
attention in an effort to get faster and more frequent interventions
The resident's emotional state can have a direct
effect on their physical health. When they are anxious, depressed,
or upset, they may experience:
- loss of appetite
- sleep disturbances
- breathing difficulties
- muscle aches
These symptoms can threaten the resident's already
poor health and lead to other complications.
Adjusting to life in a long term care facility
can be very challenging for the resident and their family
members. A poor adjustment can lead to additional health problems
and diminish the resident's quality of life. A good adjustment
can enhance the resident's abilities, social interactions,
and overall outlook on life.
The staff plays a pivotal role in helping the resident
and their family ease the transition from life in the community
to life within the facility. Here are some ideas:
- Greet the resident and their family as soon as
possible when they enter the facility -- be sure to introduce
- Make sure the resident doesn't need anything before
beginning the admission process
- Take them to a private area, offer refreshments
and explain the admission packet to the resident and their
family -- try to streamline this process as much as possible
- Take the resident and family to his/her room
- Introduce them to the nurse, CNA, roommate, etc.
and orient them to their immediate surroundings
- Explain the "basics" -- where the resident
will eat their first meals, overview of the assessment process,
yourself in the resident's and family's shoes. Imagine what
it would be like for you to enter a nursing home or place
a loved one there. Treat the resident and their family just
like you would like to be treated if the roles were reversed.
- Give the resident and their family your business
card and explain how to contact you
- Provide assistance to the resident and their family
as they "settle in"
- Work with the interdisciplinary team to stagger
the assessment process so that everyone isn't trying to
access the resident on his/her first day in the facility
- Give the resident a chance to adjust to their environment
-- allow them to move at their own pace
- Introduce the resident to another resident who
has been in the facility for a while so that their "buddy"
can help orient them to the facility and introduce them
to other residents
- Check on new residents and their families at frequent
intervals -- encourage involvement in the activity program,
especially those activities related to the resident's past
interests, provide information about the Resident Council,
Family Council, and/or available support groups
- Explain the facility's routines such as times
for meals, the housekeeping schedule, visitation times,
- Encourage the resident to talk and express their
- Work with the interdisciplinary team to provide
the resident with as many choices as possible
- Watch for signs of "learned helplessness"
and increased dependence -- educate the family and staff
about what the resident is still capable of doing and emphasize
the importance of encouraging the resident to accomplish
these tasks instead of others doing the tasks for them
- Understand that it is normal for residents to
be sad and cry about being in a nursing home. Encourage
them to talk about their feelings instead of saying, "it's
not so bad," or telling them to "cheer up."
- Report any unusual observations to the nurse --
difficulty breathing, signs of pain, keeping their room
dark, sleeping too much, refusing to leave their room, excessive
- Welcome visitors and help them feel at ease --
greet them with a smile and ask how you can be of assistance
- Put yourself in the resident's and family's shoes.
Imagine what it would be like for you to enter a nursing
home or place a loved one there. Treat the resident and
their family just like you would like to be treated if the
roles were reversed.