A Death in the Family: Report of a Single-Session Trauma Group for Nursing Home Residents and Staff

This article describes a single-session trauma-debriefing group conducted at a nursing home following the death of a resident on an outing. The group had as its core an existing weekly therapy group in the facility, with the addition of affected staff, family, and other residents who were on the outing. The treatment illustrates four principles relevant to counseling and psychotherapy in nursing homes: 1) recognition of death; 2) treatment in and of the milieu; 3) flexibility and structure; and 4) dealing with countertransference. Along the way, we see how the residents are capable of giving, and not merely receiving.     

Pro-active positioning of a social robot intervening upon behavioral disturbances of persons with dementia in a smart nursing home

Behavioral disturbances of persons with dementia residing in a nursing home impose a significant burden on other residents and on the care staff. A social robot can provide an adequate technological support tool for the caregivers by approaching a resident that exhibits a behavioral disturbance. In this paper, we focus on how to position the robot in the nursing home, taking into account the profile and location of the residents. We minimize the time between the detection of a behavioral disturbance and the robot having arrived near the resident and starting an interaction scenario. Our algorithm is evaluated using realistic data that was collected during 3 months in two Belgian nursing homes.     

A Survey Report of Nursing Home Ministry and Perceived Needs with Implications for Pastoral Care

ABSTRACT

The last 40 years of growth in the development of pastoral care to the sick appears to have virtually bypassed persons in nursing homes. A study within 13 nursing homes in one city revealed that spiritual ministry within those institutions was generally limited to a series of 9 to 13 worship services per month, attended by approximately 20 percent of the patients/residents. Some patients receive an occasional personal visit by a pastor. The staff perceive that pastoral ministry as good, but inadequate, and expressed their views on that which is needed within their institutions and challenge the clergy with specific suggestions for pastoral care for nursing home patients/residents, their families, and staff.     

Incapable sex: a case study

Although it is well known that intimacy and sexual expression are an important part of being human and of healthy living, facilities such as nursing homes, adult group homes, or assisted living residences commonly struggle with knowing how to balance supporting residents who are incapable to have sexual lives with their duty to protect them from foreseeable harm. This article presents a challenging case and uses the British Columbia Supporting Sexual Health and Intimacy in Care Facility Guidelines to determine what should be done.     

Autonomy for nursing home residents: the role of regulations

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.     

Health,Healing and Wholeness in Frail Elderly People

ABSTRACT

This article explores the relationship between health, healing and wholeness in a group of twenty frail older residents of nursing homes, using in-depth interviews. While the participants in this study were all frail and lived with a number of disabilities, they demonstrated signs of transcendence in their responses to their disabilities. While independent living older adults in a previous study had all expressed fears of future vulnerability, only 45% of these nursing home residents said they had fears. Failure to thrive is discussed as one area of concern for frail older people, noting that this may stem from a lack of nourishment of the soul. Pastoral care is described as a multidisciplinary intervention for these residents, forming part of their wholistic care.     

End-of-life care in nursing homes: the interface of policy,research, and practice

Much attention has begun to focus on the quality of care for persons near the end of life. Palliative care, especially through hospice, has generated much discussion as possibly the most holistic care available. Consideration of how chronically ill older adults receive such care as a result of public policy can benefit from adopting a multidimensional perspective. This paper adopts Bronfenbrenner's ecological model to understand current end-of-life care for nursing home residents, followed by consideration of how each of these dimensions or levels of influence can be used to foster both research agendas and policy reforms to improve end-of-life care of nursing home residents. Specifically, the benefits of considering the influence of such policy initiatives as the Medicare hospice benefit and the Patient Self-Determination Act (PSDA) on end-of-life care in nursing homes and the means through which policy can be informed by clinical research is emphasized.     

Opportunities for development via group psychotherapy in the nursing home

This paper illustrates the benefits of group therapy within the nursing home, and considers the enhancing and problematic factors in conducting groups within this setting. Growth which empowers staff and residents is possible and can be achieved despite significant challenges and social change. A lifespan developmental perspective can assist residents to achieve their maximum developmental maturity and group therapy can be effective in accomplishing that goal. This paper discusses the effect of the nursing home environment and staff on the resident, the task of the therapist in the nursing home, the value of group therapy, therapeutic goals in group therapy, what precipitates the need for group therapy in nursing homes, and the issue of group therapy with the cognitively impaired.     

Providing Pastoral Care for the Elderly in Long Term Care Facilities Without a Chaplain Utilizing Coordinated Congregational Resources

Elderly persons living in long term care facilities are often separated from or have no pastoral care sources. Spiritual care by chaplains was not available in any of the six nursing homes in Wausau, Wisconsin. Twelve Lutheran congregations in the area worked out a plan to provide the necessary pastoral care. The congregations formed a coordinating agency, Greater Wausau Christian Services, Inc. Through the services of one staff person, the director, who enlisted the lay and pastoral resources of the participating congregations, pastoral care was provided. Worship led by the pastors, meaningful visits made by trained and supervised lay people, and the availability of a trained chaplain became a reality for nearly seven hundred residents in the six long term care facilities.     

Accounting for job satisfaction: Examining the interplay of person and situation

In the present study, we investigate the interplay of personality traits (i.e., person) in frontline care staff in nursing homes and the way they relate to the residents (i.e., situation) to account for their job satisfaction. Participants completed a survey including Mini‐IPIP tapping the five‐factor model of personality, Individualized Care Inventory tapping four aspects of person‐centered care and job satisfaction. The results revealed that staff scoring high on neuroticism experienced less job satisfaction. This relationship was partly accounted for by resident autonomy, suggesting that part of the adverse influence of neuroticism on job satisfaction may be mitigated by organizations providing a supportive care environment. In contrast, staff scoring high on agreeableness experienced higher job satisfaction. This relationship was accounted for by another aspect of person‐centered care, that is, knowing the person. This suggests that agreeableness in a sense facilitated adjustment of acts of care toward the unique needs and preferences of residents and this partly explained why the more agreeable the staff was the more they felt satisfied at work. In sum, effects of personality traits on job satisfaction in care staff are partially mediated by the perception of working conditions and care policy and to the extent that a certain personality trait affects whether the staff have a positive or negative perception of the way they relate to the residents, they will experience, respectively, higher or a lower job satisfaction. This finding has implications for how to combine a focus on delivering person‐centered care with improving personal job satisfaction.     

Direct assessment of quality of care in a geriatric nursing home

Direct observation was used to examine multiple aspects of care provided in a proprietary nursing home. The samples were taken at random intervals, 7 days per week for 5 weeks, across several categories of environmental and resident conditions as well as staff and resident activity. Results showed a high degee of compliance with predefined standards (based on current federal regulations) for environmental and resident conditions. Overall distributions of resident and staff activity showed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff spending the majority of their time engaged in nonresident work. When data were analyzed across areas of the facility, times of day, and weekdays versus weekends, some differences were noted. Weekend versus weekday comparisons showed higher resident:staff ratios on weekends and more resident inactivity, but no significant differences in environmental or resident conditions. In addition, more frequent resident care, resident interaction, and resident activity were observed in Medicare units than in non-Medicare units. Results are discussed in terms of federal requirements for monitoring the quality of care in nursing homes and the potential use of time sampling expressly for this purpose.     

How the “Not Religious” Experience and Witness Suffering and Death: Case Studies

ABSTRACT

This article is based on a subset of a multi-site (8), multi-year (4) research study that explored the cultural construction of dying and death in long-term care facilities. In open-ended interviews with residents and staff members, we learned how four individuals who describe themselves as “not religious” respond to queries about the meaning of suffering and death while working and living in long-term care.

We present case studies of two residents and two staff members from one of the sites–a secular, for-profit nursing home–who described themselves as not religious. We offer a brief history of their lives and daily activities, and present their responses to our queries about dying and death.

A finding of this article is that the nonreligious residents and staff members discussed here found significance in personal meaning systems developed through past, positive life events and present uncertainty about suffering and death. The self-described “not religious” provide another perspective on facing the end of life.     

Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender

The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff members and patients rated their self-images using the Structural Analysis of Social Behavior (SASB). Male staff seemed less influenced by the patient, with their feelings relating mainly to aspects of their own self-image, while the feelings of the female staff were more related to the patient's self-image. The patient's diagnosis was less important for a staff member's feelings than that member's self-image. Generally, the relation between feelings and self-image was stronger for negative feelings. The results point to the importance of understanding more about the influence of staff members' self-structure on their negative feelings toward their patients and how this relates to both the staff member's and patient's gender.     

Increasing Communication Among Nursing Home Residents

In this preliminary, intrasubject study (N = 8), we examined the effects of communication skills training and the use of memory books by Nursing Assistants (NAs) on the social ecology of a nursing home. Through inservice and on-the-job training, NAs were taught to use communication skills and memory books during their interactions with residents with mild to moderate cognitive impairment (Mini Mental Status Examination, M = 16.25), but relatively intact communication abilities. An abbreviated staff motivational system called Behavioral Supervision (Burgio and Burgio, 1990. Int. J. Aging Hum. Deve. 30: 287–302.) was attempted to encourage performance of these skills on the nursing units. Results showed that, regardless of sporadic implementation of the intervention by nursing staff, the intervention improved communication between staff and residents during care routines, increased the amount of time other residents and visitors spent talking with target residents, and increased the rate of positive statements made by the target residents and others in their immediate environment. Results are discussed in terms of limitations of the staff motivational system and modifications made to the system in a larger ongoing intervention trial.     

Duke University's Program on Religion,Aging, and Health

ABSTRACT

Assisted living facilities (ALFs) offer a level of care between independent living and nursing homes. Recently researchers have begun to explore quality-of-life issues concerning residents of ALFs. Considerable research suggests that religion is positively associated with both emotional and physical health. This study examines how residents use religious practices to cope with the challenges of life in ALFs. Qualitative analysis of in-person interview data from 55 residents of ALFs revealed a variety of religious practices, such as prayer, church attendance, and Bible reading. Most residents deemed religion important and reported that religious practices provided a framework for coping with problems. Coping ranged from the mundane (e.g., attending a gospel concert to offset the otherwise dull routine of the home) to the transcendent (e.g., enlisting the support of an omnipotent ally in the face of adversity). Six ways residents utilized religion as a coping mechanism emerged. Residents used religion to maintain continuity with their previous lives; to obtain relief from physical or emotional pain; to provide a framework for socialization; to develop courage; to maintain a purpose for their lives; and to prepare for death. Suggestions for enhancing the quality and variety of religious activities within ALFs are offered.     

Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

Slicing White Bre(a)d: Racial Identities,Recipes, and Italian-American Women

This article focuses on Italian-American women and on how they construct, understand, and maintain their ethnic identity in relation to Whiteness and White privilege. Since language cannot serve as symbol for these women because speaking Italian was often forbidden in their homes, or spoken only between adults in covert communications, they often must cling to other symbols of Italianness in order to preserve their sense of gendered ethnic identities. I argue that one such symbol is food, wherein participants manipulate recipes and use food to navigate and negotiate being both Italian and American, Whiteness, femininity, and social class. Implications for therapy about how we understand our multiple identities in relation to others as part of larger systems of power and privilege are explored.     

Clinical staff’s attributions about diabetes: Scale-development and staff vs. patient comparisons

Clinical staff’s attributions about diabetes management were measured using newly developed scales. Eighty-five physicians and nurses provided data to investigate the psychometric properties of the scales and to examine the patterns of attributions made. Alpha coefficients for the 7 six-item scales were satisfactory, ranging from .51 to .73. A comparison between attributions for positive and negative outcomes of diabetes management produced examples of self-serving bias. Comparisons were made with data from 286 insulin-dependent diabetes patients. Staff tended to rate patients as having less personal control over positive outcomes (t=2.94;df=338;p<.01) and tended to emphasize chance to a greater extent than did the patients (t=?4.32;df=338;p<.001). There was a tendency for staff to rate negative outcomes as being more foreseeable by the patients than the patients did themselves (t=?3.11;df=346;p<.01). Both patients and staff demonstrated bias towards dispositional attributions. The implications of between and within group differences in attribution patterns are discussed.     

Interpersonal Conflicts of Women in Nursing Homes: An Administrative Perspective

Older women may respond to conflicts by suppressing anger. Suppressed anger is associated with depression and hypertension. Research on the everyday conflicts of community-dwelling older women has begun to emerge. Such information is not available for women in nursing homes, and is necessary for developing interventions that can help protect women in nursing homes against anger-related illness. Nursing home administrators were surveyed to evaluate women's health promotion programming in general, and the incidence of and institutional response to conflicts of women residents. About 74% of residents were women; yet, women's health promotion programs were rare (offered in 1 out of 25 facilities, or 4%). Ninety percent of administrators identified depression as the most significant women's health problem, but tended to see it as warranting medical rather than programmatic attention. Eighty percent identified strained interpersonal relationships as a significant health problem for women, requiring programmatic attention. In particular, administrators identified the need for programming to help women residents resolve conflicts with roommates and family members. Formal mechanisms for managing conflicts of residents did not exist in sample nursing homes.