Nursing homes are filled with people, yet residents often experience a depth of loneliness that affects their physical and mental health. Research reveals low rates of social interaction among nursing home (NH) residents, but few studies have examined residents’ preferences for social contact. Assessment and care planning processes should highlight social preferences because friendship and a sense of community are an essential part of the human experience. These needs are lifelong and do not disappear with dementia. Strong connections to community are associated with longer survival rates and higher perceived quality of life and well-being.
Resident Responses to Social Preferences Questions
Researchers asked 255 NH residents about barriers to fulfilling their social preferences and factors that influence changes in their social preferences. Below are key findings from more than 1,400 responses to questions about: regular contact with family and friends, meeting new people, volunteering, spending time one-on-one with others and with groups, participating in clubs, being around children, reminiscing about the past, gift-giving and roommates.
Barriers to Social Interactions & why Preferences Change
Nursing home residents describe barriers that prevent them from meeting their preferences for social contacts:
- Reduced sensory, functional or cognitive ability — hearing and visual limitations, difficulty walking or other physical problems, and memory impairment can inhibit residents from engaging in social activities they prefer.
- A perception that residents have few choices or few resources — some cite no clubs to join, no opportunities to volunteer and no children to interact with. Others mention “no family left,” “family too busy or far“ – or friends were “dying off,” “no friends here,” or “no one to talk to.”
- Challenges forming new relationships of the caliber that “make life worth living.”
- Organizational policies – such as rules that prohibit residents from giving gifts to staff members, or protocols that restrict a resident from participating in preferred activities due to safety concerns.
While preferences tend to remain stable over time, residents cite three main reasons why their social preferences may shift:
“Whatever’s available, that’s where they put you. Sometimes they think you want a certain type of person — for example, someone who talks a lot. But that’s not the case. They think they know what you want but they really don’t.” – Nursing Home Resident
- Quality of the interaction — the other person’s mental health, “whether I can hold a conversation with them.”
- Type of relationship – “It all depends on who the other person is,” and spending time one-on-one “depends on the relationship,” or “only with my son.”
- Level of interest and context — “If it’s something I want to do, then it’s important” and it “depends on what it’s for.”
Recommendations to Strengthen Social Connections
Ask residents about their preferences for contact with family and friends, spending time in groups or one-to-one, specific activities and more. Recognition and respect for preferences can improve relationships between residents and staff and assure that residents are truly known. Use preference information to improve resident quality of life and satisfaction, including to:
Sustain, protect and nurture relationships:
- Help residents maintain key relationships by providing support to use communication methods preferred by the residents, children and grandchildren, such as cell phone, Skype, FaceTime and letter writing.
- Foster friendships among residents with common preferences and interests.
- Reconsider rules that prohibit staff from accepting gifts of value from residents; instead, allow gestures of appreciation, such as personal notes or homemade crafts that can be created during activities.
- Review policies designed to maintain resident safety and reduce risk; seek opportunities to adjust the balance so that resident preferences can be met more often.
- When a nursing home resident’s preferences change, explore the reasons. A shift in a strongly held preference may signal a change in the resident’s clinical condition (physical or mental health status), or an interpersonal conflict.
- Never view a resident as an “unreliable” reporter of preferences. Instead, seek to understand the social, environmental or other factors that may be influencing a resident’s choices or changes in preferences.
Enhance activity planning:
- Develop activities with guidance from an advisory board of residents, family members and the community to identify and prioritize opportunities to engage meaningfully, such as volunteering, participating in clubs and spending time around children.
- Encourage residents to share unique abilities and knowledge (i.e. lead a chorus or current affairs discussion group).
- Offer residents options for the way they participate in activities and tailor experiences to residents’ current abilities. Examine the steps involved in preferred activities; reduce or share the steps among residents so that each person can take part in line with their strengths and interests.
- Always give residents the choice to participate in an activity. Don’t equate lack of prior participation with lack of interest.
Improve roommate matching:
- Providers without private rooms may benefit from engaging residents in the roommate matching process. Use PELI assessment feedback to identify common daily living preferences and shared interests.