Are residents of long-term care happy enough?
For the past several weeks, I have had the experience of working in a long-term care facility which is home to mainly older individuals, the majority of whom have some form of dementia. I have had a lot of time to observe the daily activities and lifestyle of these residents, and have done a lot of internal reflection on my observations. During my placement at the long-term care facility I have questioned what sort of quality of life the residents have, and if having a sense of purpose is important to quality of life for these residents.
Growing up, I spent a lot of time wondering what the purpose of life is, if one exists at all, and often questioned what my role was on this planet. As such, I have come to maintain the belief that a sense of purpose is an important contributor to one’s quality of life. My experience over the past few weeks in long-term care nursing has been influenced by this belief in a sense of purpose. Other areas of nursing seem to have a definitive purpose: on one end of the spectrum, we have areas such as acute care, labour and delivery, and mental health, where there generally exists an expected outcome and the prospect of the patient “getting better”. On the other end of the spectrum, we have end-of-life/palliative care, where the purpose is simply to make an individual comfortable in their last months, weeks, or days of life. Where does long-term care lie on this spectrum? Individuals who live in long-term care are not necessarily acutely ill, and so there is no expected outcome, but they are also not necessarily on a direct route to the end of their lives. In my view, individuals in long-term care are living in a type of purgatory, and I feel uneasy about their quality of life.
I have had several encounters that have led me to develop this opinion. On my most recent clinical day, I talked to a resident who said she felt trapped in long-term care. She had previously been in a long-term care home in Peterborough where she was able to be a more active member of the community, but she feels stranded in her current long-term care home that her family moved her to. I sat with another resident who was wailing uncontrollably and had tears streaming down her face. When I asked her if she could tell me what was upsetting her, she had a very difficult time vocalizing her feelings. These encounters can be generalized to most patients I’ve talked to on my home area: whenever I ask a resident how they are on that day, I usually get a neutral response like “I am okay” or a negative response like “I’m not feeling very good”. Residents always seem to be grateful for the care given and they always thank me, but nonetheless there seems to be a feeling of dissatisfaction among residents.
I believe there are two main reasons for my discomfort in this situation. One is that it is extremely difficult to gauge the feelings of those with dementia, as very often they have limited ability in communication, and the second is that I have so little experience in other areas of long-term care. From what I’ve seen in my home area, quality of life seems to be low, but this may be different in other home areas or even other long-term care homes. Caring for residents in different settings may allow me to understand quality of life better. This also underscores the importance of family involvement in care. After all, the family includes the people who know the resident best and would be able to tell if they felt happy or satisfied with their life; talking to family members would help me further my knowledge of resident experience in long-term care and tailor my care to each patient.
I believe the way most long-term care facilities are structured currently are not conducive to person-centred care. While I do accept that staff put residents as their first priority and do care very much for the residents, the system itself seems to be structured as a place for individuals to live comfortably, but not necessarily to thrive. A recent article released by Griffin (2018) in the National Post describes a village that is currently being developed in Langley, British Columbia. It is an enclosed community where residents live in small houses and are able to freely go outside, engage in commerce, socialize, and basically do the activities they desire, while still having access to medical attention and almost one-to-one resident care. This model is based off several long-term care homes in the Netherlands and seems like an amazing way to care for residents who are dependent on others but still allows them freedom and autonomy.
Maybe my view on the quality of life in long-term care facilities is naïve. Perhaps residents are truly happy, and their level of dementia makes it such that they don’t need a lot of stimulation or choice in activity to feel fulfilled. As a young, psychologically well individual, it’s hard to imagine what an older, psychologically ill individual feels and wants. However, I have learned that non-verbal communication is so important. Even though many residents aren’t able to communicate verbally, the upset resident I mentioned above seemed to glean some comfort when I held her hand. Another resident who was unable to verbalize and gave little indication that she was aware of her surroundings squeezed my hand when I was drying it after a shower. Furthermore, almost all residents are receptive to a smile. I’ve realized what is obvious, but not often acknowledged: older adults are as varied as young people and have very different personalities, and need care and communication to be tailored appropriately. In terms of my nursing career, I’ve realized that, despite the funny, fulfilling, and satisfying moments I’ve had with the residents, I’m more interested in areas of nursing that have a defined purpose and end goal. However, this is likely to change. Hopefully by continuing to care for and talk to residents, talk to their families, and experience other types of long-term care I can develop a more robust picture of the experience of individuals living in long-term care.
Note: this is an excerpt from a journal reflection originally written on March 7, 2018 as part of the clinical course. Some sections have been edited for clarity and brevity.
Growing up, I spent a lot of time wondering what the purpose of life is, if one exists at all, and often questioned what my role was on this planet. As such, I have come to maintain the belief that a sense of purpose is an important contributor to one’s quality of life. My experience over the past few weeks in long-term care nursing has been influenced by this belief in a sense of purpose. Other areas of nursing seem to have a definitive purpose: on one end of the spectrum, we have areas such as acute care, labour and delivery, and mental health, where there generally exists an expected outcome and the prospect of the patient “getting better”. On the other end of the spectrum, we have end-of-life/palliative care, where the purpose is simply to make an individual comfortable in their last months, weeks, or days of life. Where does long-term care lie on this spectrum? Individuals who live in long-term care are not necessarily acutely ill, and so there is no expected outcome, but they are also not necessarily on a direct route to the end of their lives. In my view, individuals in long-term care are living in a type of purgatory, and I feel uneasy about their quality of life.
I have had several encounters that have led me to develop this opinion. On my most recent clinical day, I talked to a resident who said she felt trapped in long-term care. She had previously been in a long-term care home in Peterborough where she was able to be a more active member of the community, but she feels stranded in her current long-term care home that her family moved her to. I sat with another resident who was wailing uncontrollably and had tears streaming down her face. When I asked her if she could tell me what was upsetting her, she had a very difficult time vocalizing her feelings. These encounters can be generalized to most patients I’ve talked to on my home area: whenever I ask a resident how they are on that day, I usually get a neutral response like “I am okay” or a negative response like “I’m not feeling very good”. Residents always seem to be grateful for the care given and they always thank me, but nonetheless there seems to be a feeling of dissatisfaction among residents.
I believe there are two main reasons for my discomfort in this situation. One is that it is extremely difficult to gauge the feelings of those with dementia, as very often they have limited ability in communication, and the second is that I have so little experience in other areas of long-term care. From what I’ve seen in my home area, quality of life seems to be low, but this may be different in other home areas or even other long-term care homes. Caring for residents in different settings may allow me to understand quality of life better. This also underscores the importance of family involvement in care. After all, the family includes the people who know the resident best and would be able to tell if they felt happy or satisfied with their life; talking to family members would help me further my knowledge of resident experience in long-term care and tailor my care to each patient.
I believe the way most long-term care facilities are structured currently are not conducive to person-centred care. While I do accept that staff put residents as their first priority and do care very much for the residents, the system itself seems to be structured as a place for individuals to live comfortably, but not necessarily to thrive. A recent article released by Griffin (2018) in the National Post describes a village that is currently being developed in Langley, British Columbia. It is an enclosed community where residents live in small houses and are able to freely go outside, engage in commerce, socialize, and basically do the activities they desire, while still having access to medical attention and almost one-to-one resident care. This model is based off several long-term care homes in the Netherlands and seems like an amazing way to care for residents who are dependent on others but still allows them freedom and autonomy.
Maybe my view on the quality of life in long-term care facilities is naïve. Perhaps residents are truly happy, and their level of dementia makes it such that they don’t need a lot of stimulation or choice in activity to feel fulfilled. As a young, psychologically well individual, it’s hard to imagine what an older, psychologically ill individual feels and wants. However, I have learned that non-verbal communication is so important. Even though many residents aren’t able to communicate verbally, the upset resident I mentioned above seemed to glean some comfort when I held her hand. Another resident who was unable to verbalize and gave little indication that she was aware of her surroundings squeezed my hand when I was drying it after a shower. Furthermore, almost all residents are receptive to a smile. I’ve realized what is obvious, but not often acknowledged: older adults are as varied as young people and have very different personalities, and need care and communication to be tailored appropriately. In terms of my nursing career, I’ve realized that, despite the funny, fulfilling, and satisfying moments I’ve had with the residents, I’m more interested in areas of nursing that have a defined purpose and end goal. However, this is likely to change. Hopefully by continuing to care for and talk to residents, talk to their families, and experience other types of long-term care I can develop a more robust picture of the experience of individuals living in long-term care.
Note: this is an excerpt from a journal reflection originally written on March 7, 2018 as part of the clinical course. Some sections have been edited for clarity and brevity.
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