RESEARCH TO PRACTICE
The Meaning of Relationships in Nursing Homes
Meyers, S. (2006). Role of social worker in old versus new culture in nursing homes. Social Work, 51, 3, 273-277.
Sandy Meyers addresses the role of social workers in the lives of people living in nursing homes. Social workers are taught to get to know each person they work with, appreciate the value of relationships, and to respect each individual’s right to decision making. However, the reality of nursing homes often discourages social workers from enhancing residents’ ability to choose the best options for themselves. The right of decision making is often weakened or eradicated due to the nursing homes’ focus on residents’ care. Because of this primary focus people are treated as objects due to concerns about their physical bodies, diagnosis, and functional limitations.
Social workers are often occupied with getting answers related to residents’ benefits and similar problems associated with their lives in a nursing home. Completion of documentation too often becomes the primary duty of a social worker and does not leave time for developing relationships with residents. An unspoken assumption in the nursing home environment is that the professionals know what is good for residents. The plans developed by the professional teams expect people to comply with these plans and accept nursing homes’ routines and programs. Residents’ feedback is not always considered. This results in social death for the entire nursing home community. Residents exhibit “helplessness, loneliness, boredom, alienation, and feeling of powerlessness.” This in turn impacts the attitudes of social workers who start seeing residents as “incompetent, dependent, and childlike.”
Often older adults and children are regarded in the same way: the non-contributing to society segment of the population. Very few opportunities are developed to help residents give back and contribute in a meaningful way to the community they live in. As a result, the personhood of residents is diminished. Residents are not seen as people with a past, stories to tell, achievements to discuss but rather as a set of diagnoses and appropriate care tasks that address their illnesses.
Meyers identifies that deterioration of physical strength does not mean that people stop living. Social workers should assist residents with normalizing their lives, identifying things that they can still do and enjoy, and create opportunities for old adults “to live life to the fullest.” The core of this attitude is the development of a meaningful relationship between staff and residents. “The relationships are the blocks of life, and they must be alive and vigorous.”
Residents should direct their own care. For staff to value the person over the task and truly respect their autonomy and independence they have to get to know the person. Every person is unique and has very unique stories to tell. Each resident has distinctive interests, talents, skills, wants, and wishes. The principle of common humanity should guide all staff members to refer to each other as people by drawing on feelings, emotions, intuition, spontaneity, faults, insecurities, individuality, sharing, receiving and giving. This last component is too often denied to nursing home residents. Staff need to create opportunities for older adults to give and repay and not always be on the receiving end. Reciprocity helps people feel worthwhile and alive.
Strong and meaningful relationships between staff and residents are the hallmark of culture change. Active listening and helping people grow is based on their individuals needs and interests not those of the nursing home. Staff have to believe that everyone has the capacity to grow and can contribute regardless of their cognitive and/or physical abilities. Creating communities where people feel they matter to each other is based on valuing each and everyone on the same level.
Implications: Homes that have implemented the principles of culture change foster the development of meaningful relationships between staff and residents. Administrations quickly recognize many benefits not only for residents but also for staff and their homes. It has to start with a change of attitude that places residents and their needs in the center. Social workers can be a valuable resource for homes as they change to a more person-centered model. Social workers can model to other staff how to cultivate relationships with residents. The development of relationships within the nursing home community will “ensure that the forces of life, not death, prevail.”
The article includes a few stories that illustrate staff’s concerns and ways they have helped residents be more involved.