With population ageing continues, the demand for and quality of long term care for elders is no doubt a topic of major concern for Hong Kong.

Would you consider living in elderly homes?

Research shows that admission to institution was often triggered by sudden changes in health status, such as health deterioration associated with dementia, visual problems and fall accidents . As admission to long term care institutions is tied with disability and helplessness, an average elder usually holds negative attitude towards this. Yet when elders are unprepared psychologically or have negative feelings towards long term care, adjustment would be even harder.

The nature of admission (whether it is voluntary or involuntary), pre-existing attitudes towards long term care and readiness for admission are associated with adjustment outcomes and satisfaction in institutional living. Support from care-giving staff and family regarding daily living, leisure participation and interpersonal relationships would definitely help elders establish a sense of security and facilitate their adjustment to living in long term care institutions.

What emotions would elders go through?

Common emotional reactions include:

• Fear and sense of insecurity
• Moving away from familiar environment
• Changing from individual to group living, resulting in decreased autonomy in daily routine
• Perceiving institutional living as a place of passivity and death
• Difficulties living “under the same roof”, disturbed by interpersonal problems
• Sense of abandonment and low self worth
• Perceiving self as worthless, a burden to family
• Feeling abandoned by their children
• Sense of loss
• Grieving for losses, such as health, autonomy, family roles, privacy, neighbors and friends

Just as kids who are new to kindergarten or primary school may experience negative emotions, elders who are newly admitted to institutions would inevitably feel lost or annoyed to a certain extent. But such transitional stress should by no means devalue residential care for elders.

Is residential care beneficial for elders?

For those with decreased self care abilities, residential care has its advantages such as having caregivers on duty round the clock. Family members are also relieved from caregiving stress. Elders who used to live alone may also get the chance to connect with peers, thus alleviating their sense of loneliness.

How can family members prepare elders before moving into residential care?

1. Honor shared decision-making and psychological preparation

Get to know elders’ perception of residential care. Respect and involve them in the elderly home selection process to clear any doubt and reduce sense of helplessness. Arrange site visits, and introduce to elders the service, facilities, charges, etc. of the nursing home. If site visits are not feasible, videos or pamphlets can help elders get to know the home environment better.

2. Foster sense of belonging and pay visits to maintain connectedness

Help elders bring along their personal belongings such as memorable items or their photos, family pictures, cups for use in the care home to maintain familiarity and sense of belonging. Be mindful that elders often long for seeing their children and grandchildren, but at the same time worried if they have become a burden. In fact, family support is the main source of life satisfaction for elders, so family members should pay regular visits to them. To prevent elders from feeling abandoned, try to keep their bed / bedroom at home so that they can have home-leave during festive seasons, and can store personal belongings there.

3. Anticipate emotional distress

low elders to express their feelings and try to understand their struggles. Maintain regular visits. Do not expect them to cheer up very soon nor blame yourself for their negative feelings. Have some fun and show your care during visits by bringing favorite snacks, sharing news update, styling their hair or trimming their nails.

4. Maintain good communication and be considerate to nursing home staff

Family members are partners of nursing home staff in elder care. Positive response and encouragement to the staff may nourish the working relationship. Avoid focusing on problems or imperfections of their work as this may spoil the partnership and put elders in a difficult situation.

How can nursing home staff help elders’ adjust to institutional care?

1. Maintain good communication

Designate one or two staff for communication with newcomers to reduce confusion and apprehension. Maintain eye contact, address elders with their preferred name and title to show respect and enhance familiarity. Make sure you notify and prepare the elders before taking them to shower or changing diapers.

2. Help them preserve their competence and get them involved

Most elders would like to take care of themselves in daily living. If they can walk with aid, avoid using wheelchair. If they can eat by themselves, avoid feeding. Solicit elders’ support in tasks like folding clean clothes and setting the table. When elders can contribute their part in daily living, they would have more self-confidence and sense of belonging. Leisure activities can increase motivation, pleasure and can give life a positive touch. Staff may organize more healthy leisure and group activities and encourage elders to participate actively.

3. Enhance the pleasure in dining

A comfortable dining environment can make people happy and boost appetite. Try to avoid serving meals at bedside. Diversity in food choices is preferable. It is also fun to organize get-together with choice food and special dishes during festive seasons or birthdays.

4. Protect personal space and privacy

Privacy is important for dignified care. Separate rooms, lavatory and bathroom with lock are recommended. When resources are limited, partitions or shades can be used to increase privacy. Arrange same-sex staff to take care of cleaning and bathing needs of elders as far as possible.

5. Promote interpersonal harmony and emotional health

Chinese elders consider interpersonal relations with staff and other residents the most challenging task in adjustment . Nursing home staff can help elders acquire social skills and maintain harmonious relationships. They may also facilitate conflict resolution. Staff should also heed the emotional and behavioral changes of elders. If elders show persistent depressive, anxious, or distressed mood, and seemed to have lost interest in what they used to enjoy, staff should take them to doctors, social workers or clinical psychologists for help.

Conclusion

Moving to long term care is a significant transition for elders. Adjustment takes time. Some of them may experience low mood, anxiety, loss of appetite and insomnia initially. If nursing home staff and family members could render care and support, most of the elders would gradually come to accept and adjust to institutional living. In case depressive or anxiety features are observed in elders, seek medical attention early.