Nursing home residents tell their story: researchers find themes emerging from a resident survey—and they offer actions for administration to take

Nursing Homes, Sept, 2006 by Roma Lee Taunton, Valorie Coffland, Sara Pedram, Ubolrat Piamjariyakul, Marjorie J. Bott

In your nursing home, what makes residents happy or unhappy? What are their special wishes? We posed those questions to 245 residents at 10 nursing homes located in two Midwestern states. Approximately three-fourths of the residents we interviewed reported positive feelings about being in their present nursing home, and 43% told us that that nothing makes them unhappy there. Four themes emerged from resident responses: community, care, supportive relationships, and loss and grief. In this article, we share our findings with nursing home administrators and staff. Some of this may confirm what you already know and the actions you should be taking. We offer our own recommendations and suggestions to address these themes.

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Community

As in any community, nursing home residents focus on their living space, neighbors, and what is happening. For some residents, having others around affords conversation and companionship, especially when their roommate is or becomes a friend. The nursing home provides a sense of "fellowship, friendship, and care." In contrast, other residents may be uncomfortable with the number of people and the amount of activity level within the environment. These residents are unhappy because they "always have someone around," and wish for "a private room" or "a lot of space like I had at home."

Residents enjoy going to the dining room and visiting with their tablemates. They are happy when the food is good, there are snacks at night, and they celebrate birthdays together. They are unhappy when the coffee is not freshly brewed, the same foods are served too often, or the food is not cooked to their personal taste. Residents' special wishes include "to have food and meat like I had on the farm," "for someone to bring food from outside for my birthday," and "to have a martini once in a while."

The planned activities provided by nursing homes are an important part of the community. Residents like to be busy and enjoy "the chance to play bingo and laugh." Some are happy because church services are offered in their home. Many residents want to get into town and see new sights. One resident's special wish is to "get a group together and get away from here," whereas another simply would like to "get out more and see flowers and trees." Others want to go shopping or go out to lunch.

Most residents are elders, and the nursing home community may be less satisfying for younger residents. A younger resident says, "There's a bunch of old people here instead of people my own age." Another tells us, "It's such a sad place, so many old people."

Actions. Fulfilling residents' special wishes could increase their sense of community. One approach would be for the care planning coordinator or social worker to ask residents about special wishes when completing the quarterly or annual MDS assessment. Many of the wishes are easy to grant through staff or family members, and that special treat could be added to the respective resident's care plan as a onetime event. Using the MDS assessment process ensures that residents with limiting physical or mental impairments would be included.

Other actions to increase residents' sense of community might include providing quiet places where they can go to be alone or arranging activities targeted for younger residents that offer interactions with age-mates. Access to the Internet, with assistance in learning to use that technology, could facilitate participation in chat rooms and, perhaps, cyber friendships with peers in other facilities.

Care

Residents come to nursing homes because they need help with basic activities of daily life. Many residents are happy because someone else does the housework, prepares the meals, washes the dishes, and does the laundry. They like having someone who pays attention to them and helps them meet their needs.

Having things go the resident's way is important. Residents appreciate special attention to unique interests or needs, such as having staff communicate with sign language, being able to listen to music of their choice, and having coffee with the chaplain. They need flexibility; for instance, too many baths make one resident unhappy, whereas another's special wish is to have more baths.

Residents are happy when they are satisfied with staff and believe they receive good care. They describe good care as having staff listen to what they say, having someone respond quickly to the call light, being handled gently by staff during care, receiving proper medications and treatments, and having the doctor visit. Personal cleanliness is valued--being kept clean, having clean clothes, and having clean teeth.

Good care depends on the facility having enough qualified staff to meet resident needs. Long waits--for meals to be served, for help to the bathroom, or for the nurse--make residents unhappy. Sometimes busy staff save time by doing things residents could do for themselves. It may be faster to change a resident's briefs than to take him to the bathroom, or to push a resident's wheelchair to the dining room rather than letting her use a walker. High staff turnover also creates problems. One resident says, "The people who help me change all the time; they don't know what they're supposed to do."