Imagine a long-term care (LTC) facility that feels like home to everyone. A place where residents from all walks of life feel respected, valued, and comfortable expressing themselves authentically. This vision isn't just a feel-good aspiration; it's the foundation for delivering exceptional care.

LTC facilities can't afford to comply with minimum standards in today's diverse society. As an administrator and registered nurse, true quality care hinges on embracing diversity and fostering inclusion. This means going beyond regulations and creating a welcoming environment that celebrates each resident's unique needs and backgrounds.

This line of work is never normal. Being a leader in senior living and healthcare is grief-inducing, emotional, and uncertain every day. Burnout and breakdown cannot be how your hard work in this field ends. You deserve better, and you certainly cannot afford to crack!

Something has got to give.

I would like you to participate in a brief mental exercise.

Close your eyes and visualize the images you see when you say the following words: “old man, elderly gentleman, old woman, elderly lady.” 

The elderly, because of reasons of pride or because of mental impairment may not always state their problem or problems directly. Tolerance and patience may be required in teasing out the issues. Often a great deal of trust must be present before a frail elder will confide in a professional who may be caring for them.

Working with this group of older individuals simply takes more time to form a strong relationship to be effective. That relationship must also include a sincere and caring attitude. The older individual in return for that care may worry and want to give “gifts” of some sort to staff and caretakers. It is their way at an attempt of feeling less dependent and an attempt to have greater control over their situation.

In this article, I will be examining the concept of belonging, i.e. relationships with family, friends, and community as it relates to the aged individual.

There is a classic study by the researchers Lowenthal and Haven who qualify the importance of a caring relationship as a buffer against, what they declare “age-linked social losses.”

Grandparenthood has multiple meanings for the person, depending in part on age at the initial time of grandparenthood, and the number and accomplishments of the grandchildren are probably a source of status. The stage of grandparenthood may come to middle-aged persons depending on the age of their own childbearing and age of their children’s childbearing. The relatively young grandparent may either like and accept or resist the role and may not like the connection of age and being a grandparent.

Grandparents are often happy with their role in that they can enjoy the young person and enter into a playful, informal, companionable and confiding relationship. The grandchild is seen as a source of leisure activity, someone for whom to purchase items that are also enjoyable to the grandparent.
Grandchildren have a special tie to grandparents. The research indicates that even when there was a divorce in the family, adult children from divorced families continued their relationships with grandparents.

We often mistake an old person’s quiet withdrawal and lack of complaint as philosophic acceptance when, in fact, she is putting her best possible face on a bitterly disappointing, humiliating or frightening situation.

Either assumption, that it is normal to be unhappy or that old people are somehow happy about being unhappy, obstructs our view of the person’s true state of mind. Signs of distress deserve attention in old age as much as at any point in the lifespan.

Society has an alternative method of classifying people by age. The distinctions are based on a person’s life situation, especially the place held in society, rather than on number of years since birth. Sociologists and anthropologists sometimes refer to this as an age-grading approach. It has been the most important basis of age distinction in many societies, and continues as a supplementary approach in industrialized nations today.

A simple age-grading approach divides the population into the young, the grown up, and the aged.

The following is a quote by the researcher, M. Schwab: “These early morning hours are terribly lonely…that’s when I have such a longing for someone who loves me to be there just to touch and hold me…and to talk to.”

Touch is the most important and neglected of our senses. An individual can survive without one or more of the other senses, but one cannot survive and live in any degree of comfort without the physical and emotional sense that touch is capable of offering.

Western clinicians are beginning to embrace Eastern healing modalities more than ever, especially in regard to patients with unrelieved pain. According to Maureen Foye, an RN, employed at the in-patient pain management program at Spaulding Rehabilitation Hospital in Boston, “Many people don’t understand the role that Eastern healing can play in the management of pain.” Foye began working with patients in severe pain after being exposed to the principles of therapeutic touch. She has now come full circle by instructing other practitioners in the value of these principles with plans to conduct further research into the clinical effectiveness of energy healing and therapeutic touch associated with the field of pain management.

Many patients with chronic pain tend to isolate themselves. A major focus of the program is to therefore, create community among her patients.

In almost every book or article on aging, one idea continues to be stressed: longevity is desirable if accompanied by a life of high quality. But, I continue to ask, what makes for such a good life? Most of us want love, meaningful work, safety and security, energy and health, and to varying degrees, power, fame, freedom and wealth, and we want to live in a society that supports these goals.

How can we measure quality of life? There is no simple answer. It is an amorphous concept, constantly changing with the historical period and one’s culture, personal background, stage of life, and socioeconomic status. A person’s definition of quality of life is and should be highly individualized and objective.

A resident in a facility where I was the Director of Nursing, claimed the reason he and his wife got married while in their late eighties, was the following,” It was a marriage of convenience. Rather than using a cane or a walker, we can lean on each other.”

Mobility is the capacity one has for movement. In infancy, it is a major mode of learning and interacting with the environment. Throughout life, it remains a significant means of contact, sensation, exploration, pleasure, and control. In old age one moves more slowly and purposefully, sometimes with more caution.

The old person is largely responsible for his own place in society. What is experienced as rejection or exclusion by one person may be a welcome opportunity to shed responsibility by another. One individual’s lifestyle may keep him closely linked with society, while that of another individual may encourage an earlier withdrawal.

The reality of individual differences is well illustrated in several studies in the field of aging. As an example, researchers in their studies among men, have identified five types of personality.

Today, in general, Americans are living longer than their predecessors. Yet those who make policy have been slow to recognize the implications of this unprecedented increase in longevity. As a result, social institutions (i.e.: educational organizations, healthcare providers and work settings) have not fully adapted to the challenges and opportunities posed by America’s aging population.

It has been projected by 2030, the U.S. will experience accelerated growth in its aging population. It has also been projected that by 2050, the number of U.S. citizens 65 and older, will reach 88.5 million. That’s more than double the 40 plus million that was originally reported in a federal document on “aging in society.”

A person who appears demented may be tormented by grief and anxiety. His demented behavior may have been brought about by emotional pain. A grieving person at any age is less able to pay close attention to everything that happens around him. He takes less care in grooming and dress. He has less emotional energy to welcome new opportunities or to respond to challenges. He feels uncomfortable with his body. His mind may be constantly uneasy or tortured.

Loss and grief are common in old age as death removes loved ones. An old person may have suffered other significant losses, of occupation, residence, physical mobility, belonging, or usefulness – all of which produce a grief response.

Without question, working in long term care is demanding and stressful. In addition to the intrinsic stressors staff must face daily in nursing homes, often they must also struggle with managers who add to the stress. It takes only one thoughtless supervisor to create a work environment that goes from bad to worse in an instant.

Unfortunately, there are managers and supervisors in long term care who may lack self-awareness or the desire to evolve into better leaders. They may intentionally create “power distances” between themselves and their employees. This distance may also signal that they may be unapproachable.

A few weeks ago, I had the pleasure of sitting in on an orientation for our client, Rowntree Gardens, a faith-based Continuing Care Retirement Communities (CCRC) that provides a full range of integrated onsite services to meet the changing needs of people as they age. Randy Brown, CEO, engaged Drive in our services because he understands the importance of their rich history and deeply rooted culture.

Together we are working to enhance their already strong culture and create a sustainable program to retain their top employees while also finding new ways to recruit the right candidates.

Have you ever heard an employee utter the words, “That’s not my job?” Or maybe you’ve secretly wished the ground would open up and swallow you when you heard how an employee spoke to a customer. Have you ever been on the receiving end of, “That’s not how we do things around here?”

What do all these things have in common? Culture.