How to Combat Loneliness in Residential Care Settings

By Geralyn Magan

Resident engagement and peer support can be more effective than traditional activities programs in addressing loneliness and depression among residents of nursing homes, assisted living settings, and retirement communities.

That’s the conclusion of a new paper co-authored by Robyn Stone, executive director of the LeadingAge Center for Applied Research.

“The Need for a Social Revolution in Residential Care” appears in the December 2015 edition of the Journal of Aging Studies. Stone wrote the paper in collaboration with 5 experts in the fields of medicine, rehabilitation science, and social work from Yale University, the University of British Columbia, and Trinity College Dublin.

Engagement Instead of Entertainment

The authors describe an approach to psychosocial care – called Resident Engagement and Peer Support or REAP – that they say could revolutionize how nursing homes, assisted living settings, and retirement communities address residents’ mental health concerns.

The approach represents a marked shift away from the traditional practice of trying to ease loneliness among residents by filling the day with formal, task-oriented recreation programs. These superficial activities often make residents feel lonelier and more isolated, the authors maintain.

As an alternative, the authors call for a new approach that focuses on providing opportunities for “emotional and meaningful social engagement” that are developed in collaboration with residents and tap those residents as sources of peer support.

Long-Standing Concerns about Loneliness

The Journal of Aging Studies article begins by describing a 50-year old study, conducted in homes for the aged in England and Wales, which identified the negative effects associated with residential living, including:

  • Loss of occupation.

  • Isolation from family, friends, and community.

  • Tenuousness of new relationships.

  • Loneliness.

  • Loss of privacy and identity.

  • Collapse of self-determination.

“The same concerns are still prevalent today and in some ways have become magnified within institutional settings with the increasing frailty and chronic health conditions of residents,” write Stone and her co-authors. “Residents report frustration around their lack of influence and independence, and paternalistic communication styles among staff.”

To back up their claim, the authors cite more recent research studies in which 29% to 55% of older adults living in residential care settings reported feeling lonely. Loneliness is linked with depression and impaired mental health among older people, they say.

Traditional recreation programs don’t ease these feelings of loneliness because they are:

  • Planned, scheduled, and implemented without input from residents.

  • Often intended to entertain and distract, rather than foster meaningful connections or engagement.

  • Based on the assumption that simply attending an activity – rather than having a space to speak and be heard – is what promotes better quality of life among residents.

Resident Engagement and Peer Support

REAP has 3 features that the authors say “have potential to reorganize institutional recreation practices” for all residents, including those who are living with dementia. Those features include:

  • Meaning: Residential communities implementing REAP assess and clarify what forms of group participation are meaningful for each resident. An integral part of this process includes the exploration of how residents can actively engage in those groups and how they might contribute to those groups.

  • Participation: Existing or new groups following the REAP model foster relationships among residents and help those residents discover and value their shared identity.

  • Service: REAP encourages residents to develop and participate in groups or membership clubs that focus on being of service and helping others.

Benefits Outweigh Obstacles

Residential care communities will undoubtedly encounter obstacles as they attempt to implement an approach to psychosocial care that features social identity, productivity, and peer support principles, write the authors. These obstacles include:

  • Apprehension about potential liability associated with autonomy.

  • Lack of support from health professionals for programs that deviate from a biomedical approach.

  • Low staffing levels or lack of staff competence with non-pharmacological alternatives.

  • Resident difficulty tolerating and embracing diversity and dissent among their peers.

  • Limited incentives for change among staff, due to lack of funding, low wages, or difficult and demanding work.

Despite these challenges, the REAP model can be successfully implemented and can bring about a seismic shift in how residents and staff see themselves, say the authors.

Staff members will begin to see the value of collaborating with residents to develop opportunities for meaning and contribution, they predict.

Residents will begin to see themselves as experts on what constitutes meaningful experience, and as active participants in reform and change.

“Through reaching out and tending to the needs of others, residents may regain a sense of self and purpose, view themselves and their problems from a new perspective, and find that they are not alone,” conclude the authors. “With the right supports in place, residents can actively engage in their own psychosocial care, thereby improving quality of life for themselves and their peers.”