Moving into a nursing home involves changing roles for the resident, but also for relatives.

This article is written from a Swedish perspective, but hopefully it can inspire interested parties from other countries.

People sometimes talk about four cornerstones of good aging. Physical activity, good eating habits, meaningfulness related to being involved and needed, and social community. There is a connection between health and social relationships. For those who move into a nursing home, these change. Role loss can be a challenge for those moving into a nursing home and their relatives, but there are ways to handle it in a constructive way. By offering support, continuity and opportunities for meaningful activities, the nursing home can help to facilitate the transition and promote a sense of well-being and belonging for the residents and their families.

Social Roles

The resident moves from an environment where status, memories, and relationships are taken for granted to a more anonymous existence. Often, the opportunity for spontaneous contact is worsened or made more difficult. In their previous home, the resident chose their company and environment, but upon moving in, their freedom and independence decrease. The eldercare home is an institution and thus sets boundaries for the resident's opportunities to choose freely. Some, of course, choose solitude, but it is hardly a desirable choice, as it is not good for health.

In many eldercare homes, natural conversation occurs among residents. They share memories of life, laugh, flirt and argue. In other homes, silence spreads. The staff play a significant role in creating a culture where natural conversation can flourish. Many elderly people have impaired hearing, so the sound from the TV, radio or dishwasher can make it difficult to have a conversation.

There are many ways to initiate a conversation with the residents. One way could be reminiscence. By bringing out old objects, memories and stories can be awakened. Likewise, residents may need to be matched up in the dining room or other contexts to create the conditions for conversation.

Setting the table for a fancy dinner where everyone dresses up, perhaps with seating arrangements and a glass of wine, can be another way to help residents break the ice and find something common to talk about. Likewise, visits from animals or children can stimulate conversation.

Many elderly people have been active in associations, had a professional role, and had many social contacts, thus also experiencing a loss of role. As we age, new layers are added to life, but we still retain our experiences and memories from when we were 17, 35 or 50. Those ages also exist within us.

Dealing with Role Loss When Moving to Elderly Care Home

Moving to an elderly care home can be a major life change, not just for the one moving in but also for their loved ones. One of the most palpable challenges that can arise is the feeling of role loss. Role loss can be deeply affecting and impact the individual's self-esteem and quality of life.

What is Role Loss?

Role loss occurs when an individual loses a previous role or identity that they have held for a long time. When someone moves into an elderly care home, they may lose several roles at once. This may include the loss of their home, independence, autonomy, and social network. In addition, the spouse of the person moving in may also experience role loss when their role as the primary caregiver changes.

Effects of Role Loss

Role loss can lead to a range of emotional reactions, including grief, anxiety, depression, and loss of self-esteem. The individual may feel powerless, worthless, and isolated from their previous social context. For the spouse, the role loss can mean a feeling of loss of their identity as the primary responsible and part in a lifelong partnership.

Managing Role Loss

To help manage the role loss for the residents of an elderly care home and their loved ones, it is important to have support and understanding from the staff and other residents. To support a person suffering from role loss, one can
Provide emotional support: Offer a listening ear and compassion for those experiencing role loss. Allowing them to express their feelings and thoughts can be healing.
Create continuity and a homely feel: Try to maintain as much continuity and normality as possible in the new environment. This can involve bringing personal items and routines from the previous home.
Focus on new useful roles: Help the person moving in to find new meaningful roles and activities in the elderly care home. This could be participating in community activities, being part of gardening or mentoring other residents.
The life story: Getting to know the person moving into the elderly care home in depth, by understanding the life they have lived before. What has been important to the person. The life story can also be a support for meaningful conversations.
Support for relatives: Offer support and resources for relatives who may also experience role loss. This can include counseling, support groups or even training on how to best support their loved ones.

Life Partner

If the resident has a spouse who is still alive, but they are forced to live separately due to circumstances beyond their control. There are often many emotions. They have promised each other to stay together until death do us part. But the life we live can force us to make other decisions. The strength is not enough to take care of the loved one. The healthier partner has for a long time sacrificed everything so that the sick one can have a good life. Finally, it affects their own strength and health. The loved one is completely powerless and drained of energy.

Then there is often grief over this. The partner may also feel grief that the life partner is slowly deteriorating. Impaired memory or increased frailty can mean that the opportunities to do things together decrease. The partner often visits and can then experience deficiencies in care or treatment.

Sometimes the loved one may also feel guilty about not being with the resident enough. All of this can sometimes lead to difficulties in the relationship with the home's staff. Staff with a sense of sensitivity and understanding for the situation of loved ones can make life easier for the loved ones. Viewing the loved one as a welcome resource and creating participation can be a way to build a trusting relationship.

Even though there are differences between people, it is often the case that women have somewhat fewer but deeper social relationships while men have more but shallower ones. Many people also have experience of losing close friends. These are factors that can affect the conditions for socializing with others in the elderly care home.

People who move into elderly care homes often previously requested service housing to get social relationships. Social workers may then think that the needs can be met with home care. What is overlooked in that case is the quality a conversation has that takes place between people of the same age.

For those living in elderly care homes, many conversations are with staff who belong to a completely different generation and who have other frames of reference. There are elderly care homes that work to create good conditions for conversation between residents. There might also be volunteers from outside who are more "age-appropriate" i.e. belong to the same generation as those living in the elderly care home.

Bullying and Exclusion

In all social contexts, there is also a risk of cliques and exclusion. Staff at the home must be vigilant that no resident is subjected to teasing, ridicule or bullying from other residents. Sometimes, care staff switch to baby talk when talking to residents. If asked why, it is often because they think the elderly are "cute". For many who have had a rich language, this can contribute to the feeling of isolation. If you are used to talking about the political development in the world, Nietzsche's theories, motorsport, cooking or environmental destruction, then baby talk can make you choose silence instead.

Reflection Questions - Role Loss
Care Staff:
- Do you have a culture where residents talk to each other?
- Do you involve relatives in care?
- How do you handle a situation where a colleague or temporary staff member starts speaking baby talk to residents?

Manager, Nurse, Occupational Therapist and Physiotherapist:
- How do you work to create a social context for residents?
- Are there any who are left out of the conversation?
- How do you work to create a trusting relationship with relatives?

Residents and Relatives:
- Do you feel that the care provides you with the conditions to maintain a good relationship?
- Are you involved in the planning and design of activities and care?

Erland Olsson
Specialist Nurse
Better care every day

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