Improving the Mental Health of Patients in a Nursing Home Environment.

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12-JanePinelBy Jane Pinel, MEd.

My special interest has always been the workings of the human mind; therefore my degree in Psychology from Cornell University and an MEd in Counseling from the University of New Hampshire. Add to that the fact that I grew up in my mother’s nursing home from the age of 8 until I married at 22 years old. Many patients were with us for years. I’ve thought a lot about them, some who stayed active and alert and some who gradually withdrew into their own world. What made the difference?

What are the psychological needs of elderly patients, especially those in nursing facilities? We know many places have entertainment, TV, movies and crafts to keep residents interested and active. Is that enough?

Many years ago, when my parents were trying to climb out of the great depression my mother and her nurse friend started a nursing home. They bought the Hollingsworth Estate in Braintree, Massachusetts, a beautiful complex of gardner’s house, greenhouse, sunken gardens, and a thirty room mansion with ballroom and bowling alley, all beautifully landscaped. 

At top capacity they had 16 patients and a staff of 10 or more. Some patients were with us for months and even years so I got to know each one well.

Braintree Manor

 Grammie Marston was a bed patient, locked in a rigid body before there was medicine to loosen arthritic joints. During the day she was lifted into her chair. Her world had shrunk to her bed, her chair, and a daughter who visited often.

 Mr. Mason was a Civil War veteran, having joined as a drummer boy at the age of 16. The town would send a car to pick him up to ride in the parade on 4th of July and Veteran’s Day. The nurses dressed him up in his best suit and sent him off with cheers.

Aunt Maggie only stayed with us in the winter. She was in her 90’s but still had her little house and garden. She had a friend who was a funeral director and every fall she arrived in his hearse. He helped her unload her clothes and also all her canned foods from her garden. She wore a Mother Hubbard dress and big galoshes, open and flapping as she walked up the steps. We were all glad to see her return each October.

 Each patient had a life that may have been only a memory when they lived with us.

 Old age is usually a time of loss starting with the loss of strength and agility of our own bodies, our eyesight, our balance, our memory, and sometimes our mind. Besides that we start to lose our friends and acquaintances through sickness and/or death. Our children are now on their own, not needing us in the same way. Retirement from a job  separates us from those we worked with. Our power and influence diminish. Sometimes the nurses and workers in a nursing home provide the only world left for us.

What does help us feel whole and alive. What do we all need?

1. We need a sense of worth. To feel important. Not in a celebrity sense but in the realization that someone enjoys us, listens to us and validates the worth of our existence.

2. We need to be heard. How often have we talked to someone at a party and shared a feeling or experience only to be drowned out by the other person’s similar experience. We all need to know we have been heard. We need to stay with the subject as the speaker relives the experience. The important part lies in repeating back the essence of what they have told us. Then, and only then, will they know they have been heard.

3. Safety. People need to know they can be open and share themselves without shame or disinterest. They need to feel psychologically safe.

4. Sense of Identity. All those people in the nursing home had an identity at one time that defined them; teacher, carpenter, doctor, college president, cook, parent and/or bus driver. Even at a younger age it is challenging to create or describe our identities without mentioning our jobs.

These needs are there all our lives but the opportunities to meet them diminishes with age and situation. Those in nursing homes have a smaller world and less influence in it. How can we contribute in our daily contacts with patients?

* Bring some of your world to them. Talk about your day, your children, your hopes and dreams. Share parts of your life with them. If you have a problem ask for advice. If it’s joy you are sharing, celebrate with them. They will feel more alive for sharing yours.

* Questions that can open doors to memories:  

What was your job in life; teacher, nurse, etc. Listen.

What was the house you remember most?

What happened in that house that made it so important?

What was your favorite pet?

What was the happiest day of your life?

All of this takes time, I know, but time can be just a few moments now and then, these suggestions may make those moments add a little value to lives that have shrunk to a room, a bed, and, with luck, a window.

Even a patient that doesn’t or can’t respond may be hearing you. For example:

Many years after the nursing home was sold my mother’s partner lost her battle with Alzheimers. She had always been a wonderful nurse. She had a special fondness for my father when we all lived together in the nursing home. She would introduce him as “our husband.”

My last visit to her was heart breaking. She was in a nursing home, sitting in a chair, a sheet tied around her so she couldn’t get up or fall out. She made no eye contact nor speech of any kind. As we sat there I noticed her looking at my hands (so like my father’s).

 “My hands are like Well’s, aren’t they?” I said.

 As I watched for some response two large tears coursed down her wrinkled cheeks.

Jane Pinel is the author of two books, Dolly: Her Story, a memoir/biography of her mother’s life, (reviewed here) and The Picnic Basket, a how-to book on entertaining with picnics. The contents of which were gleaned from her experience as a restaurant owner.  She is the only child of Dolly.


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3 Responses to Improving the Mental Health of Patients in a Nursing Home Environment.

  1. Elizabeth Scala says:

    Wow, what a heartfelt and powerful piece.

    I love how the author shares possible questions to open up the conversation with these patients. It does take time to stay, be present and listen. But that bit of time goes a very long way.

    I also enjoyed her four points on what we need. It’s very true that in conversation, there is often a lack of listening and feeling heard. Thank you for putting this article together and sharing it here so that we can all learn and grow!

  2. Lori Grosse says:

    What an interesting perspective on aging and life in nursing homes. If everyone treated the elderly like they were valuable up to the end of life, the world would be a better place. It takes intention and thoughtfulness to bring others into our own world while working along side them, but it can be easily done with kind words and gentle questioning to start a conversation.

What are your thoughts?