happiness

1 Senior Care Canada, 9, 4th issue, 2007 Reflections Column: Senior Care Canada (2007) Happiness of Residents of Long...

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Senior Care Canada, 9, 4th issue, 2007

Reflections Column: Senior Care Canada (2007)

Happiness of Residents of Long-Term Care Homes By Mike Stones Ellen Langer from Harvard and Judy Rodin at Yale were psychologists who studied ways to make residents of long-term care homes happier. Their 1976 findings caused a quiet upheaval in the senior care industry around the world. What they did was to involve residents in the running of their home. Not in a big way: they hoped to make a difference by assigning them small but necessary duties, like looking after potted plants on the units where they roomed. The findings more than confirmed their hopes. Not only did residents with such responsibilities get happier but they also lived longer than did those without them. These findings were was among the earliest to relate a delay in mortality to positive mood. Other studies with similar findings soon followed. There are many ways to give long-term care home residents more control over their lives; with increased control came gains in happiness. Our own research in Newfoundland, with graduate student Christine Rattenbury, had a related aim. The program revolved around group discussion. Residents either reminisced about important events in their past or talked about major issues-of-the-day. The findings showed that both forms made residents happier. They also had fewer adverse health outcomes.

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Senior Care Canada, 9, 4th issue, 2007

Why did the program work? Talking within a group helps to create social bonds, and residents looked forward to the weekly meetings. Principles to promote happiness are simple in form and few in number. They were there in philosophy and folklore long before the science of psychology affirmed their validity. With basic needs for physical comfort accounted for, people of any age and in any setting need just three things to be happy. They are: • Someone (or something) to love; • Something meaningful to do; • Something they can look forward to. Helping to make residents of long-term care homes happier is not difficult. The programs can be simple – looking after plants, talking within a group – and without sophistication. They worked then and they will work now. The Eden alternative evolved from such foundations. Begun by William Thomas in 1991, it aims to foster a culture supportive of a ‘life worth living’ for those in care. The movement now claims over 300 registered homes in Canada, the USA, Europe, and Australia. However, it seems an age ago when people working within or alongside the long-term care home industry had good reasons to be optimistic. They believed they knew how to transform the homes into happier and more homelike places. Then something happened that set these dreams on a downward spiral. The accountants took control.

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Senior Care Canada, 9, 4th issue, 2007

It all began because of fiscal debt. Federal and provincial government over-spending was out-ofcontrol. So they had to streamline and cut back. An outcome for the senior care industry was that funding for long-term care homes became stingier. Staff-to-resident ratios got lower. The residents admitted were older and needed more care. As compliance requirements got stricter, the autonomy of overworked staff decreased. Now there is only enough funding to meet the bare necessities of care. So programs to promote the happiness of residents became of secondary concern. The culture that displaced the optimism of the Eden alternative focuses more on ways to resolve problems than to make residents happier. At its best, this culture links care planning to careful assessment. Use of the Resident Assessment Instrument (RAI) 2.0 is a prime example. This tool contains 18 Resident Assessment Protocols (RAPs) to guide care planning. Seventeen RAPs address problems ranging from delirium to the use of restraint. Only one RAP, Psychosocial Well-Being, relates directly to happiness. However, even on this RAP seven items (called triggers) measure problems and just two measure strengths. It provides little help on proactive ways to promote happiness other than to deal with problems.

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Senior Care Canada, 9, 4th issue, 2007

But let’s return to principles. Helping residents to be happier – to have a ‘life worth living’ – is what everyone says they want. Residents, their families, staff, administrators, government, even accountants agree about this. Although the latter might add, ‘So long as it isn’t expensive.’ But it needn’t be expensive. How much does it cost to give residents menial but meaningful duties within the home? They might fold towels, water plants, help lay out cutlery at mealtimes. Even the most impaired can do something. The key to happiness promotion is to ensure that the assigned tasks are ongoing and regular; the resident gets praise and respect for doing them; they have some measure of control when carrying them out. So some residents do their task poorly: so what – thank them profusely anyway. How much does an event to look forward to cost? I remember the rapt faces of Jewish seniors with dementia when watching a video of Fiddler on the Roof. They so easily identified with the characters and culture depicted. The staff at that setting proactively prolonged the period of eagerness with constant reminders that the movie was coming up soon. Psychologists would say they prompted the prospective memory of the seniors to good effect. The staff also used volunteers to round up the seniors and run the video.

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Senior Care Canada, 9, 4th issue, 2007

How much does it cost to foster a friendship? Reminiscence groups, friendly visiting, and pet therapy are just some examples of low cost programs. An ordinary volunteer can run a reminiscence group. The training needed is basic, something a Recreation Director can do easily. More difficult may be the recruitment of unhappy residents that stand to gain most from the program. Because such residents may express unhappiness through withdrawal, someone good at coaxing should make the first approach. Once there, the group leader can help instil a sense of belonging. The keys to success in all such programs are constancy; meaningfulness to residents, and expressed respect for their contributions. In pet therapy, the resident who bonds with an animal and helps care for it (e.g., through grooming) deserves praise. The next visit then becomes an eagerly anticipated event. A caution, however, is that friendship must endure. Whether with a person or animal, friendship gained then withdrawn without replacement can cause harm. In an ideal long-term care home, residents would not be free from problems but as happy as their conditions allow. It is this author’s opinion that the ceiling on acceptable levels of happiness is set too low. Ways to make residents happier do not require new discoveries from health researchers; we know them already. What we need are the will and the desire to put those principles into routine practice.