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The Importance of Meaningful Relationships in Long Term Care

March 2, 2020

For those wondering if a senior living community is right for their loved one or client, a study featured in Social Work Today brings encouraging news. It states that these communities – be it assisted living, skilled nursing or residential care homes – offer a new home and bonds based on affection for many older adults. The qualitative study out of the United Kingdom illustrates how deeply important family-like relationships are to long-term care residents in adjusting to and enjoying their new homes with a sense of dignity, security, and belonging. The study also found that social workers can help residents cultivate meaningful relationships, but they need to be aware that creating relationships is a delicate balance between involvement and detachment. The study involved over 100 in-depth semi-structured interviews in more than 40 different residential care homes and assisted living communities. Respondents were care providers, residents, volunteers, and managers, and the goal was to understand how people felt about their lives and what was happening around them that affected those feelings. For instance, what helped people to feel loved, known, and valued as individuals, secure in their lives, and at peace?  What matters to staff and residents? Among its findings:
  • For residents, the most positive feelings were around creating a "family" and living in a "home." The author observed that almost every person interviewed described their home as it related to the experience of "family bonds," while some further acknowledged, "We are a family, and we support each other." They expressed value for relationships "that they would never have had on their own" and were considered "like another family."
  • The community appeared to strongly influence the potential for residents to feel a sense of dignity, security, and belonging. No one wanted to live in a care home that looked like a hospital or hotel; they wanted somewhere to belong. They seemed happier when they didn't have to uproot themselves from friends and their community to receive long term care. A variety of sitting areas with books, pictures, and things that people used to decorate their space was important, and it was important to have at least one area not dominated by television.
  • Green space and gardens also were important. They encourage mobility, a connection to nature, and extra space. Good, nutritious food described as transformative; the daily meals brought people together and provided a structure to live.
  • Privacy and quiet times were needed for both residents and caregivers. Quiet spaces, such as a small retreat room, a corner of a garden, or an empty room or office, allowed caregivers to be alone when they needed a break.
  • Having meaning in life was found not only in favorite activities but, most importantly, in relationships with other people (and pets). This included a desire among most residents to contribute to daily life by taking on tasks actively (e.g., helping others, setting the table) or roles (e.g., the person who opens the door to visitors), but mainly through an interest in the lives of others in the community and in helping those they perceived to be anxious or in need. In this way, residents experienced the joy of informal caregiving.
  • Older people often felt alone and vulnerable in their previous home, so safety and security are very important for them to regain confidence and to forge new relationships. Security was described as both physical safety and the security of established relationships, such as those with care providers they see and know daily. The study found that the three most important things to residents were "security, companionship, and good food—but of the three, security" is what mattered the most. Meaningful relationships included caregivers (including social workers), who were willing to listen and provided a consistent presence and allowed time for trusting relationships to grow.
  • The study showed that loving a company, offered during the day, brings meaning, joy, and security to life. It stated that there is a concern that social workers are seen as uncaring when the time taken to nurture relationships becomes secondary to other job demands or is avoided due to discomfort in managing boundaries and compassion fatigue. The authors said that boundaries should be "drawn with a light touch that enables social workers to maintain their personal lives without feeling the need to hide them from view when at work."
  • The study concluded that long term care communities are essential as people age but cautioned that residents don't need to be involved in daily activities. It said there need to be opportunities for authentic, mutual engagement, but forming meaningful relationships is also critical for residents (and staff) to experience comfort, personal choice, and privacy. Social workers can help older adults draw strength from meaningful relationships that emerge in long term care communities to make their house a home.
Full details of the study can be found in Developing a Relational Model of Care for Older People: Creating Environments for Shared Living.