Homeliness and Comfort

The ability to decide for oneself risks decreasing as care efforts increase. In the worst case, those who provide care may cause suffering by not seeing and being responsive to the individual's needs and desires.

Elderly care is constantly changing. Much has improved, but there is still much to do. The Ädel reform was a major step in the transition from poor relief to a social right. The dismantling of long-term care departments and psychiatric dementia care departments increased opportunities for a dignified life. The municipalization of home health care in large parts of the country has enabled the social and medical perspective to go hand in hand.

Role Loss

Good aging is based on four cornerstones
• Physical activity
• Good eating habits
• Meaningfulness related to being involved and needed
• Social community

There is a link between health and social relations. For those who move into a nursing home, these change. The resident moves from an environment where status, memories, and relationships are self-evident to a more anonymous existence. One consequence may be that the opportunity for spontaneous contacts becomes more difficult. In the previous home, the resident has chosen company and environment, but upon moving in, the freedom of choice and independence decreases. The nursing home is an institution and sets limits for the resident's opportunities to freely choose. Some, of course, choose solitude, but it is hardly a desirable choice, as it is not good for health.

In many nursing homes, a natural conversation takes place between the residents. They share memories from life, laugh, flirt, and argue. In other homes, silence prevails. The staff plays a major role in creating a culture where natural conversation can flourish. Many elderly people have impaired hearing, then the sound from TV, radio, or dishwasher can hinder the ability to have a conversation.

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

Setting up for a nicer dinner where everyone dresses up, perhaps with table placement and a glass of wine can be another way to help the residents break the ice and find something common to talk about. Likewise, visits by animals or children can start conversations.
For many elderly people who have been active in associations, had a professional role, and had many social contacts, this becomes a role loss. As we age, new layers are added to life, but we still have our experiences and memories from when we were 17, 35, or 50. Those ages also exist within us.

Life Partner

If the resident has a wife or husband who is still alive, they may be forced to live separately due to circumstances they cannot control. This often gives rise to many emotions. They have promised each other to stick together until death separates them. But the life we live can force us to make other decisions. The energy is not enough to take care of the loved one. The healthier partner has sacrificed a lot for a long time so that the sick one can have a good life. Finally, it affects their own energy and health. The loved one may be powerless and drained of energy and may even risk their own survival.

The partner may feel grief that the life partner slowly deteriorates. Impaired memory or increased frailty may mean that the opportunities to do things together decrease. The partner visits and may then experience deficiencies in care or treatment, which in turn raises concerns and doubts.

Relatives may feel guilty about not being with the resident enough. This can lead to difficulties in the relationship with the home's staff. Staff with a delicate touch and understanding of the relatives' situation can make life easier for the relatives. Seeing the relative as a welcome resource and creating participation can be a way to build a trusting relationship.

Even though there are differences between individuals, it is the case that women often have somewhat fewer but deeper social relationships while men have more but more superficial ones. Many have experience of losing close friends. These are factors that can influence the conditions for socializing with others.

Many who move in have previously requested serviced living to get social relationships. Assistance officers may then believe that the needs can be met with home care. What is overlooked in this case is the quality a conversation has that takes place between people of the same age.

For the resident, there are many conversations with staff members who belong to a completely different generation and who have other frames of reference. There are nursing homes that work to create good conditions for conversation between the residents. There may come volunteers from outside who are more "age appropriate" i.e., belong to the same generation as those living.

Aphasia

I read a post that made me sad. A woman with expressive aphasia had to sit with feces on her hands because she answered no when she meant yes when staff asked her if she wanted to wash her hands. This type of ignorance means that care runs the risk of falling into disrepute. If nothing else, there should be a nurse in charge of the unit who realizes that feces on the hands pose a risk of infection.

Aphasia means a changed linguistic ability. It involves reduced ability to speak, understand speech, read and or write. Stroke is a common cause of aphasia. Brain tumors and other brain injuries can cause aphasia. Aphasia can be expressive, i.e., it is difficult to find words and it can even mean that the person says the opposite of what they mean. Impressiv aphasia means a difficulty understanding what others are saying. Often the aphasia is milder and it can mean that it takes time to find the right words and to express oneself correctly.

The person gets easily tired. As a staff member, you can help by shortening sentences, speaking slower and clearer than usual. Use hands and body language to clarify what you are saying. Maintain eye contact when you speak. The occupational therapist can arrange picture support and other aids if needed.
Those who have suffered from aphasia often suffer from the inability to make themselves understood or to understand. If, in addition, healthcare workers do not realize and take into account that the person has aphasia, the suffering becomes even worse.

Bullying and Exclusion

In all social contexts, there is a risk of cliques and exclusion. Staff must be vigilant so that residents are not subjected to ridicule, mockery or bullying from other residents. It happens that people switch to baby language when they are going to talk to the elderly. If you ask why, it is often because they think the old people 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 political developments in the world, Nietzsche's theories, motorsports, cooking or environmental degradation, cute-talk can contribute to choosing silence instead.

If residents are subjected to harassment, discrimination, rough treatment, coercive measures, or are otherwise treated poorly, care personnel are obliged to write deviation. This can lead to the operation conducting a lex Sarah investigation and sometimes also reporting the incident to the police.

Reflection - what is a home and how do our roles change upon moving in
Care Staff:
• What is important for you to feel comfortable in your home?
• What can you do to make those who move in feel welcome?
• Do you have a culture where residents talk to each other?
• Do you involve relatives in care?

Manager, Nurse, Occupational Therapist and Physiotherapist:
• Do you have routines and ways of working that facilitate orientation for those who are newly moved in?
• Do you have any follow-up after moving in to check comfort?
• How do you work to create a social context for the residents?
• How do you work to create a trusting relationship with relatives?

Resident and Relative:
• Is the nursing home pleasant?
• Do you feel that care provides you with the conditions to maintain a good relationship?
• Do you have a good dialogue with staff and management?

Erland Olsson
Specialist Nurse
Sofrosyne - Better care every day.