Rights vs. Rules: Policies Can Restrict/Isolate Residents

"I sometimes feel like I'm in jail." "My mother calls the nursing home Riker's Island."  These hotline comments are alarming.  What leads some nursing home residents to feel so isolated and to loose their sense of freedom?

Rigid routines, short staffing, administrative defensiveness, and residents' physical isolation from others in the community can create an institutional atmosphere that sometimes feels like a prison.

Most direct care staff and professionals want to make their facility welcoming and home-like.  Unfortunately, procedures and policies often favor efficiency and order over residents' need for community and connection.  These policies can unwittingly contribute to an oppressive, institutional atmosphere.

All too often, residents' opportunity to leave the facility or even to enjoy on-site gardens and courtyards is severely limited.  Arrangements to go off-site require staff time and a change in usual routines.  Staff who feels overburdened already by their daily workload may be resentful of the additional responsibilities. If staff are not assigned to accompany residents to outdoor gardens, only the most independent residents or those with visitors can take advantage of these amenities. 

In contrast, the nursing home culture change movement seeks to reduce resident isolation by making nursing homes "permeable."  Culture changed homes encourage resident participation in the broader community and bring outside community activity into the nursing home. They invite community organizations to meet in the home, art groups to rehearse, and school groups to hold events.

Opening the facility up to the broader community is difficult when efforts to maximize revenue have led to a facility designed without large common areas.  Some facilities can't even accommodate large gatherings for their own residents let alone community groups.  Others can't accommodate visitors in the dining area, even though this is in violation of New York state regulations. 

In order to encourage engagement and prevent isolation, homes must be a comfortable and welcoming place for visitors.  At some facilities, visitors feel their involvement and their advocacy efforts are met with resistance.

FRIA has recently intervened when facilities have implemented or threatened restrictions on visitors. Even the threat of restrictions on visitation has a chilling effect.  Visitors often perceive such policies as retaliation for "rocking the boat."   Visitors report feeling scared and humiliated when they are singled out for restriction, and the result is an overall atmosphere that discourages rather than welcomes visitors. 

Except in extreme situations when visitors pose a danger, New York State Regulations guarantee nursing home residents the right to receive visitors (See inset for more details).

For families and others, restrictions on access to information can exacerbate feelings that the nursing home is an unwelcoming and rigidly institutional place.  Families are sometimes denied basic information like the name and phone number of a relative's psychiatrist or how long a relative has been on a particular medication.  Families often interpret restrictions on access to information as an attempt to curb their involvement and limit their role as advocates.

Sometimes involved families and even volunteers are seen as a barrier to high quality care rather than an asset.  Some homes have disbanded volunteer programs. Others prevent visitors from talking to direct care staff, insisting that all concerns be addressed with professional staff only.  Such policies contribute to visitors' feelings that information is tightly controlled and the home is unwelcoming of outside involvement.

It's true that visitors' questions and concerns can disrupt routines and reduce staff efficiency.  Visitors must balance the need to ensure high quality care for their loved one with consideration and respect for other residents and staff time.  Culture changed nursing homes recognize the value of interaction between staff and visitors.  They view partnership between families and staff as an essential component of a home-like atmosphere. 

Too often, families and other visitors respond to their feelings of frustration and discomfort in the nursing home by reducing the frequency of their visits.  This only serves to exacerbate the problem of resident isolation.  What can we do to promote a nursing home environment that encourages connections and community for residents?

• Visit often and bring others. 
• Get support.  FRIA hotline counselors can validate your feelings of frustration and help you to strategize a plan to make the home more open to visitors and outside involvement.
• Join the Family Council and work to promote community and family involvement.
• Connect with families from other facilities at FRIA's Family Council leadership meetings.   Exposure to families in facilities with good policies can inspire and fuel efforts to demand greater openness in your facility.
• Find out about the culture change movement and work with others to promote culture change at your facility.

You don't need to have someone you love in a nursing home to help reduce the problem of resident isolation.  Visit or volunteer at your local nursing home.   Increasing visitors can go a long way in improving residents' lives.