Best Practices for Supporting Resident Emotional Wellness

Dr. Kendra Ray, PhD, dementia program director at Menorah Center for Rehabilitation and Nursing Care

The past few years have been especially trying for senior care residents, but even pre-pandemic, resident emotional wellness was a significant concern in senior care settings. While senior care organizations focus on caring for residents’ physical needs, their emotional wellness is just as important. Integrating these best practices into daily care can help to ensure that residents receive the emotional wellness support they need, too.

How Senior Care Environments Impact Emotional Wellness

While performing her doctoral research at Delft University of Technology, Hester Le Riche, CEO and founder of Tover, examined how physical environments influenced behavior. “In a senior care setting, the environment plays a major role in residents’ emotional wellness,” she says.

“The finest details in a facility’s environment can impact feelings of belonging, self-efficacy, and confidence,” explains Le Riche. “A common emotion experienced by residents is feeling like an outsider. The most impact we can have on residents’ emotional wellbeing is if they can relate to their peers. If they have a positive shared space to spend time with others and talk, even if it’s a little bit nudged or stimulated by something else, it will have a positive impact.”

Dr. Kendra Ray, PhD, is dementia program director at Menorah Center for Rehabilitation and Nursing Care, and its MJHS Memory Care Residence. She is also a board certified music therapist. Dr. Ray notes that the pandemic significantly changed many residents’ lives, particularly by reducing visitation. “I think that feelings of loss of past lives and relationships negatively impacted residents’ emotional wellness, especially for many residents who felt isolated from family members,” she says.

Dr. Ray works with residents who have moderate to severe dementia, and explains that there are additional factors that may impact memory care residents’ emotional wellness. “Residents in memory care might be preoccupied by their former responsibilities,” she says. “Often, they’re not aware of where their children are, or of the fact that they are in a nursing home.” Some residents may feel that they need to go pick up their kids from school, and when that is paired with limited visitation, it can cause residents to become upset.

Monitoring Emotional Wellness

There are many signs that indicate a resident may need emotional support. By watching for these signs, staff can better monitor residents’ emotional wellness and quickly take action to offer that support to residents in need.

Le Riche notes that residents who feel out of place or uncomfortable often enter an apathetic state. “They retreat into their own cocoon and don’t respond or connect with the outside world,” she says.

She notes that restless behavior can also indicate emotional distress. That behavior often occurs during the sundowner moment, when the sun sets. “For most people, prior to their retired life, it was the end of their working day,” she says. “It occurs when there’s a shift change in the facility and residents observe that something is changing, which sometimes leads to confusion and distress.”

Dr. Ray explains that while there are times when residents can’t pinpoint what they are experiencing or express themselves, staff who are trained and educated can still anticipate their needs. Often, staff can recognize signals in art and music therapy that indicate a resident may need extra support. “A resident might be in music therapy and we notice a difference in her improvisational style,” says Dr. Ray. “Instead of playing nicely on the drum, she might bang on it and not be rhythmic. In art, there might be a change or an occurrence of the dynamic of color choices. Rather than having something more organized, the art might become more disorganized with scribbles. We’re able to see through art and music, and also through people wanting to isolate or not wanting to engage socially, that there might be something happening.”

Strategies to Support Resident Emotional Wellness

Fortunately, there are many ways a senior care organization can support resident emotional wellness, particularly during these difficult times. Dr. Ray notes that she tries to incorporate person-centered trauma informed approaches. “We have a large Holocaust survivor population,” she notes. “We try to educate the staff to look for triggers, and if one is noted, to adapt the care they’re providing.” That might mean staff use soft music during shower time to reduce agitation or anxiety.

Dr. Ray explains that adapting a more flexible approach to caregiving during the pandemic has also been successful. “Instead of having only in-person therapeutic activities between family and residents, we offer virtual music therapy and schedule times for families to join,” she says. The organization took the same approach with art therapy, sending art supplies to family members so they are able to virtually participate in the sessions. “We noticed that it changes the residents’ moods,” says Dr. Ray. During therapy groups, residents often mention missing their family and not being able to speak with them, but these virtual groups give residents that valuable opportunity to engage with family members, even at a distance.

According to Le Riche, apathy is a major barrier to a high quality of life for residents. “Apathy, literally sitting still all day staring out the window, has a massive impact on joints and muscles getting stiff, and causes boredom and depression,” she says. “If residents are socially active, it will reduce apathy on various levels. When you have a conversation, your brain is more active than sitting still. Social interaction has an effect on our health and wellbeing.”

“In senior care facilities, when we talk about shortage of staff, unfortunately social activities will fall away first because the basic care needs have to be met,” says Le Riche. “We can’t replace people with technology, but I think there is a whole day to fill and a whole environment senior care staff are capable of making suitable, inspiring, and stimulating. Technology is a great asset within that environment to really strengthen the caregivers’ efforts to open up new opportunities for interaction for the residents.”

To combat this effect, senior care organizations have used the Tovertafel, an interactive game-based therapeutic tool, to provide that essential stimulation. “All the games are developed in such a way that a group of residents can play together, and staff doesn’t have to sit side-by-side to help,” explains Le Riche. “That gives employees a little bit of time to, for example, help a resident that is restless, or needs to go to the bathroom, or just have that little bit of extra one-on-one connection. If staff knows that the rest of the residents are entertained, it brings down their stress level.”

While technology can help to foster these social connections, provide stimulation, and support emotional wellness, Le Riche notes that it’s important for staff to understand and support the technologies a senior care organization adopts. “The technology needs to become part of the daily routine,” she says, “because only then will it give the residents the stability and the familiarity with the product needed to provide longer-lasting effects.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.