Grandma's Nursing Home Isn't always Like Home

How do we put the "home" in nursing home? Research by a Saint Louis University geriatrician answers the question in this month's issue of Geriatrics and Aging.

Games, interactions with pets, music therapy, activities and holiday events may make nursing homes more enjoyable - but not necessarily for all residents, says William Banks, M.D., professor of geriatrics in the department of internal medicine and professor of pharmacological and physiological science at Saint Louis University School of Medicine.

"We need to take into consideration that what one person loves, another may hate," says Banks, who also is a staff physician at Veterans Affairs Medical Center in St. Louis. "What we like in our older age is often a reflection of what we enjoyed when we were younger. As an initial guide, what we want or miss when we are living in the nursing home will reflect our tastes prior to our arrival."

One-size-fits-all cheerfulness programs don't do the trick for everyone. In an earlier study, Banks and his wife, who has a doctoral degree in nursing, researched whether having animals nearby makes nursing home residents feel less lonely and found that it does - but only for those patients who said they like animals.

"We found that the animal assisted therapy program made a big difference for those persons who desired it," Banks says. "Animals, more than humans, are a source of unconditional love. They help residents recall joyful experiences of taking care of a pet when they were younger. Pets also are a great conversation icebreaker because they give people who don't know each other very well a neutral topic to discuss.

"However, there was a portion of the population who definitely did not want animal assisted therapy. To force it on those who dislike animals would not make living in a nursing home more pleasant."

Likewise, those who enjoy music might be soothed and fulfilled when they participate in a music therapy program. But older adults who had considered music as noise probably would view music therapy more as a punishment than as a source of pleasure.

"We should view various attempts at making our institutions more homey through the eyes of the residents, not through ours," Banks says. "The best approach towards making an institution more homey is to emphasize availability, variety and choice."

Surprisingly, more is not necessarily better when it comes to adding the extras that turn a nursing care facility into a nursing home.

"The residents enjoyed a slower pace of life and an event or two in the course of the day was quite enough to consume their energies," Banks says.

Even those nursing home residents who loved dogs felt overwhelmed by multiple hour-long structured sessions with an animal each week. Instead one 30-minute interaction a week with a dog was enough to combat loneliness.

"It may be that knowing an animal was coming to visit was as important as the actual visit," Banks says. "There are few things we want more than those which are not available."

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first M.D. degree west of the Mississippi River. Saint Louis University School of Medicine is a pioneer in geriatric medicine, organ transplantation, chronic disease prevention, cardiovascular disease, neurosciences and vaccine research, among others. The School of Medicine trains physicians and biomedical scientists, conducts medical research, and provides health services on a local, national and international level.

Saint Louis University division of geriatric medicine was ranked among the top 10 in the country in last year's U.S. News & World Report listing of America's best hospitals and specialties. Its physicians staff Saint Louis University Hospital, ranked by Modern Maturity as one of the 50 best hospitals.