Quality Measure 1: Keeping Residents Active and Engaged

Choose Well Quality Measure 1 – Activities & Socialization:  Ensuring that residents have access to planned activities that are appropriate to the interests and capabilities of the residents.

Moving into assisted living is often seen by seniors and their families as a remedy to the social isolation experienced when living alone.  For example, by moving into a facility, mom or dad will have greater access to peers, caregiving staff and activities. However, an incorrect assumption during this well-intentioned effort is just because mom or dad is now living among more people in a more stimulating environment, they will not still experience loneliness.

Perceived loneliness among those north of 65 years of age is of great interest to aging researchers.  This is because studies continue to demonstrate the health benefits connected to positive social ties, such as healthier weight, stronger immune systems, fewer depressive symptoms and improvements in physical and cognitive functioning (The Gerontological Society of America, 2017).  

With depression among assisted living residents reportedly common (18%) and under treated, Choose Well members can improve their understanding of loneliness -  a common cause of depression -  and take advantage of readily-available solutions to improve resident socialization  (Watson L. S., 2006).

The Choose Well team has consolidated current research focused on social isolation and loneliness below to give Choose Well members easy access to tools and strategies that may increase opportunities for positive social connection.

1.  Facility staff need to be aware of events that can trigger feelings of loneliness and to be attentive to residents who are experiencing these events (Watson L. J.-B., 2003).  Common triggers are

• changes in one’s routine and/or social network as a result of the move to a facility;
• changes in mobility;
• hearing loss;
• receiving a new diagnosis;
• a referral to hospice;
• a change in financial status;
• the loss of a loved one; or
• identifying with a marginalized group such as an ethnic minority or the LGBT community.

2.  Experts recommend observing residents’ communication patterns to identify those who may be experiencing feelings of loneliness.  Some questions you and your staff may ask yourselves might include:

• Does the resident talk to outside family or friends at least once per week? 
• Do they stay in their room a lot or seem withdrawn? 
• Do they seem to be overly focused on negative aspects of their life? 
• Do they seem to need help regaining a sense of purpose in their daily life?

3. Hearing loss is a major contributor to feelings of isolation.  Encouraging the use of hearing devices can help a resident reconnect with the sounds and people around them.  While hearing aides are well known, they are also expensive.  Personal Sound Amplifiers may be a less costly solution for those with mild hearing          impairment.  In addition, background noise, such as television or music, can interfere with the quality of exchanges among residents and between residents and staff.  Designating “quiet time” for conversation can help residents stay engaged and effectively communicate their thoughts, needs and feelin

4.  Using planned activities to provide emotional support is an ideal way to help residents establish trusting relationships with staff and to recreate a sense of family.  Some activities to consider are—

• 20-30 mins of exercise or stretching time for all staff and residents;
• A simple happy hour or tea time with an open invitation to outside family and friends;
• The daily routine of caring for potted plants or feeding birds outdoors;
• Coordinating small group or individual outings to a local community park or event for higher need residents.  Or if housebound, arrange for dining outdoors. 
• Helping residents contact family via phone or creating a closed (private) Facebook group for your facility and resident families to share and interact;
• Providing music therapy – background music and group singing are clinically proven to reduce feelings of loneliness.

For more information on the importance of social connectedness and other ideas on how to help residents thrive, we encourage you to check out Connect2Affect.[1]  Connect2Affect is an online resource spearheaded by the AARP Foundation that exists solely to seek out solutions to the issue of social isolation.

Planned activities has long been a requirement of Title 22 (Section 87219).  As CCLD launches its new Senior Care Inspection Tool Pilot Program[2], LPAs will be using a new tool to evaluate facility compliance with planned activity requirements called the RCFE Specialty Planned Activities Tool.  You can view the draft version of the RCFE Specialty Tool for Planned Activities here.  Reviewing this tool may help you improve your compliance in this area prior to your next inspection.  

In addition, CCLD’s Evaluators Manual continues to instruct LPAs to interview residents about the facility’s planned activities.  Which brings to mind the adage that “people may not remember what you say or do, but they will remember how you made them feel.”  Being mindful of feelings of loneliness among your residents and helping residents express and manage these feelings through strategically developed activities and opportunities for socialization is ultimately a win-win for everyone.