The Critical Period in Nursing Home Placement

I couldn’t wait to go to college.  I was ready to shake off the old me, and begin a brand new self.  No one would know who I’d been, and I could therefore be whomever I wanted to be.  

In my Psych 101 textbook, there was a picture of animal behaviorist Conrad Lorenz, followed by a row of baby geese. The goslings had found Dr. Lorenz during their critical period of imprinting, when they bonded to the first suitable stimulus they saw. Conrad Lorenz became the goslings’ mama.

When residents enter nursing homes, they have the opportunity to create new identities.  They are surrounded by strangers and novel social situations, with as limited a pull from family and friends to be their old selves as they are likely to have experienced in decades.  While most residents aren’t necessarily looking to become new people, their early nursing home contacts can affect how they settle into their environment.

Mrs. Leibowitz arrived at the nursing home depressed, but wasn’t referred for psychological services until months after her arrival.  She’d already established the pattern of spending days alone in her room, watching television for hours at a time.  She was irritable with staff members, often refusing care, or chasing them out of her room with her foul language.  “There’s nobody to talk to here,” she told me.  I had my work cut out for me.  The critical period had been lost.

Mr. O’Conner, on the other, was lucky enough to be placed in a room with Mr. Chu, the President of the Resident Council.  Mr. Chu took Mr. O’Conner under his wing (so to speak), and together they played cards with some of the other gentlemen, and attended activities which appealed to them both.  Our new resident integrated nicely into the community and never needed psychological treatment.

I’d like to see every nursing home form a welcoming committee, by residents, for residents, to help aid the transition to the nursing home.  And I’d like to get my referrals early, during the critical period, instead of after the conflicts, isolation, and other problems have become entrenched.  That way I can more easily help people take advantage of the best that nursing homes have to offer.

10 thoughts on “The Critical Period in Nursing Home Placement”

  1. Eleanor,
    While I do agree that early nursing home contact/experiences can affect how residents fair in their new environment, I believe their are many factors that impact on a residents adjustment in a nursing home; basic personality traits; illness; the new resident’s inability or unwillingness to identify with one’s peers, etc.

  2. Thanks for your comment, Anonymous. I agree, there are many factors affecting how people adjust to the facility. Some newcomers will benefit from positive social experiences to the point where they won’t need additional help assimilating, and others won’t. I believe most staff members recognize very early in a stay whether or not a new resident is having difficulty. What I’m suggesting is that the newcomer is referred for psychological treatment within the first few days of admission, as soon as problems are suspected, rather than waiting until negative patterns are established.

  3. i like this post a lot. i like it that you’re forthright. i imagine that the extended care facilities are plagued to some extent by doublespeak of various kinds for various reasons and i think it’s probably good for everyone that you don’t do that. cheers.


  4. Eleanor, I like your thought that being in a nursing home is an opportunity to reinvent yourself. I found that was true with my mother. She found a new assertive self. She added a lot to the place, people looked forward to coming into her creative environment (her room), and she even fell in love for the second time in her life (the only one who came before was my father). Every situation has possibilities, and thanks for seeing that.

  5. Aiyana, I love to hear stories like yours about your mother falling in love at the nursing home. I like to share them with the residents I meet. Thanks for spreading hope.

  6. I saw something like this with my Mother-in-law in two ways.
    1) when she saw what people were wearing she said, "They are Lord & Taylor people and I'm K-mart." She wanted new clothes and we took her shopping (that was fun for me). We were surprised she was still so aware of her appearance.
    2)She was place in a "temporary" room which was a double room (I'm still a angry they showed me a room that would be her room and then never put her in that room), since we had asked for a private room we had her moved when one became available. In hindsight, that was not a good move. She had started to make two friends on that wing. She never did make a connection on the new wing, even though she had been on the other one only a few weeks. You can't go back in time and do an experiment, but my feeling is her decline would have been slowed by not moving her around, even in the same facility.

  7. Hi Kristen,

    I find that most alert residents are very conscious of their appearance, but it’s interesting that your mother-in-law was concerned enough to purchase new clothes in order to fit in with her peers.

    Regarding her move to a new wing of the facility, it’s hard to know in advance how she would react to the change, but I think your point about friends is well taken. In my observation, despite illness and advanced age, most people want to find others they can relate to and who’s company they enjoy. There was no way for you to know in advance whether your mother-in-law would meet new friends in her new wing. For those considering such moves in the future, it may be worthwhile to ask the staff if they think there will be others with whom they can connect, and then balance that against the benefits of a private room.



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