In 1967, psychiatrists Holmes and Rahe created a scale that measures the stress levels of various life events, and found that people with stress levels over 300 are at high risk of illness. I’ve always considered a nursing home stay to be a very stressful experience, but applying the scale was illuminating.
I took the Holmes and Rahe Stress Scale and modified it based on working with nursing home residents. For example, the Social Readjustment Rating Scale (SRRS) allots 65 points for a marital separation, but since moving away from one’s spouse to enter a facility isn’t a typical marital separation, I gave it 50 points. Nursing home residents aren’t technically imprisoned (63 points), but it is extremely confining, so I reduced that item to 50 points.
In my view, residents are not retired, but have started their jobs of working with the staff 24/7 in order to attend to the business of taking care of themselves, so I included many work-related items not usually considered the province of residents.
This left me with the following items on the 43-item scale:
471 points, on a scale that finds a high risk of illness at stress levels over 300 points. On the updated SRRS, the total comes out much higher, with the person considered in a life crisis.
Upon admission to the nursing home, residents are required to see the dietician, dentist, social worker, and recreation therapist. A life crisis, and we have yet to require a psychological evaluation of the residents. Referrals are currently haphazard, and based on the psychological-mindedness of the nursing home staff.
Readers who feel they, their residents, or their loved ones might benefit from the assistance of a psychologist in coping with the magnitude of these life changes can suggest a referral for evaluation for a particular individual (until regulations catch up with the need).