Social isolation and boundary issues for elderly nursing home residents

Nursing homes and facilities that are somewhat less restrictive are needed and necessary in some situations so as to allow for the proper level of care and supervision. However, the isolation and removal from the outside world that people experience as a result of being in a nursing home can be oppressive and hurtful. There are often times where temporary jaunts outside of the nursing home or fun activities within the same can allow for relief from monotony and so forth. However, advanced medical conditions like Alzheimer's, infectious diseases and bacterial/hygiene issues can all aggravate the isolation just mentioned as there have to be more restrictions on freedom and activity.

Nursing Home Isolation

Other than the obvious concerns about medical care, quality of life and so forth, perhaps one of the most saddening things about seniors being in nursing homes is the isolation and "border" that is created by the outside walls of said nursing home. Indeed, nursing home patients are confined to the inside of the building that they inhabit in many cases. Even when they are allowed to move around outside at all, supervised or not, there are restrictions on where they can do, when they can go and so forth. This report shall explore the loneliness and isolation that exists with nursing home patients and both primary and secondary sources shall be used to describe the same. While there is necessity and need associated with confining senior adults to nursing homes, there are a number of tradeoffs and negative effects that cannot be denied or, for the most part, avoided.

Analysis

Social isolation of any sort is typically not a good thing. Humans are, by nature and biology, social creatures and any forced limitations put on the same can be soul-crushing and harmful in many ways. This is precisely the issue found in nursing homes. However, the people that are relegated to nursing homes are typically there for a reason. It has been determined by family and/or medical professionals that their mental and/or physical health precludes them from being able to live on their own and there are not viable alternatives other than the nursing home itself, whether they be financial- or medical-related. Coming back to the social isolation aspect in particular, one primary study consulted for this report looked at precisely this and the authors of the study made it a point to compare and contrast people with social distress. To be more specific, they compared people in a nursing home environment with people that had freedom of movement and travel in the general public. What was found after multiple regression analysis is that there are certain social behaviors and reactions that are created by social isolation and these events are more prominent with nursing home residents given that their confinement in the nursing home is often not voluntary or wanted (Carstensen). Even with that, there is also primary research that proves that there are ways to mitigate such anxiety and other negative effects. Indeed, even if there is a firm "border" involved when it comes o nursing homes, there is a lot that can be done within those borders that still allows for a life that is enriching, fun and otherwise enjoyable. This progress is through the use of technology. This can take on many forms including the ability to connect via phone or internet to people on the outside including relatives, friends or even residents of other nursing homes that the patient might know. There is also the use of things like video games. This sort of thing engages the residents, keeps them active, reduces falls and otherwise improves their quality of life and the enjoyment of the same (Oliver, Demiris and Hensel)

As with many things, there are certain situations where even novel ideas and tricks cannot overcome the borders that the patients cannot cross. In some cases, there can be borders within borders in a nursing home. One example would be a patient that has dementia or Alzheimer's and is thus not of sound mind. Their movement has to be restricted as their concept of self-preservation is simply not there, if it ever was. Another example would be if a patient is stricken with MRSA, which is shot for methicillin-resistant Staphylococcus aureus. The staph bacteria is bad enough but MRSA is worse because it is drug-resistant. As such, people that are stricken with that bacteria need to be isolated so as to prevent the spread to other people. This goes double in a nursing home as the people in said homes are much more likely to get sick and succumb to the same as compared to people that are of normal age and health. A third and final related example would be people with certain infectious diseases. For the same reasons as MRSA (and other bugs like it), isolation within isolation is not uncommon because no chances can be taken when it comes to those bacterial or viral strains spreading to other people within the facility. There are some ways to help transcend these situations and minimize the further isolation involved. However, there are also certain protocols that should not be violated for health and sanitation reasons (Washio et al.)

Part of the problem, though, when it comes to borders and nursing homes and the associated isolation is the talk and speech about the subject. While there are some valid concerns about nursing homes and the isolation that comes with it, a lot of what is said is bluster and is truly not fair. Beyond that, nursing homes and such exist for a reason and that is because the level of care given by nursing homes is necessary and needed in a lot of instances. Further, the adult children of people in these homes have their own kids to raise, have jobs and so forth and thus they will not be able to balance that while at the same time giving the level of care that a nursing home can provide. As noted before, the social isolation rendered in many nursing homes can be combated the level of care in question is needed. As such, people need to be careful to give nursing homes a fair shake and realize when they are the best option. Of course, choosing the right one is important and not all nursing homes are of the same quality. However, things are changing and people just need to be fair and realistic. Even when the concerns and complaints are valid, it is not because of the nurses or professionals that work with the patients and residents. Rather, it is a matter of financing and the business/funding models used for the facilities. That being said, poor choices in this regard can absolutely create more and more isolation as business/agency decisions built on confining and warehousing people rather than treating them in a dignified way is just a nasty way to isolate the people from the outside world or even within their own small room or space (Graham).

One inescapable thing about the outer walls of a nursing home is that nothing replaces getting out and about. Thankfully, that is a possibility to and allows people in nursing homes to literally transcend the borders and boundaries pushed upon them. Indeed, there are many nursing homes that allow their residents to go to church with their friends for family on Sunday. While it may be a sporadic thing, it is still beneficial. This is often done in partnership with local community and governmental groups as they want to see the elderly enjoy times at church or other such places so that they are not confined to nursing homes all day every day with no interruption. Sometimes, that is not available but the occasional jaunt out of the nursing home is absolutely possible and helpful for many nursing home residents (Weston). However, there are some limitations that have to be (or perhaps should be) set on patients. While some might argue that a sexual relationship in a nursing home involving a dementia patient is a bridge too far, others say that they still retain personhood even with their deteriorated mind state and thus should not be limited in terms of voluntary behaviors such as intimacy and other such things (Mclean).

On the flip side of the argument above, there are many that are in nursing homes that really need to be there due to the danger they pose to themselves or even others. While some might associate nursing homes with the old and decrepit, there have been nursing homes that have been used to confine and control the mentally ill. Some might consider that a modern-day asylum while others would consider the outer walls of those nursing homes, that border, to be a jail. Forced confinement of any sort is a very dicey subject. This is true with the mentally ill just as it is true with the old and those without control of their mind. When it comes to the non-elderly that are mentally ill, states like New York have gone to court and it has ended up with many people being cut loose despite being horribly mentally ill. Even with the forced confinement, there are valid concerns about what those people will do if allowed to roam free. Conversely, they are humans and just warehousing them and confining them rather than truly trying to address their problems comes off to many as inhumane and heartless. Even with that, there are people that are mentally ill that will never have a normal life again, if they ever did. They are much like bed-ridden nursing home residents in this regard (Levy).

While not viable for all people, the most viable way to provide freedom and less oppressive borders, limitations and disconnection from the outside world are assisted living situations. Not everyone needs anything approaching 1:1 care and just needs to be checked on here and there to ensure that medication is being taken, the patient has not fallen, household chores that might be a bit cumbersome to the patient and so forth. Just as with most things, assisted living and independent living apartments offer degrees along a spectrum and the amount of freedom and control needs to be put along the right part of the spectrum. If and when things need to be adjusted and changed, that can be done. Until/unless that is necessary, it is not something that has to be worried about. Of course, the decided degree of freedom and control over the patient that is decided may run counter to what the patient really wants. However, it was noted before that dangers to one's self or others is a concern and that remains the truth. For example, just because an older woman thinks they can drive just fine does not mean that they can (Vitez).

Conclusion

There are times and situations where enforcing strong borders and boundaries in a nursing home and isolation from the outside world is needed and necessary. Even so, it is not an easy choice to make and should be avoided when possible. Regardless, these are choices that are not always easy and should be diligently considered and analyzed before taking action.

Works Cited -- Annotated

Carstensen, Laura L., and William J. Fremouw. "The Influence Of Anxiety And Mental Status

On Social Isolation Among The Elderly In Nursing Homes." Behavioral Residential

Treatment 3.1 (1988): 63-80. Psychology and Behavioral Sciences Collection. Web. 29

Nov. 2016.

• This is one of the primary sources used for this report. It looks at social isolation and its symptoms using a multiple regression approach. The two groups compared are those that are free to come and go anywhere as they please and the other group are those in nursing homes, who are obviously confined. Indeed, both groups showed symptoms consistent with social anxiety and its nasty effects. However, the people in the nursing homes obviously have much more of these nasty results than those that were not confined to nursing homes. Just one reason for this is that nursing homes tend to be monotonous and repetitive as compared to environments that are not always in the same space and structure.