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The Power of Social Relationships With Peers and Staff in Post-Acute and Long-Term Care

      Throughout the COVID-19 pandemic, we have witnessed the deleterious effects of social isolation on older adults in home settings and in post-acute and long-term care. Although the use of technology and telephone calls has helped buffer the impact of social isolation, we have learned that they are no substitute for face-to-face interpersonal interactions.
      As the older adults that we care for and the staff in PALTC are re-engaging with their social networks, I am reflecting on the power of positive social relationships and how they are vital components to well-being and quality of life (Aging Ment Health 2017;21:910–916).

      Peer Relationships

      I have always enjoyed observing how many older adults in PALTC are able to forge new and satisfying relationships with their peers, despite the stressors of declining health, functional disability, and often cognitive impairment. For instance, there were three gentlemen who were residents in a newly opened assisted living community where I once worked. All had been admitted around the same time, and they included a retired attorney, an accountant, and an FBI agent. All three had severe cognitive impairment, and their ability to communicate verbally with one another was limited.
      Fortunately, they were all able to ambulate independently. Despite the communication challenges, they located one another every morning during their walks around the unit. They always greeted one another with smiles, handshakes, and incomprehensible verbal banter. They ate meals together, walked together, and observed structured activities from a distance. On two occasions, they combined resources for failed elopement attempts — once by cutting a window screen with a butter knife and pushing a heavy bench closer to the outside fencing. When redirected from these “activities,” they smiled, laughed, and patted one another on the back in a sign of solidarity. They remained close to one another until their deaths several years later.
      It is no surprise that positive social relationships with peers can positively influence life satisfaction, well-being, and the ability to thrive, as well as decrease feelings of loneliness among older adults in community and PALTC settings (Dementia 2008;7:71–93; J Appl Gerontol 2002;21:275–293; Int J Aging Hum Dev 2000;51:137–141). A recent qualitative study conducted with residents living in nursing homes suggests that peer relationships help to promote a sense of “belonging, purpose, achievement and significance” (J Clin Nurs 2020;29:1162–1174). Residents are described as making use of their remaining strengths to engage in meaningful activities that help and support their peers. Among cognitively intact nursing home residents, social engagement with peers has been associated with greater longevity after controlling for comorbidities, functional ability, facility characteristics, and contact with family and friends outside the PALTC setting (BMC Geriatr 2020;20:480).
      Given the benefit of positive social relationships with peers in the PALTC setting, there are a few evidence-based strategies that staff can try for promoting the development of these relationships (J Clin Nurs 2018;27:4361–4372):
      • Introduce newly admitted residents to peers with similar interests, hobbies, and life experiences. Introductions can be made during recreational activities and require the staff have good knowledge of the residents.
      • Optimize the residents’ ability to maintain their mobility for as long as possible. Physical proximity is key for the development of friendly peer relationships. Mobility also helps residents remove themselves from the company of others whom they may find stressful or overstimulating.
      • Match residents with similar communication and cognitive capacities. This minimizes the chance of frustration when there is a significant discrepancy between peers’ ability to converse and remember.

      Patient and Staff Relationships

      We all have been fortunate to experience or witness a strong relational bond between a resident and a staff member. One of my favorites involves a resident, “Gloria,” and a nursing assistant, “June.” June was one of the few staff members who could assist Gloria with bathing and toileting without Gloria screaming loudly and hitting her caregiver. The other staff tried to model their own care approaches on June’s strategies, but there was just something about the two of them that truly clicked.
      June’s daughter was getting married, so she was scheduled to be off from work for two weeks; Gloria and the remaining staff were quite concerned. For one month before the wedding, June would regularly bring other nursing assistants into Gloria’s room to get them acquainted with Gloria’s care routines and her likes and dislikes. Because Gloria was anxious about June’s departure, they made a large calendar that hung on Gloria’s wall to mark the days until her return. June also made brief recordings of herself giving words of encouragement to Gloria that the other staff would play when Gloria would become upset or resistant.
      On the day of the wedding, one of the nursing assistants helped Gloria get dressed in her best outfit and took pictures of her to share with June. It wasn’t easy, but everyone survived, and Gloria managed to build improved relationships during June’s absence.
      Like peer relationships, the staff can try several evidence-based strategies to promote the development of positive relationships between patients and staff (J Clin Nurs 2018;27:4361–4372):
      • Be responsive to patient needs. The patients that we care for rely on us for many of their daily needs. Partnering with a staff member who is familiar and responsive in a timely and positive way helps to build trust early and goes a long way in building a positive relationship.
      • When possible, spend some time with a patient that doesn’t involve the delivery of care. Although time for socializing and support is limited, particularly during staffing shortages, sitting with a patient while you complete some documentation or offering a friendly hello, a mutual hug, or a brief conversation about a shared interest can be meaningful to both the resident and staff member.
      • Learn patients’ preferences and life stories. Knowing the little details helps care be more personalized. A recent study demonstrated that a life story intervention was more effective for building social relationships between staff and nursing home residents than it was for peer-to-peer relationships (Int J Environ Res Public Health 2021;18:1808).
      As we welcome family, friends, and visitors back into PALTC, let us not forget the power of social relationships with staff and peers for older adults in PALTC settings. Please share with us some of your favorite relationships and why they keep you engaged in PALTC.
      Dr. Galik is editor in chief of Caring for the Ages, professor at the University of Maryland School of Nursing, and a nurse practitioner in LTC through a clinical practice with Sheppard Pratt Health System. The views the editor expresses are her own and not necessarily those of the Society or any other entity.

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