Socialization in Group Care

Socialization in Group Care

Loneliness is a widely discussed problem and the public often thinks that Group Care locations are a solution to this problem. The answer is more complicated. Success with socialization in a Group Residence depends on the individual’s personality, their cognitive ability and the cognitive ability of their potential relationships nearby. When we are into our 80s it is not uncommon to have only a few peer relationships left and making new ones is often more challenging due to low energy or difficulties with communication, mobility and cognition. Increasing age-related challenges make it harder to find peers who are people we get along with, can communicate with and will still be here next year. In a Group Residence there may be opportunities for peer relationships, especially within Independent Living, but as care needs and age related challenges increase it is more likely that intergenerational relationships with family and caregivers will be the primary socialization available.

• Our social fabric as older adults shifts because there are fewer people in our peer group we can successfully connect with and intergenerational relationships become easier to access and maintain.
• Intergenerational relationships outside of family are often the employees that work nearby or caregivers that come to visit you.

Caregivers within a Group Residence often get cycled between different floors, wings or times of day. When considering a Group Residence it is important to find out how the facility handles scheduling and fosters the potential for relationships to form. Relationships are about trust, who we can rely on seeing and talking to. Continuity, predictability and reliability are necessary for that to be possible. Group Residences may have several dozen rotating caregivers and other employees. The caregivers you see each day or each week may change as they rotate between floors and sections. It is difficult to build relationships from both directions when the rotations seem designed to eliminate continuity and predictability. Some people argue that the need for continuity in group care diminishes as the level of care increases and people have increasing challenges with communication. This is meant to justify haphazard rotations that prioritize penny pinching over quality of care. Myself and others argue that diminished ability to communicate doesn’t diminish the importance of having reliable people who know your normal and how to communicate with your specific needs. People who cannot speak up for themselves due to communication and cognitive challenges arguably need better continuity!

Independent Living

houses people who are generally more cognitive, mobile and able. 

• Peer relationships are easiest to find in this type of Group Residence.
• There is some opportunity for intergenerational relationships with staff onsite.
• The biggest threat to your relationships would be a change to your needs or theirs that requires a move to a higher level of care. This is part of why people try to remain in Independent Living for as long as possible.

Assisted Living

houses people who are generally mobile but need more help and may have significant cognitive decline. 

• Peer relationships are harder when the people around you have their own challenges in communication or cognitive decline.
• There may be opportunity for intergenerational relationships with staff onsite if the scheduling practices allow for consistency in relationships. If the caregivers constantly rotate between floors and wings it is far less feasible.

Residential Care (LTC)

houses people with significant cognitive decline or mobility limitations. 

• Peer relationships are the least likely in LTC because most people around you have significant cognitive decline. Individuals in LTC with intact cognition but serious mobility issues are faced with finding the few others who also have intact cognition but serious mobility issues.
• There may be opportunity for intergenerational relationships with staff onsite if the scheduling practices allow for consistency in relationships. If the caregivers constantly rotate between floors and wings it is far less feasible.
• Individuals with intact cognition but impaired mobility should avoid LTC for as long as possible. There is a lack of adequate socialization for these individuals in this environment.
• It is important that individuals of ANY cognitive capacity living in LTC have outside visitors regularly checking on them. This is important for socialization but also for quality of care; ensuring that facility employees know the person is being monitored and checked on.

• Some Independent Living and all Assisted Living buildings offer social outings and events to see different sights and help people stay active.  
• In Residential Care the residents usually have impaired mobility or serious cognitive decline and the focus shifts to activities in the building and escorted trips out while they can mobilize safely or go out in wheelchair.