In the Autumn 1992 issue of The Docent Educator, we discussed touring with older adults. This article departs from that one by focusing on a specific segment of older adults ╤ residents of long-term care, nursing facilities.
In the previous article, one of our main points was that, even though there are differences between younger and older adults that should be taken into consideration, the attitudinal starting point for touring older adults was to treat them as adults first. Is it necessary for us to alter this dictum when discussing nursing home residents? Absolutely not. Even though the differences between most adults and those in nursing homes can be substantial, we argue that the starting point is to recognize these people as adults. The all too often heard, “I just love working with old people. I treat them like my children.” has no place in senior citizen centers, in hospitals, or in museums.
While residents of long-term nursing homes tend to be, on average, older and to have lower levels of physical and cognitive ability than other adults does not suggest that you should significantly alter the approach you take. Treating these visitors as adults who happen to be older respects their dignity and should help to reduce any anxiety present in the docent who provides the tour.
Docents should understand that nursing facility residents with greater functional and mental difficulties are not going to be members of a touring group. It is highly unlikely that nursing homes would include anyone at risk of developing problems in a tour group. If nothing else, their potential liability would discourage it. In addition, the planning and implementation of an activity such as a tour is far more time consuming for the facility than just keeping the residents in-house. Simply put, nursing homes do not organize tours to get their problem residents out of the facility.
Conscientious docents gather information about their tour groups prior to providing tours. In most institutions, reservations are not accepted from schools without knowing something about the group of youngsters and their chaperones. Likewise, it is paramount that you learn about the nursing home group and about the staff who will accompany them.
You have every right to ask about the general physical and mental condition of those to be toured. For example, you will want to know how many of the tour members will be in wheelchairs. Some docents may have experienced a reticence or refusal on the part of a nursing home to discuss these issues on the grounds of confidentiality. If you experience such hesitance when working with the home’s activities personnel, ask to speak to the director of nursing, or, as a last resort, the administrator. Make it clear that you are not asking for confidential information but that you simply want to be prepared so that everyone will have a successful tour. Knowing what medications someone is taking or their medical diagnosis, which are confidential, will probably not mean much to you anyway. But, you certainly should know about general physical and mental capacities. We suggest that if you cannot secure the information needed to help you properly plan for the event, consider not giving the tour. It is inconceivable that a reputable nursing home would refuse to share the necessary information.
You should also be very specific about transportation arrangements and necessary escorts. Will the nursing facility supply enough individuals to assist in transferring participants from the vehicle to your facility and back, or are they expecting you to arrange for this? How many nursing facility staff will accompany the group on tour; what are their qualifications; and what are their responsibilities in case of some emergency? Will the group be accompanied by a registered nurse, a licensed practical nurse, and/or a certified nursing assistant? Will there be nursing home volunteers accompanying the group? Will you need to recruit volunteers to assist with the group?
Circumstances of Residents
It is instructive to remember the general environment of such facilities. With few exceptions, the lives of residents in long-term care nursing facilities are controlled by the rules of the institution, not by the personal wishes of the residents. Nursing home residents may find such decisions as when to go to bed, when to arise from bed, when to bathe, when to dress, when to eat, when to receive visitors, with whom to share a room are all governed by institutional regulations.
Suggestions for Docents
The circumstances described above suggest that you keep in mind that nursing residents have suffered not only the loss of functional and/or mental capacity (prompting nursing home placement), but also loss of the freedom to make many of life’s decisions. An approach that comes across as paternalistic and emphasizes what the residents cannot do will simply reinforce the negatives many of them feel very acutely already. Most nursing home residents do not need reminders that they are different, but instead could benefit greatly from an approach that recognizes their humanness and worth, not their disabilities.
For example, plan the tour so as to de-emphasize the need for mobility. If possible bring items to a central location, obviating the need to move from room to room. This will be especially useful for a group that has a large number of individuals who are in wheelchairs, because it takes time just to move from one room to another. This also reinforces their lack of mobility.
Do not presume the presence of disabilities. Even if the nursing home staff indicates that the cognitive abilities or attentiveness of a group will be low, remember that they see the residents in an entirely different environment than you. Do not rule out the possibility that the stimulation of your interest in them and of the new environment will spark a response that the staff is not likely to see in the nursing facility.
We know of a situation where a docent was touring a group from a nursing facility. One resident, let’s call her Mary, indicated on a couple of occasions that she was bored and wanted to go home. During the movement from one room to another, an attendant from the nursing home leaned over and whispered to the docent that Mary had Alzheimer’s, in an apparent attempt to explain Mary’s behavior. Later, as the group stopped to observe a particular piece of sculpture, the docent singled out Mary asking her how she would want to look at this piece. Mary went over to the sculpture, circled it and declared, “In order to get the full effect you have to feel it from all sides.” She had succeeded in providing an extremely appropriate response, much to everyone’s surprise. By assuming an ability to participate, rather than writing off Mary as a victim of Alzheimer’s disease, the docent was able to evoke a response no one would have predicted.
Another technique that is sometimes successful with nursing home residents is to relate items to their childhood or early adulthood. This is particularly effective if you can focus on items that suggest an earlier time period, such as photographs or objects that might have been more common earlier in the century than now. Or, even if the theme is contemporary, you can relate it to an earlier time period. For example, images of modem architecture could prompt questions about the first time residents saw a skyscraper or what people might have thought of such a building if it had been erected in 1920. Evidence of a genuine interest in what things were like “back then” can sometimes evoke meaningful responses. And, being in a situation where the more knowledgeable person – – the docent–is asking them to be the educator can feel empowering.
Rehabilitation Patients, Assisted Living Residents, and Retirement Home Residents
With the enactment of cost containment legislation for Medicare forcing older patients to leave the hospital earlier than in the past, a sizable minority of new nursing home admissions are temporary ones, while the individual is continuing a rehabilitation program begun in an acute care hospital. If your touring group consists of these individuals you are likely to find most of them to be cognitively normal and more like your typical older adult clientele than the typical nursing home resident.
Likewise, residents of assisted living facilities should not be confused with the nursing home resident. Assisted living facilities (which are known by different names in different locations) are for individuals who need some assistance with activities of daily living, but do not need skilled nursing care. Usually they will be more mobile and more alert. Do not confuse these individuals with nursing home residents.
Residents of retirement homes or retirement communities should not be confused with nursing home residents. These individuals will be totally independent and even more alert and mobile than assisted living residents.
Docents with considerable experience with nursing home residents can attest to the tremendous satisfaction they gain from working with these people. In all likelihood, these successful tours were characterized by careful planning, knowledge of the group’s needs, a recognition of the dignity and worth of the group members, and by aggressive attempts to engage the participants during the tour.
Raymond M. Leinbach. Ph.D., is an associate professor in the School of Community Health Professionals and Physical Therapy at the College of Health Sciences: and is the director of the Center for Gerontology at Old Dominion University, in Norfolk. VA.
Betsy Gough-DiJulio is director of education at the Virginia Beach Center for the Arts in Virginia Beach, VA. Ms. Gough- DiJulio received her M.A. in art history from Vanderbilt University.
Dr. Leinbach and Ms. Gough-DiJidio collaborated on the article “Touring with Older Adults, ” which appeared in the Autumn 1992 issue of The Docent Educator.
Leinbach, Raymond M. and Gough-DiJulio, Betsy. “Touring Nursing Home Residents,” The Docent Educator 2.4 (Summer 1993): 16-17.