Enhancing relationships in nursing homes through empowerment.

Abstract

As our population ages, an increasing need exists for gerontological social workers. An important role for these social workers is to help empower older people and their caregivers (Cox & Parsons, 1994). Within the top-down hierarchy of nursing homes, the contributions of family members and nurses aides often are overlooked, resulting in feelings of powerlessness and resentment (Mok & Mui, 1996; Tellis-Nayak, 1988). This article describes a model in which social workers help empower these caregivers to become involved in planning the care of nursing home residents. Family members and nurses aides are caregivers who are especially familiar with residents' needs. Many family members stay vitally involved in the lives of their institutionalized elderly relatives and want to play a part in their care (Bowers, 1988). Likewise, the nurses aides know residents' intimate routines and personal preferences (Aroskar, Urv-Wong, & Kane, 1990). Often, however, both these groups feel unrecognized for their efforts and powerless to make changes in resident care (Cox & Parsons, 1994; Duncan & Morgan, 1994). When these feelings become intense, conflicts between family members and staff can erupt, thereby diminishing the care of the resident (Pillemer et al., 2003; Vinton & Mazza, 1994). Social workers can help empower family members and nurses aides to have a voice in the care of residents. Empowerment includes several overlapping components (Gutierrez, Parsons, & Cox, 1998). The three components most relevant to our caregiver empowerment model are (1) cultivating individuals' own strengths (Cox & Parsons, 1994; Mok & Mui, 1996); (2) encouraging caregivers' sense of potency (Simon, 1990); and (3) fostering an exchange of information among equals (Holmes & Saleebey, 1993; Simon; Wells, & Singer, 1988). The importance of empowerment in nursing home settings has been recognized but empowerment efforts have typically focused on residents who are cognitively intact. For instance, residents have evaluated their nursing homes (van Green, 1997), attended empowerment workshops (Lee & Carr, 1993), and participated in residents rights campaigns (McDermott, 1989). These efforts are beneficial, but less feasible when nursing home residents have dementia. In such cases, the empowerment process needs to in volve family members and staff who know residents and can communicate on their behalf (Pillemer, Hegeman, Aibright, & Henderson, 1998). Suggested Approaches Plan: A Bottom-Up Model In nursing homes the social worker or the nurse or both develop a care plan for each resident. Family members and nurses aides are generally not involved in the care planning process. Our empowerment model differs from the traditional care planning approach by soliciting ideas from family members and nurses aides, which are included in a suggested approaches plan. Because of the high incidence of problem behavior among residents with dementia (Deutsch & Rovner, 1991), this suggested approaches plan focuses on residents' behavior and is placed in residents' charts as an adjunct to their other care plans. Our bottom-up model emphasizes the involvement of family members and nurses aides, but it is also important to include the administration and management team in the empowerment process. Therefore, our model includes ongoing contact with administrators and managers to brainstorm ways to address obstacles to change (for example, turnover among nursing aides and changes in their assignments to residents). Such contact helps maintain improvements over time. To assess our empowerment model, we involved residents (ages 60 and over) with dementia who had one or more of the following problems: wandering, physical aggression, or verbal aggression. These residents also had family members who visited them at least twice a month. The participants in our project were family members and nurses aides of 21 residents of two nursing homes (a for-profit and a nonprofit nursing home). …