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Although senior living communities advertise as offering the cruise-ship lifestyle, this lifestyle is not reducing the loneliness and depression that residents may experience upon joining a community. Recent research shows that one way of reducing these mental health issues is by adopting an activity program that fosters resident engagement instead of entertainment.

Creating Emotional Connections

By their very design-with an emphasis on gathering areas and opportunities to socialize with fellow residents during dining or activities-senior living communities should prevent the loneliness that can arise from living alone at home. Yet the reality is that the rates of loneliness and depression have not changed in 50 years, regardless of the care type offered at the community. This is according to Kristine Theurer, a PhD candidate at the University of British Columbia in the Graduate Programs in Rehabilitation Sciences who recently published The Need for a Social Revolution in Residential Care in Journal of Aging Studies. “Some of the research indicates over half of the residents struggle with loneliness and depression,” she said. “I think the industry is aware there is an issue, but perhaps not the extent of it.” In the paper, she discusses that a new approach is required to address these mental health issues. In addition to an academic background researching psychosocial care in residential care settings, Theurer has spent over 20 years in the industry as a music therapist working in these same communities.

Although activity programs should prevent loneliness and depression because they offer opportunities for residents to interact with each other, Theurer said that these activities typically offer superficial interactions amongst residents instead of developing the emotional connections necessary to combat loneliness. To further complicate the matter, the social situations that are common in high school, such as cliques and avoidance of certain residents exhibiting signs of dementia or awkward behavior due to physical impairment, also occur at senior living communities and consequently residents do not actively seek out opportunities to form connections with their neighbors. “In some ways you’d think this [forming of connections] would just happen on its own, but it doesn’t,” Theurer explained. “I’m not sure why, but there’s something about the environment of a long-term care home or a retirement or assisted living community where it just doesn’t happen. That residents on the whole don’t generally visit, actively go out and seek out the lonely people and talk to them and bring them into the community. So I think when we put a structure in place to foster and facilitate that, it spreads.”

Although her research calls for a “social revolution” in moving beyond only offering entertainment-focused activities, this revolution does not necessarily require a complete overhaul of activity programs or hiring more staff. Instead staff can tap into residents’ unvoiced desire to remain socially productive to help reduce the rates of loneliness and depression.

In the senior living industry, “we see residents as passive recipients of care and we need a shift in focus,” she said, “This is really what inspired the article is a shift from what we can do to them and for them, to what residents can do for one another.”

The REAP Model

This social revolution is based upon the Resident Engagement and Peer Support (REAP) model, and its emphasis on resident engagement is what sets it apart from the cruise ship-activity model where “programs are planned and implemented in a task-oriented approach without input from the residents,” Theurer said. “The REAP model is really a foundation for a fundamental change in how we think of psychosocial care: it puts residents at the center of the process.” Peer support exists in other aspects of life, from diabetes support groups to Alzheimer’s caregiver support groups, and she saw that a personal network of this sort was missing in a residential care setting.

“This revolution really takes [resident engagement] out of the care orientation and puts it into a partnership and engagement orientation,” said Robyn Stone, executive director of LeadingAge Center for Applied Research and senior vice president of research. She was also a coauthor of the paper.

How the REAP model is implemented at a community is through staff and resident collaboration to develop programs reflecting residents’ interests, with staff available to facilitate those programs. Although staffing resources are needed to initiate the programs, Theurer explains that the benefit of using the REAP model is that residents assume ownership and lead the program themselves. Dr. Michael Barber, the former chief medical officer for the National Church Residences, saw firsthand how the REAP model benefited residents at their communities serving low-income seniors. “We face a lot of issues in affordable housing, isolation and loneliness is certainly one those,” Barber said. “Plus we have scarce resources to address these issues.”

Two and a half years ago, he piloted the Java Music Club (JMC) program in their communities which had service coordinators. The Java Music Club Program was developed by Theurer based upon her REAP model research and is currently used by providers that include Holiday Retirement, Chartwell Retirement Residences (Canada), Arbor Company, and Sienna Senior Care Corporation. “Once [the program is] up and running, often the resident themselves will do the facilitating and keep it going,” Barber explains. “Compared to many other programs it was low-cost and it was readily accepted by the residents. And in one facility we ended up having to go with two groups. When you get above more than 15 regular attendees, the group gets too large.”

Just like traditional activity programs, the REAP model it is structured around an activity, but how it differs is that the residents have chosen the activity and that it’s “highly structured in a way to get people engaged and in conversation with one another,” Barber said. “It’s designed to facilitate more intimate relationships among residents,” adding that “it’s the power of peers, and being understood by others is really the difference in addressing the loneliness in elders. Peers can understand you in a way that no one else can, including family.”

He has also observed that residents who observe an activity from the sidelines also appeared to benefit and that “staff and volunteers often comment that they feel they get as much out of a JMC activity as the residents.” Theurer worked with Barber to collect data on the program’s effects upon the residents for her research and their data analysis revealed that it was easy to recruit and retain volunteers as facilitators when necessary, which Barber said, was “a very good finding.”

There are other tangible benefits of the revolution in resident engagement using the REAP model. “What we’ve learned, and there has been an evidence-base developing around this, that social engagement-the tailoring of activities to the needs, preferences and strengths of folks-not only does it engage people but it actually contributes to better quality of life and health and functional outcomes,” Stone said.

She sees the need for improved resident engagement as only increasing in the future as the demographics transition to the baby boomers who are just now starting to join senior living communities. “The demand is going to be there for something very different and much more individualized and flexible. The literature is pretty clear that the Depression and WWII generation were a much more passive elderly population in terms of just sort of accepting what was there for them, and the notion that the Baby Boomers are going to be much more demanding will be true, I think, even with cognitive impairment.”


Andrea Watts is a writer at SeniorHomes.com, a free resource for families and seniors who are navigating the issues surrounding long-term care, such as costs and care options. We offer helpful guides on the long-term care options and connect families to family advisors who can serve as their guide every step during this process.

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