The Critical Period in Nursing Home Placement

Posted by Dr. El - January 23, 2009 - Depression/Mental illness/Substance Abuse, Transitions in care - 10 Comments

I couldn’t wait to go to college.  I was ready to shake off the old me, and begin a brand new self.  No one would know who I’d been, and I could therefore be whomever I wanted to be.  

In my Psych 101 textbook, there was a picture of animal behaviorist Conrad Lorenz, followed by a row of baby geese. The goslings had found Dr. Lorenz during their critical period of imprinting, when they bonded to the first suitable stimulus they saw. Conrad Lorenz became the goslings’ mama.

When residents enter nursing homes, they have the opportunity to create new identities.  They are surrounded by strangers and novel social situations, with as limited a pull from family and friends to be their old selves as they are likely to have experienced in decades.  While most residents aren’t necessarily looking to become new people, their early nursing home contacts can affect how they settle into their environment.

Mrs. Leibowitz arrived at the nursing home depressed, but wasn’t referred for psychological services until months after her arrival.  She’d already established the pattern of spending days alone in her room, watching television for hours at a time.  She was irritable with staff members, often refusing care, or chasing them out of her room with her foul language.  “There’s nobody to talk to here,” she told me.  I had my work cut out for me.  The critical period had been lost.

Mr. O’Conner, on the other, was lucky enough to be placed in a room with Mr. Chu, the President of the Resident Council.  Mr. Chu took Mr. O’Conner under his wing (so to speak), and together they played cards with some of the other gentlemen, and attended activities which appealed to them both.  Our new resident integrated nicely into the community and never needed psychological treatment.

I’d like to see every nursing home form a welcoming committee, by residents, for residents, to help aid the transition to the nursing home.  And I’d like to get my referrals early, during the critical period, instead of after the conflicts, isolation, and other problems have become entrenched.  That way I can more easily help people take advantage of the best that nursing homes have to offer.