Thanksgiving is a wonderful holiday but not one that is enjoyed by all. A lot of medical and long-term care settings do a great job in decorating and planning for this first major holiday in winter. The irony is that the more everyone around them seems to be celebrating, the lonelier some residents may feel. Some end up acting especially withdrawn or irritable.
As much as we try to understand why they are behaving this way, the holiday stress on the home front and the work front also makes it hard for service providers to give additional support. It is common to be short-staffed on major holidays. Regular weekday staff may be off for a few days. There may be one or two major facility-wide event but there may not be any other structured recreational activities. For some residents, the relative lack of familiar faces, routine activities, and the presence of temp staff may fuel agitation and confusion. If they want to speak with their social worker or psychologist on Thanksgiving Day, I can guarantee you that 99% of the time it will not happen.
“Their kids are visiting and we’re serving them turkey and ham. We even decorate the hallway to make it look festive. What more can we do to make them happy?”
“They get to celebrate their grandkids who are visiting. My grandmother is still upset with me because I have to work and skip her Thanksgiving dinner this year.”
They may be surrounded by their loved ones who come to visit, or by people who stick around to provide care, but it isn’t the same when they are not “home.” Thanksgiving is a big family-oriented holiday. For a lot of older adults, especially women, it defines their identity as a provider for the family. Even if they complain about all the holiday preparation and the lack of appreciation they receive in return, they’d rather be doing something than to suddenly be told to just sit down and eat that plate of sugar-free low-sodium pumpkin-pie-looking orange mush.
Another awkward situation is when family members who hardly ever visit suddenly show up. Some of these family visits really need to be “mediated” or at least “monitored” by staff. I’ve seen residents beg their most-trusted staff to be present during these visits so that they could get wheeled away from catastrophe the minute things went south. Again, when we are short-staffed, that presents additional challenge.
Whether the family visit ends up in disaster or not, the post-celebration calamities can also be overwhelming. Having a delightful visit with the family in no way predicts a calmer and happier evening for a resident. In fact, some residents may become more confused and upset when their family leave. Despite all the dietary concerns and restrictions being clearly stated to staff, residents, and family, an extra slice of pie or turkey sometimes slips through. Their blood sugar level may shoot through the roof. They may aspirate. They may choke. They may experience GI symptoms that increase irritability…All bad news.
I know I am being Debbie Downer as I write this on the eve of one of my favorite holidays. All I really want to say is that Thanksgiving can be a difficult time for some, but there are ways to make it a little better. Here are a few thoughts:
Allow residents to help with Thanksgiving planning or decoration. Even if all they can offer is a piece of Thanksgiving memory, let them feel that they are contributing to the holiday.
Prepare residents, family, and friends in advance, especially with regards to dietary restrictions and potentially inflammatory interactions.
Provide helpful tips to family and friends who are a little nervous about their visit by placing pamphlets at the entrance that say something like “For first time visitors…”
Encourage staff who will not be there during the holiday to inform residents ahead of time and wish them a happy holiday and tell them when they will return. Ask residents to write down their concerns or speak with another trusted staff.
Make good use of your volunteers, if your facility allows that. Some of the best volunteers are family caregivers who find it more exciting to plan a Thanksgiving dinner at their loved ones’ nursing home than visiting with their in-laws’ family elsewhere in town.
Have staff who are great with family visitors “volunteer” a few hours on Thanksgiving Day if they are available to be the “facilitator” or “greeter.”
Cultivate a culture of gratitude. Have residents, staff, and management write or sketch what they are thankful for on colorful silps of paper and use them to decorate the hall. Research shows that gratitude REALLY does make people happier!