boy playing flute
Music Is Hope

Love: The Missing Ingredient

A No-Cost Way to Improve Our Nursing Homes

C. Gourgey Ph.D.

(Reprinted from The Caring Heart, Advocates of Nursing Home Residents Newsletter, April 2010)

Mrs. Xavier, very old, a little confused, but clear about what she needed, needed help. Unable to move from her wheelchair, she asked for assistance to the bathroom. I moved quickly down the corridor, looking for her aide. I drew the aide’s attention for a brief moment, but just as I was anticipating Mrs. X’s relief, the aide barked at me:

“Mrs. X has been here a long time. She knows the deal. It’s time for the shift change. We have to do our reports. When we finish, then I’ll come. She has to wait.”

And with that she was gone.

How many times do we hear such excuses for not providing care: “My shift is over now”; “She’s not my patient”; “I’m on my break right now”; “I’m just a floater and I don’t even know your mother.” Inside many nursing homes with hearts in their logos and pretty words in their mission statements one finds an atmosphere of intimidation. In a variety of ways residents and the people who love them are discouraged from speaking up.

Those who care for the most intimate needs of the people we love should be our friends, not our adversaries. Nevertheless, a deeply ingrained nursing home culture encourages a subtle adversarial relationship. The refusal to make eye contact, the surly tone of voice, the use of short, clipped sentences, all make the caregiver feel she is a nuisance, bothering these busy people who have more important things to do than listen to her complain about her loved one’s food needs or toileting needs or physical or emotional distress. A wall descends, separating the staff from the caregiver and the resident. This wall is not seen but felt. The caregiver feels this wall as an anxiety that may gnaw at the root of her stomach as she ponders how to express a need without drawing resentment. The staff sees this wall as protection; it is “professional distance.”

It is time to penetrate this wall. “Professional distance” too often becomes indifference, and when people are frail and vulnerable, indifference is toxic. When I was a music therapist at a long-term-care hospital I had one patient who complained: “There is not enough love in this place!” In the music therapy group she could safely express her concern. And we worked on it, and eventually we succeeded in letting this lady know that she was loved.

Unfortunately “love” is a dirty word in professional circles. To some it means transgressing boundaries. To many it is threatening. It is safer not to feel. But safer is not healthier, not for the residents, not for the caregivers, and not even for the staff.

There is a way to love without becoming either inappropriate or overwhelmed. It is practicing love as awareness. We just need to be aware of the individual who requires our attention, of his essence, of her uniqueness. Then we begin to desire that person’s well being. The other person will feel it, and it will heal us both.

How can we put this into practice? There are simple things we can do. A smile instead of a scowl does much to diminish stress by making both the giver and recipient feel better. A soft voice, a kind word sincerely meant, defuses resentment and so makes life easier not just for the caregiver but for the staff member as well.

This change must start from the top. Singling out only the nurses and CNA’s would not be fair. We need supervisory personnel who cherish these human values and who are not afraid of love. And we need an administration that will carefully choose and train such personnel. This means administration must cherish these same values. Administrators and nursing home staff must be concerned with more than just keeping “difficult” people under control. These people are human beings who feel defenseless and who need our love. We must not be afraid to love, and we have a right to ask that not only our nursing homes but our entire health care system be more loving.

Love is not just sentiment. It can be expressed in very practical ways. For now, simply consider which type of nursing home you would prefer for your loved ones or for yourself: one where love thrives - or one like the nursing home you will very possibly encounter when you must search for a place where your loved one can safely reside.