Chapter 13: Bridging Community and Long-Term Care Settings 13 Bridging Community and Long-Term Care Settings Elaine Wiersma and Stephanie Chesser C H A P T E R

Bridging Community and Long-Term Care Settings: Key Points Definition of community Transition from community to long-term care settings Challenge long-term care facilities as institutions (continued)

Bridging Community and Long-Term Care Settings: Key Points (continued) Long-term care settings as communities How health care professionals can support older adults as they transition from community into long-term care settings

Definitions Long-term care vs. long-term care home Total institutions Community

Long-Term Care Long-term care—ongoing indefinite care for those people who can no longer care for themselves Long-term care homes (LTCHs)—publicly subsidized institutional facilities designed to care for seniors, also referred to as nursing homes, skilled nursing facilities, or long-term care facilities

Creating a sense of community in LTCHs involves supporting and maintaining relationships that are fulfilling for residents.

Total Institutions A place of residence where like individuals lead an enclosed way of life, removed from wider society Residents have little or no control over the administration of the institution

Community Geographic location Groups of which one is a part Sense of connectedness

Aspects of Community Social networks Role identities Sharing

Social Networks Interpersonal ties Connect individuals to each other Connect individuals to services and organizations

Role Identities Social meaning of one’s position within a group and social relationships Defining a person as a social object

Sharing Common experiences, history, and goals Contribute to a sense of community

Adjusting to life in a long-term care home can be difficult, but often it results in new social networks, new neighbors, and new friends.

Transition From Community to LTCH Homelessness Learning the ropes Getting used to it Claiming a place and creating a neighborhood

Homelessness Grieve the loss of what many consider their home. Can leave older adults with feelings of loss and isolation.

Learning the Ropes Become socialized into the long-term care environment. Involves learning how to maneuver in a new space, becoming oriented with residents and staff, and learning the rules and routines. Can leave residents feeling like prisoners.

Getting Used to It For some this means simply living in the facility while time passes. Some try to fit in by purposefully meshing with the circumstances of long-term care life, while others try to fit in by not fitting in.

Claiming a Place Occurs approximately two to three months following admission. Involves creating a neighborhood within long-term care. Neighborhood provides a place where new memories, new social networks, and new neighbors can be made.

Community in LTCHs Internal community—the LTCH as a community External community—the geographical area in which the LTCH is located, and the sense of community associated with the residents, staff, and families of the LTCH

Leisure in LTCHs Sharing, as a concept of community can be fostered through leisure that is integrated with the external community. Social networks and relationships developed through leisure can reduce sense of loss. Leisure can provide residents with role identities.

Creating Community in Practice TR practitioners can build community in LTCHs by –facilitating sharing with the external community, –encouraging the development of social networks, and –fostering residents’ role identities.