The 40 Year Old Study That (Should Have) Changed Nursing Home Culture Forever

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The 40 Year Old Study That (Should Have) Changed Nursing Home Culture Forever

In 2014, the Centers For Disease Control reported that 1.4 million Americans lived in United States nursing homes. Of these, 40 percent have some level of depression, according to the American Geriatrics Society. This depression can be caused by a range of factors (including, in many cases, ill health), but loss of control is arguably one of the most significant elements of poor life satisfaction.

When nursing home residents believe that they have little say in the direction of their everyday lives, they are more likely to feel listless. Even small changes that give residents greater autonomy can have a significant impact on their physical and mental health. This is backed up by multiple studies, including an influential experiment led by Ellen Langer.

Ellen Langer’s Famous Study

Often referred to as the mother of positive psychology, Harvard professor Ellen Langer has contributed a great deal to the existing body of research on aging and wellbeing. In arguably her most notable study, she teamed up with Judith Rodin to determine how nursing home residents would respond if instructed to care for a plant. Prior to the study, these residents lived in a largely decision-free environment. Those in the experimental group were explicitly told that they would have full control over their plant, and that care for the plant was entirely their responsibility. In the control group, residents were informed of the staff’s responsibility over plant care and other aspects of their everyday lives.

As Langer predicted, residents allowed to care for their own plants showed positive outcomes, including greater feelings of self-worth. Despite having been explicitly told that their happiness was of utmost concern, only 25 percent of respondents from the control group (which had reduced autonomy) reported feeling happier by the end of the study, compared to 48 percent of those in the experimental group. Langer concluded that nursing home residents would be far happier and healthier if given the ability to direct their own lives, as much as possible.

Follow-Up Research

The findings from Langer and Rodin’s study are supported by a variety of additional studies conducted during the last few decades. In a 1987 review of literature and research on aging, John W. Rowe and Robert L. Kahn concluded that autonomy played a chief role in determining “whether aging is usual or successful.” More recently, Margie E. Lachman has examined age-related perceptions of control and how they impact both physical and cognitive function. In a 2014 study published in The Gerontologist, researchers at the University of Minnesota suggested that nursing home residents would enjoy far greater quality of life if they were more involved in goal-directed activities.

Nursing Home Life Today

Langer’s plant study was published in 1976, a time in which deteriorating nursing home conditions were of grave concern. In the years following the publication of this groundbreaking study, several new policies were enacted in hopes of making nursing homes and other facilities more conducive to positive mental health outcomes. For example, the Nursing Home Reform Act from the 1987 Omnibus Budget Reconciliation Act mandated several protections for nursing home residents, as outlined in the Residents’ Bill of Rights. Additionally, the Patient Self-Determination Act of 1991 has paved the way for greater control over end-of-life care through living wills and advance health care directives.

Despite numerous legislative efforts to improve conditions in nursing homes, depression and feelings of hopelessness remain common. Abuse and illness have a role to play in this, but perceived loss of control continues to be an even more significant problem. It takes more than nutritious meals and sanitary facilities to make nursing home residents healthy; if they feel that they have limited control over their lives, they are more likely to fall into depression. To combat this, many nursing homes have adopted policies that emphasize resident choice. These decisions can be as simple as choosing meals and preferred activities. In many facilities, the emphasis is not on providing services for seniors, but rather, giving them the ability to “do for themselves.”

Langer’s efforts have resulted in significant changes to the overarching perception of aging, although the elderly still face damaging stereotypes about their alleged feebleness and inability to make decisions for themselves. As these stereotypes fall away, however, more and more seniors are able to practice autonomy and make key decisions. More progress is needed, of course, but the future is bright for geriatric care.

At Rosenbaum & Associates, we believe that all nursing home residents should be treated with respect and dignity. If you or a loved on has been abused in a nursing home or assisted living facility, it is imperative that you reach out for legal support. Call Rosenbaum & Associates today for a free, no obligation consultation.