This literature review examines concepts of quality of life for residents in nursing home facilities. It discusses person-centered care which prioritizes resident autonomy, dignity and choice. Culture change aims to shift care from a medical model to a person-centered model through staff education, meaningful activities and consistent staffing. Relationships between residents and family, friends, staff and other residents impact well-being. Daily uplifts and story sharing can help staff build relationships. Resident choice in activities and spirituality can enhance satisfaction. The Selective Optimization with Compensation model describes how older adults adapt to loss of function through selection, optimization and compensation. Overall the literature emphasizes improving quality of life through individualized, enriched care plans.

1. Life Enrichment in
Nursing Homes:
A Literature Review
Paul R. Fletcher III
University of Southern Indiana
8600 University Blvd.
Evansville, IN 47712

2. Talking Points
 The aim of this literature review:
 Evaluate current and prospective concepts regarding Quality of Life in nursing
home facilities
 Examine current culture change in nursing home facilities
 Discuss person-centered care movement, importance of relationships, and resident
choice in nursing home facilities as it pertains to non-clinical life enrichment.
 Link literature to the Selective Optimization with Compensation model

3. Quality of Life
 Quality of life can be defined as a perception of satisfaction and general well-
being that can be affected by current health status, level of function,
relationships, or other environmental features (Sullivan & Asselin, 2013).
 Since the year 2000, the 80 and older age group is expected to grow from 9.3
million to 19.5 million by the year 2030 (Sullivan & Asselin, 2013)
 How will Quality of Life be delivered to this growing cohort?
 Stakeholders in the long-term care industry have recognized the need for
transformation from a medical model of care to a person-centered care
model (Burack, Reinhardt, & Weiner, 2012)
 This culture change will be pivotal in the years to come as our population
ages, and there will be a great need for an understanding of how to provide
person-centered care

4. Person-Centered Care

5. Person-Centered Care
 Autonomy, dignity, comfort, and safety may be jeopardized when entering in
to a nursing home setting (Kane et. al., 2005)
 Person-centered care exhibits an approach for care that puts the needs of the
individual first (Sjorgren et al., 2013)
 The goal of person-centered care is to promote an environment that
prioritizes personhood, social relationships, and communication (Sjorgren et
al., 2013)

6. Person-Centered Care
 Culture Change in Nursing Homes
 Shift from a medical model to a person-centered care model
 5-year longitudinal study monitored 41 long-term care units as they transitioned
from a traditional medical model facility to one that was focused on person-
centered care (Burack et al. 2012).
 Changes included: staff education, organizational structure, including meaningful
activities, increased family involvement, consistent staffing, and environmental
improvements.
 Interviews utilizing the Duncan Choice Index identified initial support of a positive impact
of changes.
 Researchers suggest further examination is needed to measure sustainability of these types of
changes.

7. Person-Centered Care
 Personhood
 Can be defined as a sense of self and status bestowed upon an individual, through
interactions with others, that provides a sense of respect, recognition, and trust
(Buron & Killian, 2014).
 The dependence on care providers may emphasize the lower function of an
individual, stripping away their independence and ultimately their personhood
(Buron & Killian, 2014).

8. Person-Centered Care
 Role of Activity Director
 Provide gender appropriate activities and events for residents
 It has been reported that a majority of activities in nursing home settings tend to
favor the female residents instead of their male counterparts (Kracker et al.,2011)
 This may be detrimental to male residents as they age, it is imperative for activity
directors to explore various activities that promote personhood for both men and
women (Buron & Killian, 2014).

9. Relationships

10. Relationships
 Resident and….
 His/her family
 Friends
 Staff
 Volunteers
 Other residents
 It has been found that forming new relationships has more of a positive effect than
the continuation of existing relationships (Thomas et al., 2013)

11. Relationships
Social Engagement
 Increased levels correlated with:
 Lower mortality rates
 Better cognitive function
 Greater physical/health functions
 Over all well-being
Social Isolation
 Can be associated with:
 Risk of poor nutrition
 Negative health behaviors
 Cancer
 Cardiac disease
 Increased risk of all-cause
mortality
(Thomas et al., 2013)

12. Relationships
 Role of nursing home staff
 CNAs provide more than 80% of personal care to their residents
 Education and practical training may not prepare them for the type of care that
fosters meaningful relationships with those residents (Heliker, 2009).
 Suggested interventions to build and maintain relationships with nursing home
residents:
 Daily uplifts
 Story sharing

13. Daily Uplifts
(Danhauer et al. 2006)
 Meaningful events include, but
not limited to:
 Praying
 Reminiscing
 Visiting/writing someone
 Feelings of safety
 Socializing
 Gossiping
 Giving/getting love
 Maximizing opportunities for
events such as these promotes
Quality of Life
 Defined as perceived positive
events or occurrences in
one’s life that bring feelings
of joy.
 These events have been
associated with well-being
and quality of life.
http://seniorcarecorner.com/nursing-home-choosing-right-one

14. Story Sharing
(Heliker, 2009)
 Connects the care provider
to the resident by making
them aware and sensitive to
that person’s background.
 Enhances relationships with
other residents
 Communication on a personal
level
http://www.hebrewseniorlife.org/

15. Resident Choice

16. Resident Choice
 When an individual enters into the nursing home environment, they are
integrated into an unchanging system that can lead to repetitive activities
resulting in reduced autonomy (Sullivan, Asselin, 2013).
 Observational studies have discovered that staff members often neglect to
present residents with choices because they may not be convenient for the
efficiency of the facility (Burack et al., 2012).
 The average resident day is defined by the schedule of the facility, and often
revolves around mealtimes (Burack et al., 2012).

17. Resident Choice
 Activities
 “Activities can enhance a person’s sense of well-being and serve as a source of
interest, satisfaction, and structure in daily life” -(Kracker et al., 2011)(p.103)
 Activities that are chosen by the resident(s) have been associated with positive
reactions and overall satisfaction with life (Danhauer et al., 2006).
 Studies have shown that residents who engage in regular activities appear to
express less depressive symptoms and are happier (Kracker et al., 2011).
 Kracker et al. (2011) reported a study that covered 45 facilities and 135 residents
and discovered that sixty-one percent of participants ranked “choice and control”
of activities “very important” in their daily life (p. 104-105).

18. Resident Choice
 Spirituality
 has been found to be an important component of health and healing, and the
choice to participate should be incorporated in the daily curriculum of nursing
home residents (Carr, Hick-Moore, & Montgomery, 2011).
 can give a person purpose, forgiveness, inner strength, and connect them to self,
others, and the world around them (Carr et al., 2011).
 may also provide self-transcendence, and a framework for coping skills for illness,
loneliness, despair, and death for nursing home residents ultimately effecting their
overall well-being (Haugan, Rannestad, Hammervold, Garåsen, Espnes, 2014).

19. Selective Optimization with
Compensation Model

20. Selective Optimization with
Compensation Model (SOC)
 The SOC model utilizes a process that reviews and analyzes adaptational
behaviors in older adults as levels of function change.
 Defined by three criteria:
 Selection
 the limiting or removing of certain activities as a result of loss of capacity
 Optimization
 the effort placed in augmenting desired activities in order to continue functioning
 Compensation
 searches for alternate means to reach desired goals
(Baltes & Baltes, 1990)

21. Selective Optimization with
Compensation Model (SOC)
 Perceived constraints, or barriers, may prevent an individual from being
physically active, and/or participating in other activities or social situations
(Son, Kerstetter, Mowen, Payne, 2009).
 Constraint-self-regulation strategies such as time-management, skill
acquisition, interpersonal coordination, and asking for help can aid in
offsetting the impact of constraints experienced by older adults in nursing
homes (Son et al., 2009).
 Loss of function due to chronic illness, or disability, affects the lives of many
older adults; to that end, a systematic integration of coping mechanisms,
such as the SOC model, allows older adults to adapt to disability in order to
manage their condition efficiently (Gignac, Cott, Badley, 2002).

22. Conclusion
Collectively the literature portrays many initiatives towards
improving quality of life; however, these studies are only
useful if they can be translated to the daily practice of care
providers. With the aging of America upon us, it is
imperative for health care professionals to not only focus on
physical needs of individuals in long-term care, but also
create personal, individualized care plans that can enrich
one’s life on different levels

23. References
Baltes, P.B., & Baltes, M.M. (1990). Psychological Perspectives on Successful Aging. The Model of
Optimization with Compensation. In P.B. Baltes & M.M. Baltes (Eds.), Successful Aging:
Perspectives from the Behavioral Sciences (pp. 1-34). Cambridge, England: Cambridge University
Burack, O. R., Reinhardt, J. P., & Weiner, A. S. (2012). Person-Centered Care and Elder Choice: A Look at
Implementation and Sustainability. Clinical Gerontologist, 35(5), 390-403.
doi:10.1080/07317115.2012.702649
Buron, B., & Killian, T. (2014). Promoting Personhood in Men in Nursing Homes: The Role of Activity
Directors. Anals of Long-Term Care, 28-33.
Carr,T.J., Hick-Moor,S., Montgomery, P. (2011). What’s so big about the ‘little things’: A
phenomenological inquiry into the meaning of spiritual care in dementia. Dementia,
10(399),originally published online 31 May, 2011. doi: 10.1177/1471301211408122

24. References
Danhauer, S., Sorocco, K., & Andrykowski, M. (2006). Accentuating the positive: recent "uplifts" reported
by nursing home residents. Clinical Gerontologist, 29(3), 39-58.
Freund, A.M. (2002). Selection, Optimization, and Compensation. Encyclopedia of Aging. Retrieved from
http://www.encyclopedia.com
Gignac, A.M., Cott,C., Badley,E.M. (2002). Adaption to Disability: Applying Selective Optimization with
Compensation to the Behaviors of Older Adults with Osteoarthritis. Psychology and Aging, 17(3),
520-524. Doi:101037//0882-7974173520
Haugan, G., Rannestad, T., Hammervold, R., Garåsen, H., & Espnes, G. A. (2014). The relationships
between self-transcendence and spiritual well-being in cognitively intact nursing home patients.
International Journal Of Older People Nursing, 9(1), 65-78 14p. doi:10.1111/opn.12018

25. References
Haugan, G., Utvær, B.,Karin St, & Moksnes, Unni Karin,PhD., R.N. (2013). The herth hope index-A
psychometric study among cognitively intact nursing home patients. Journal of Nursing
Measurement, 21(3), 378-400. Retrieved from
http://search.proquest.com/docview/1495394262?accountid=14752
Heliker, D. (2009). Enhancing relationships in long-term care through Story Sharing. Journal Of
Gerontological Nursing, 35(6), 43-49. doi:10.3928/00989134-20090428-04
Kane, R., Rockwood, T., Hyer, K., Desjardins, K., Brassard, A., Gessert, C., & Kane, R. (2005). Rating the
importance of nursing home residents' quality of life. Journal Of The American Geriatrics Society,
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Kracker, J., Kearns, K., Kier, F. J., & Christensen, K. A. (2011). Activity Preferences and Satisfaction Among
Older Adults in a Veterans Administration Long-Term Care Facility. Clinical Gerontologist, 34(2),
103-116. doi:10.1080/07317115.2011.539522

26. References
Sjögren, K., Lindkvist, M., Sandman, P., Zingmark, K., & Edvardsson, D. (2013). Person-centredness and
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