Responding to Distraught Families Crucial to Nursing Home Care

It is a mistake for psychiatrists and mental health professionals who work in or consult to nursing homes to assume that the nursing home resident is going to be their sole focus. Many of these clinicians and other nursing home staff find they spend as much—or even more—time responding to the emotional needs and psychological stresses of the resident’s family members.

For Nancy O’Dowd, a clinical nurse specialist in geriatric psychiatry who consults to several New Jersey nursing homes, more than 10 percent of the consultation visits turn up no new problem with the resident, but serious problems being caused by his or her family “driving the staff crazy.”

Speaking at an APA annual meeting session in Philadelphia in May, O’Dowd identified several factors that lead to the frequent stress-related outbursts that family members direct at nursing home staff.

Paramount among these are the “trap of cognitive impairment”—frustration at not being able to find a way to respond to or communicate with a loved one shifting between lucidity and dementia—and trying to cope with the “ambiguous loss” they feel when their impaired relative no longer recognizes them or mistakes one of them for another person.

She also urged psychiatrists confronting emotionally distraught relatives to be aware that aggressive or unreasonable behavior might be symptoms of the “constant and evolving grief cycles” relatives go through as the resident stays in the home much longer than the relatives had anticipated. Such behavior may also be arising from guilt over decades of family conflict and the relatives’ inability to discuss or resolve the issues now with their cognitively impaired relative.

The emotional expressions that signal relatives grappling with grief reactions are often far from insignificant, O’Dowd pointed out. These include statements accusing the staff of unprofessional behavior or poor decision making, yelling and cursing at the staff, and even verbal or physical threats. Inappropriate behaviors by residents’ relatives are also common, and nursing home staff needs to be alert to them, she advised. In one case she cited, a family who thought they were being helpful handed out sweets to all the residents in the relative’s area, including those who were diabetic and on restricted diets.