Ideas & Tips for
Visiting Nursing Home Residents

We should value all ages in our communities, from the very young to the very old. But the oldest old in nursing homes and assisted living facilities often feel isolated and excluded (find out more about Community and the Old). Developing stronger connections between these older adults and their community can have tremendous benefits for young and old. Even older adults with serious memory loss can still enjoy a visit, even if they don't remember it later. Elementary-aged children, especially those in fourth to seventh grades, often value the opportunity to make a difference in an older person's life. They are eager to help in a nursing home once they become comfortable. They learn how to interact with people different than themselves and they learn responsibility -- because the older people depend on them.

While a single visit to a nursing home is a valuable experience for children and will brighten the day for older adults, an ongoing visitation program is most effective. Said one staff member in a nursing home, "We don't want it to be 'let's go see the old people' just like it's a trip to the Statue of Liberty." An ongoing series of visits allows the understanding and trust to develop which are essential for a real connection between people of any age.

Before children visit a nursing home, you may want to read and talk about some of these storybooks: Sunshine Home by Eve Bunting; My Grandma's in a Nursing Home by Judy Delton; Loop the Loop by Barbara Dugan; Wilfrid Gordon McDonald Partridge by Mem Fox; Always Gramma by Vaunda Micheaux Nelson; Remember That by Lesléa Newman; A Visit to Oma by Marisabina Russo; Old People, Frogs and Albert by Nancy Hope Wilson.

Talk about what to expect during a visit to a nursing home (e.g. residents in wheelchairs, unfamiliar smells, some residents may not seem responsive, etc.). Answer any questions or concerns young people may have. Talk about their feelings about visiting older adults. Many older people never have visitors and spend their days alone and lonely. Why do you think this is? Do you think it's because we don't want to think about growing old? Why or why not? Have you ever been in a nursing home or other seniors' care facility? How did you feel?

Now plan a visit to a nursing home or other seniors' care facility near you. Some general tips:

• Be sure to plan a visit at least two weeks in advance. Let the activities director know you're coming. They can often suggest the residents who would most welcome a visit (some older adults are in higher care units than others). The best times to visit are generally mid-morning from 10:00-11:30 am, in the afternoon from 2:00-4:30 pm, and sometimes in the evening from 6:00-7:30 pm.
  
  
• Since visitors may be rare, the activities director will probably put your visit on the calendar of events so that residents can look forward to it.
  
  
• Babies and toddlers who are full of grinning energy make good visitors, as do older children and teenagers. For toddlers, make sure they've had a nap beforehand and are fed.
  
  
• You can make the visit informal, just talking with and moving to various residents one-on-one, or you can plan to do a presentation like a short play or a series of songs (you can even invite residents to participate in familiar songs by singing along or clapping). Children can also bring gifts for the residents, like drawings or colorful, handmade cards (many ideas are included in the various Legacy Project activity kits). Or work on a project beforehand like making a scrapbook of funny cartoons (which children have either drawn or cut out of the newspaper) to share with residents. Other appropriate gifts for special occasions include live flowers, a colorful lap blanket or pillow, and warm, soft slippers (with a good tread) or sweaters. If you want to bring food, make sure you clear it with staff beforehand.
  
  
• If you're going to be visiting with specific people, learn something about them beforehand -- their interests, background, limitations, and needs. And although some behavior may seem childlike, remember that older adults are adults, not children. Acknowledging a person's personal history and lifetime of experiences is what allows older adults to maintain their respect, dignity and, often, their connection to the world around them.
  
  
• Remember that the care facility is home to the older adults and you should respect their privacy and living space as much as possible. When you're entering a room, even if the door is open, knock first.
  
  
• One-on-one visits will vary. You may find residents in the lobby, hallway, garden, community room, as well as their individual rooms. Start a conversation by introducing yourself casually: "Hello. My name is... Would you like me to visit with you today?" Some people may not want to visit, but most will say yes. Your interaction will be short or long depending on the person. Even a few minutes can brighten a resident's day.
  
  
• During one-on-one visits, children may need some gentle encouragement to get past their shyness. An adult like a parent or teacher can lead in some questions to get the interaction going. For example, children can talk about what they like to do in school, or what hobbies they have or sports they play in. This might lead into questions about sports or hobbies the older adult might be interested in, or their memories of their schooldays. Young children might bring a favorite stuffed animal to "introduce" to residents.
  
  
• Don't be in a hurry. Most residents have time on their hands and your visit will probably seem short no matter how long you stay.
  
  
• Don't feel obligated to solve the personal problems of a resident. Just being there to listen and empathize is important.
  
  
• At the end of each conversation, before you move on to visit with the next person, thank the resident for spending time with you. You can shake their hand or offer to give them a hug. If a person doesn't want you to leave, try to get them involved in another activity, take them to be with a group of people, turn on the television, or place something in their hands like a small memento that they can hold on to.
  
  
• Keep promises. Don't promise to return if you aren't able to come back. Never say anything unless you mean it.

After a first visit to a nursing home, talk about what happened and how young people felt. Do you think you made a difference in the lives of the residents? Why? What did you learn about older people? Do you think visiting older people is important? Why?

One of the biggest barriers to young and old coming together is often difficulties communicating. They may not know what to say to each other, feel uncomfortable, or are unsure about how to make a meaningful connection. A great introduction to communication in general is Aliki's storybook Communication. It explores the many forms and aspects of human communication and is a good starting point for intergenerational communication.

For older adults with few functional limitations, reading a picture book with a child can be a great icebreaker. Reading takes the pressure off both young and old to "entertain" each other. Other simple activities to help older adults communicate with the young include the "Hot -- and Not List" and "Grandchild Interview" in the Communication & Storytelling section of the Grandparents Day Activity Kit, and the "Did You Ever...?" activity in the Storytelling for Hope section of the Holiday Activity Kit. Children might want to do an interview with an older adult using pages from the "Generations Scrapbook" activity in the Scrapbooking & Other Photo Fun section of the Grandparents Day Activity Kit, or use the "Grandparent Interview" activity in the Communication & Storytelling section of the Grandparents Day Activity Kit. Teenagers can take the lead in communicating with older adults using the "Fill-in-the-Blanks Life Story" in the Storytelling for Hope section of the Holiday Activity Kit. The Ages & Stages section of the Grandparents Day Activity Kit also has useful information and activity ideas.

Here are some tips to help children, teenagers, and adults communicate with older adults with serious cognitive or other functional limitations:

• Begin a conversation with orienting information. Identify yourself, if necessary, and call the other person by their name. Say something like, "I'm here to visit with you."
  
  
• Reduce distractions to minimize the person's confusion -- noise (e.g. phones ringing, people talking, even street traffic), crowding, glare, unrelated activity, etc. Even moderately impaired people can "overload" from too much distraction and may withdraw, have outbursts, or attempt to leave.
  
  
• Be aware of how you're presenting yourself. Are you angry, tense, or frowning? Older adults can be extremely sensitive to nonverbal signals like facial expression, body tension, and mood. If you make a point of being relaxed and smiling a lot, the other person is more likely to respond in the same way.
  
  
• Touch and emotional tone are important. Take a calm, gentle approach. Reach out and make physical contact at appropriate times during a conversation (e.g. touching a person's hand in a comforting way).
  
  
• It's important to be at eye level with the person you're talking with. Look directly at them when you speak, and make sure you have their full attention.
  
  
• Use your normal conversational tone, but take into account any hearing impairment (e.g. favor good ear).
  
  
• Speak slowly, articulating each word. Use simple, straightforward sentences. Be clear, but not patronizing. Take your cues from the other person to determine what they do and do not understand. If necessary, slowly and calmly repeat a statement. It may take several repetitions before the person understands you. Supplement words with nonverbal gestures to reinforce or explain your message.
  
  
• Be patient. You need to allow time for the older adult to absorb, understand, think, and respond.
  
  
• The capacity to understand is usually greater than an older person's ability to express themselves verbally. Don't put a lot of emphasis on expecting answers to your questions, like "Tell me about your day?" or "What did you have for lunch?" Instead, provide them with information.
  
  
• When you do ask questions, ask one at a time. Start by asking questions simply, in a way that requires only a "yes" or "no" answer. If a person is able to communicate more, they will, and you can adjust accordingly.
  
  
• Use statements that emphasize the "here and now" (e.g. "I like your sweater"). At the same time, linking to the past can evoke fond memories and help structure a visit (e.g. looking through old photos).
  
  
• Respectful, polite listening is often what people want most. They may seem to be rambling, but even the attempt to communicate with you is a good sign. Respond not only to their words, but also to their emotional tone. You can acknowledge a feeling by saying something like, "You sound very sad."
  
  
• If you don't understand something the person says, apologize and ask them to repeat it. Try to focus on a word or phrase you do understand and build on it. If you make a guess, phrase your guess as a question to help minimize frustration (e.g. "Are you saying that you like my ring?").
  
  
• Be prepared that not everything the person does and says will "make sense." For example, a person may ask if you like the hat they're wearing when they're not wearing a hat. You can smile respectfully and move on to talking about something else.
  
  
• Be aware of changes in mood or behavior during a visit and adapt accordingly. If a person becomes upset or angry, don't try to reason or argue with them. It will only make the situation worse. The person may no longer have the ability to be logical or rational. Try cheerfulness, humor, or distraction to politely move on to something more positive. Ignore a verbal outburst if you can't think of any positive response.
  
  
• To minimize everyone's frustration, focus on what the person can do instead of what they can't do. For example, if a person wants to go outside and it's winter, suggest looking through a magazine together.
  
  
• You don't need to fill every moment with conversation. Just sitting and looking out the window can be enough. There are many ways to communicate -- familiar songs, favorite foods, holding hands, walking.
  
  
• Respect the person for the adult individual they are. And remember that even someone with serious memory loss can still enjoy the moment. A compliment, shared joke, or caring smile makes everyone feel good.

Click here to download a free tip sheet -- Tips for Communicating with Cognitively Limited Older Adults -- you can use as a reference and pass along to others.

Click here to get more information and free resources from the
Legacy Project.