Social aspects in care homes: often underestimated, but indispensable

What about social participation, interpersonal care and well-being in retirement and nursing homes? Sociologist and ageing expert Prof. Dr phil. François Höpflinger explains in our first expert interview why social factors are often neglected in long-term care and why they should be given more attention.

François Höpflinger, Prof. Dr. phil., is a renowned social scientist, emeritus titular professor and member of the steering committee of the Centre for Gerontology at the University of Zurich. With his many years of expertise, he is probably the most sought-after expert on ageing in Switzerland and a key voice in the debate on the challenges and opportunities of an ageing society.

We asked Mr Höpflinger to answer some of our burning questions about the importance of social aspects in retirement and nursing homes:

How do you assess the current situation in retirement and nursing homes with regard to social aspects and interpersonal care?

This varies depending on the staffing situation and how the facility is embedded in the neighbourhood and community.

The situation varies enormously depending on the age and care facility, depending on the staffing situation and how the facility is embedded in the neighbourhood and community. A precarious staffing situation, probably exacerbated by numerous redundancies, leads to a concentration on pure nursing and care services, to the detriment of social relationships. However, retirement and nursing homes that are well integrated into the neighbourhood and community are more likely to be able to mobilise additional volunteers or financial resources for social encounters and projects such as walking companions or regular visits from the neighbourhood.

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What role does social participation play in the quality of life of residents of retirement and nursing homes?

The desire and strength to socialise is individual.

Being recognised for your individual life story is also important in a care home. Opportunities to maintain previous contacts - for example with former neighbours - or to take part in social events inside and outside the home can also play an important role. However, the desire as well as the strength to socialise is individual. Especially among very old care home residents, there are quite a few who prefer peace and quiet and not too much ‘hustle and bustle’.

Participation projects in retirement and nursing homes (residents' council, etc.) are only popular with a minority. Many elderly people are happy to delegate the organisation of everyday life. This is especially true for those who no longer have the strength to deal with complex issues.

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To what extent are social factors taken into account in the current quality assessment of retirement and nursing homes? Is this sufficient?

A higher evaluation of social factors is crucial not only for the residents, but also for the staff.

Previous quality assessments of retirement and nursing homes have focussed on nursing services (good care, cleanliness/hygiene, etc.) and less on social factors - partly because support and communication are not services that are covered by health insurance. A higher evaluation of social factors is not only important for the residents, but also for the staff: a good team atmosphere has a positive effect on the residents, just as good social interaction between residents relieves the staff. Conflicts among staff and conflicts among residents are often interrelated.

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What challenges does demographic change pose for retirement and care facilities, particularly with regard to social care?

The social transition from living alone to living with others must be accompanied and organised in a more targeted way in future.

Firstly, the proportion of residents with dementia-related limitations has increased in care facilities and will continue to rise. Dealing with people suffering from dementia not only requires targeted training for staff, but also adaptation of the social environment. In addition, new generations of people with dementia sometimes have a strong urge to move around, which increases the need for targeted walking support (including by volunteers).

Secondly, the proportion of residents who have no relatives or whose relatives do not live nearby is increasing. This leads to a growing number of residents who are dependent on new confidants in the home, with the establishment of new contacts after entering the home becoming an increasingly important task.

Thirdly - at least in Switzerland - many elderly people who move into a retirement or nursing home have often lived alone for years. They are used to deciding everything themselves and on their own. When they move to a care facility, they enter an often overwhelming social community; many unfamiliar faces, shared meals with other residents, etc. The social transition from living alone to living with others must be accompanied and organised in a more targeted way in future.

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What measures would be necessary to anchor social aspects more firmly in care? Are these currently given sufficient consideration?

It is essential that individual differences in social needs are recognised and acknowledged.

Better financial compensation for communicative processes in medicine and care (in the KVG) is certainly crucial, not least because communicative misunderstandings are not uncommon among people in old age - whether due to hearing problems or because people from previous generations are unable to understand today's terms.

However, it is also crucial that individual differences in social needs are recognised and acknowledged. Example: Visits by children to the home are met with a very positive response from the majority, but some older people can and want nothing more to do with children, e.g. because of bad memories of their own childhood.