Peer Exclusion at Care Facilities

You thought cliques at the cafeteria ended in high school? Think again! While personality conflicts in care facilities are usually unavoidable, peer exclusion is sadly a real thing for kūpuna who have lower physical and cognitive abilities. The exclusion often stems from the higher-functioning residents' stigma, fear, and mistaken beliefs that they cannot connect with the lower-functioning residents, and perpetuated without an adequate bridge to connect the residents. Some kūpuna will even forego all meals in public and social events because they do not feel welcomed or embraced by others.

At the same time, it's common for kūpuna (and/or their families) to worry that they will be the only "normal" person at a care facility. And some kūpuna will even forego moving into a community or facility for that reason, and risk inadequate and/or unnecessarily expensive care at home.

Sound familiar for someone you know? They're not alone!

Generally it's better for kupuna to feel like the biggest fish in the tidepool rather than a manini beyond the reef. So how can that be achieved when the reality is that residents/patients at a care facility will always come and go, and always have different abilities?

First of all, set up the kupuna for success with an appropriately-sized care setting (see our other post about size). Secondly, make sure that the physical and cognitive abilities of the kupuna are within the facility's range of expectations. For instance, residents at an Assisted Living Facility are usually expected to be able to feed themselves in a relatively tidy way.

Then, caregiver support and group activities are the best opportunities to bridge the gap between kūpuna with differing abilities and cognitive conditions.

The caregivers must be aware of everyone's needs, conditions, and abilities, to be able to encourage meaningful interactions between kūpuna. If one resident has a difficult time feeding herself, then other residents may distance themselves from her. With a caregiver bridge facilitating inclusive conversations, then the residents can still enjoy each other's company without focusing on that ability gap.

Well-designed group activities are another bridge. The best activities are simple but can still be engaging and exciting to higher-functioning residents. But more complex activities can also bring residents together, so long as there are modifications that can simplify participation for residents with lower physical or cognitive abilities. Seated balloon volleyball with the assistance of activity aides is a great example that residents with varying degrees of ability can enjoy. Other games that rely on guessing, matching, and chance are another way to level the playing field between residents.

In order for either bridge to function successfully, there has to be enough staff present in the first place: the greater the needs of the residents, the more caregivers and aides are required.