25 Common Nursing Home Problems & How to Resolve Them
This reader-friendly guide covers 25 common nursing home problems encountered by residents and their families. These problems occur in nursing homes across the country. Even the supposedly “good” nursing homes often follow procedures that violate federal laws and harm residents. Knowing your rights and having the tools to force or push nursing home staff and management to follow the law can make all the difference.
Whether you are a nursing home resident, a family member, or a supportive friend, this guide gives you the tools you need to identify and then resolve the problems that residents most frequently face. Your determined advocacy can be the difference between going-through-the-motions nursing home care, and the high quality, person-centered care that residents are promised by federal law.
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5 Effective Ways to Handle Common Problems and Complaints in Nursing Homes
As an adult child, caring for your elderly parents who can no longer look after themselves can be a challenge. You may find that juggling between their needs and your responsibilities can become unmanageable in the long run. Although this may be a difficult choice, you may need to think about sending your loved one to a nursing home or consider in-home care. All in all, you want your parents in an environment where they can thrive and enjoy a quality life.
Nursing homes provide care to millions of senior citizens in the United States. These facilities provide compassionate quality care from the professionals most of the time. However, family members or even residents may sometimes complain about the quality of care. Feel free to speak out if you have concerns about a specific incident or an ongoing situation. Read on to learn how to problem-solve in nursing homes to get results.
How to Handle Common Problems and Complaints in a Nursing Home
The nursing home industry is constantly faced with various challenges due to ever-changing regulations, staffing shortages, and declining profits. These may lead to negligence issues since the available staff is expected to perform complex treatments with limited resources.
While some actions may cause inconveniences but no harm to the overall health of patients, others may cause pain and even serious harm. Physical abuse and neglect are major causes of concern because they put your loved one in immediate danger of severe injury or death.
Here are practical steps to take if you have concerns about the quality of care in a nursing home.
Investigate Before You Complain to the Staff or Administration
There are various forms of complaints in nursing homes. While many are valid and need immediate action, some are personal views about the lack of quality care among residents and family members with straightforward solutions. Be sure to talk to primary caregivers and get details before complaining to the staff or administration. It might just be a misunderstanding with a simple explanation. Some common complaints include:
There is always a possibility of conflict when people share a room due to differences in personalities and interests. It is best to give the residents a period of adjustment to know each other if the facility lacks private rooms or if you cannot afford one. Also, many nursing homes allow room change if the conflict cannot be resolved.
Items are likely to get lost in shared spaces. They may not be necessarily stolen but can be misplaced. It is advisable to have an insurance cover on items that get easily lost, like eyeglasses, hearing aids, and dentures.
There is no doubt that home meals are better than nursing facility food. As people age, they tend to lose taste making it impossible to enjoy even good food. This may lead to malnutrition if left unchecked. You can ask the caregivers about the kinds of food allowed within the facility and bring some whenever you visit. Just ensure that the meals are within their special diet list.
Work To Establish Good Relationships with the Nursing Aides
The aides are the people who look after your loved ones. Build trust and friendship between them, your family, and other residents. Make an effort to know them as individuals and appreciate the excellent work they do. You can also help them understand your mother’s habits, preferences, and quirks. This allows the staff to take good care of your loved ones. For instance, they may know to whom the hearing aids they found in the bundled bedsheets belong.
Get Involved in the Nursing Home
Do you have any talent that you can share with the residents? Most times, there is nothing much for the elderly to do, leading to another common problem in nursing homes, boredom. You can volunteer your skills during regular events and become a familiar face in the community. The skills can be music, computer instruction, storytelling, or art.
At times, all your parents need is to spend some quality time with their loved ones. Ask your family and friends to join in the fun and become part of the community. Your parents are more likely to participate in group activities, keeping them engaged. Also, become a regular visitor, show up any time of the day, and make yourself a welcome presence among staff and residents. It allows you to observe, note, and report serious lapses in care such as neglect of personal hygiene, weight loss, illness, or apparent deterioration.
Don’t Miss Important Meetings
Nursing homes have regular meetings, quarterly or yearly. You can ask the staff for the dates and times of such meetings and include them in your calendar. Take this opportunity to understand how things run in the facility and give suggestions where needed. Compliment the staff when they are doing well, and they will be more inclined to change when things go wrong
You can also ask questions and raise your concerns with the direct caregivers regarding your family member. Be sure to consider what the staff says since they spend more time than anyone with the residents. They may know your loved one needs more than you may like to admit.
Follow Chain of Command in Case of Serious Problems
It is a good idea to try solving things with the staff or organization first. You can talk to the individual in question or manager to put things right through an informal conversation. However, you should launch a formal complaint about serious issues such as verbal, physical, and sexual abuse to the nursing home administration, an ombudsman, and the department of health in your state.
Nursing homes provide 24/7 skilled nursing and supportive care to aging and disabled adults. While most residents and their families have a positive experience with nursing facilities, problems may sometimes arise. Raising concerns is crucial in protecting the rights of the elderly and improving the quality of nursing home services. Ensure to approach the issue with a mindset of problem-solving as opposed to blaming. And if all this doesn’t work, email [email protected] and someone on our corporate team will contact you.
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Using Nursing Home Staff to Solve Problems in the Nursing Home
Nursing home staff can help solve some of the problems within a nursing home.
Nursing home residents and their advocates, as a general rule, should always try to solve any problems with the facility by talking to the person who has the power to fix the problem. You have the right to voice complaints, including complaints about treatment that was received or was not received, without fear of retaliation. The facility must promptly attempt to solve the problems.
Here are some people within the nursing home staff that might be able to help you. There may also be other people in your nursing home that can help. Some of the people listed (for example, the bookkeeper) may be available only during normal business hours or by appointment, if an evening consultation is needed.
The nursing home administrator is the one who is responsible for the overall operation of the home. The administrator has the most responsibility. However, you should usually first go to the person who is in charge of the particular area where you are having a problem. It is important to talk to a person who does have authority to correct the problem.
There is generally a "charge nurse" responsible for the nurses on the shift.
There is also a director of nursing who is responsible for nursing staff and nursing policies and procedures.
Most homes have a person in charge of housekeeping. The nursing supervisors may also have authority over housekeeping personnel.
All homes have a food service supervisor who is responsible for buying, preparing, and serving food. If nursing staff serves the food, the nursing supervisors are responsible to see that it is served properly (at proper temperature, for example). There should also be a dietician or consultant dietician available.
Generally, the bookkeeper and administrator are most directly responsible for residents' finances.
The nursing home's social services staff may be of assistance in solving problems that do not fall into the above areas. For example, the social services designee is responsible for helping the resident cope with problems. A social services designee has successfully completed a training course. A social worker with a college social work degree may also be available.
Last revised: 04-2014 LSC Code: 1591904
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14 Common Nursing Home Problems & How to Fix Them
One of the most difficult choices adult children have to make is how to take care of your aging parents when they’re no longer able to care for themselves. As you juggle your responsibilities and their needs, you may find you can’t provide all the care your parents need in the long term.
You and your family may need to consider whether your loved one should be in a nursing home or whether they are better suited to in-home care. Ultimately, you want your loved ones to be in a setting where they will thrive and enjoy a good quality of life.
Nursing homes are often the first choice because these facilities offer 24/7 medical care from professional nurses – but it’s important to consider some common nursing home issues before making a decision. Read on for details.
14 Common Nursing Home Problems
1. increased costs.
Nursing homes generally cost more than in-home care or assisted living facilities. While some costs will be covered by private insurance, Medicare, or Medicaid, you may find monthly fees are outside what’s affordable.
If your parents own their own home and don’t need more intensive medical care, having a caregiver stop by to provide daily assistance and other services might be a better option.
2. Smaller Living Arrangements
Nursing homes try to provide different areas in the facilities so the residents can move about. Still, your aging parents will likely be transitioning from their home to smaller living arrangements than they’re used to.
Such sudden changes can lead to a more difficult transition for your aging parents who now have to become familiar with their new environment.
3. Living Among Other Residents
One of the perks that nursing homes promote is that your aging parents will be among other residents in their age group, so they can interact and make friends. Yet this perk isn’t always well accepted.
If your loved one doesn’t get along with other residents or prefers to spend time alone, you may be able to request room changes. But not all nursing homes can accommodate everyone’s wishes.
4. Fewer Chances to Go Out
Nursing homes generally provide social activities that your parent can participate in, both inside and outside the care facilities. But in most nursing home settings, residents have less freedom to venture out to do activities of their own choosing.
Instead of being able to go to a museum or catch a movie on their own schedule, they will generally have to follow the social activities set by the nursing home.
5. Boredom and Isolation
While nursing homes strive to provide age-appropriate activities, they may not be ones that your parents had done before or liked. Your loved ones may isolate themselves in their rooms if they can’t do the activities they enjoyed before moving to the nursing home.
Your loved one may also feel depressed or overwhelmed because of all the changes to their living environment. Simply put, they may want to go home.
6. Disregarding Preferences
They say we shouldn’t sweat the small stuff, but what if the small stuff is what really matters to your loved one? They may have a preferred chair, cup, or newspaper.
More importantly, they may have a preferred time of day to wake up and go to bed. Many of these wishes are impossible to fulfill in a nursing home setting.
7. Less Say in the Care Plan
Nursing homes often have a set procedure for running their program, the health care systems, and caring for their residents.
While you might express your opinions or desires for your loved one, the care plan will ultimately be carried out based on what the nursing home staff members deem appropriate.
8. Restricted Visiting Hours
It can be hard for friends and family to find the time to visit loved ones in nursing homes, especially if the available visiting hours are restricted. Keeping your loved ones at home means they can receive visitors anytime they like.
9. Poor Food Quality
Providing nutritious food to people who all have different preferences is a challenge. Nursing homes may strive to do their best, but a limited budget may mean the food is sometimes bland or unappealing. If your loved one is at home, they’ll have more meal options.
10. Disruptions in Sleep
Anyone who has ever given birth knows that just when you and your baby are getting to sleep, a medical assistant may show up to check your vitals and run more tests. The same goes for a nursing home.
Your loved one may prefer hours – or even days – without care but often they won’t have a choice due to protocols of the establishment.
11. Improper Use of Restraints, Medications, or Feeding Tubes
In more serious cases, nursing home residents may face extra challenges. Your loved one may be restrained, given medications to alter their behavior, or fed by a tube against their will. At home, those decisions will lie with you and your loved one.
12. Staffing Issues and Slow Response Times
Staffing levels are part of a wider economical and social picture and sometimes a nursing home may not be able to attract the personnel it needs. This may lead to slower response times and a drop in the quality of care.
Insufficient care could mean your loved one suffers from bedsores or an infection due to a missed check-up, whereas in-home care will be on schedule.
13. Complications with Medicaid
Most nursing homes accept Medicaid but there can be issues getting approval for certain treatments and services. For example, a service may be discontinued and the coverage revoked if your loved one wasn’t seen to make enough improvement.
14. Eviction Issues
There’s always be a risk of eviction when your loved one isn’t living at home. Reasons for eviction may include being “difficult,” complaining too much, refusing medical treatment, or be related to non-payment or the end of Medicare.
How to Fix Common Nursing Home Issues
1. form a good relationship with staff.
Take the time to build trust and a friendship between your loved one, the staff, residents, and family members at the nursing home. Let the aides know you value their hard work and, in turn, they may value your input about the things that matter most to your loved one.
2. Be an Active Visitor and Get Involved
Volunteer to help out with special events and spend time in the community visiting rooms so your loved one sees you interacting with the aides and other residents. This may mean they’re more likely to take part in group activities.
3. Go to Meetings and Raise Concerns
Attend administrative meetings at the nursing home, such as quarterly or annual meetings. Find out how things run and provide your input. Don’t be afraid to mention issues but balance the problems with positive feedback where possible.
4. Keep Notes on Any Lapses
Make sure you keep detailed records of anything that’s bothering you at the nursing home. Maybe you don’t feel a lapse is worth mentioning the first time, but then after a second or third time, you will want to bring it up. Make note of any weight loss or signs of neglect.
5. Get All the Details Before You Complain
Before you lodge a complaint, talk to your loved one’s immediate caregivers and get as much detail as you can. Then go up the ladder – all the way to your ombudsman – until you get a positive response and see change.
Are You Considering In-Home Care?
In-home care is a more cost-effective alternative to a nursing home. Even better, it doesn’t come with many of the issues that nursing homes face. You can help your parents make the best decision for their future by considering their health, happiness, and individual preferences.
How To Choose The Right Home Care Agency [A Guide]
AARP: 5 Rules for Handling Common Problems and Complaints Justice in Aging: 25 Common Nursing Home Problems and How to Resolve Them
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Long-Term Care Basics
preventing & Resolving problems
Unfortunately, it is common to experience problems with the long-term care system, from staff not answering call bells to administering medication without consent to abusing or neglecting the residents. You have a right to quality long-term care, and providers have an obligation to address your concerns.
Your Regional ombudsman
Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen provide information about how to find a facility and what to do to get quality care. They are trained to resolve problems. The ombudsman can also assist you with complaints.
Know your Resident’s Rights
It is very important for all of us — resident, family, volunteer, staff, friend, or citizen — to understand the legal rights of people who live in long-term care facilities. It is easy for residents and their family members to feel helpless and overwhelmed.
However, it is important to remember that consumers have choices, and there are many laws designed to protect long-term care residents. Knowing your rights will help ensure that you receive an excellent quality of care.
Resident Rightsin a nursing home
The rights of nursing home residents are codified in both federal and state statutes with the intent of further protecting each resident’s civil, religious, and human rights while they reside in a nursing facility.
Residents Rights in an Adult Care Home
The rights of residents in assisted living facilities are codified in N.C. General Statute with the intent of promoting and protecting each resident’s civil, religious, and human rights while they reside in an assisted living facility.
Tips for Resolving Conflicts
If a problem or conflict arises, communication and documentation are crucial. Communicate your concerns to the right people. See our Fact Sheet on Nursing Home Concerns: Where to go for help.
Go up the chain of command. If speaking to the attendant/staff person most directly involved is not successful, work your way up. Speak to the supervisor, the administrator/director/manager of the agency or facility, and, if necessary, the person to whom the administrator/director/manager reports.
Put your concerns in writing. Document details about the problem including each time the problem occurs, who was involved, and how the facility responded. Document all conversations. Keep copies of all correspondence
Remember that speaking up often results in better care and services rather than in retaliation. Frequently the "squeaky wheel" really does get the "grease".
Follow the agency/facility policy for grievances. The strength of this approach is that you are using the provider's own process. You can usually express your concern orally or in writing. If you voice your complaint verbally, it is a good idea to also submit it in writing.
Ask for a special care plan meeting to discuss your concerns. Make sure that someone with the authority to change things attends.
Unite with others who share the same concern.
Be calm, polite, and persistent.
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Subscribe here and we’ll send you a monthly newsletter, occasional event announcements, and important long-term care policy alerts.
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April 17, 2017 at 11:09 pm
My facility has always purchased them through our main vendor. They are available from AliMed as well. We keep about 5 on hand all the time. The patient keeps them when discharged for maintenance.
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Original research article, the effects of modified problem-solving therapy on depression, coping, and self-efficacy in elderly nursing home residents.
- 1 Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, China
- 2 Xiangya Nursing School, Central South University, Changsha, China
Background: With the increasing trend of aging, the mental health problems of the elderly require urgent attention. Depression is a common psychological problem of the elderly, which affects their quality of life and physical health. Problem-solving therapy can effectively improve depression in the elderly, but there are few studies on problem-solving therapy for depression in the elderly in China. The purpose of this study was to evaluate the effects of modified problem-solving therapy (MPST) on depression, coping and self-efficacy in elderly nursing home residents.
Methods: This study was a randomized controlled trial. A total of 60 older adults from two nursing homes were recruited to participate in this study and randomly assigned to the intervention group (MPST) or the control group (usual care). The intervention lasted 8 weeks, and information on depression, coping skills, and self-efficacy was collected before the intervention, immediately after the intervention, and 3 months after the intervention. Repeated measures ANOVA was used to compare changes at multiple time points between the two groups. If the interaction effect (group * time) was significant, independent samples t-test was used to compare the differences in outcome indicators between groups at post-intervention and 3 months post-intervention.
Results: Compared to the control group, depression scores in the intervention group were significantly lower at the end of the intervention and remained significantly lower than the control group 3 months post-intervention ( p < 0.05). Negative coping and self-efficacy in the intervention group also improved significantly at the end of the intervention, and 3 months post-intervention, while positive coping in the two groups did not differ significantly at 3 months post-intervention.
Conclusion: The findings of this study suggest that MPST could be beneficial in reducing depressive symptoms and enhancing positive coping and self-efficacy levels in older adults in nursing homes.
The number of people over 60 years old in China reached 267 million in 2021, of which 201 million (14.2%) are over 65, which means that China’s aging problem has already become severe ( National Bureau of Statistics of China, 2022 ). As a part of China’s long-term care system, nursing homes assume an enormous role in developing healthy aging. Due to the late development of China’s nursing home system, most nursing homes are facing several problems (lack of professional caregivers, security service system to be improved, etc.), and their services are mostly daily care and medical services, lacking psychological care services ( Chen et al., 2021 ; Meng et al., 2021 ). Additionally, the closed environment of nursing homes and the lack of social support for residents also influence negatively on the mental health of elderly in nursing homes ( Zhao et al., 2018 ). With aging, older adults experience degenerative changes of the nervous system, including sensory slowing, attention decline, and thinking slowdown, which may result in low self-esteem, low self-efficacy and negative coping, heightening the risk of depression in the elderly ( Fernández-Pérez et al., 2020 ; Whitehall et al., 2020 ). A meta-analysis showed that the overall prevalence of depressive symptoms among older adults in nursing homes in China was up to 37.49% ( Zhao et al., 2020 ). Depression in older adults is not only associated with physical health, quality of life, and suicide risk, but also a potentially increased social burden ( Casey, 2017 ; Alexopoulos, 2019 ). Hence, implementing psychological interventions to reduce depressive symptoms among the elderly in nursing homes is of great value.
As a non-pharmacological treatment method, problem-solving therapy (PST) is structured, systematic, and widely applicable, and has been widely used in the treatment of depressed patients with effective results ( Cuijpers et al., 2018 ). PST is a problem-oriented approach to guide depressed patients to identify their problems, supplemented by problem-solving skills correctly (e.g., setting reasonable goals, brainstorming methods to identify solutions). Therapists use PST to help individuals better manage their life problems and improve their daily life experiences, thus effectively solving problems, improving their coping skills and reducing depressive symptoms caused by complex problem-solving ( Alexopoulos et al., 2016 ; Shang et al., 2021 ). Alexopoulos et al. (2016) conducted a randomized controlled trial of problem-solving therapy versus supportive psychological interventions in homebound elderly depressed patients and showed that problem-solving therapy was superior to supportive psychological interventions in improving depression in the elderly.
Unlike other psychotherapies, PST can be administered by healthcare professionals with non-psychological backgrounds, such as community physicians, nurses, and social workers who can qualify as therapists after a brief training period. Two studies that took nurses as therapists to intervene with depressed elderly patients showed that nurse-led PST had an ameliorating effect on depression ( Gellis et al., 2014 ; Haejung et al., 2015 ). This characteristic of PST enabled a much lower intervention cost and facilitated its replication. Compared to other psychological interventions, PST has greater adaptability to the environment, and is not only suitable for face-to-face interventions but also performed in telephone format, for which different forms of PST could improve the patients’ depression ( Kirkham et al., 2016 ). Despite its many advantages, PST is rarely used in the elderly population in China, but it has been carried out in other populations (kidney transplant patients and stroke patients) with positive results, which have confirmed the improvement of depressive symptoms of PST, indicating the applicability of problem-solving therapy in the depressed population in China ( Gong, 2015 ; Ye et al., 2019 ).
Based on previous observations by the team members, the researchers found that the elderly in nursing homes have low knowledge towards depression and psychological interventions, and the traditional PST program has a relatively short time for education on depression. Thus, a modified problem-solving therapy (MPST) in this study was designed based on social problem-solving theory and self-efficacy theory ( Bandura, 1977 ; D’Zurilla and Nezu, 1990 ; Chang and D’Zurilla, 1996 ) see Figure 1 . The traditional PST, and the main differences between MPST and traditional PST are (1) increasing the time for older adults to understand the knowledge about depression and intervention. In the first session, only the knowledge was introduced. Only introducing the relevant knowledge in the first session is beneficial for the older adults to adequately understand the relevant knowledge and increase the interaction between the researcher and older adults, deepening older adults’ trust in the researcher. (2) By adding a group intervention, we encourage older adults to share their experiences and feelings during the intervention to increase their recognition and sense of belonging, and improve their confidence in coping with problems. The study aimed to explore the effects of modified problem-solving therapy (MPST) on depression, coping and self-efficacy in nursing homes elderly. The main hypothesis of this study was that participants who received MPST would experience greater remission of depressive symptoms compared to those who received usual care. The secondary hypothesis was that participants who received MPST had higher positive coping and self-efficacy.
Figure 1 . Theoretical framework.
2. Materials and methods
2.1. study design.
The study design was a randomized controlled trial from two nursing homes in Changsha City, China, between March and December 2021. The researchers contacted the directors of the nursing home and obtained their consent to gain information about the living conditions of the elderly. The researchers introduced the research purpose to eligible elderly depressed people in nursing homes to obtain informed consent and recruited participants based on inclusion and exclusion criteria. After participants provided informed consent and completed the baseline questionnaire (T1), participants were assigned to the intervention group (MPST) and control groups (usual care) according to a random number table. The following measurements were made at the immediate post-intervention (T2) and 3 months post-intervention (T3) to analyze the effect of the intervention.
The inclusion criteria of the participants were (1) Chinese-speaking adults (aged ≥60 years); (2) screened positive for depression (score > 5 using the Brief Geriatric Depression Scale); (3) able to read and communicate in daily life; (4) volunteered to participate in this study. Participants were excluded if they had (1) severe cognitive impairment or serious physical illnesses such as cardiopulmonary failure; (2) currently participating in other studies; (3) currently undergoing psychotherapy or taking antidepressant medication.
2.3. Sample calculation
The sample size was calculated by reference to Zvi’s study ( Gellis et al., 2007 ), through the formula for the sample size required to compare the mean of two samples ( Sun Zhengqiu, 2014 ).
A 5% level of significance (two-tailed test) and a power of 0.90 were adopted, μ α = 1.96 μ β = 1.28, μ α + μ β = 3.24, effect size = δ σ = (μ 1 -μ 2 )/σ = (6.77–1.77)/5.14 = 0.973, n 1 = n 2 = 2(3.24/0.973) 2 + 1 4 1.96 2 ≈23, considering a 20% sample attrition rate, 29 older adults in each group is sufficient to satisfy the hypothesis of the parametric test.
The random grouping method of this study was as follows: Firstly, random numbers were constructed by SPSS 19, and the fixed value of 100 was set as the starting point. The range of random numbers was within the range of 1 to 60, and random numbers were divided into group 1 and group 2 according to the visual box. Group 1 was set as the intervention group and group 2 as the control group. Based on the selected list of the elderly in nursing homes, they were sorted from 1 to 60 in the initial order of last name and matched with the random numbers constructed by SPSS 19.0. If the number was 1, it was included in the intervention group, and if it was 2, it was be included in the control group, so as to achieve randomization.
2.5.1. control group.
The control group received routine care. That is, they were given the necessary care services by nursing home staff, including daily care services, medical care services, health education and social activities.
2.5.2. Intervention group
The intervention group received MPST on the basis of routine care. The MPST was conducted for eight weekly sessions of 30 to 60 min. The MPST intervention program was designed by researchers working in the field of geriatric psychology, including three graduate students, one clinical psychologist, and two geriatric nursing specialists with more than 10 years of experience. Of the three graduate students, two were assigned to collect pre-and post-intervention data, the other graduate student was received training from the clinical psychologist on the content of the MPST and assigned to implement the intervention. The clinical psychologist administered the development of the intervention protocol and the training of the intervention implementers. Two geriatric nursing specialists were involved in the development of the intervention protocol. Based on the preliminary survey, researchers found that the elderly in nursing homes lacked knowledge about depression. Hence, this study developed an intervention model based on the traditional PST to be more suitable for the elderly in Chinese nursing homes. For example, the traditional PST had more content in the first session, including knowledge of depression, the introduction of PST and formal problem solving, while the first session of MPST only introduced the depression-related knowledge and the PST intervention steps to assure that the elderly adequately understood the depression-related knowledge and the content of the study protocol, and the second session formally performed problem solving; based on observations, the researchers found that communication needs existed among the elderly in nursing homes, while traditional PST rarely involved communication within the depressed participants. MPST in this study set up a group session with the purpose of sharing information about their difficulties and experiences during the intervention. Table 1 illustrates the themes of the eight-week MPST intervention. The entire intervention was led by one graduate student. Except for the seventh use of group intervention, MPST was delivered through a one-on-one, in-person approach. The first session focused on introducing the elderly to depression, guiding them to recognize the relationship between depression and daily life problems, and introducing the PST steps. In the second to sixth sessions, the elderly were provided with daily life cases to promote their awareness and selection of problems, and brainstorming techniques were used to create a problem-solving plan and activity schedule. In subsequent meetings, the researcher would be engaged in discussion with the elderly about the implementation of the program and the difficulties encountered in the course of action.
Table 1 . Outline of MPST intervention.
Demographic and disease information such as gender, age, education level, marital status, time in the nursing home, and type of disease were collected.
The short version of the Geriatric Depression Scale (GDS-15) was used to evaluate depression, which had 15 items ( Sheikh and Yesavage, 1986 ). The total score ranges from 0 to 15, with a score of <6 being the normal range, 6–10 being mild depression, and 11–15 being moderate to severe depression. Previous study has reported that the Chinese version of the scale has a Cronbach’s alpha value of 0.79, with a retest reliability of 0.73, which indicates that the Chinese version GDS-15 is widely applicable to the Chinese elderly ( Tang, 2013 ).
2.6.3. Coping ability
The Brief Coping Style Scale was designed by Xie (1998) to evaluate coping ability, which had 20 items. The scale includes two dimensions: positive coping (items 1–12) and negative coping (items 13–20) and was rated on a four-point Likert scale from “not adopted” to “often adopted,” with scores ranging from 0 to 3. The positive and negative coping scores are the sums of the respective entries, and the scores range from 0 to 36 and 0 to 24, respectively. The reliability of the scale applied to the elderly population was good, with a Cronbach’s α value of 0.908, which had good reliability and internal consistency in Chinese populations ( Zhu et al., 2016 ).
The General Self-Efficacy Scale was used to evaluate self-efficacy with 10 items ( Schwarzer et al., 1999 ). The scale is based on a four-point Likert scale, ranging from “not at all correct” to “completely correct,” with scores ranging from 1 to 4, and the scale’s total score is the sum of the entries. The higher the total score, the higher the patient’s self-efficacy level. This scale is a commonly used self-efficacy scale for the elderly at home and abroad, and the Chinese version of the scale has a Cronbach’s alpha value of 0.81, which is suitable for screening self-efficacy of the Chinses elderly ( Qin et al., 2020 ).
All scale data before and after the intervention were collected by two graduate students, who received training on the questionnaire-related items, including the requirements for questionnaire administration and completion; the purpose and significance of the study.
2.6.5. Ethics approval
The study was formally approved by the Review Board of Xiangya School of Nursing, Central South University (No. E202179). This research was conducted after obtaining informed consent from participants. The researchers made an effort to ensure that the participants were fully informed about the aims of this study, the process, and the potential risks and benefits. For those whose depressive symptoms did not decrease after receiving the MPST, the researchers offered other psychological treatment options for them. If the elderly in the control group had intervention needs at the end of the study, they were provided with the same quality of intervention support as the intervention group.
2.6.6. Statistical analysis
SPSS 19.0 software was used for data analysis. (1) Descriptive statistical analysis: Normality test was performed for the quantitative data in general information, depression score, coping style and self-efficacy score; mean and standard deviation were used for data conforming to normal distribution, median and interquartile spacing were used for data not conforming to normal distribution; frequency and percentage were used for qualitative data. (2) Statistical inference: independent sample t-test and chi-square test were used to compare baseline information between the intervention and control groups; Group effects, time effects, and interaction effects (group * time) were calculated by repeated measures analysis of variance (ANOVA) to examine the mean score differences on outcome measures within and between the groups at baseline, post-intervention and 3 months post-intervention. If the interaction effect (group * time) was significant, independent samples t-test was used to compare the differences in outcome indicators between groups at post-intervention and 3 months post-intervention. The test level α = 0.05 and p < 0.05 indicates statistical significance.
Sixty older adults participated in this study, and three older adults were lost during the intervention period, including one person in the intervention group ( n = 29) and two persons in the control group ( n = 28), for a total of 57 older adults who completed the entire intervention. The reasons for the loss of visit: one older person in the intervention group was hospitalized and withdrew due to aggravation, one adult in the control group went home and one adult was hospitalized and withdrew, as shown in Figure 2 .
Figure 2 . Flow chart of study participants.
3.1. Baseline measurements
No statistical differences were found between the intervention and control groups in age, sex, educational status and other sociodemographic data (see Table 2 ). There was no significant difference in the scores of depression, positive coping, negative coping and self-efficacy between the intervention group and the control group (see Table 3 ).
Table 2 . Baseline characteristics of participants.
Table 3 . Depression, coping, and self-efficacy at baseline for both groups.
3.2. Effect of MPST intervention on depression of the elderly in nursing homes
As shown in Table 4 , the results of the repeated measures ANOVA showed that no differences in group effects ( F = 2.738, p > 0.05) on depression were observed between the two groups, while time effects ( F = 24.771, p < 0.001) and the group by time interaction effects ( F = 11.831, p < 0.001) were significantly different. Figure 3 showed depression scores in the intervention group declined significantly from T1 to T2 and increased from T2 to T3, while depression scores in the control group did not change significantly from T1 to T3. Table 5 showed that participants in the intervention group had significant improvements in depressive symptoms at T2 ( t = −2.698, p < 0.01) and T3 ( t = −2.297, p < 0.05) compared to the control group, which indicates that depressive symptoms were significantly improved in the elderly receiving MPST compared to the control group and the effect was maintained at 3 months post-intervention.
Table 4 . Analysis of the effect of time and intervention on depression, coping ability, and self-efficacy.
Figure 3 . The trends in mean scores of depression in the intervention (solid line) and control groups (dashed line) between baseline and 3 months post intervention.
Table 5 . Comparison of depression score among the intervention group and control group after MPST.
3.3. Effect of MPST intervention on coping of the elderly in nursing homes
According to the results of repeated measure ANOVA, the group effects ( F = 1.575, p < 0.05), time effects ( F = 14.626, p < 0.001), and interaction effects ( F = 16.305, p < 0.001) on positive coping were significant. Figure 4 shows that from T1 to T2, positive coping in the intervention group had a significant upward trend and slightly decreased in the control group; from T2 to T3, positive coping in the intervention group slowly decreased. As shown in Table 6 , participants in the intervention group showed significant improvements in positive coping at T2 ( t = − 2.744, p < 0.05) compared to the control group; though the positive coping score in the intervention group was higher than the control group at T3 (22.07 ± 3.89 vs. 20.93 ± 3.08), the difference between the two groups was not statistically significant ( p > 0.05). As shown in Table 4 , the group effects ( F = 6.219, p < 0.05), time effects ( F = 43.290, p < 0.001), and the group by time interaction effects ( F = 24.580, p < 0.001) were significant in negative coping. Figure 5 showed negative coping in the intervention group consistently tended to decrease between T1 and T3, while there was no significant change in the control group. Table 7 showed that participants in the intervention group had significant reductions in depressive symptoms at T2 ( t = −3.087, p < 0.01) and T3 ( t = −3.799, p < 0.001) compared to the control group.
Figure 4 . The trends in mean scores of positive coping in the intervention (solid line) and control groups (dashed line) between baseline and 3 months post intervention.
Table 6 . Comparison of positive coping score among the intervention group and control group after MPST.
Figure 5 . The trends in mean scores of negative coping in the intervention (solid line) and control groups (dashed line) between baseline and 3 months post intervention.
Table 7 . Comparison of negative coping score among the intervention group and control group after MPST.
3.4. Effect of MPST intervention on self-efficacy of the elderly in nursing homes
Table 4 shows that there were no significant differences in group effects ( F = 2.840, p > 0.05) on self-efficacy between the two groups, while time effects ( F = 14.993, p < 0.001) and the group by time interaction effects ( F = 18.033, p < 0.001) were significantly different. Figure 6 shows that the self-efficacy of the intervention group rose to T2 and then decreased, while the control group showed insignificant changes between T1 and T3 ( Table 8 ). The t -test results showed that the self-efficacy scores of the intervention group were higher than the control group at T2 (28.69 ± 6.66 vs. 24.57 ± 6.41) and T3 (27.66 ± 6.15 vs. 24.29 ± 6.07), which were statistically significance ( p < 0.05).
Figure 6 . The trends in mean scores of self-efficacy in the intervention (solid line) and control groups (dashed line) between baseline and 3 months post intervention.
Table 8 . Comparison of self-efficacy score among the intervention group and control group after MPST.
This study investigated the effects of MPST on depression, coping ability, and self-efficacy of the elderly in nursing homes. The results found that the elderly who received MPST had reduced depression and increased levels of coping and self-efficacy.
In this study, participants in the intervention group had lower depression levels than the control group at the T2, indicating that MPST is superior to usual care in improving depression in older adults, consistent with the results of previous studies ( Gellis et al., 2007 , 2014 ). Moreover, some studies have confirmed that PST could apply to the elderly with depression in different treatment settings ( Albert et al., 2019 ; Kanellopoulos et al., 2020 ), which reported the effectiveness of PST on depression in older adults under home care as well as outpatient follow-up. This study revealed the effectiveness of PST on depression in older adults who lived in the nursing home setting, consistent with the above findings. MPST can improve older adults’ misconceptions about daily hassles, reduces attitudes of avoiding problems and improves their problem-solving skills, which promotes stress reduction, enhances self-management confidence, and decrease depression ( Shang et al., 2021 ). Separately, older adults receiving PST still maintained significantly lower depression than usual care at T3, demonstrating that the beneficial effects of MPST remained invariable at 3 months post-intervention.
Older adults in nursing homes are often exposed to frequent stressful events due to weakened social support and physical dysfunction, and the choice of coping style may more easily affect their mental health status ( Fernández-Pérez et al., 2020 ; Bergmans et al., 2021 ). The present study indicated that the elderly who received MPST had higher positive coping abilities as well as lower negative coping abilities compared to usual care at T2, consistent with the result of Visser et al. (2016) . Positive coping and depression possess a significant positive association and can influence each other. MPST provides the elderly with positive approaches to problem solving, leading to a sense of contentment in the process and increases positive coping, and indirectly improve depression in the elderly ( Damush et al., 2016 ; Visser et al., 2016 ). While, positive coping in the intervention group was higher than the control group at T3, it was not statistically significant. On the contrary, negative coping in the intervention group remained significantly lower than that in the control group at T3. The reason for the different results may be that PST focuses on correcting negative problem orientation of older adults and targeting their negative behaviors with strategies ( Choi et al., 2016 ; Bai et al., 2022 ). Therefore, MPST produced more impressive improvements in negative coping of older adults.
Self-efficacy is a subjective judgement of an individual’s own ability to behave judgment. Studies have revealed that the elderly with low self-efficacy have less confidence in handling daily events and less willing to partake in social activities, thus becoming lonely and depressed ( Qin et al., 2020 ). Due to diminishing family support, changing interpersonal relationships, and adjustment to new environments, the elderly in nursing homes are prone to experience lower self-efficacy ( Olsen et al., 2015 ; Könner et al., 2016 ). The results of this study showed that the self-efficacy of the intervention group at T2 and T3 were significantly different from those of the control group (both p < 0.05), indicating that MPST was effective in improving the self-efficacy of older adults in nursing homes, similar to the results of Rahim’s study ( Habibi et al., 2016 ). This may be related to the ability of MPST to correct individuals’ misperceptions of problems and promote positive behavior change ( Haejung et al., 2015 ; Graven et al., 2018 ). During the intervention, the researcher helped individuals to view problems correctly, learn problem-solving skills, and apply the skills to real problems to enhance individuals’ self-efficacy by solving problems and improving self-efficacy.
4.1. Evaluation of intervention programs
Considering the decreasing attention, memory and thinking of the elderly in nursing homes, MPST arranged theoretical knowledge sessions with examples of the elderly’s daily life to enhance their understanding of the relationship between “problems-depressive symptoms-physical functioning.” To ensure that older adults better understand, MPST includes question-and-answer section during in each session. When arranging the activity schedule, MPST uses symbols to represent different activities instead of written descriptions of daily activities to reduce the learning burden of older adults with lower education levels.
Our study had several limitations. Firstly, the participants in this study were all from two nursing homes and the small sample size of this study may have an impact on the generalizability of the findings. Secondly, this study only used a depression screening scale to assess depression in older adults. Thirdly, MPST in this study was only compared with usual care and not with conventional PST. Finally, this study was only followed up to 3 months post-intervention, which could not assess the long-term effect of MPST on depression of older adults in nursing homes. Future studies with multicenter, large samples and extended follow-up could be conducted to determine the effect of the intervention on the improvement of depression in older adults.
The findings of this study suggest that MPST could be beneficial in reducing depressive symptoms and enhancing positive coping and self-efficacy levels in older adults in nursing homes, which provides an essential reference for mental health care of older adults in nursing homes.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by the Review Board of Xiangya School of Nursing, Central South University. The patients/participants provided their written informed consent to participate in this study.
XW and JX made significant contributions in conceptual design, data acquisition, data analysis and interpretation. JL, CZ, XZ, XD, and HC conducted statistical analysis and provided consultation in the study design and the intervention development. YD, SW, ML, and QZ provided advice during the research design process and critically revised the contents of the manuscript. All authors contributed to the article and approved the submitted version.
This research was supported by the Hunan Innovative Province Construction Project of Hunan Province (No. 2019SK2143).
The authors would like to thank the patients and health care professionals who contributed to this study.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: modified problem-solving therapy, nursing home, the elderly, depression, coping ability, self-efficacy
Citation: Wu X, Li J, Zhang C, Zhou X, Dong X, Cao H, Duan Y, Wang S, Liu M, Zhang Q and Xie J (2023) The effects of modified problem-solving therapy on depression, coping, and self-efficacy in elderly nursing home residents. Front. Psychol . 13:1030104. doi: 10.3389/fpsyg.2022.1030104
Received: 28 August 2022; Accepted: 15 December 2022; Published: 06 January 2023.
Copyright © 2023 Wu, Li, Zhang, Zhou, Dong, Cao, Duan, Wang, Liu, Zhang and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jianfei Xie, ✉ [email protected]
† These authors have contributed equally to this work
This article is part of the Research Topic
Caring for the Elderly with Cognitive and Psychological Symptoms and their Caregivers
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