Mental Health in Nursing Homes
Aging and disabled individuals regularly struggle with their mental health in nursing homes. Unfortunately, many nursing homes aren’t equipped to handle these serious life struggles. It is important for family members to identify signs of mental health problems early on, intervene, and help loved ones get the support and assistance they need.
- What mental health issues do nursing home residents commonly struggle with?
- Why are mental health problems so common in nursing homes?
- Are nursing homes equipped to help residents who struggle with mental health issues?
- What can I do if I suspect a nursing home resident is struggling with a mental health issue?
- Mental Health Resources for Nursing Home Residents and Family Members
We don’t just trust nursing homes to keep our aging and disabled family members physically safe. We also expect that they will provide an engaging and emotionally stable environment for our loved ones.
Unfortunately, it is estimated that between 65 and 91 percent of nursing home residents suffer from a significant mental disorder. This category includes dementia as well as a host of other behavioral and psychiatric issues. It is estimated that more than 500,000 people currently struggle with mental health issues other than dementia in American nursing homes.
To make matters worse, most nursing homes are ill-equipped to handle residents with mental health issues.
So, why does mental health decline in a nursing home setting, and what can you do if you suspect that an aging loved one in a nursing home is struggling with mental health issues? Here is what you need to know.
What mental health issues do nursing home residents commonly struggle with?
Mental health issues are defined to include “mental, behavioral, or emotional” health conditions that cause a “serious functional impairment” and “substantially interfere with or limit” a person’s major life activities. Studies show that some of the most commonly cited mental health issues in long-term care residents include:
- Depression
- Anxiety
- Dementia
- Schizophrenia
- Bipolar disorder
- Alzheimer’s disease
- Post-traumatic stress disorder
These are just a few of the struggles that nursing home residents may experience while living in a long-term care facility.
What are the signs and symptoms of mental health issues among nursing home residents?
Some common mental-health-struggle signs in nursing home residents include:
- Self-isolation
- Reluctance to see or visit with family
- Withdrawal from social activities
- Agitation
- Irritability
- Unexplained sadness
- Fearfulness
- Indications of self-harm, including bruising and lacerations
- Bedsores
- Drug or alcohol abuse
- Negative statements
The best way to stop a mental health issue from progressing is by identifying the problem in its early stages and intervening. You can do this by staying in regular contact with your family member while they live in a nursing home, visiting regularly, and checking in on their mental health frequently. If you suspect something isn’t right, bring it up with their caretakers and/or the facility immediately.
Why are mental health problems so common in nursing homes?
Depression and other mental health struggles are incredibly common in nursing homes across the country. But why? Research suggests that there are four primary risk factors for mental health issues in nursing homes: isolation, loss, chronic pain and other health problems, and cognitive decline. These can help explain why people in nursing homes might be depressed.
Isolation
Nursing home residents don’t live in the homes they have known all their lives or made for themselves. They don’t live close to their old friends or family members. While they may be physically surrounded by other people, these are effectively strangers. This can be incredibly jarring to the nervous system and create a sense of isolation, loneliness, and loss.
In turn, nursing home residents may begin to isolate themselves more and turn inward, seeking refuge in their memories and personal belongings. Over time, this can put them at an increased risk of becoming depressed or developing other serious mental issues.
Loss
Nursing home residents can deal with a lot of grief. They may hear about loved ones or friends who have passed away. People they have become close with or developed relationships with in the nursing home might die or become incredibly ill. As we age, reminders of death become more and more commonplace.
It can be difficult for anyone to grapple with loss and grieve properly. This is most certainly true for nursing home residents who are away from family members and emotional support systems. Without the ability to process grief in a healthy way, feelings of depression can manifest and, ultimately, lead to other serious mental health issues.
Chronic Pain
As we age, our health declines. It is part of life. This is certainly true for nursing home residents who have limited mobility, don’t exercise a lot, and eat meals lacking nutrition daily.
When we struggle with health problems, it is common to experience chronic physical pain. Research done by the Clinical Interventions in Aging suggests that elderly individuals with chronic pain are up to 4.1 times more likely than others to become depressed.
Cognitive Decline
Aging residents often struggle with cognitive decline—worsening memory, concentration, and thinking. When it becomes more difficult to remember things, keep a train of thought, or think clearly, it is easy to become agitated, angry, or downright upset. Over time, mental health issues can rise as cognitive function decreases.
Nursing home residents may also develop mental health problems if they experience emotional abuse, verbal abuse, or are abandoned by nursing home staff.
Are nursing homes equipped to help residents who struggle with mental health issues?
Simply put, no. Nurse aides and certified nursing assistants are responsible for up to 90 percent of all direct patient care in long-term facilities. However, these caretakers often have the least amount of training when it comes to identifying and handling mental health problems among nursing home residents.
Studies suggest that behavior management—not pharmacological intervention—is the best way to support nursing home residents who have been diagnosed with depression, bipolar disorder, and other mental health struggles.
However, nursing aides aren’t necessarily expected to get training in behavior management. Most states simply require a basic nursing class, 40 hours of clinical experience, and completion of a certified nursing assistant exam.
Further, some studies suggest that about 75 percent of nursing homes “were unable to obtain consultation and educational services for behavioral problems.”
When psychological services were provided, residents were typically prescribed medication to help them deal with the side effects and symptoms of their mental health disorders. However, when it came to offering behavioral management and “nonpharmacologic management techniques, staff support, and dealing with staff stress and family conflicts,” the support was inadequate.
So, residents are likely to suffer from depression and other mental health problems, but (outside of writing prescriptions) nursing homes are not equipped to monitor the psychological effects of nursing homes on the elderly or help them manage these serious life struggles.
What can I do if I suspect a nursing home resident is struggling with a mental health issue?
Ultimately, we are responsible for the health and emotional well-being of the people we love. We can’t blindly trust that a nursing home or long-term care facility will have their best interests at heart, no matter how great the level of care might be.
Signs and symptoms of mental health struggles can be difficult to identify. Nursing home staff are woefully under-trained when it comes to supporting the mental health of their residents.
If you suspect that a nursing home resident is struggling with a mental health issue, it is important to take prompt action. First, bring your concerns to the resident’s caretakers. Talk to the aides and assistants who spend time with them on a day-to-day basis.
If you highlight the potential problem, you can jumpstart a solution. Aides who are aware of potential issues can bring in specialists and escalate the matter to nursing facility physicians and nurses.
You can also speak with the nursing home administration and request specific help for the resident—including psychiatric consultations, therapy, and other services that might be available through the home.
Some nursing homes allow private therapy, which means you could bring in a mental health professional to work one-on-one with the resident. However, you would have to clear this with the nursing home first or physically bring your loved one to counseling services off-site.
Mental Health Resources for Nursing Home Residents and Family Members
You don’t have to struggle alone with the declining mental health of a loved one in a nursing home. Resources out there can offer incredible support and guidance as you work to get your family member the help they need.
The Department of Health and Human Services offers support through the Substance Abuse and Mental Health Services Administration. You can find treatment, locate an early serious mental illness treatment provider, and access information about depression and mental health issues on the agency’s website.
You can also find helpful information and strategies for dealing with nursing home mental health issues from these organizations:
- American Psychological Association
- Anxiety and Depression Association of America
- National Alliance on Mental Illness
- Mental Health America
- Depression and Bipolar Support Alliance
- Alzheimer’s Association
You can also reach out to an experienced nursing home abuse attorney near you if you suspect that your loved one’s mental health struggles are not being handled appropriately by their caretakers or the facility.
Withholding treatment or ignoring the problem can be a sign of nursing home abuse and neglect, for which the facility could be civilly liable. An attorney can help you understand your rights and formulate a strategy to support your loved one during this difficult time.
- Last Modified April 30, 2023
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Dr. Patricia Shelton, MD
Education:
- University of Washington, Doctor of Medicine – MD. June 2008
- University of Washington, Bachelor of Science – BS, Jun 2003
Background:
Neuroscience and Medicine
Career:
- Dr. Shelton primarily writes content for health-related websites, but has also written test prep materials, white papers, published research articles, court documents, and more.
- Dr. Shelton teaches anatomy and physiology at the college level for the National Institutes of Health.
