In the late 80’s, my first job in high school was washing dishes in the kitchen of a long-term care facility in rural Kansas. My mother worked at the facility at a STNA, and often told stories about the residents — stories that made me smile and laugh, and stories that made me incredibly sad. When I went to the facility for my job, I saw so much sadness, loneliness, and isolation, but also moments of joy between residents and staff.
A younger resident named Kenny (not his real name) befriended me and often came into the lunch room for coffee. He talked to me while I was on break and shared stories from his life “before” the nursing home. During this time I realized what amazing stories were within each person at the facility, and that if I only had the time to sit down with each resident, I could learn so much. Although Kenny died while I was an undergraduate, I will never forget his stories and wisdom. The more time I spent with him and the other residents of the facility, the more I realized how great the need was for emotional and social services. I already knew that I was going to become a psychologist, but Kenny (and the other residents) solidified my decision that working with older adults in long-term care settings would be the place that my passion and career would find the most impact and joy.
Unfortunately, when I went to graduate school, most of my colleagues were puzzled by my choice of practice location. Most Counseling Psychology students that I knew wanted to work in clinical practice were choosing college counseling centers or private practice with adults or children. I often heard – not just from colleagues, but also from friends and family – “You want to work where? Isn’t that depressing?” There was little understanding about work with older adults in the counseling psychology field, and even less understanding about the long-term care setting.
Less than 4% of older adults live in long-term care settings, which sounds like a very small number of older adults. However, when broken down by age, this is 1.1% for those aged 65-74, 3% for those aged 75-84 and 11% for those over the age of 85 (Administration on Aging U.S. Department of Health and Human Services, 2012). These numbers do not include the 2.7% of older adults living in senior housing that has at least one type of supportive service available (Administration on Aging U.S. Department of Health and Human Services, 2012). Statistics indicate that large numbers of long-term care residents struggle with a mental illness such as dementia (58%; Seitz, Purandare, & Conn, 2010) and depression (10% with major depressive disorder and 29% with depressive symptoms; CDC, 2013; Seitz et al., 2010). Anxiety disorders, bipolar disorder, personality disorders, and other mental health conditions are also frequently seen in long term care settings. Despite these numbers and the fact that close to 90% (86.6%; CDC, 2013) of nursing homes offer mental health or counseling services, few psychologists choose to practice in long-term care settings. Of those who do practice, the majority are from clinical psychology programs.
Why should Counseling Psychologists work in long-term care settings? Although in the licensure world there is no distinction made between counseling and clinical psychology, and the differences between the fields have shrunk, the history and training in the two programs have differences. The two notable differences are adaptation across the life-span approach and the focus on strength-based interventions (APA Division 17; http://www.div17.org/about-cp/counseling-vs-clinical-psychology/). These two pieces of Counseling Psychology fit quite well with Geropsychology, as a robust number of older adults are healthy and focused on adaptive coping to late-life concerns, such as grief, retirement, grandparenting, and aging in place.
In my own work in long-term care, a place where it could be easy to solely focus on loss and sadness (e.g., the stereotype that work in nursing homes is “depressing”), I appreciated the training that helped me focus on client strengths, adaptations over the life-span, and coping strategies that allow them to navigate the challenges within the long-term care setting. My counseling background prepared me to work with the family systems that function within the LTC setting (both biological families and the family systems that staff form), as well as the multiple diverse identities, roles and concerns with older clients. The field of Geropsychology in long-term care settings is rapidly growing, and we are facing a workforce shortage – one that Counseling Psychologists could fill. The long-term care work setting is a varied setting that can include work with younger residents who face chronic emotional or physical disabilities, neuropsychological assessment, health and behavior interventions, and staff training/in-services, to name a few.
My work is not depressing, although it can be challenging. I learn so much from my clients; life-long wisdom, profound resiliency and strength, hope and joy. I am truly humbled by the trust and life stories that they share with me, as well as the fact that my clients are willing to let me in a space where they have lost almost everything. The change I can engender with my clients is profound, particularly given the challenging environment and situation. Rather than asking, “Why would you work in long-term care?” the question should be, “Why wouldn’t you work in long-term care?” If you enjoy a challenge, have a passion for social advocacy and systems work, and love meaningful engagement with underserved populations, then the long-term care setting is for you!
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About the Author
Mary M. Lewis, Ph.D., ABPP is a tenure-track instructor in the Psychology Department at Columbus State Community College, and leads their Service-Learning Program for the Human Growth and Development Across the Life-Span course. She also is a licensed psychologist and provides counseling and assessments to long-term care and nursing home residents with Senior Life Consultants, Inc. Dr. Lewis is the chair of the Ohio Psychological Association Science Committee, Past-President of Psychologists in Long-Term Care (2011-2013) and a member of the American Psychological Association, APA Divisions 17, 12/II, 20, and 31. Her professional and research interests include social responsibility and social justice issues, end-of-life concerns for individuals with dementia, mental health and aging, and spirituality. You can contact her at firstname.lastname@example.org