The lost generations

Most nursing homes have one, maybe a few.

They’re usually among the oldest residents in the community. They’re almost always men.

They might sit for hours in the activities room, but they rarely join in. They’re seemingly always on guard, always on duty. They keep their heads down and their chair backs to the wall. Staff may be tempted to ignore them or observe from a distance, figuring it’s best to leave them alone. Sometimes a slightly younger resident, wearing a Korean Veteran’s hat, might sit next to them for a while. They don’t converse much, but they know they have a lot in common and are bonded somehow in their unique isolation. When they occasionally explode in unexplained outbursts, the staff often placates them any way they can. But no one is really sure what to do.

Somehow, the Greatest Generation became a lost generation, at least as far as person-centered skilled nursing care goes. Korean War veterans haven’t fared much better, outside of the Veteran Association facilities specifically trained to relate with their war experiences.

At a recent industry conference, I found myself sharing a lunch table with a director of nursing from an East Coast nursing home. “We just got our first war veteran,” she confided, “and we don’t really have any idea how to engage him.”

We’d all better get over that and learn—fast.

A new “boomer” generation is here. In the next few years, tens of thousands of people from the Vietnam-service era will reach age 75. They’ll be entering the senior services sector with all the baggage they still carry with them from their early 20s, including an entire generation of undiagnosed and untreated post-traumatic stress.

But when dementia is added to the mix, it changes everything we think we know about dementia-related “behaviors” and what we should view as the appropriate person-centered interventions.  While most of the residents in the memory care unit may spend some time reliving their youth in the 1950s, others could be reliving the horrors of China Beach or the fall of Saigon or the torching of a Viet-Cong village deep in the jungle.

The long-term care industry needs to learn a lot more about what post-traumatic stress is, and what it is not. We need to learn much more about the behavioral triggers specific to those who have had combat experience, especially when dementia makes its ugly entrance into the picture. We need to learn more about how to interact and intervene with a person who was trained to fight and has a deep-seated need to feel safe. Above all, we need to learn how to serve this unique resident population as well as we serve all our other skilled nursing residents.

The winner of the 2016 Long-Term Living OPTIMA Award has built a caregiver training program from the ground up, designed to gather and track information on behavioral triggers and adjust interventions to fit the needs of each veteran resident. Their three-year journey shows us what is possible when caregivers are engaged in the histories of their residents and when veteran residents receive the individualized understanding and interaction they deserve. Stay tuned as we share the stories from our 2-day site visit during the next week.

Topics: Alzheimer's/Dementia , Executive Leadership