The stress of nursing home admission

In 1967, psychiatrists Holmes and Rahe created a scale that measures the stress levels of various life events, finding that people with stress levels over 300 are at high risk of illness. I’ve always considered a nursing home stay to be a very stressful experience, but applying the scale was illuminating.

I took the Holmes and Rahe Stress Scale and modified it based on working with nursing home residents. For example, the Social Readjustment Rating Scale (SRRS) allots 65 points for a marital separation, but since moving away from one’s spouse to enter a facility isn’t a typical marital separation, I gave it 50 points. Nursing home residents aren’t technically imprisoned (63 points), but it is extremely confining, so I reduced that item to 50 points.

In my view, residents are not retired, but have started their jobs of working with the staff 24/7 in order to attend to the business of taking care of themselves, so I included many work-related items not usually considered the province of residents. This left me with the following items on the 43-item scale:

Marital Separation (50)

Imprisonment (50)

Personal Injury or Illness (53)

Business Readjustment (39)

Change in Financial State (38)

Change to a Different Line of Work (36)

Change in Responsibilities at Work (29)

Change in Living Conditions (25)

Revision of Personal Habits (24)

Change in Working Hours or Conditions (20)

Change in Residence (20)

Change in Recreation (19)

Change in Church Activities (19)

Change in Social Activities (18)

Change in Sleeping Habits (16)

Change in Eating Habits (15)

Grand Total: 471 points

That’s 471 points on a scale that finds a high risk of illness at stress levels over 300 points. On the updated SRRS, the total comes out much higher, with the person considered in a life crisis.

Upon admission to the nursing home, residents are required to see the dietician, dentist, social worker, and recreation therapist. A life crisis, and we have yet to require a psychological evaluation of the residents. Referrals are currently haphazard and based on the psychological-mindedness of the nursing home staff.

Readers who feel they, their residents, or their loved ones might benefit from the assistance of a psychologist in coping with the magnitude of these life changes can suggest a referral for evaluation for a particular individual (until regulations catch up with the need).

Dr. Barbera is an author and a licensed psychologist consulting in long-term care facilities in the New York City area. She frequently lectures on subjects related to psychology, aging, and nursing homes. Dr. Barbera is available for private consulting with organizations, institutions, and individuals around eldercare issues. Visit her personal blog at

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