Successful Visiting

Adapted from Handbook for Successful Visiting
by Elizabeth McKean, Riverview Health Centre

We hope that this information will make visiting a little easier and perhaps more rewarding for you and the resident. We encourage you to try out the different suggestions. Some will work and some won’t, but we hope the suggestions will help your visits become positive experiences.

It is not uncommon for people in your position to find it difficult and awkward to visit your loved one. You may not know what to say or do in these changed circumstances. But visits with family members and old friends are very important. It is the longstanding relationships in life—the ones that connect residents to their past—that are important in maintaining the meaning and quality of residents lives.

Visiting is all about being together with people you care about, sharing present events and reliving past memories. Visits can also be an important time for both you and your family member or friend to heal past hurts and to grow closer together.

To help with visits

Visiting is all about being together with people you care about, sharing present events and reliving past memories. Visits can also be an important time for both you and your family member or friend to heal past hurts and to grow closer together.

People visit to:
  • give the resident something to look forward to
  • help keep strong links between the residents family and community
  • stimulate physical and mental health abilities
  • maintain the residents sense of dignity and self worth
  • promote feelings of achievement
  • provide company, friendship, support and help
  • make sure the resident is receiving good care

If you keep these goals in mind, you may find that your visits become more meaningful.

Anyone who was important to the resident throughout his or her lifetime should visit. Arrowsmith Lodge and Cokely Manor have few restrictions on who can visit. Young children who are accompanied by their parents are very welcome.

Family pets are welcome, with these few restrictions:
  • the pet must be on a secure lead
  • the pet must be well behaved and able to interact calmly with other visiting pets & cats
  • the pet must have up to date vaccinations
  • please avoid dining room spaces and be sure to bring a waste pickup bag

To choose the best time, please consider the following:
  • Does the resident have a good or bad time of day?
  • Does the resident have daily rest periods?
  • Are there scheduled appointments times that would interfere with your visits?
  • Is there a special Activity or Music Therapy program that you would like to attend with your relative/friend?
  • Does the resident have a special activity program that he or she would like to attend, but won’t or can’t while you are visiting?
  • Does the resident have other regular visitors?
  • Can these visits be spread out through the week or month?
  • One visitor at a time may be more enjoyable for the resident that several visitors at once. When a number of visitors come at one time, the resident may get left out while the visitors talk to each other.
  • Is there a special out-of-town person visiting this week? Maybe this is a good week for you to take a well deserved break.
  • If you are feeling guilty because the resident claims that visitors never come (but you know that they do!), keep a guest book in the room for all visitors to sign. It can be nice to review the guest book together and talk about the people who have been by.

Many people find it difficult to visit once a person is placed in a care facility. The reasons for difficult visits may include:

A feeling of uneasiness about the environment at the care facility. “Its a place full of old, sick people with varying degrees of physical or cognitive disability.”

Difficulty interacting with family member or friend because of the physical and/or cognitive changes of the resident. “I cant stand looking at my Dad ever since his stroke, he drools all the time.” Or “My mother doesn’t even recognize me anymore. We cant talk together anymore.”

The reality that your prior relationship with the resident often comes into play during visits. “Mother complains all the time when I visit—I don’t visit often enough, I was mean to place her in the home. It drives me crazy all my life, all she ever did was criticize me.”

It is important to identify what it is that actually makes you feel uncomfortable.

If it is the physical environment of the care facility that bothers you, visiting on a regular basis may actually help to minimize your discomfort. People often find that, once they become familiar with the environment, they become more comfortable in it. If you can’t get over your unease, find a spot for your visit that seems most homelike, such as your relative’s room, a small lounge, the computer alcove, one of the gardens or gazebos. There are lots of these comfortable spaces at Arrowsmith Lodge and Cokely Manor.

If it is the physical and/or memory changes in your family member or friend that disturbs you, arm yourself with knowledge. We are often most uncomfortable with things we don’t understand and don’t know how to cope with. Learn about your family member/friend’s disability and its effects on the person. Our Charge Nurses, RNs, Pastoral Care Coordinator, Resident Lifestyle Director, and other professionals can help you to learn how to make the most of the remaining strengths of your family member/friend. We are also happy to loan you resource materials from of our library.

If it is the emotional aspects of the visit that are difficult, try to figure out what it is about the situation that is causing you emotional distress. There are several possibilities. For example:

  • People enter a care facility because their care needs or safety is beyond what can be provided at home by family and community supports. This reality can cause great emotional distress guilt, anger, and grief in both you and your loved one. Visits can bring out these emotions.
  • If your past relationship with the resident was always stressful, and there are unresolved points of pain, you may be trying to resolve these issues during your visits. These visits become difficult because of the expectations and emotions that you bring. You may need to accept that you are not going to be able to heal past hurts.

Understanding and coming to terms with your emotions can ease some of the stress of a visit. Individual counseling or joining a support group may be helpful. Speak to the unit staff about resources available to you.

  • Do you find the visit boring?
  • Does the visit follow the same pattern time after time?
  • Are you watching the clock throughout the visit waiting for a time when it would be acceptable for you to leave?
  • Is the resident sleeping through most of your visit?

Care Facility visits are different than hospital visits. When people are in hospital, they are usually these for short time due to an acute health problem. The focus of the resident’s life is on the acute health problem and on getting better, and as a result, the visit also revolves around the health problem.

Those living in a Care Facility are at ‘home’. Health problems will exist, but the objective of visiting is to provide the best quality of life possible within the resident’s abilities. Come and be part of your relative’s new home—participate in scheduled activity programs, join us for a meal or take part in caring for your relative. Finding independent leisure pursuits that you can do together can also provide a focus to your visit. The only limits to activities are your imagination and an individual’s abilities.

Many residents are physically frail. You may be afraid that an activity is too strenuous for the resident. While some activities may be too taxing, even the most physically frail person needs some fun in his or her life. If you have an idea for an activity, but are afraid about whether or not the resident can physically cope with it, don’t give up on the idea. Discuss it with the resident and staff.

Could you engage in the activity for a shorter period of time? Could the program be held at the Lodge, instead of going out? Could the activity be adapted to suit the abilities of the resident? Most interests or activities can be adapted to suit your needs. For example, perhaps your family member was an avid gardener, but now has limited ability to move.

You can tend a raised planter together, keep indoor plants in the window bay, or bring in flowers during your visits for holding and smelling. If you don’t know how to adjust an activity to the appropriate functional level, please ask the Director of Resident Lifestyle & Community Programs for help.

Be Creative

Don’t do the same activity over and over again. Try different activities. Talk to the Director of Resident Lifestyle & Community Programs for suggestions. There are books and recreation equipment at the Lodge for you to borrow.

Consider Past Interest and Hobbies

If you base an activity on a past interest, you will likely get a positive response from the resident.

Use an Activity Jar

Make an event out of pulling a suggested activity for the next visit out of an activity jar in the residents rooms.

Stimulate the Senses
  • Hearing — Listen to favourite music or new music. Read aloud passages from books, newspapers, letters and emails from friends and family, borrow one of the talking books, a musical instrument or drum, go outside and listen to the sounds of nature.
  • Sight — Look through magazines or photo albums; use seasonal decorations to brighten the residents room; spend some time window gazing. Borrow some of the Snoezelen equipment.
  • Touch — Bring in a baby or a puppy for the resident to hold, or find the facility cat. Encourage the handling of fabrics of different textures (there are some fabric books that you can borrow) or put together your own fabric book using material from old and much loved clothing. Borrow the manicure supplies and give a hand rub or apply nail polish. Bring seasonal objects for the resident to touch such as leaves, flowers, sand, sea shells, snow, etc.
  • Smell — Bring in a variety of herbs, favourite scented flowers, bake or cook a favourite food, or borrow our aromatherapy kit.
  • Taste — Bring in a snack or a home cooked meals, or stay to enjoy a meal together.

This is one of the most important of all activities. Through reminiscence, you and your relative can better appreciate the person’s life. For the resident, reminiscence can validate his or her life and the uniqueness of that life. Here are some ways to help the resident to reminisce:

  • Create a Memory Album — a collection of photos highlighting special life events. Be sure to include the story of each photo, so that our volunteers and staff can use the album to reinforce identity and memories in between your visits.
  • Put together a collection of favourite small objects into a Life Kit. Include things like favourite ornaments, pictures of family, a favourite scent, a fondly remembered piece of jewelry and so on.
  • Read books, newspapers or magazines together. If you cant carry on the conversations you used to, just hearing your voice will be a comfort for your relative.
  • Use our Time Slips binder select a picture and make up your own story!
  • Borrow our Montessori-based Activity folders to assist with maintenance of language and other functional skills.
  • Do some volunteer work together. Feed the cat, fold some laundry, help weed in the garden or sweep the walkway, provide visitation together to other residents a great way to help your relative make other social connections at the Lodge. For residents who liked to feel needed, these activities help to provide a sense of meaning and purpose.

Social visits have resumed at long-term care facilities. All visitors are allowed at long-term care and seniors’ assisted living facilities if they meet the following visitation requirements as determined by the BC CENTRE FOR DISEASE CONTROL:

Proof of vaccination

  • All visitors to long-term care, assisted living, and acute care facilities will need to show proof that they are fully vaccinated with two doses of COVID-19 vaccine (excluding children under the age of 12 or those with an approved medical exemption and compassionate visits related to end of life).

Screening

  • Visitors must be screened for signs and symptoms of illness prior to every visit. Visitors with signs or symptoms of illness, as well as those in self-isolation or quarantine in accordance with public health directives, are not permitted to visit.

Rapid antigen testing

  • All long-term care visitors who are 12 years of age and older must also complete a rapid antigen test. They have the options of using a take home test kit, available through the facility and community pharmacies, within 48 hours of their visit or undergo testing at the entrance.
  • Visitors to standalone seniors’ assisted living residences are not required to undergo rapid antigen testing. However, if a seniors’ assisted living residence is part of a campus of care with long-term care where there is a common entrance and/or hallways, visitors (12 or older) to seniors’ assisted living may be required to undergo rapid antigen testing.

Visiting hours

  • Operators designate visiting hours in order to ensure there is adequate staff to support safe visiting practices.

Masks

  • All visitors to long-term care and seniors’ assisted living sites are required to wear a medical mask in hallways, common areas and multiple occupancy rooms (long-term care).
  • Masks are not required when fully vaccinated visitors are visiting residents in single occupancy rooms or seniors’ assisted living units.

Gatherings

  • Outdoor gatherings may include fully vaccinated family and friends who have met the requirements for visitation (e.g. no symptoms of illness, fully vaccinated, rapid antigen testing for long-term care facilities).

Hand hygiene

  • Visitors and residents are expected to clean hands before and after visiting, practice hand hygiene and respiratory etiquette – i.e. cough or sneeze into elbows sleeves and dispose used tissues properly.

During your visit

  • Proof of vaccination is not required for:
    • Children under the age of 12
    • People with a medical exemption
    • Compassionate visits related to end-of-life

An important component of every visit is the communication that occurs between you and the resident. Therefore, you must try to minimize any problems caused by hearing, vision, physical disabilities and memory changes.

  • Learn all you can about the specific communication problems that your family member has, along with action you can take to reduce the effect of the problem. For example, should you sit on a certain side of the person to accommodate a hearing loss?
  • Create a comfortable environment physically and emotionally for both of you.
  • Place yourself at eye level with the resident.
  • Use your normal conversational voice when speaking.
  • If you or the resident need a hearing aid, glasses or communication board, make sure they are in place and working before you start.
  • If the resident doesn’t understand what you are saying, try using different words, or shorter sentences.
  • Be patient your relative may need time to take in, understand and come up with an answer.
  • If your family member has trouble expressing him or herself, avoid asking information-seeking questions. Instead of questions, use statements, such as “You look nice today” or “That is a pretty sweater”. Make a reasoned guess and ask for verification with a nod of the head if the resident has lost the words.

If your family member has experienced memory challenges:

  • Use a calm, reassuring voice.
  • Use short, simple sentences. Be clear.
  • Break down instructions into steps. Give instructions one step at a time.
  • Provide visual cues through gesture or pictures
  • Don’t offer too many choices
  • Watch for signs of anxiety in nonverbal cues
  • Sing songs or use adapted programs, such as TimeSlips, art designs or Montessori-based activities
  • As language deteriorates, place less emphasis on conversation and more on how much the resident appears to achieve contentment and pleasure from your presence.

Don’t visit for lengthy periods of time. We tend to think of communication as talking. But remember, nonverbal communication is equally, if not more important. Try a hug! Just being together may be enough.

An important part of remaining connected to one’s family is to have contact with members of all generations of that family.

For example, it is important for the resident to maintain contact with grandchildren after placement in a care facility, especially if the resident enjoyed close relationships before. Loss of contact with grandchildren may be perceived by the resident as abandonment or punishment.

But it’s not just the resident who can benefit from intergenerational visits; younger family members also benefit from seeing older family members, even after they are ill or frail. Visits with a grandparent show that families can stay committed to all of its members. These visits also show younger family members that the life cycle is a natural process.

Very young children rarely react negatively to older or ill people, but may be fearful of going into strange environments. Older children and teenagers may respond negatively to illness or disability, and may need time and assistance in adjusting. Your reaction to visiting and to aging in general will have an effect on these children. If you can show them, through modeling, that visiting with an older relative or friend can be rewarding and worthwhile, then the children’s visits are more likely to be positive experiences. Again, finding an activity that you can all do together (playing the slot machine, shuffleboard, surfing the internet, playing cards or a board game) can help to enhance the visit.

Preparing Younger Family Members

Describe what they are likely to see (people using walkers, wheelchairs, broda chairs or in bed, confused people wandering). Listen to their concerns and perceptions, answer all of their questions, and acknowledge fears/concerns.

You may find that saying goodbye at the end of a visit is the most difficult part of the time together. For the resident, feelings of grief and abandonment may surface when the loved one leaves. For you, the visitor, leaving may bring out feelings of guilt. There are many approaches you can try to ease the transition.

Be Consistent

For some residents, consistency in the timing of your visit can be helpful in developing a routine. The resident then becomes accustomed to when you will be leaving.

Plan for leaving

Providing the resident with something else to do at the moment you leave may make the leaving easier (i.e. Accompany the resident to an activity program that is just about to begin, to afternoon or evening tea, or meal time)

Asking Staff for Help

Request that the staff assist you in distracting the resident while you leave. They are very skilled in this!

Focus on the Positive

I will see you again soon.

Provide Reassurance

Reassure the resident that you care. Try a hug.

Leave Quietly

While it is usually better to tell the resident that you are leaving, in certain cases (i.e. a severely cognitively impaired resident) it does work better to you just leave without saying goodbye.

The tradition of giving gifts to celebrate special occasions can easily be continued for the residents. If you are having trouble thinking of gift ideas, ask our Charge Nurses for additional ideas. Please don’t bring scented items (perfume, heavily scented flowers) into the Lodge.

  • Appropriate Clothing — Staff can assist you in determining what clothing would be appropriate. Safety in footwear and ease of dressing in clothing should be considered. Please ensure that these items are labeled by the Laundry staff before you add them to the closet.
  • Toiletries — Nice hand lotion, hair brush, lip stick, but nothing heavily scented.
  • Photos — Bring old photos, or new family pictures
  • Food — Please consider any dietary restrictions before bringing food. Do not bring more that can be shared at a single visit.
  • Audio Tapes — Talking books, music, cd player
  • Calendars — Especially those depicting a favourite subject
  • Large Print — Books, magazine or newspaper subscriptions
  • Sensory Items — that you can use together during visits.

How often should I visit?

There is no right answer to this question. Only you can decide on the right amount of time you should spend visiting. Consider your other demands and your health. If you are not taking time to maintain good physical and emotional health for yourself, you will not be able to bring your best to the visit. Sometimes fewer, but better quality visits are the best compromise.

Should I tell my relative if something bad has happened to someone in the family (i.e. Death, serious illness or divorce)?

There can never be an absolutely right answer to this because there are always unique considerations in every situation. But, as a general rule, all family members should be advised about family issues, whether good or bad. Being part of a family involves both the good things and the bad things in life; just because a person is physically removed from the family doesn’t mean that he or she should be excluded.

As we can never be certain about the depth of understanding of an individual who has experienced severe memory changes, even they should be told about family issues. However, little is gained by repeating information they find distressing. With this population, it is often advisable to tell them once and then, unless they ask, don’t raise the issue again.

Planning when and how to deliver bad news is important. Like you, the resident will feel overwhelmed. It is important that they receive the necessary support at the time the news is delivered and afterwards.

Whenever and however bad news is relayed to a resident, it is also important to give the details to staff. Then, if the resident is distraught in the coming hours or days, staff will be able to provide the appropriate care and support.

Comatose or Severely Cognitively Impaired Residents

You may wonder if there is any point in visiting residents who are comatose or who have experienced severe memory changes. Questions you might ask are:

  • How can I tell if my family memory or friend knows I have visited?
  • How do I know if my loved one benefited from the time spent visiting?

It’s impossible to answer these questions with any surety. However, you may find it comforting to know that many professionals who work in this area believe that the person does know, at some level, that someone is offering support and comfort. And even though there is no way to tell if there is benefit to the residents, coming to see a loved one may benefit you by helping you to work through some grief issues. Focus your visits on sensory activities and your communication, so the resident can continue to hear your voice.

A Resident Who Is Dying

At this time, visiting can be vitally important. By holding the resident’s hand you are offering emotional support through this difficult time. Being present at a dying loved one’s bedside provides the visitor with the opportunity to grieve and to come to terms with the pending death. Please talk with our staff or your support people if you are feeling overwhelmed through this difficult time. Our staff can answer questions you might have about the process. Please use our “Bedside Boxes” which contain comforting items and visit with our Nurses or Pastoral Care Coordinator.

As a visitor to a facility, you play an important role in ensuring that residents receive appropriate care. Keep your eyes and ears open during your visits. If you see or hear anything that you have questions about, discuss it with the Charge Nurse as soon as possible.

It’s impossible to answer these questions with any surety. However, you may find it comforting to know that many professionals who work in this area believe that the person does know, at some level, that someone is offering support and comfort. And even though there is no way to tell if there is benefit to the residents, coming to see a loved one may benefit you by helping you to work through some grief issues. Focus your visits on sensory activities and your communication, so the resident can continue to hear your voice.

A Resident Who Is Dying

At this time, visiting can be vitally important. By holding the resident’s hand you are offering emotional support through this difficult time. Being present at a dying loved one’s bedside provides the visitor with the opportunity to grieve and to come to terms with the pending death. Please talk with our staff or your support people if you are feeling overwhelmed through this difficult time. Our staff can answer questions you might have about the process. Please use our “Bedside Boxes” which contain comforting items and visit with our Nurses or Pastoral Care Coordinator.