Being Old: A Confronfation Group with Nursing Home Residents PHYLLIS BRAUDY HARRIS
HEALTH AND SOCIAL WORK, Vol. 4, No. 1, February 1979
0360-7283/79/0401-0152 $0.50 0 1979 National Association of Social Workers, Inc.
Elderly nursing home residents who participated in a group experience openly discuseed and attempted to deal with the process of aging in their own lives. The group experiences that are described illustrate the elderly people's ability to face their life situation and demonstrate their potential for growth and change.
T
HE IMPORTANCE OF GROUP WORK with the elderly in an institutional setting has not been sufficiently recognized. This form of treatment can have many benefits for older persons, and it deserves to become a more popular practice. For example, it can give the elderly a chance to develop or relearn social interaction skills, to make new social contacts, and to develop peer support systems. The group experience also offers the elderly a chance for therapeutic ventilation, the opportunity for the personal growth and development that is possible at any stage in life, and a chance to evaluate their own situations in life in terms of others in comparable situations. In general, however, group work with the elderly has been focused around specific problems that are not necessarily related to old age, such as widowhood,
153
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HEALTH AND SOCIAL WORK
marital problems, recovery from stroke, and so on. Little group work has dealt specifically with the problems of aging or has involved elderly nursing home residents who have adequate social interaction skills These concerns can be addressed in a confrontation group that openly and honestly talks about being old and how it feels. Such a group was formed at the Detroit Jewish Home for Aged. The topics discussed in this group had never been dealt with or discussed openly before in the home. The techniques were a combination of confrontation, ventilation, and self-help. The goals of the group were the following: n To encourage verbalization of fears, feelings, and problems of old age. n To encourage group members to share feelings and experiences. n To develop the beginnings of a peer support system. n To encourage self-help among the participants. n To provide educational information that would clear up misinformation and misunderstandings about physical and mental health problems of old age. n To help the members as a group and as individuals come to some self-realization and acceptance of the aging process. Brody articulates the philosophy of the group when, in talking about the nursing home population, she states: Residents are helped best when they engage in helping themselves to the best of their abilities. The goal in this effort is to restore purpose as well as function; to
BEING 0 LD
155
fix attention on the quality as well as the quantity of life, and to temper expectations with realistic yardsticks. 1
GROUP COMPOSITION AND FORMAT The group was led by a social worker with the assistance of a registered occupational therapist, who joined to lead the discussions on health-related subjects. The group met on a weekly basis for five months, twenty sessions in all, and was open to any resident of the Detroit Jewish Home for Aged. A total of twenty-eight people came to the group, but the average attendance was nine to twelve people per session, consisting mostly of a constant core of the same nine persons. Thus, approximately one-third of the people who attended at least one session continued to come on a regular basis. The majority of regular participants were residents with a higher level of functioning and adequate social interaction skills, but other residents allo came and were able to participate. The leaders chose as general topics for discussion the five main problem areas for the elderly outlined in the OARS Multidimensional Functional Assessment Questionnaire prepared by the Older Americans Resources and Service Program: physical health, emotional health, social resources, financial resources, and independence versus dependence. 2 Each topic could have been discussed for months, but the leaders chose the problems that the nursing home residents most commonly experienced in each area. The occupational therapist led the discussions in the area of physical health, which covered, among other topics, cardiovascular disease, arthritis, diabetes, and sensory loss. The book
156
HEALTH AND SOCIAL WORK
"At times, a group member would ask the leaders what they were leuning from the meetings, and the leaders would then have to struggle with their own feelings and prejudices about growing old."
Aging and Mental Health was used as a reference for the discussions of emotional health, which dealt with the attitude of giving up, loneliness and losses, ageism, senility, death and dying, and coping mechanisms. 3 Discussions of social resources inciuded such topics as sexuality and loss of friends, family, status, and prestige in the community. The area of financial resources included the topics of retirement and lack of financial reserves. The last problem area discussed, independence versus dependence, dealt with elderly persons' increased dependence on their children and the institution. This was seen as almost a role reversal or, as Edna Wasser describes it, the stage of filial maturity. 4 The first three meetings were the most difficult sessions for the social worker to control. The group began with a relaxed, "get acquainted" atmosphere to set a warm, accepting tone. Because all the participants lived in the nursing home, most of them knew each other, although not by name, and this helped speed up the initial period. The goals of the group were stated, and from the onset the leaders insisted on group participation and involvement and encouraged potential group leaders. The initial meetings were difficult because the members did not want to express their feelings and therefore tried to change the subject of the discussions. This initial resistance and fear of talking about "being old" was a
BEING OLD
157
barrier to the group process. Apparently, the group members had been socialized not to talk openly about subjects such as senility, death, and sexuality. The social worker had to be directive to maintain control of the meetings and keep the group on course. The group members made some important statements in these early, difficult sessions. In the first session, the group named itself the "being old group." The leaders had initially called it the "growing old group," but one woman suggested, "Let's say it as it is—we are not growing old, we are old." The same participant said, "People talk but never listen to each other. Here we should be willing to listen to each other." Another woman confided, "I was a very independent person once; I never understood how many problems old people had until I became old." Another woman, who was filled with a great deal of hostility and bitterness about being old, verbalized her anger by saying, "I'm so sick of it, I could almost cry." The participants' defense mechanisms and coping patterns became quite obvious during these initial sessions. Some people used silence, others used humor, intellectualization, anger, and rationalization. No one denied, though, that they had problems with growing old. SHARING FEELINGS AND GROUP SUPPORT By the fourth session group cohesion had begun to develop, and the elderly group members were ready to open up and discuss their feelings more freely. An accepting, nonjudgmental atmosphere had been established, and they felt more trusting of each other. The members were more willing to share feelings and take
risks.
158
HEALTH AND SOCIAL WORK
During this session, which dealt with sexuality, one participant was able to express her feelings honestly for the first time, as follows: Is there anything wrong with having a certain person of the opposite sex that you enjoy just talking with, just sitting together and conversing? Is there anything wrong with it? I have done nothing I would be ashamed of, but as I sit in the lobby or walk through the halls people talk about me as if I have done a terrible thing, and it hurts me.
Other participants reacted to this woman's statement, some supportive of her and others not. One woman said, "We are old people already and have children. Our husbands are dead. It is a shame to be with another man." There was definite movement in this session from group members addressing their comments to the group leader to direct interaction between group members. As Knopka states, "The dynamics of the group process are determined by the kind and quality of the interaction among members," and this direct interaction was encouraged. 5 By the sixth session, the basic core of nine persons who always came to the group meetings had been established. This session dealt with ageism and society's attitudes toward aging and old people. The members shared feelings a great deal during this session and gave each other a lot of support. Everyone present made at least one comment. The leaders started the session by defining ageism by quoting from a newspaper article. Three women expressed resentment at the fact that all old people are stereotyped into one negative image. The first woman stated: "I don't feel like I'm old. I keep up my old activities as I did before. I keep very
BEING OLD
159
busy physically and mentally. I read the newspaper daily, and I still do my own washing and ironing even." Another woman commented: I agree with you, but how do we define old age? Who is old? You see a lot of young people who are old, absolutely old, their minds are asleep. They have never exercised their minds. Me, I was never afraid to give my age. You are as young as you act and feel. I never feit old and I don't feel old, now at 87 years old. Yes, I feel weak, unsure of my footing, but I don't feel old and I don't like being stereotyped. I do not live in the past and I am not afraid of the future.
The third woman added: I don't get older in my mind. Maybe my body gets old, but not my outlook on life. Reading and looking at what's happening in the world, that's what makes me young. I don't want to be stereotyped as an old person. I'm me. This discussion group means so much to me, because I can come and teil what I feel.
The group members did not want to leave after this session was over and continued talking in small grouns on their way to lunch. Thus, throughout this middle stage of group development, sharing of feelings among the members and group support were evident.
TAKING INITIATIVE The termination stage of the group had two parts to it. The first was evident by the tenth session, when group members showed themselves more willing to accept some responsibility for running the group. The topic for this session, the attitude of giving up, was chosen by one of the elderly participants. She brought in two related articles to read and helped lead the discussion.
160
HEALTH AND SOCIAL WORK
The articles she chose were about two elderly persons, both of whom had equal financial and social resources. One of the women remained active and interested in things around her, but the other woman had not left her house in five years and often cried out of loneliness. The participant leading the discussion said that the differente between these two women was their mental attitude. She stated, "Mental attitude has to be taken care of first. The woman who never left her house has given up completely." A lively discussion ensued from this article. The group struggled to understand why some people keep on going and others give up. One participant stated: The woman who never left her house had just stopped fighting. I never did. I have been widowed for twenty-five years and I got tired of being alone with the four walls, so I started my own seamstress business. I've always been a fighter. It's got to be within you.
Another participant added, "You have to have strong will power to live and to fight what comes against you. If you can't do it, you're bound to give up." Another woman continued, "It starts in your childhood. Some people have a fighting spirit all their lives. You are what you are, old or young." The group member who had initiated the discussion summed up by saying, This is what I wanted to bring out from the article: If your character is such that you're a fighter, physically or mentally you won't give up, but what happens to the people who do not have that character? They sit and brood and give up. What can we do for those people?
The staff leaders opened this question to the group. Several participants suggested that they could talk with
BEING OLD
161
these residents who have "given up," show an interest in them, and educate them to the possibilities for constructive activity at the nursing home. The underlying theme of this session was, "Am I my brother's keeper?" and the group members overwhelmingly answered "Yes." This feeling was best summed up by a group member when she said, "It is the responsibility of everyone living here at the home to help each other. It makes a differente when we old people try to help each other, in any way and as much as we are capable of." That the group was able to agree on this philosophy was particularly significant, considering that the members were living in an institutional setting, which does not usually foster this type of responsibility and concern for other people. Unwittingly, nursing homes usually promote exactiv the onposite behavior and attitude, that of "the survival of the fittest." ACCEPTANCE OF AGING The second stage of termination was the members' development of a self-realization and acceptance of the aging process with both its fears and joys. It started with the session that covered the topics of chronic organic brain syndrome—in layman's terms, senility—and reality orientation—a form of therapy that tries to reverse senility. For this session the leaders asked the reality orientation coordinator of the nursing home, who deals with the more confused residents and tries to improve their memories, orientation, and socialization skiffs, to give a presentation about senility and her work with the mentally impaired elderly. Her presentation, complete with a slide show of her work, was given in a gentle,
162
HEALTH AND SOCIAL WORK
sensitive way. It emphasized that stat' in the nursing home had not given up on senile residents but were exploring new ways of helping them. However, a change in atmosphere was quite evident from the previous session, in which group members talked openly about their own impending deaths, to the frightened silence of this session. The leaders pointed out this change to the group members, who slowly began to acknowledge that "becoming senile" was their greatest fear of old age. One woman stated honestly: I can't go visit people on the third floor [the section of the building where the most mentally impaired residents reside], it upsets me too much. I go up there and get sick of it and I must come down. I don't believe there is anything we can really do to help these people, and that scares me. Other members showed agreement with her by nods of their heads. There were many such nonverbal cues during this session, that indicated the residents' fear of senility. Another member stated, "What is most frightening is that it may happen to any of us. A close friend of mine became senile." One group participant dealt with this frightening subject by shutting it out completely and falling asleep, which she had never done in the group before. This was the most difficult session for the elderly members to face, but unlike the early sessions, the majority of them were willing to admit their feelings, verbalize their fears, and support each other. The final sessions of the group dealt with the acceptance of growing old and the positive aspects of aging. One man stated: We're getting old, but you've got to take it, be satisfied with it. It's natural. Our fathers and mothers
BEING OLD
163
were wonderful people, but they got old and died. It's the most tragic thing to lose your parents, but it will happen to us. We get old, we can't help it. We have to take life as it is.
In the discussion about the positive aspects of growing old, the joys of being grandparents were discussed. Some members also said that they feit they had attained a certain amount of wisdom. "After all," one member stated, "we have lived so long, we had to learn something." Another group member added, "It is really a privilege to be old, you know, and to be able to understand that you still can do things." Another man continued, "You know old age is respected in Judaism, it is a Jewish tradition. Look at Moses who lived to be 120 years old." A member who had emerged as the group leader remarked, "Now at age 87, I feel a new freedom. People don't expect as much of me as before and I feel a new personal freedom to express myself." Group members also brought in appropriate newspaper articles and shared them with the rest of the group. Thus, through the group work process, a group of elderly nursing home residents were able to confront and attempt to come to terms with their aging process. They began to accept "being old." PROBLEMS WITH THE GROUP There were some problems that developed in running the group that should be mentioned. One problem was a high dropout rate. After talking individually with elderly residents who lelt the group, the leaders did not insist that they rejoin, but extended an open invitation to come back. Some basic reasons for their dropping
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out were ill health, prior commitments because of scheduling in the nursing home, and inability to face the subjects being discussed. Another problem was that the time of the group sessions conflicted with other activities in the nursing home, thus helping to keep attendance small. This seems to be a constant problem in nursing homes. Among the dropouts was a woman who attended the first two sessions and who could have benefited greatly from the group. This woman was filled with a great deal of anger and bitterness about being old. She had no close friends in the nursing home and had raid that she trusted no one. She stated, "You start to make a friend, but it doesn't last long. You see through each other." This woman dropped out because of a conflicting commitment. However, the leaders feit it was partly due to her inability to communicate to other group members without expressing deep hostility and anger, which the others resented. The last problem confronting the group was societal attitudes, expressed by the group members in their initial resistance to talking about such "forbidden topics" as death, sexuality, senility, and old age. Through the group process, the members were able to push through some of these barriers, but they remained ever-present obstacles to tackle. OBSERVATIONS AND SUMMARY One of the most significant outcomes of the "being old group" was the establishment of a camaraderie and closeness among its members that carried beyond the group sessions. This was a definite accomplishment in an institutional setting where the atmosphere generally
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promotes an unhealthy competition for attention among the residents. Throughout the sessions, the social worker and occupational therapist tried to share their feelings, thoughts, and fears about growing old with the elderly group members. This helped to set the tone of the group, facilitate discussion, establish rapport, and show the human side of the leaders. At times, a group member would ask the leaders what they were learning from the meetings, and the leaders would then have to struggle with their own feelings and prejudices about growing old. The group had the complete support of the nursing home's administration, which greatly facilitated the group's work. For example, the meetings were held in the board room of the home, a room rarely used by the residents. This support added legitimacy, respect, and status to the group and gave the members a feeling of importance. Thus, through the group work process, elderly people who at first showed great resistance to sharing their feelings and talking about being old progressed to the point of sharing feelings, supporting each other, and accepting responsibility for themselves and others. The participants had a chance to examine, share, ventilate, and come to terms with their feelings about being old. The leaders felt that the goals of the group were reached and that the "being old group" was a successful experience for the elderly nursing home residents who attended. They have been asked by other nursing home residents to run another "being old group" at a different time so that they, too, could have the opportunity for this experience.
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About the Author Phyllis Braudy Harris, MSW, is Assistant Administrator, Detroit Jewish Home for Aged, Detroit, Michigan. The author would like to thank Davida Doneson for her assistance in leading the group.
Notes and References 1. Elaine M. Brody, A Social Work Guide for LongTerm Care Facilities (Rockville, Md.: National Institute of Mental Health, 1974), p. 134. 2. Eric Pfeiffer, OARS Multidimensional Functional Assessment Questionnaire (Durham, N.C.: Duke University Center for the Study of Aging and Human Development, Older Americans Resources and Services Program, 1975). 3. Robert Butler and Myrna Lewis, Aging and Mental Health (St. Louis, Mo.: C. V. Mosby Co., 1973), Part I. 4. Edna Wasser, "Family Casework Focus on the Older Person," Social Casework, 47 (July 1966), pp. 423-431. 5. Gisela Knopka, Social Group Work: A Helping Process (Englewood Cliffs, N.J.: Prentice-Hall, 1964), p. 54.
HEALTH AND SOCIAL WORK, Vol. 4, No. 1, February 1979
0360-7283/79/0401-0152 $0.50 0 1979 National Association of Social Workers, Inc.
Elderly nursing home residents who participated in a group experience openly discuseed and attempted to deal with the process of aging in their own lives. The group experiences that are described illustrate the elderly people's ability to face their life situation and demonstrate their potential for growth and change.
T
HE IMPORTANCE OF GROUP WORK with the elderly in an institutional setting has not been sufficiently recognized. This form of treatment can have many benefits for older persons, and it deserves to become a more popular practice. For example, it can give the elderly a chance to develop or relearn social interaction skills, to make new social contacts, and to develop peer support systems. The group experience also offers the elderly a chance for therapeutic ventilation, the opportunity for the personal growth and development that is possible at any stage in life, and a chance to evaluate their own situations in life in terms of others in comparable situations. In general, however, group work with the elderly has been focused around specific problems that are not necessarily related to old age, such as widowhood,
153
154
HEALTH AND SOCIAL WORK
marital problems, recovery from stroke, and so on. Little group work has dealt specifically with the problems of aging or has involved elderly nursing home residents who have adequate social interaction skills These concerns can be addressed in a confrontation group that openly and honestly talks about being old and how it feels. Such a group was formed at the Detroit Jewish Home for Aged. The topics discussed in this group had never been dealt with or discussed openly before in the home. The techniques were a combination of confrontation, ventilation, and self-help. The goals of the group were the following: n To encourage verbalization of fears, feelings, and problems of old age. n To encourage group members to share feelings and experiences. n To develop the beginnings of a peer support system. n To encourage self-help among the participants. n To provide educational information that would clear up misinformation and misunderstandings about physical and mental health problems of old age. n To help the members as a group and as individuals come to some self-realization and acceptance of the aging process. Brody articulates the philosophy of the group when, in talking about the nursing home population, she states: Residents are helped best when they engage in helping themselves to the best of their abilities. The goal in this effort is to restore purpose as well as function; to
BEING 0 LD
155
fix attention on the quality as well as the quantity of life, and to temper expectations with realistic yardsticks. 1
GROUP COMPOSITION AND FORMAT The group was led by a social worker with the assistance of a registered occupational therapist, who joined to lead the discussions on health-related subjects. The group met on a weekly basis for five months, twenty sessions in all, and was open to any resident of the Detroit Jewish Home for Aged. A total of twenty-eight people came to the group, but the average attendance was nine to twelve people per session, consisting mostly of a constant core of the same nine persons. Thus, approximately one-third of the people who attended at least one session continued to come on a regular basis. The majority of regular participants were residents with a higher level of functioning and adequate social interaction skills, but other residents allo came and were able to participate. The leaders chose as general topics for discussion the five main problem areas for the elderly outlined in the OARS Multidimensional Functional Assessment Questionnaire prepared by the Older Americans Resources and Service Program: physical health, emotional health, social resources, financial resources, and independence versus dependence. 2 Each topic could have been discussed for months, but the leaders chose the problems that the nursing home residents most commonly experienced in each area. The occupational therapist led the discussions in the area of physical health, which covered, among other topics, cardiovascular disease, arthritis, diabetes, and sensory loss. The book
156
HEALTH AND SOCIAL WORK
"At times, a group member would ask the leaders what they were leuning from the meetings, and the leaders would then have to struggle with their own feelings and prejudices about growing old."
Aging and Mental Health was used as a reference for the discussions of emotional health, which dealt with the attitude of giving up, loneliness and losses, ageism, senility, death and dying, and coping mechanisms. 3 Discussions of social resources inciuded such topics as sexuality and loss of friends, family, status, and prestige in the community. The area of financial resources included the topics of retirement and lack of financial reserves. The last problem area discussed, independence versus dependence, dealt with elderly persons' increased dependence on their children and the institution. This was seen as almost a role reversal or, as Edna Wasser describes it, the stage of filial maturity. 4 The first three meetings were the most difficult sessions for the social worker to control. The group began with a relaxed, "get acquainted" atmosphere to set a warm, accepting tone. Because all the participants lived in the nursing home, most of them knew each other, although not by name, and this helped speed up the initial period. The goals of the group were stated, and from the onset the leaders insisted on group participation and involvement and encouraged potential group leaders. The initial meetings were difficult because the members did not want to express their feelings and therefore tried to change the subject of the discussions. This initial resistance and fear of talking about "being old" was a
BEING OLD
157
barrier to the group process. Apparently, the group members had been socialized not to talk openly about subjects such as senility, death, and sexuality. The social worker had to be directive to maintain control of the meetings and keep the group on course. The group members made some important statements in these early, difficult sessions. In the first session, the group named itself the "being old group." The leaders had initially called it the "growing old group," but one woman suggested, "Let's say it as it is—we are not growing old, we are old." The same participant said, "People talk but never listen to each other. Here we should be willing to listen to each other." Another woman confided, "I was a very independent person once; I never understood how many problems old people had until I became old." Another woman, who was filled with a great deal of hostility and bitterness about being old, verbalized her anger by saying, "I'm so sick of it, I could almost cry." The participants' defense mechanisms and coping patterns became quite obvious during these initial sessions. Some people used silence, others used humor, intellectualization, anger, and rationalization. No one denied, though, that they had problems with growing old. SHARING FEELINGS AND GROUP SUPPORT By the fourth session group cohesion had begun to develop, and the elderly group members were ready to open up and discuss their feelings more freely. An accepting, nonjudgmental atmosphere had been established, and they felt more trusting of each other. The members were more willing to share feelings and take
risks.
158
HEALTH AND SOCIAL WORK
During this session, which dealt with sexuality, one participant was able to express her feelings honestly for the first time, as follows: Is there anything wrong with having a certain person of the opposite sex that you enjoy just talking with, just sitting together and conversing? Is there anything wrong with it? I have done nothing I would be ashamed of, but as I sit in the lobby or walk through the halls people talk about me as if I have done a terrible thing, and it hurts me.
Other participants reacted to this woman's statement, some supportive of her and others not. One woman said, "We are old people already and have children. Our husbands are dead. It is a shame to be with another man." There was definite movement in this session from group members addressing their comments to the group leader to direct interaction between group members. As Knopka states, "The dynamics of the group process are determined by the kind and quality of the interaction among members," and this direct interaction was encouraged. 5 By the sixth session, the basic core of nine persons who always came to the group meetings had been established. This session dealt with ageism and society's attitudes toward aging and old people. The members shared feelings a great deal during this session and gave each other a lot of support. Everyone present made at least one comment. The leaders started the session by defining ageism by quoting from a newspaper article. Three women expressed resentment at the fact that all old people are stereotyped into one negative image. The first woman stated: "I don't feel like I'm old. I keep up my old activities as I did before. I keep very
BEING OLD
159
busy physically and mentally. I read the newspaper daily, and I still do my own washing and ironing even." Another woman commented: I agree with you, but how do we define old age? Who is old? You see a lot of young people who are old, absolutely old, their minds are asleep. They have never exercised their minds. Me, I was never afraid to give my age. You are as young as you act and feel. I never feit old and I don't feel old, now at 87 years old. Yes, I feel weak, unsure of my footing, but I don't feel old and I don't like being stereotyped. I do not live in the past and I am not afraid of the future.
The third woman added: I don't get older in my mind. Maybe my body gets old, but not my outlook on life. Reading and looking at what's happening in the world, that's what makes me young. I don't want to be stereotyped as an old person. I'm me. This discussion group means so much to me, because I can come and teil what I feel.
The group members did not want to leave after this session was over and continued talking in small grouns on their way to lunch. Thus, throughout this middle stage of group development, sharing of feelings among the members and group support were evident.
TAKING INITIATIVE The termination stage of the group had two parts to it. The first was evident by the tenth session, when group members showed themselves more willing to accept some responsibility for running the group. The topic for this session, the attitude of giving up, was chosen by one of the elderly participants. She brought in two related articles to read and helped lead the discussion.
160
HEALTH AND SOCIAL WORK
The articles she chose were about two elderly persons, both of whom had equal financial and social resources. One of the women remained active and interested in things around her, but the other woman had not left her house in five years and often cried out of loneliness. The participant leading the discussion said that the differente between these two women was their mental attitude. She stated, "Mental attitude has to be taken care of first. The woman who never left her house has given up completely." A lively discussion ensued from this article. The group struggled to understand why some people keep on going and others give up. One participant stated: The woman who never left her house had just stopped fighting. I never did. I have been widowed for twenty-five years and I got tired of being alone with the four walls, so I started my own seamstress business. I've always been a fighter. It's got to be within you.
Another participant added, "You have to have strong will power to live and to fight what comes against you. If you can't do it, you're bound to give up." Another woman continued, "It starts in your childhood. Some people have a fighting spirit all their lives. You are what you are, old or young." The group member who had initiated the discussion summed up by saying, This is what I wanted to bring out from the article: If your character is such that you're a fighter, physically or mentally you won't give up, but what happens to the people who do not have that character? They sit and brood and give up. What can we do for those people?
The staff leaders opened this question to the group. Several participants suggested that they could talk with
BEING OLD
161
these residents who have "given up," show an interest in them, and educate them to the possibilities for constructive activity at the nursing home. The underlying theme of this session was, "Am I my brother's keeper?" and the group members overwhelmingly answered "Yes." This feeling was best summed up by a group member when she said, "It is the responsibility of everyone living here at the home to help each other. It makes a differente when we old people try to help each other, in any way and as much as we are capable of." That the group was able to agree on this philosophy was particularly significant, considering that the members were living in an institutional setting, which does not usually foster this type of responsibility and concern for other people. Unwittingly, nursing homes usually promote exactiv the onposite behavior and attitude, that of "the survival of the fittest." ACCEPTANCE OF AGING The second stage of termination was the members' development of a self-realization and acceptance of the aging process with both its fears and joys. It started with the session that covered the topics of chronic organic brain syndrome—in layman's terms, senility—and reality orientation—a form of therapy that tries to reverse senility. For this session the leaders asked the reality orientation coordinator of the nursing home, who deals with the more confused residents and tries to improve their memories, orientation, and socialization skiffs, to give a presentation about senility and her work with the mentally impaired elderly. Her presentation, complete with a slide show of her work, was given in a gentle,
162
HEALTH AND SOCIAL WORK
sensitive way. It emphasized that stat' in the nursing home had not given up on senile residents but were exploring new ways of helping them. However, a change in atmosphere was quite evident from the previous session, in which group members talked openly about their own impending deaths, to the frightened silence of this session. The leaders pointed out this change to the group members, who slowly began to acknowledge that "becoming senile" was their greatest fear of old age. One woman stated honestly: I can't go visit people on the third floor [the section of the building where the most mentally impaired residents reside], it upsets me too much. I go up there and get sick of it and I must come down. I don't believe there is anything we can really do to help these people, and that scares me. Other members showed agreement with her by nods of their heads. There were many such nonverbal cues during this session, that indicated the residents' fear of senility. Another member stated, "What is most frightening is that it may happen to any of us. A close friend of mine became senile." One group participant dealt with this frightening subject by shutting it out completely and falling asleep, which she had never done in the group before. This was the most difficult session for the elderly members to face, but unlike the early sessions, the majority of them were willing to admit their feelings, verbalize their fears, and support each other. The final sessions of the group dealt with the acceptance of growing old and the positive aspects of aging. One man stated: We're getting old, but you've got to take it, be satisfied with it. It's natural. Our fathers and mothers
BEING OLD
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were wonderful people, but they got old and died. It's the most tragic thing to lose your parents, but it will happen to us. We get old, we can't help it. We have to take life as it is.
In the discussion about the positive aspects of growing old, the joys of being grandparents were discussed. Some members also said that they feit they had attained a certain amount of wisdom. "After all," one member stated, "we have lived so long, we had to learn something." Another group member added, "It is really a privilege to be old, you know, and to be able to understand that you still can do things." Another man continued, "You know old age is respected in Judaism, it is a Jewish tradition. Look at Moses who lived to be 120 years old." A member who had emerged as the group leader remarked, "Now at age 87, I feel a new freedom. People don't expect as much of me as before and I feel a new personal freedom to express myself." Group members also brought in appropriate newspaper articles and shared them with the rest of the group. Thus, through the group work process, a group of elderly nursing home residents were able to confront and attempt to come to terms with their aging process. They began to accept "being old." PROBLEMS WITH THE GROUP There were some problems that developed in running the group that should be mentioned. One problem was a high dropout rate. After talking individually with elderly residents who lelt the group, the leaders did not insist that they rejoin, but extended an open invitation to come back. Some basic reasons for their dropping
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out were ill health, prior commitments because of scheduling in the nursing home, and inability to face the subjects being discussed. Another problem was that the time of the group sessions conflicted with other activities in the nursing home, thus helping to keep attendance small. This seems to be a constant problem in nursing homes. Among the dropouts was a woman who attended the first two sessions and who could have benefited greatly from the group. This woman was filled with a great deal of anger and bitterness about being old. She had no close friends in the nursing home and had raid that she trusted no one. She stated, "You start to make a friend, but it doesn't last long. You see through each other." This woman dropped out because of a conflicting commitment. However, the leaders feit it was partly due to her inability to communicate to other group members without expressing deep hostility and anger, which the others resented. The last problem confronting the group was societal attitudes, expressed by the group members in their initial resistance to talking about such "forbidden topics" as death, sexuality, senility, and old age. Through the group process, the members were able to push through some of these barriers, but they remained ever-present obstacles to tackle. OBSERVATIONS AND SUMMARY One of the most significant outcomes of the "being old group" was the establishment of a camaraderie and closeness among its members that carried beyond the group sessions. This was a definite accomplishment in an institutional setting where the atmosphere generally
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promotes an unhealthy competition for attention among the residents. Throughout the sessions, the social worker and occupational therapist tried to share their feelings, thoughts, and fears about growing old with the elderly group members. This helped to set the tone of the group, facilitate discussion, establish rapport, and show the human side of the leaders. At times, a group member would ask the leaders what they were learning from the meetings, and the leaders would then have to struggle with their own feelings and prejudices about growing old. The group had the complete support of the nursing home's administration, which greatly facilitated the group's work. For example, the meetings were held in the board room of the home, a room rarely used by the residents. This support added legitimacy, respect, and status to the group and gave the members a feeling of importance. Thus, through the group work process, elderly people who at first showed great resistance to sharing their feelings and talking about being old progressed to the point of sharing feelings, supporting each other, and accepting responsibility for themselves and others. The participants had a chance to examine, share, ventilate, and come to terms with their feelings about being old. The leaders felt that the goals of the group were reached and that the "being old group" was a successful experience for the elderly nursing home residents who attended. They have been asked by other nursing home residents to run another "being old group" at a different time so that they, too, could have the opportunity for this experience.
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About the Author Phyllis Braudy Harris, MSW, is Assistant Administrator, Detroit Jewish Home for Aged, Detroit, Michigan. The author would like to thank Davida Doneson for her assistance in leading the group.
Notes and References 1. Elaine M. Brody, A Social Work Guide for LongTerm Care Facilities (Rockville, Md.: National Institute of Mental Health, 1974), p. 134. 2. Eric Pfeiffer, OARS Multidimensional Functional Assessment Questionnaire (Durham, N.C.: Duke University Center for the Study of Aging and Human Development, Older Americans Resources and Services Program, 1975). 3. Robert Butler and Myrna Lewis, Aging and Mental Health (St. Louis, Mo.: C. V. Mosby Co., 1973), Part I. 4. Edna Wasser, "Family Casework Focus on the Older Person," Social Casework, 47 (July 1966), pp. 423-431. 5. Gisela Knopka, Social Group Work: A Helping Process (Englewood Cliffs, N.J.: Prentice-Hall, 1964), p. 54.
