Nursing facilities have made tremendous strides in the past 25 years. An abundance of truly compassionate, highly trained caregivers is common in most facilities, and many facilities provide state-of-the-art services with deluxe accommodations.
Having highly competent staff working around the clock, being provided more choices in their daily lives, and having ample opportunities to socialize and engage in activities, it would seem that residents have everything they need, right? So why, according to the American Geriatrics Society, do nearly half of all nursing facility residents experience apathy and depression?
Historically, nursing facilities have borrowed the acute hospital model of care—clinical excellence and compassionate care. Both are needed and fundamental to what hospitals and nursing facilities do. This model works well in the acute-care setting where people are soon going back to their homes. However, for nursing facility residents, this model leaves them in the long-term position of a “care receiver.”

Even if the care is of the highest caliber and staff are beyond wonderful, residents are left with their greatest fear realized: “No one needs me anymore; I am now just a burden on society.”
Without an opportunity to give back in a real and meaningful way, the stage is set for apathy and depression.

Making The Switch

In 2008, staff members at Mission View Health Center in San Luis Obispo, Calif., were brainstorming about why their residents seemed unfulfilled and unhappy, in spite of excellent treatment and care—they didn’t have that spark in their eyes. Kathy, a resident, had recently asked the administrator, “Isn’t there something I can do? Any way I can help? I am bored to tears—and I mean tears.”
A nurse assistant commented that his “life would suck if all I had to look forward to every day was thanking everyone for helping me and no one needed me anymore.”
For the first time, it struck the group that the residents really were relegated to the role of “care receivers,” no matter how good the staff were as “caregivers.” As a result, Mission View adopted a service-based approach to health care, allowing residents to give as well as receive.
In order to accomplish this goal, Mission View would align itself with the needs of the local community. By partnering with a local homeless shelter, Mission View staff set the wheels in motion for their first resident service opportunity to feed the homeless in their community.
To support this venture, residents use the activities budget to make Helping Hands Homemade Soap and sell it at the local farmers market.
At first, residents weren’t particularly excited about what they considered another arts and crafts activity. However, when the residents understood the bigger picture of feeding the homeless, there was a change of heart. They realized they were needed and could make a real difference in their community.
Today, residents with dementia use water color to decorate the soap wrappers, three residents in their 90s hawk the soap at the farmers market, while residents with vision problems and physical disabilities help prepare the meals.
Six of the residents serve food onto the plates of 150 men, women, and children at the shelter every month.
Clearly, for the residents, the activity was not about making and selling soap, but about making a difference in their community. Because the shelter truly depends on them, the residents experience purpose and meaning in their lives, as well as the joy and fulfillment of service.

Giving More

Following the success of Helping Hands, Mission View began working with a local hospice agency. Within two weeks, the first seven-week resident training was underway, enabling residents to become certified hospice volunteers, helping other residents who sometimes simply needed someone to hold their hand.
Staff at Mission View started seeing that residents were regaining that spark in their eyes; after all, when they roll out of their room as a hospice volunteer to visit another resident, they are a hospice volunteer, not a resident, and have a hospice badge to prove it.
The service-based approach extends to facility activities as well. Even with physical and cognitive challenges, residents are more capable than commonly believed.
For example, a very unhappy and cranky resident who had suffered a stroke and left-sided paralysis changed his attitude when staff realized he was bilingual and called on him to become the facility Spanish instructor.
He now spends his week planning his class and making sure he is clean-shaven and looking sharp for his lesson. Residents love his class and can be seen practicing their Spanish up and down the halls.

Word Has Spread

Initially at Mission View, staff could not picture their residents feeding the homeless, opening a food bank distribution point at the facility, or running a nonprofit business like Helping Hands Handmade Soap. And yet, it is actually happening.
It’s easy to underestimate the potential of nursing facility residents, especially when they are in a depressed and apathetic state. It is important to focus on what they can do and remind them that they can still be valuable members of their community.
Today, 40 to 50 percent of all Mission View residents are actively involved in service projects. With Mission View’s success, additional nursing facilities under the Compass Health umbrella are adopting similar programs.
Residents in one facility are baking and selling dog biscuits to help rescue elderly dogs from a local shelter. Another group is selling handmade jewelry to buy backpacks and stock them with school supplies for local underprivileged children.
Having heard about the program, another provider with 30 facilities is adopting the same program for its residents.
The cost of this culture change? It’s virtually free, with a little time and effort.
Rev. Martin Luther King Jr. once said about service, “Everybody can be great, because anybody can serve … you only need a heart full of grace.”
To purchase the residents’ Helping Hands Handmade Soap, go to To view a documentary about Mission View's work, click here: 
Matthew Lysobey, MPH, LNHA, has worked in the long term care industry for more than 15 years and spearheads the Compass Health service-based approach in San Luis Obispo, Calif. Lysobey can be reached at