Happiness in continuing care

June 30, 2016

By Debra Clark


The pursuit of happiness is real. Young or old, it is part of our natural instinct as human beings. We spend money to protect it, switch jobs to attain it and sometimes even travel to find it. And while many of us struggle to fully define “happiness,” ultimately each of us has the autonomy to decide what makes us happy.

But what if the right to govern our own existence, and happiness, was limited? The reality is that baby boomers—that massive legion of people born during the 20 years following the Second World War—will continue to transition into old age, and the probable number of Canadians who will experience life in a continuing care centre (CCC) is staggering.

Seniors and happiness

Today’s fourth-generation seniors, aged 85 years and older, is the fastest growing age group in the Canadian population. Between 1981 and 2005, this demographic grew by about 300,000 people. By 2056, Statistics Canada expects this number to swell to more than 2.5 million. Unfortunately, the quality of life for this greying group is often impacted by the loss of health and, to a greater extent, the loss of independence, income, social life and personal relationships. In fact, almost one-third of fourth-generation seniors currently live in institutional environments, yet residents are often excluded from the vast majority of studies on aging, a fact that diminishes their voice in discussions about their own well-being—not to mention happiness.

“Research in this area is limited mainly because it’s a fairly new phenomenon for this aging population—people are living longer,” says Shirley Galenza, director of MacEwan University’s Centre for Professional Nursing Education (CPNE). “There is a reluctance within people to think about aging and no longer being able to live in their own home and leaving everything they know behind. So, rather than associating a continuing care facility with negativity, the goal of residents should be to accept that there has been a change in their life and that they are now part of this other community. It should be the goal of care providers to help residents achieve this shift in perspective,” Galenza explains.


“ It’s important to raise awareness—that the residents have needs, still have wants and desires, and seek control over their own environment.Shirley Galenza 


Over a two-year period ending in 2014, a study team at MacEwan University set its sights on uncovering how care providers can support the happiness and overall well-being of those living in a CCC. To explore this topic, and to ease the fears that the elderly experience, Dr. Irene Coulson, the study’s principal investigator, gathered a group of co-investigators from MacEwan University including Galenza, Dr. Mary Haase (psychiatric nursing), Dr. Sharon Bratt (computer science), and Dr. Lori Harper (psychology), as well as research assistant Ellen Klaver.

When happiness goes missing

So what exactly is happiness? It’s a concept that has captivated great thinkers, not to mention you and me, for thousands of years. In third-century BC, Aristotle presented his philosophy of happiness, or what he described as “eudemonia,” as a way of living, rather than simply feeling good. In other words, happiness is associated with many different aspects of psychological well-being that include pleasure, life satisfaction, as well as a sense of meaning and greater purpose. In turn, these elements help promote physical health.

Self-determination theory and our basic psychological needs for autonomy, competency and relatedness formed the basis of the team’s conceptual framework. “The institutionalized environment within continuing care can compromise these basic needs, especially for seniors in the fourth generation,” says Coulson. “Rigid routines and regulations designed to promote efficiency are often achieved at the expense of resident autonomy.” Similarly, retaining a sense of competency (one’s sense of mastery in managing one’s environment, in spite of their disabilities) and relatedness (an individual’s relationships with family, friends and other community members) can prove challenging within the structure of a CCC.

Funded by the research boards of Covenant Health and MacEwan University, the teams’ study was conducted in two Covenant Health care centres in Alberta. The study consisted of care-policy analysis, resident interviews and focus groups that, in turn, generated a number of propositions, or hypothesis, about what produces happiness for those in life’s final stage.

How to bring it back

With respect to autonomy, the team found that residents must have a voice in decisions about their health care and well-being, and a daily routine that focuses on individual needs, abilities and desires. Fourth-generation seniors in care are reluctant to challenge the status quo. “Residents don’t want to ‘rock the boat’ even if they disagree with decisions being made about their care. This makes it very important to educate caregivers about how to encourage residents to express what they want without fear of reprisal,” says Coulson.

For seniors in continuing care, competency in mastering their own environment is also crucial. While their day should have meaningful purpose, residents accept that assistance with daily routines is required. Facility expectations about living in a CCC should be clearly communicated to residents in language that is easily understood. The study also found that continuing care centres provide a place where residents live but don’t generally perceive as home.

Relatedness, or how relationships are promoted, is also key to producing a eudemonic environment in continuing care. Encouraging social relationships with other residents and staff, maintaining and supporting positive relationships with family and friends, providing opportunities to practice spiritual beliefs or religion, and respecting resident opinions are all important contributors.

“Residents in continuing care seek purpose in life and want to be seen as a valued person with ongoing potential for growth,” notes Coulson. “We found that for this group, family and friends make life worth living—it was primarily internal motivations that produced happiness.”

Envisioning a new approach

Coulson and her group found that there is no magic formula for creating a eudemonic environment within a CCC, but that every CCC is unique in its philosophy. Facilities are also guided by national, provincial, regional and operational government policies. “If administrators, educators and clinicians understand what enables residents to become happy, then we need to foster policies, education and practices to create a ‘happy’ environment for residents, specifically within the realms of autonomy, competency, and relatedness,” Coulson asserts.

“It’s important to raise awareness—that the residents have needs, still have wants and desires, and seek control over their own environment,” says Galenza. Whether a nurse, occupational therapist or dietician, there is a need for staff and the residents to collaborate to create a eudemonic environment. “It’s really about the broader picture of person-centered care … I think as caregivers we sometimes get so wrapped-up in getting tasks done that we need a reminder every now and then to look at the individual,” she explains. According to Coulson, this type of care provides the foundation for relational care, which encourages staff to develop relationships with each resident and their family. “Residents can’t do it on their own. It’s done collectively—that’s the only way it can happen,” Coulson says.


The Centre for Professional Nursing Education provides continuing education for nurses and health-care professionals.

Get MacEwan University news delivered to your inbox.
Sign up for our weekly e-newsletter