Beyond the Beaten Path: The Psychologist’s Role in Senior Care Settings

Fifteen years ago, psychologists working in elder care facilities were a rarity. The various settings ,  nursing homes, care homes, assisted living facilities ,  turned to psychology once it became clear that genuine care cannot be anything less than holistic. Meaning: life, not mere survival; life that goes beyond meeting basic needs. To ensure that holism, what was needed was interdisciplinarity. And so these settings began to value the richness of multiple perspectives, in a framework where each speciality would nourish and be nourished by the others. Alongside physiotherapists, physicians, fitness instructors, nutritionists, social workers and occupational therapists, the psychologist was called to contribute their own piece to the care of older adults. Right there, beside their beds, in their most personal space.

Older adults, however, are not just any population group. Those living in care facilities are often described as fragile, vulnerable, sometimes unable to care for themselves, sometimes highly dependent on those around them. This is the terrain where the clinical psychologist is called to intervene. To work with older adults who have “little room for intervention” ,  as one sometimes hears ,  whose only option is supposedly to “accept their situation” with nothing but “realistic expectations for the future.” These are terrible phrases. And yet the challenge is real: the psychologist is called to act in a landscape of symptoms that are often diffuse and hard to define, where the arsenal of pharmacological treatment proves insufficient. In a battle theoretically lost before it begins, and under the permanent shadow of death, the psychologist must find their footing, lay their cards on the table, and say what role they play.

Feeling our way forward, to define what a clinical psychologist in a care setting actually is, it may be easier to start with what they are not.

Not a test administrator

Standardised assessment of cognitive functioning is sometimes necessary, and part of a psychologist’s training concerns this area. But a psychologist is not a technician, not a mechanic of the mind. Their work cannot be reduced to the dry application of expertise. A meeting with a person in pain is not a routine procedure.

We grow accustomed to administering dementia rating scales, measuring deficits, quantifying loss. Yet no scale or test ,  however mini ,  can relieve a psychologist of their responsibility toward each person, one at a time.

Not an office worker

A psychologist who spends their time with “computers and numbers” behind closed doors, entering questionnaire data or waiting for residents to come to them, is doing the exact opposite of what their title implies. Because the place of a “clinical” psychologist is beside the bed ,  at the bedside, literally at the edge of the mattress.

Not a Good Samaritan

Those who claim to work for the good of others often draw from it a rather narcissistic satisfaction: “I will be the one who helps, who heals.” A French saying overheard from a bedridden elderly man captures it perfectly: “La compassion est la passion du con” ,  compassion is the passion of the fool. A psychologist has far more to offer a person in pain than pity.

Not a coach

Who needs a package of perfect advice? Common sense fills volumes. But who would dare rattle off a list of tried-and-tested tips and ready-made prescriptions to someone who has lived life to the fullest? The psychologist knows well that there are no one-size-fits-all solutions, and that to support an older adult you must first listen.

Not a knowing oracle

Psychologists spend many years in training, inside and outside of universities. They are tested through their own personal therapy, and remain in continuous professional development. Yet all this training, formal or otherwise, does not make them gurus who possess all the knowledge and wisdom of life. For the psychologist, there is no pre-formed knowledge. Knowledge is always under construction, a work in progress, with each person individually. Because the only certainty, in the end, is that clinical practice never stops overturning theory.

So if the clinical psychologist in a care setting holds none of the above roles, what do they actually do? What is their responsibility toward the older person in their care?

The first thing seems simple: they listen. Floor by floor, room by room, they visit each resident with a simple offer: “I’m here to listen.” The older person may accept this offer, or they may refuse it. Either way, what is sought is a genuine encounter. One that allows the person to express their hopes, worries and fears, to put into words what is happening to them, to examine their anxieties and vulnerabilities.

There is also a tendency to define older adults through a series of absences: agnosia, amnesia, dementia, apraxia. In this framing, a resident in a care setting is more spoken about than speaking. Family, doctors, staff, each carries their own version of the person. The psychologist is called, rather than focusing on deficits or the words of those around them, to shift the centre of gravity toward the person themselves and their story, which is always singular and irreplaceable. How does this person experience each loss? What ways have they found to get through it? The psychologist gives the floor to the subject themselves, who will always have something more to tell us about what is happening to them.

For such a real encounter to be possible, it falls to the psychologist to create the conditions. An art workshop, a short walk on the balcony, a game, a group activity, a song ,  all can become openings for storytelling. The same goes for a memory exercise or a test, provided the psychologist is not a cold executor of the task but someone who allows speech to open up. Here is another particularity of clinical work with older adults: it demands inventiveness at every moment. Sensitivity, inventiveness, tact, delicacy. The psychologist’s approach mirrors the fragility of the ageing body.

Finally, a care facility is not only its residents. The psychologist therefore has a role in relation to the staff who work and struggle there every day. That role may be more informal ,  a presence “in-between,” often taking the form of a “corridor clinic.” In the small, chance daily encounters ,  on the stairs, in the lift, on the balcony, during a break ,  the psychologist creates small openings: spaces where each caregiver can express their thoughts and observations, their doubts and anxieties about the complex situations that make life in a care setting anything but smooth or predictable.

Strange and demanding, clinical work with older adults. But within its strangeness, it can also be a source of unexpected encounters, of small daily miracles. A psychologist knows well that uncertainty is the territory. In the face of suffering, is there standard knowledge? There are, at least, a poet’s words, like a small compass:

“Traveller, there is no road; the road is made by walking.” Antonio Machado, “Caminante no hay camino” (1912)