She stays in her room all day: depression in long-term care, and two numbers you can look up

When she stops talking

She is not unwell, exactly. She just stops asking for anything. She stays in her room, the television on without being watched, answering you in single words. When you raise it, you are told she has "settled in", or that this is normal at her age.

Both answers are wrong. Depression is not a normal part of aging. In long-term care it is common, under-recognized and treatable — and common is not the same as inevitable, any more than it is with pain.

The two numbers you can look up first

Here is the Canadian advantage, and almost no family uses it. Every long-term care home submits standardized resident assessments, and among the quality indicators collected and publicly reported by home are:

• Residents whose depressive mood worsened.
• Residents given antipsychotics without a diagnosis of psychosis.

That second one matters enormously here, because it is the exact failure this article is about: sedating a withdrawn resident instead of treating her. It has been a national quality priority for years precisely because the rates were high, and it is published per home against the provincial average.

Look both up before your next care conference. If this home is well above average on either, you are not having a conversation about your mother's temperament. You are having one about how the building is run — and you can say so with a number in your hand.

Three things to rule out before calling it depression

Withdrawal looks identical whatever is causing it, and the wrong order leads straight to the wrong prescription. Ask for these to be excluded:

1. Untreated pain. The leading cause of withdrawal and apathy in older adults, and in someone with dementia it is not reported in words. Ask whether pain was assessed with an observational tool, and when. Pain is also a reported indicator — ask for that result too.
2. Delirium. Withdrawal that developed over days rather than weeks, with fluctuating confusion, is delirium until proven otherwise: infection, dehydration, constipation, or a new medication. That is a medical urgency, not a mood problem.
3. Hearing, vision and teeth. A hearing aid that is dead, broken or simply not put in isolates someone completely within weeks. So do missing glasses and dentures that no longer fit — a resident who cannot manage a meal in the dining room retreats to her room.

The right treatment and the wrong one

If assessment confirms depression, treatment is an appropriate antidepressant plus non-drug support — activity, relationships, movement, routine. What is not a treatment for depression is an antipsychotic.

Check the medication list and ask directly: "Has an antipsychotic been started, for what documented diagnosis, who prescribed it, and when is the reduction attempt scheduled?" In older adults with dementia these drugs increase the risk of falls, stroke and death, and using them because someone is quiet and not disruptive is a chemical restraint, not care. Least restraint is the standard across Canadian long-term care legislation.

Ask for a pharmacist medication review covering everything she takes. Benzodiazepines, some blood pressure medications and anticholinergics all flatten mood and alertness — and homes have pharmacist review built into their service, so this is a request, not a favour.

The care conference questions

Request a care conference and put these in writing to the director of care:

• When was she last assessed for mood, with what tool, and what did it show?
• What does her care plan say about participation and social engagement, and who delivers it day to day?
• Which activities has she actually attended in the past month? Ask for the record, not an impression.
• What has been tried to get her out of her room, and what happened?
• Is there access to social work, recreation therapy, or a mental health consult through the home or the region?

What you can do, and it counts more than you think

• Predictable visits beat long ones. Twenty minutes three times a week on the same days gives the week a shape; three hours on Sunday does not.
• Bring a task, not just conversation. Folding laundry, going through photographs with names on the back, shelling peas. Someone with a role withdraws less.
• Get her out of the room while you are there, even just into the hallway or outside. Light and movement act on sleep, and sleep acts on mood.
• Ask about the room itself. A room far from the common areas isolates. Requesting a move is reasonable — put it in writing.
• Check the hearing aid every visit. Battery, switched on, actually in the ear. The most effective and most neglected intervention there is.

If nothing happens

1. A written request to the director of care and administrator, with a care conference date.
2. The Family Council or Residents' Council, if the problem is building-wide — and it usually is.
3. The province's long-term care complaint or action line, which takes family complaints directly and can trigger an inspection.
4. The patient ombudsman, where your province has one.

When the problem is the building, not the person

There is a difference between a home where your mother is sad and one where everybody is in their room. If the lounge is empty at four in the afternoon, if a television plays to ten people who are not speaking, if recreation is a poster rather than a log with names in it, the problem is not your mother's mood — and the published indicators will usually agree with you.

If that is where you have landed and you do not have another round of calls in you, that is the part we do. Tell us the region, your parent's needs and what went wrong here, and you get a shortlist of homes worth calling, for CA$99. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here

This article is general information for families, not medical advice. Assessment and treatment decisions belong to the treating clinicians, and reporting, staffing and complaint procedures differ by province and territory. If you are worried about immediate risk to your parent, speak to the nurse in charge without delay. Curalune does not allocate beds and does not guarantee availability.