Liminality: What It Is and What to Do About It

“Why Isn’t Mom Feeling at Home Yet?”
Liminality: What It Is and What to Do About It

As the “baby boomers” move into their later years, it is clear that the number of older adults needing comprehensive care will certainly increase, and probably at a more dramatic rate than it is now. Frequent are the radio and TV ads offering either in-home care for seniors who are still living relatively independently, or a residential venue promising a gracious living environment along with diligent, round-the-clock care.

When moving a loved one into a residential community is called for, caregivers will usually focus on places that offer excellent physical care, personal comfort and safety opportunities for social engagement—a place where their loved one will feel “at home”. In response, most senior residential communities do their utmost to create an ambience that is safe, stimulating and aesthetically pleasing.

Yet, while caregivers may succeed in finding such a community for Mom, Mom may not feel so “at home”—even months after moving in. Leaving a beloved home in which she lived for decades to a place where she must be more dependent and less autonomous, she may feel useless and a burden to her family. Despite her new lovely surroundings and the good intentions of her family and staff to make her physically comfortable, she may feel displaced and abandoned.

In my work as a long-term care chaplain, I know that these feelings are real, but they often go unrecognized and unarticulated by the residents themselves. Instead, they are often expressed in the form of complaints about the facility itself, the staff, or other residents. Such complaints are often interpreted as the resident being unappreciative of the efforts being made on his/her behalf, when in reality, they are often a symptom of unarticulated feelings, which in turn are themselves a symptom of a common, but often unrecognized, phenomenon.

Clinicians and anthropologists call this phenomenon being a state of liminality. Liminality is defined as “the ambiguity or disorientation that a person often feels when standing at the threshold between their previous way of structuring their identity, time, or community, and a new way that becomes necessary because of the transition into a new ‘life stage’.”

While every transition into a new “life stage” has its challenges, those that accompany a person’s transition into the later years are unique, and the changes in life “roles”—spouse to widow/widower, worker to retiree, parent to grandparent/great-grandparent, adult to “senior citizen”, contributing individual to one who has to receive– may certainly evoke such feelings of ambiguity and disorientation, of being an “in-between” place. Add to this the transition from living autonomously and independently, to living in group setting that functions according rules and policies set by others, and it is not hard to understand why many new residents feel displaced, abandoned, anxious—even hopeless– about the future (all the more so if there is dementia to cope with!)

Unfortunately, the distress caused by liminality is often thought to be nothing more than “depression”, to be treated with medication. I would humbly suggest that diagnosing it merely as a medical problem to be treated pharmacologically is a bit short-sighted, for this reason: it ignores the axiom upon which quality care today is based: that a person is composed of body, mind and spirit. Certainly, a program offering true comprehensive care should therefore be more holistic, and provide care from disciplines other than just medicine.

With this in mind, it is important that those who are caring for individuals living in senior residential venues—both family members and staff—recognize the signs of distress caused by liminality and provide the multi-disciplinary wherewithal to cope with its deleterious effects on everyone involved—the resident, family members, and staff. Because the distress caused by liminality is primarily emotional AND spiritual nature it affects the resident’s sense of identity and personal meaning), communities should avail themselves of not only the services social workers and psychologists, but also those of clinically-trained chaplains who specialize in working with this population. In addition, staff who come into contact with residents on a daily basis—nurses, aides, activities, dietary and maintenance personnel—should have some training in understanding what liminality is, and the effects it may have on their own interactions with residents and their families.

Recognizing and responding to resident liminality and the distress it causes can enhance a community’s program of total care and thus an enhanced sense of well-being for residents and their families.

Which can lead to an enhanced sense of satisfaction with the community itself.
Which can lead to a higher rate of client retention.
Which is, of course, a most desirable goal!

Cary Kozberg is CEO of Side by Side: Life Transitions. He is a Board-Certified Chaplain with over 25 years experience working in senior residential communities. He can be contacted at cary@choosesidebyside.com or at 614-214-3954.

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