Journal of Gerontological Nursing

Guest Editorial Free

Not Everything That Counts Can Be Counted: Fostering Healthy and Vibrant Communities

Clifford Warner, LICSW

Creating a therapeutic milieu, an environment and corresponding culture in which physical activity, social support, engagement, and learning are encouraged, makes a difference in residents' quality of life in a retirement community (Bekhet & Zauszniewski, 2011; Shives, 2008). This editorial highlights how an evidence-informed wellness program called Thrive fosters a healthy community and high quality of life through the development of a therapeutic milieu.

Thrive is a multifaceted, evidence-informed wellness program developed by a team of senior living staff and residents (Era Living) and local university faculty and students. Thrive supports healthy aging by providing a therapeutic milieu for residents at all stages of care including independent, assisted living, and memory care. Residents who participate in Thrive have the opportunity to learn new health behaviors (e.g., guided meditation), become involved in group activities (e.g., discussion groups about contemporary issues, men's or women's groups, Life Reflections), join social circles that encourage optimism (e.g., the Sunshine Club), and volunteer in the community (e.g., help at the local food bank and library, help new Americans with English skills). Thrive participation rates are between 50% and 70% of the resident population in each of Era Living's eight communities. The following Thrive examples highlight individuals who benefited from participation in Thrive and show not everything that counts can be counted.

Encouraging Physical Activity

Thrive includes a variety of physical activity classes, such as EnhanceFitness, tai chi, yoga, balance, conditioning, and walking clubs. Dance is another opportunity for residents to be physically active. For example, Mr. and Mrs. G. have been married 60 years. Mr. G. is in the advanced stages of dementia, and Mrs. G. is his full-time caregiver. Like many who live with dementia, Mr. G. still enjoys and connects through music (Bjornsdottir, Arnadottir, & Halldorsdottir, 2019). When the couple joined a line dancing class in their community they danced for more than 1 hour and then regularly returned to class. Mrs. G. remarked, “For this hour we can be dance partners again and I can take a break from caregiving.”

Creating New Patterns of Behavior

Residents have the opportunity to work with a personal growth coach. The work is focused on areas self-identified by residents. These foci might include nutritional choices, weight management, memory retention, brain exercises, social isolation, exercise, and/or balance. The coach is typically a graduate student from a local School of Social Work, or a community counselor (Master's level clinician). One resident who recently participated wanted to return to regular exercise but did not know where to begin. She worked with a coach to develop a program designed for her fitness level and lifestyle preferences. Now several months into the program, she continues to exercise regularly and has made several new social connections through her exercise program. She commented, “My coach helped me remember I can still take charge of my own life.”

Providing Social Support

A group of residents noticed a number of previously active community members who due to physical and/or cognitive limitations had become socially isolated. The group met with the community's volunteer coordinator to find ways to help their isolated friends (Anderson et al., 2014). They created the Girl Friends Club. Resident volunteers made a brief telephone call to isolated residents. Their request was simple: “We have not seen you in a while and wonder if you would be open to having us come up for a short visit. We could bring cookies and tea.” Some residents they visited began appearing at community events again. One volunteer offered, “This just feels so good. We are experiencing at least as much enjoyment from these visits as our friends we are visiting.”

Creating Opportunity for Engagement and Learning

As we age, opportunities for social engagement and learning through meaningful dialogue between generations become less frequent. Thrive offers intergenerational programming between residents and students. One community collaborated with a local high school to host a conversational forum. A group of residents and students met several weeks in advance to create the groundwork for the format and topics. At the event, a panel comprising 10 honor students and 10 residents addressed topics such as academic expectations—then and now, commitment in relationships, evolving norms and values related to dating, sexual identity, and careers. The student population was diverse in gender, sexual identity, ethnicity, family income, and life experience. During the conversation, one student shared he was still building up his courage to ask someone out on a date. A panel member quickly responded, “I wish you had been my first date.” The audience cheered. Following the forum, students and residents shared dinner and continued the dialogue. Residents proclaimed the event was “our best program ever.”

Creating Meaning Together

Evidence suggests older adults who engage in voluntary work and help others enjoy better overall self-rated health than those who do not volunteer (Jenkinson et al., 2013; Neibuur, Lente, Liefbroer, Steverink, & Smidt, 2018). The challenge of homelessness nationwide and rise of the homeless population in Seattle captured the attention of many residents. Residents and staff asked how they could help alleviate suffering in a productive and meaningful way. In four of the retirement communities, groups of residents have become involved in a regional effort called Mats for the Homeless. These mats are created entirely from used plastic bags. Organized by Thrive Volunteer Coordinators, the mats project taps into the knitting and weaving skills of residents, encourages group communication, and incorporates physical activity. Everyone plays a role from collecting and sorting plastic bags, to cutting and weaving. One volunteer weaver stated, “I feel good knowing my work might be making some small difference in someone's life.”


These stories demonstrate Thrives' success in engaging and energizing residents. Creating a therapeutic milieu is the shared responsibility of staff who have the power and privilege to make a difference in the lives of residents in their communities. Taking personal interest and encouraging residents to engage in activities that can lead to healthy aging is incorporated into job training across roles in the Era Living communities. Thrive's group programming creates friendships and peer/social reinforcement for continued engagement in exercise, social interaction, learning, and volunteering. One resident said it all: “Everything is more fun in a group.”

Strategies that residential communities could engage to employ a similar model without major investments of current staff time or adding staff and expense might include the following. Create in-house volunteer opportunities, such as resident-run programs, resident councils, delivering calendars and flyers, and reading to residents with vision impairment. Empower staff to help reinforce resident engagement as part of their daily work routine, at all staff meetings, and regular department meetings or daily stand ups. And use regularly scheduled resident reviews to identify residents who could benefit from greater inclusion via encouragement by staff they like and trust.

Clifford Warner, LICSW
Director, Thrive
Era Living
Seattle, Washington


  • Anderson, N.D., Damianakis, T., Kröger, E., Wagner, L.M., Dawson, D.R., Binns, M.A. & Cook, S.L. (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140, 1505–1533. doi:10.1037/a0037610 [CrossRef]
  • Bekhet, A. & Zauszniewski, J. (2011). Creating therapeutic milieu in retirement communities. Issues in Mental Health Nursing, 32, 327–334. doi:10.3109/01612840.2010.541329 [CrossRef]
  • Bjornsdottir, G., Arnadottir, S. & Halldorsdottir, S. (2019). Physical activity of older women living in retirement communities: Capturing the whole picture through an ecological approach. Journal of Geriatric Physical Therapy. Advance online publication. doi:10.1519/JPT.0000000000000237 [CrossRef]
  • Jenkinson, C.E., Dickens, A.P., Jones, K., Thompson-Coon, J., Taylor, R.S., Rogers, M. & Richards, S.H. (2013). Is volunteering a public health intervention? A systematic review and meta-analysis of the health and survival of volunteers. BMC Public Health, 13, 773. doi:10.1186/1471-2458-13-773 [CrossRef]
  • Neibuur, J., van Lente, L., Liefbroer, A., Steverink, N. & Smidt, N. (2018). Determinants of participation in voluntary work: A systematic review and meta-analysis of longitudinal cohort studies. BMC Public Health, 18, 1213. doi:10.1186/s12889-018-6077-2 [CrossRef]
  • Shives, L.R. (2008). Basic concepts of psychiatric–mental health nursing (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

The author has disclosed no potential conflicts of interest, financial or otherwise.


Sign up to receive

Journal E-contents