1. Coleman, Patricia PhD, APRN, BC, ANP, GCNS
  2. DeRosa, Susan MS, APRN, BC, CNS


A program that helps both at-risk high school students and the elderly is a win-win situation all around.


Article Content

The Albion Central School District in rural upstate New York offers a special educational experience for high school students-right in their county nursing home. Students who show promise but are having difficulty in a traditional school setting can earn academic credits while working and attending school in the Orleans County Nursing Home. This "community as school" program brings students to the nursing home from 8 AM to 2:30 PM five days a week, where they earn four to eight credits toward their general-curriculum high school diploma-while at the same time developing partnerships with residents, taking part in internships, and performing service. They interact with residents, engaging in friendly chats and structured activities such as bingo and line dancing, and they work cooperatively with residents on their class projects. And residents can reminisce about their own experiences-during the Depression or World War II, for example-reinforcing students' lessons and helping them to develop a capacity for listening sympathetically. The internships give students a chance to take pride in their new role, which carries new responsibilities, and to try out career choices, under supervision, in nursing, social work, and maintenance. "Service projects," which the residents help plan, involve students in making improvements-such as painting and decorating dining areas-to the nursing home.


The program was started in 1998 with 12 students. Now more than 100 students have attended, and there's a waiting list to participate. Feedback from residents, staff, and students has been unequivocally positive. Students say that the program has changed their lives. Students have said, "It got me back on track" or "I had tuned out. Now I care about school and others by being around the residents." Many students have gone on to work in long-term care. The residents enjoy mingling with young people and feel less segregated by age and infirmity and more connected to the community. One resident said, "I enjoy seeing the students. They are a breath of sunshine on a dull day." New student faces make up for the transitory-but real-loss felt when seeing old students go, but many of the students return for visits. Nursing home staff are also enthusiastic. Jean Conn, director of nursing at the home, says, "It's the most beneficial program we've ever been involved in. At first I was skeptical, but when I saw the interaction between our residents and the students, I was impressed. These kids have hearts of gold. It's a tribute to both the community and the school. They have left a lasting mark on the nursing home."


The evidence. There is little systematic research on how intergenerational programs like this one affect students and residents. Most programs studied have involved young children visiting older people on a casual basis.1, 2 However, recent studies have suggested that older people engaged in social activities (such as playing cards or bingo or visiting) and productive activities feel less stressed, live longer, and enjoy a sense of purpose.3 Older adults view a good-quality life as one that includes meaningful activity, relationships involving giving as well as receiving, and enjoyment.4

Figure. Orleans Coun... - Click to enlarge in new windowFigure. Orleans County Nursing Home resident Helen Wyonarski smiling with Albion High School student Melissa Coffey.

Research also suggests that youths having difficulty in traditional school settings experience success in alternative educational settings that emphasize caring, community, and connecting with others.5, 6 A recent randomized pilot trial found that struggling youths in urban schools who received assistance from older adult volunteers showed improvements in academic performance and classroom behavior; in addition, the elderly volunteers showed physical and cognitive improvements.7 School-nursing home partnerships appear, therefore, to have the potential to make important differences in the lives of both students and older adults.


An unpublished report on the program by Brennan Meakin, lead teacher of the program, indicates that more than 69% of the 100 participating students have graduated or are on track to graduate, compared with 40% from similar programs not in nursing homes (e-mail communication, October 25, 2006). Students miss 40% fewer school days and receive 33% fewer referrals to the office, compared with their preparticipation levels in a traditional school setting (e-mail communication, October 25, 2006). Meakin believes that the nursing home offers unique features ideal for alternative education-as separation from mainstream school culture, exposure to occupational careers, and opportunities for students to learn through active engagement with older adults. Although no formal evaluation has been done, reports from the residents' perspective suggest that the presence and participation of young people in the nursing home brightens and expands their social world. As one resident explained, "[The students] not only come to help us, they come to visit with us and that is the wonderful part. They remind us that we are alive and needed."

Figure. Leslie Allpo... - Click to enlarge in new windowFigure. Leslie Allport sitting with students (from left to right) Kylie Hughson, Joshlynn Spencer, and Nicole Brady.

Creating a School Program in a Nursing Home

Brennan Meakin, lead teacher of the program, provides the following considerations for those wishing to start a program in their own community.


* Target students having academic difficulty (have failed one or two grades, for instance).


* Don't include students with disciplinary problems.


* Develop a specific contract with each student (good attendance should be required, for example).


* Offer life skills like interviewing and balancing a checkbook, as well as approved course work that will enable them to graduate.


* Offer work experiences with career potential, such as maintenance, housekeeping, food service, activities, and transporting residents (but not providing care).


* Incorporate residents into the schoolwork and experience through


[check mark] regular visits between residents and students.


[check mark] collages of things that are interesting to students and residents.


[check mark] talent shows involving residents, staff, and students.


[check mark] poetry compilations.


[check mark] celebrations of birthdays or seasonal holidays, such as Mardi Gras.


[check mark] school assignments and projects that teach service.


* Keep teaching-to-learning ratios low (1 teacher to 12 students; 1 student to 1 resident).


* Reassure staff that students will not take their jobs (because of the limits on minors' hours).


* Obtain school district budget support for personnel on the basis of the potential cost-effectiveness of the program; emphasize the increase in employable graduates who can return to the community.





1. Uhlenberg P. Integration of old and young. Gerontologist 2000;40(3): 276-9. [Context Link]


2. Hamilton G, et al. Building community for the long-term: an intergenerational commitment. Gerontologist 1999;39(2):235-8. [Context Link]


3. Glass TA, et al. Population based study of social and productive activities as predictors of survival among elderly Americans. BMJ 1999;319(7208): 478-83. [Context Link]


4. Kane RA. Long-term care and a good quality of life: bringing them closer together. Gerontologist 2001;41(3): 293-304. [Context Link]


5. Zweig JM. Vulnerable youth: identifying their need for alternative educational settings. The Urban Institute; 2003 Jun. [Context Link]


6. Macdonald A. Best practices for at risk children. 2002. [Context Link]


7. Rebok GW, et al. Short-term impact of Experience Corps participation on children and schools: results from a pilot randomized trial. J Urban Health 2004;81(1):79-93. [Context Link]

Section Description


Short Takes on Long-Term Care, highlighting practice innovations in nursing homes and assisted living facilities, appears in AJN as a periodic column and is provided by the John A. Hartford Foundation Community Initiative to improve nursing home and dementia care, University of Rochester School of Nursing, Rochester, NY,