How to Implement the 10 and 5 Rule in Nursing Homes – iContracts (2023)

The Baby Boomers are coming to a nursing home near you, and they are used to getting what they want! Boomers are a wealthier group of retirees than previous generations. In fact, according to an article by the Population Reference Bureau, “The poverty rate for Americans ages 65 and older has dropped sharply during the past 50 years, from nearly 30 percent in 1966 to 10 percent today.” To remain competitive for this growing demographic, nursing homes should consider adopting a hospitality-industry approach. At this point in their lives, amassing “stuff” is no longer as important as it once was to Boomers. Still, they want the best that life has to offer, and creating a hospitable environment is just what the doctor ordered.

INTRODUCING THE 10 AND 5 RULEHow to Implement the 10 and 5 Rule in Nursing Homes – iContracts (1)

The 10 and 5 rule is a simple guideline that is widely used in the hospitality industry. The rule dictates that when a staff member is 10 feet from a guest, the staff smiles and makes direct eye contact, and when they are within five feet, the staff verbally greets the guest. Applying this principle to nursing homes is a simple, inexpensive way to enrich patient and staff lives.


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Human beings are hardwired to read each other’s faces to identify how they are feeling. This helps us act appropriately towards the other person. As explained in Neuroscience News, “an instinct for facial mimicry allows us to empathize with and even experience other people’s feelings.” As humans working in such a compassionate field as healthcare, empathy can wreak havoc on us and others with whom we associate. The last thing we want to do is spread one person’s sadness to another. The good news is that we can reset our emotions with a smile.

Research shows that contracting your facial muscles to smile causes more blood to flow to your frontal lobes and causes your brain to release the same mood-enhancing chemical as coffee, chocolate, and even cocaine—dopamine. So, you’re happy because you smile, and you smile because you are happy. It’s like a loop. What’s more, research shows that it doesn’t matter if you are faking the smile, the brain still produces dopamine. So, it even works to “fake it until you make it.”

How to Implement the 10 and 5 Rule in Nursing Homes – iContracts (2)


Ochsner Health System decided to use this knowledge to educate and train the entire staff to smile whenever they were within ten feet and say, “Hello,” any time they were within five feet of another person, whether that person was a patient or staff member. They didn’t simply send a memo, hang a sign or two, and forget about it. They practiced the rule, and it became so natural that staff felt awkward if they didn’t smile and greet each other and patients. It’s no coincidence that in 2015, Ochsner Health System’s operating surplus grew 429%.



Train your staff by sharing the research and examples with them. If you are short on time, train the supervisors and have them train others. Include the training in your new employee orientation and behavior code so that everyone understands the expectations. For best results, follow these tips:

  • Make it universal—all staff smiles and greets everyone in the facility. When you are within 10 feet of anyone, make eye contact and smile, and speak to them (e.g. good morning, hello, lovely day) when you are within five feet. In case you were wondering, the average person’s footstep is 2.5 feet, so 10 feet away would be roughly four footsteps and five feet is around 2 steps.
  • Trust science to fulfill its promise. Assure everyone that if they are uncomfortable at first, following the 10 and 5 rule will become very natural as their brains are rewired.
  • Encourage bonding. Suggest to your staff that they practice the rule everywhere they go. It will give them an extra opportunity to bond by sharing their experiences of following the rule in their private lives as well.
  • Support each other. Commit to helping each other. Remind each other subtly.
  • Give visual cues. Consider hanging signs or posters of smiling people in staff-only areas.
  • Commit to positivity. Asking employees not to “vent” is unrealistic, but they can commit to doing it away from patients. You may even find it helpful to designate an area for venting.

Such a simple idea as the 10 and 5 rule has the potential to create a great impact in our nursing homes. Step-smile, step-greet, could be the key to a whole new culture of happiness that our society needs and deserves.

Need a tool that can help you implement policies like the 10 and 5 rule quickly and easily? Looking to free up your busy schedule so you can spend more time on improving patient care? Then be sure to check out iContracts’ portfolio of policy, contract, and compliance software solutions by viewing a demo!

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