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Leadership. Supporting members. Promoting excellence. Supporting Families through the Residential Care Journey Reviewing the Evidence. Presentation to INECMA Conference 2013. Sinéad Morrissey, Practice Development Facilitator, NHI Wednesday 10 th April 2013 Leadership.

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supporting families through the residential care journey reviewing the evidence


Supporting members

Promoting excellence

Supporting Families through the Residential Care Journey Reviewing the Evidence

Presentation to INECMA Conference 2013

Sinéad Morrissey, Practice Development Facilitator, NHI

Wednesday 10th April 2013

aims and objectives


Supporting members

Promoting excellence

  • Explore the impact of transition on the resident
  • Review the process of social support for the resident
  • Examine common themes identified by family caregivers during the experience of placement
  • Explore models of support for caregivers
  • Analyse potential helpful interventions

Aims and Objectives:


Common themes identified by care-givers

1. Experiencing a loss of control

2. Being disempowered

3. Feeling guilt, sadness and relief simultaneously

4. Possessing a sense of failure

5. Having to make a forced and negative choice

Kellett (1999)

  • Loss, guilt and concern over the quality of care
  • Close relatives had a greater sense of having let the older person down
  • Antagonistic relationships can develop
  • Nolan and Dellasega (2000)
  • Need to justify the decision
  • Lack of an alternative
  • Ryan and Scullion (2000a)
  • Men move from the mutual loving relationship of being a loving husband to that of being a caring husband providing intimate care to a relationship based on friendship.
  • Feel confused, dissociated, dazed by the fact their wife is in a nursing home never to return
  • Eriksson and Sandberg (2006)
  • Coping dependent on interactions with loved one; other residents; family and friends; nursing staff and support group
  • Role disruption
  • Guilt over placement
  • Uncertainty of future
  • Garity (2006)

Roles, Experience and Perceptions of carers post-placement

  • Devised a 100 item inventory of tasks
  • Major responsibility was assigned to staff
  • Family assigned tasks were a distinct minority
  • Shuttlesworth (1982)
  • Families consistently attributed more overall responsibility to themselves for tasks than staff did
  • Consistently claim greater responsibility for psychosocial tasks
  • Chenitz (1983) and
  • Rubin and Shuttlesworth (1983)
  • High degree of agreement between staff and family
  • Family indicated that they were willing to assume greater responsibility particularly in personal care and activities
  • Schwartz and Vogel (1990)
  • Family carers perceived themselves to have a greater role in caring than perceived by staff
  • Nurses perceived as providing technical care with carers providing social and emotional care
  • Families trusted clinical judgement of staff but staff reluctant to trust family carers where care involved an element of risk
  • Ryan and Scullion (2000b)
  • Communication with staff
  • Involvement in relatives care
  • Importance of “little things”
  • Quality of care
  • Areas for improvement
  • Ryan and Mc Kenna (In press)
  • Checking quality of care
  • Companionship
  • Handling finances
  • Providing practical help
  • Assisting personal care
  • Wright (2000)
  • Maintaining continuity
  • Keeping an eye
  • Contributing to community
  • Davies and Nolan (2006)

Models of Support identified in the literature

  • Peer Mentoring Model
  • Volunteers recruited to serve as mentors
  • 9hr training programme (3 x 3hr sessions )
  • Weekly supervision & Monthly training
  • Had to have a loved one in same NH and been a carer for over 6 months
  • In-person, phone and email contacts on weekly basis for 12 weeks to caregivers who were newly admitting a loved one to LTC
  • Navigating the Nursing Home
  • 2 x 3hr training sessions with 6 carers
  • Baseline questionnaires and 3 month follow up
  • Lichtenberg (2006)
  • 3 A Grief Intervention Model
  • Acknowledge
  • Grieving may have started years before
  • Anticipatory grief reaction to NH
  • placement
  • Grief normal reaction at time of
  • admittance
  • Assess
  • Intuitive v’s Instrumental grievers
  • Watch for suicidal ideation due to high distress/ loneliness
  • Notice changes in long-term residents’ families appearance/ demeanour
  • Assist
  • Referrals to family Dr/ counselling
  • Identify and normalise process
  • Non-judgemental listening
  • Silverberg (2011)

Summary of potential interventions

  • Pre-placement:
  • Prepare resident/ family for impending possibility at an early stage
  • Provide supportive information/ guidance to support decision-making
  • Post-placement:
  • Collaboration of professional roles to bring validation to the decision
  • Assessment of impact of transition on residents and families
  • Encourage “sense of home” and continuity
  • Encourage supportive relationship building
  • Provision of information, advice and guidance
  • Developing caring partnerships
  • Policy and care planning which brings greater clarity and definition to roles
  • Case management for complex cases


  • Brandburg, G.L (2007) Making the Transition to Nursing Home Life: A Framework to Help Older Adults Adapt to the Long-Term Care Environment. Journal of Gerontological Nursing33(6):50-56
  • Chenitz, C (1983) Family Involvement During Institutionalisation of an Elder. San Francisco: University of California
  • Davies, S and Nolan, M (2004) ‘Making the move’: relatives’ experiences of the transition to a care home. Health and Social Care in the Community 12(6):517-526
  • Eriksson, H and Sandberg, J (2006) Transitions in men’s caring identities: experiences from home-based care to nursing home placement. International Journal of Older People Nursing3(2):131-137
  • Garity, J (2006) Caring for a family member with Alzheimer’s Disease: Coping with Caregiver Burden Post-Nursing Home Placement. Journal of Gerontological Nursing32(6): 39-48
  • Gaugler, J.E and Ewan, H.H (2005) Building relationships in residential long-term care. Journal of Gerontological Nursing31(9): 19-26
  • Kellet, U.M (1998) Transition in care: family carers’ experience of nursing home placement. Journal of Advanced Nursing29(6) 1474-1481
  • Lichtenberg, P (2006) Assisting Urban Caregivers After Nursing Home Placement: Results from Two Preliminary Programs. Clinical Gerontologist30(2): 65-77


  • Loeher, K.E; Bank, A.L; MacNeill, S.E and Lichtenberg, P.A (2004) Nursing Home Transition and Depressive Symptoms in Older Medical Rehabilitation Patients. Clinical Gerontologist27(1/2): 59-70
  • Nolan, M and Dellasega, C (1999) ‘Its not the same as him being at home’: creating caring partnerships following nursing home placement. Journal of Clinical Nursing8: 723-730
  • Patterson, B.J (1995) The process of social support: adjusting to life in a nursing home. Journal of Advanced Nursing21: 682-689
  • Presutti, M (2007) Supporting families through the nursing home transition. Nursing Homes: Long-term Care Management 56(4): 54,56
  • Reed, J and Morgan, D (1999) Discharging older people from hospital to care homes: implications for nursing. Journal of Advanced Nursing29: 819-825
  • Rubin, A and Shuttlesworth, G (1983) Engaging families as resources in nursing home care: ambiguity in the subdivision of tasks. Gerontologist23:632-636
  • Ryan, A.A (2002) Transitions in care: Family carer’s experience of nursing home placement. Nursing Times Research7(5): 324-334
  • Ryan, A.A and Mc Kenna, H (In Press) “It’s the little things that count”. Families’ experience of roles, relationships and quality of care in nursing homes International Journal of Older People Nursing


  • Ryan, A.A and Scullion, HF (2000a) Nursing home placement: an exploration of the experiences of family carers. Journal of Advanced Nursing32(5): 1187-1195
  • Ryan, A.A and Scullion, HF (2000b) Family and staff perceptions of the role of families in nursing homes. Journal of Advanced Nursing32(3): 626-634
  • Schwartz, A.N and Vogel, M.E (1990) Nursing home staff and residents: families’ role expectations. Gerontologist30: 49-53
  • Silverberg, E (2011) Applying the 3-A grief intervention approach to nursing home placement: Acknowledge, Assess and Assist. Canadian Nursing Home22(2): 22-25
  • Wilson, S. A (1997) The transition to nursing home life: a comparison of planned and unplanned admissions. Journal of Advanced Nursing26: 864-871
  • Wright, F (2000) The role of family care-givers for an older person resident in a care home. British Journal of Social Work30: 649-661

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