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Muscled by the System: Informal Caregivers’ Experiences of Transitioning an Older Adult into Long-term Care

Published online by Cambridge University Press:  31 October 2018

Christy Konietzny*
Affiliation:
School of Nursing, McMaster University
Sharon Kaasalainen
Affiliation:
School of Nursing, McMaster University
Vanina Dal-Bello Haas
Affiliation:
School of Rehabilitation Science, McMaster University
Cristina Merla
Affiliation:
School of Nursing, McMaster University
Alyssa Te*
Affiliation:
School of Nursing, McMaster University
Emily Di Sante
Affiliation:
School of Nursing, McMaster University
Luke Kalfleish
Affiliation:
School of Nursing, McMaster University
Thomas Hadjistavropoulos
Affiliation:
Department of Psychology, University of Regina
*
La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Christy Konietzny, RN, MScN St. Joseph’s Health Centre 30 The Queensway Toronto, ON M6R1B5 <[email protected]>

Abstract

This study explored informal caregivers’ experiences of transitioning an older adult into long-term care (LTC). Qualitative description guided our analysis of semi-structured interviews with 13 informal caregivers of older adults from three LTC homes in southern Ontario. Our findings illustrate that caregivers experience chronic worry and burden before deciding on, or requiring to apply for, LTC. A sense of lack of control was a prominent theme, especially when caregivers were applying for LTC beds. Participants perceived pushing, pressure, and punishment from the health care system and felt relieved and fortunate after they accepted a bed offer. This tumultuous experience stimulated caregivers to anticipate future transitions. It is recommended that caregivers receive preparation and targeted support to manage transition experiences. Improved communication among health professionals is essential. Penalties for declining an offer for a bed in LTC should be re-examined in relation to its negative influence on caregivers’ experiences.

Résumé

Cette étude a exploré les expériences des aidants devant s’occuper de la transition d’une personne âgée vers une institution de soins de longue durée (SLD). Une approche de description qualitative a été utilisée pour l’analyse d’entretiens semi-structurés effectués auprès de 13 aidants de personnes âgées hébergées en centres de soins de longue durée dans le sud de l’Ontario. Nos résultats illustrent que les aidants ressentent des soucis et un lourd fardeau de manière chronique lorsqu’il s’agit de prendre une décision sur l’hébergement ou de faire une demande pour un centre de soins de longue durée. Le sentiment de ne pas avoir le contrôle était un thème récurrent dans les entretiens, particulièrement dans les cas où les aidants requéraient une place en SLD. Les participants se sont sentis bousculés, sous pression et punis à travers le système de santé, mais soulagés et privilégiés après l’acceptation de l’offre de la place en CHSLD. Cette expérience tumultueuse a encouragé les aidants à anticiper les prochaines transitions. Il est recommandé que les aidants aient accès à une préparation et à un soutien ciblé pour mieux gérer les transitions. Une amélioration de la communication entre les professionnels de la santé est essentielle. Les amendes imposées lors du refus d’une place en SLD devraient être réexaminées, considérant l’impact négatif de celles-ci sur les aidants.

Type
Article
Copyright
Copyright © Canadian Association on Gerontology 2018 

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Footnotes

*

The authors thank the participating caregivers for sharing their challenging experiences and for all the care they provide to our older citizens.

This work was supported by a Saskatchewan Health Research Foundation Team Grant (23574, to T.H. and colleagues). This work was also funded by the Canadian Frailty Network (formerly Technology Evaluation in the Elderly Network), which is supported by the Government of Canada through the Networks of Centres of Excellence program.

The authors have no conflict of interest to declare.

References

Caldwell, L., Low, L. F., & Brodaty, H. (2014). Caregivers’ experience of the decision-making process for placing a person with dementia into a nursing home: Comparing caregivers from Chinese ethnic minority with those from English-speaking backgrounds. International Psychogeriatrics, 26(03), 413424.CrossRefGoogle ScholarPubMed
Caron, C. D., Ducharme, F., & Griffith, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193205.CrossRefGoogle ScholarPubMed
Cheek, J., & Ballantyne, A. (2001). Moving them on and in: The process of searching for and selecting an aged care facility. Qualitative Health Research, 11(2), 221237.CrossRefGoogle ScholarPubMed
Chick, N., & Meleis, A. I. (1986). Transitions: A nursing concern. School of Nursing Departmental Papers, 9. Retrieved from http://repository.upenn.edu/cgi/viewcontent.cgi?article=1008&context=nrsGoogle Scholar
Coleman, E. A., Parry, C., Chalmers, S., & Min, S. J. (2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166(17), 18221828.CrossRefGoogle ScholarPubMed
Cornes, M., Manthorpe, J., Donaghy, E., Godfrey, M., Hubbard, G., & Townsend, J. (2008). Delayed discharge from hospital: Supporting older people to exercise choice. Working with Older People: Community Care Policy & Practice, 12(1), 1620.CrossRefGoogle Scholar
Cranswick, K., & Dosman, D. (2008). Eldercare: What we know today. (Catalogue number 11-008-X) [Archived Content]. Canadian Social Trends. Ottawa, ON: Statistics Canada. Retrieved from http://www.statcan.gc.ca/pub/11-008-x/2008002/article/10689-eng.htm#a2Google Scholar
Davies, S. (2005). Meleis’s theory of nursing transitions and relatives’ experiences of nursing home entry. Journal of Advanced Nursing, 52(6), 658671.CrossRefGoogle ScholarPubMed
Dellasega, C., Mastrian, K., & Weinert, C. (1995). The process and consequences of institutionalizing an elder. Western Journal of Nursing Research, 17(2), 123140.CrossRefGoogle ScholarPubMed
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry Newbury Park, CA: Sage.Google Scholar
Liken, M. A. (2001a). Caregivers in crisis: Moving a relative with Alzheimer’s to assisted living. Clinical Nursing Research, 10(1), 5268.CrossRefGoogle Scholar
Liken, M. A. (2001b). Critical incidents precipitating institutionalization of a relative with Alzheimer’s. Western Journal of Nursing Research, 23(2), 163178.CrossRefGoogle Scholar
Local Health Integration Network (LHIN). (2017). Selecting a home. Retrieved from http://healthcareathome.ca/torontocentral/en/Getting-Care/Getting-Long-Term-Care/Selecting-a-HomeGoogle Scholar
Lundh, U., Sandberg, J., & Nolan, M. (2000). ‘I don’t have any other choice’: Spouses’ experiences of placing a partner in a care home for older people in Sweden. Journal of Advanced Nursing, 32(5), 11781186.CrossRefGoogle Scholar
McAuley, W. J., Travis, S. S., & Safewright, M. P. (1997). Personal accounts of the nursing home search and selection process. Qualitative Health Research, 7(2), 236254.CrossRefGoogle Scholar
McLennon, S. M., Habermann, B., & Davis, L. L. (2010). Deciding to institutionalize: Why do family members cease caregiving at home? Journal of Neuroscience Nursing, 42(2), 95103.CrossRefGoogle ScholarPubMed
Meleis, A.I. (2010). Transitions theory: Middle range and situation-specific theories in nursing research and practice. New York, NY: Springer.Google Scholar
Meleis, A. I., Sawyer, L. M., Im, E. O., Messias, D. K. H., & Schumacher, K. (2000). Experiencing transitions: An emerging middle-range theory. Advances in Nursing Science, 23(1), 1228.CrossRefGoogle ScholarPubMed
Naleppa, M. J. (1996). Families and the institutionalized elderly: A review. Journal of Gerontological Social Work, 27(1–2), 87111.CrossRefGoogle Scholar
Neergaard, M. A., Olesen, F., Andersen, R. S., & Sondergaard, J. (2009). Qualitative description – The poor cousin of health research? BMC Medical Research Methodology, 9(52). doi: 10.1186/1471-2288-9-52CrossRefGoogle ScholarPubMed
Patton, M. Q. (2015). Qualitative research and evaluation methods (4th ed.). Thousand Oaks, CA: Sage.Google Scholar
Penrod, J., & Dellasega, C. (2001). Caregivers’ perspectives of placement: Implications for practice. Journal of Gerontological Nursing, 27(11), 28.CrossRefGoogle ScholarPubMed
Ryan, A. (2002). Transitions in care: Family carers’ experiences of nursing home placement. Nursing Times Research, 7(5), 324334.CrossRefGoogle Scholar
Ryan, A., McKenna, H., & Sleven, O. (2012). Family care-giving and decisions about entry to care: A rural perspective. Ageing and Society, 32(1), 118.CrossRefGoogle Scholar
Sandelowski, M. (2000). Focus on research methods–Whatever happened to qualitative description? Research in Nursing and Health, 23(4), 334340.3.0.CO;2-G>CrossRefGoogle Scholar
Schumacher, K. L., & Meleis, A. I. (1994). Transitions: A central concept in nursing. Image: The Journal of Nursing Scholarship, 26(2), 119127.Google Scholar
Sinha, M. (2013, September). Spotlight on Canadians: Results from the General Social Survey. Portrait of caregivers, 2012. (Catalogue Number 89-652-X — no. 001). Ottawa, ON: Statistics Canada. Social and Aboriginal Statistics Division. Retrieved from http://www.statcan.gc.ca/pub/89-652-x/89-652-x2013001-eng.pdfGoogle Scholar
Statistics Canada. (2011). Residential care facilities, 2009/2010: Movement of residents during fiscal year in operating residential care facilities by facility characteristics and geography – Canada (Table 3-1). (Catalogue number 83-237-X). Ottawa, ON: Author. Retrieved from http://www.statcan.gc.ca/pub/83-237-x/83-237-x2012001-eng.htmGoogle Scholar
Stevens, A., Owen, J., Roth, D., Clay, O., Bartolucci, A., & Haley, W. (2004). Predictors of time to nursing home placement in White and African American individuals with dementia. Journal of Aging and Health, 16(3), 375397.CrossRefGoogle ScholarPubMed
Strang, V. R., Koop, P. M., Dupuis-Blanchard, S., Nordstrom, M., & Thompson, B. (2006). Family caregivers and transition to long-term care. Clinical Nursing Research, 15(1), 2745.CrossRefGoogle ScholarPubMed