Divergent Views of Placement Decision-Making: A Qualitative Case Study

Abstract

The purpose of this qualitative case study is to describe the contrasting perspectives between a family caregiver and the caregiver's professional provider in regards to the placement decision-making experience of the caregiver. A qualitative, descriptive, revelatory case study, using a grounded theory approach for data analysis, was conducted to identify and compare major themes drawn from interviews with the caregiver-professional dyad. The case is described on the basis of three interviews, two caregiver interviews (pre- and post-placement) and one health professional interview. The 77-year-old caregiver in this case was a wife caring for her 88-year-old husband who was diagnosed with Alzheimer's disease. The health professional was a social worker who led the support group the caregiver attended. Separate and private interviews were conducted by the principal investigator with the caregiver and health professional. Analysis revealed 11 major emerging categories that were compared from the caregiver's and professional's perspective. The perspectives of the family caregiver and the health professional had some elements that were congruent and some that were incongruent. Professionals may be unaware that they are not providing the kind of help that the situation requires. In particular, anticipatory guidance is needed before crisis events make placement immediately necessary. Further research is needed to identify what kind of conditions contribute to smoother decision-making processes and long-term care transitions for caregivers of relatives with dementia.

Perspective of Family Members of Transitions to Alternative Levels of Care in Anglo-Saxon Countries

“…The decision to transition older adults into ALH is most often initiated by a crisis situation, such as an acute admission to hospital or the sudden deterioration of an older adult's and/or caregiver's health [ 4 , 7 , 10 , 16 , 18 – 24 ]. Castle [ 12 ] found, using a sample size of 306 older adult residents, that 78% of nursing home placements occurred following hospitalization.…”

“…Penrod and Dellasega [ 21 ] describe these precipitating factors as initiating an evaluation of demands and resources among caregivers, resulting in the decision to transition older adults due to inadequate caregiving situations. Health and deterioration of the older adult and/or family caregiver, as well as influences from others, were identified in the literature as primary factors precipitating the transition [ 6 , 7 , 10 , 12 , 16 , 18 , 19 , 22 , 25 , 27 – 30 ].…”

“…Physical health concerns, such as hypertension, diabetes, fractures, stroke, incontinence, vision loss, falls, and immobility further necessitated transition decisions [ 4 , 6 , 16 , 22 , 27 ]. In Nolan and Dellasega's [ 29 ] study of 102 care providers, seven out of 10 nursing home admissions were influenced by the concern that older adults were unable to perform self-care and caregivers' inability to address increasing physical needs.…”

“…Deteriorating physical and mental health status of family caregivers also precipitated transitions to ALH [ 10 , 16 , 18 , 21 , 27 , 28 , 30 ]. Caregiver health concerns included a general awareness of deteriorating health, increased fatigue, pain, arthritis, fractured bones, surgery, receiving a cancer diagnosis, and experiencing a heart attack or stroke [ 18 , 27 ].…”

“…Caregiver health concerns included a general awareness of deteriorating health, increased fatigue, pain, arthritis, fractured bones, surgery, receiving a cancer diagnosis, and experiencing a heart attack or stroke [ 18 , 27 ]. Mental health concerns included depression, social isolation, anxiety, and stress among family members [ 10 , 16 , 27 , 28 ].…”