Entry to care: positive choice or fait accompli? Developing a more proactive nursing response to the needs of older people and their carers*

Abstract

A range of issues surrounding admission to either residential or nursing home care are considered from the perspectives of older people and their family carers. Drawing on the literature and a number of studies conducted by the authors, the processes and perceptions that shape and influence admission to care are identified. On the basis of the interaction of these factors a four-stage typology of admission is suggested: the positive choice, the rationalized alternative, the discredited option, and the fait accompli. The characteristics of each admission type are discussed and the implications for professionals, particularly nurses, working with older people and their carers are addressed.

Insights into the eldercare conundrum through complementary lenses of Boardman's SSM and TOC's Evaporating Cloud

“…Sussman and Dupuis (2012) report Nolan et al's (1996) conclusion that anticipation, participation, exploration and information are factors necessary for carers to perceive decisions as positive choices. However they quote several research studies that indicate that these pre-conditions are rarely met in practice.…”

Supporting Caregivers of Older Adults in Making Decisions

“…Decisions are often complex and multifaceted. Positive decisions include at least five components: goal definition (for type of care), anticipation (rational thought and planning for the future), participation (active involvement in the decision), exploration (understanding available options and their pros and cons), and information (about available options) (Nolan et al, 1996). staff as an opportunity to provide some information about the personal life story of the patient (Haesler, Bauer, & Nay, 2006).…”

Family members' strategies when their elderly relatives consider relocation to a residential home — Adapting, representing and avoiding

“…On an international level and in different societal systems, research has previously paid attention to family members when their burden is too heavy regarding everyday responsibilities (Gallagher, Mhaolain, Crosby, Ryan, et al 2011;Epstein-Lubow, Davis, Miller & Tremont, 2008). On the research agenda there are studies about how to better support family members in their elderly relative's transition to a long-term care setting (Davies & Nolan, 2003;Flynn Reuss, Dupuis & 5 Whitfield, 2005;Nolan, Walker, Nolan, Williams, et al, 1996;Pruchno, Michaels & Potashnik, 1990), and how to better support them after the relocation (Dellasega & Nolan, 1997;Strang, Koop, Dupuis-Blanchard, Nordstrom, et al, 2006). Previous research finds that family members do not want to let their elderly relatives down, and the process tends to constitute a time full of ambivalence and agony (Dellasega & Mastrian, 1995;Fjelltun, Henriksen, Norberg, Gilje, et al, 2009;Nolan & Dellasega, 2000;Penrod & Dellasega, 1998).…”