“You're at their mercy”: Older peoples' experiences of moving from home to a care home: A grounded theory study

Abstract

Background:Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. There is a paucity of research that takes into consideration the initial phase of the relocation process, incorporating individuals' experiences of the move. Aim:To explore individuals' experiences of moving into a care home. This paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home.Design: A grounded theory method was used to conduct semi-structured interviews with 23 participants.Results: Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: "I had to come here," (b) making the move: "Abrupt Departures,"(c) decision-making and exercising choice: "What can I do, I have no choice," (d) maintaining identity: "Holding on to self" and (e) maintaining connections: "I like my family to be near." Together, these five categories formed the basis of the concept "You're at their Mercy" which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were "at the mercy" of others who made decisions about their long-term care. Conclusions:Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre-and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision-making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel "at the mercy" of others as they navigate such a major transition. Implications for practice:There is a need to standardise approaches and develop person-centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen.

Healthcare Professionals’ Perceptions of Loneliness amongst Older Adults: A Qualitative Study

“…However, cultural factors or negatives ideas surrounding care homes lead to some older adults preferring being lonely within their own homes than being in the company of people they do not know [56,57]. Nevertheless, the discomfort and the measures taken to fight loneliness are, to a great extent, determined by the decision-making process of the older adults [58,59], hence why some of the participants referred to health conditions or the circumstances of family members as being deciding factors in older adults, leading older adults to suffer imposed loneliness [56,58,60]. This also occurs when their economic resources are limited and they are not able to access professional care to mitigate loneliness [56,58,61], as well as when there is a lack of availability in care homes [62].…”

“…The issue is that many older adults face discomfort when they feel that they are a nuisance or a burden on family members, leading them to go to a care home [59,60]. Furthermore, some interpret this decision as a new situation full of potential and a unique opportunity for introspection and to do spiritual activities [7,31,63].…”

‘Waiting and Wanting’: older peoples’ initial experiences of adapting to life in a care home: a grounded theory study

“…This paper is part of an overarching research study which aims to increase our understanding of how older adults make the transition from living at home to a care home over the course of 12 months, at four discrete time-points: prior to or within three days of admission and at three time-points after the move (four to six weeks, four to five months and 12 months). The findings from the first timepoint indicate that older people making the move to a care home are 'at the mercy' of families, health and social care practitioners, and care home staff (O'Neill et al, 2020).…”

“…leaving home and being separated from family, friends and communities. This initial post-placement time period often follows a time of crisis, an acute illness or a period of hospitalisation (Wilson, 1997;O'Neill et al, 2020). The way in which individuals are supported (or not) during this time period may have a bearing on their adaptation to life in the care home further down the line.…”

Making meaning of the new identity‐as‐resident: A grounded theory study

“…When personal possessions or preferred activities that residents use to express themselves are restricted, residents' sense of identity is compromised (Paddock et al, 2018). While these studies clearly establish that living in a RACF challenges older adults' sense of identity, there is nevertheless a dearth of studies reporting how residents' identity is detrimentally affected in sufficient detail (Carrara & Espírito Santo, 2016; O'Neill et al, 2020).…”