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Supporting families through the nursing home transition

April 1, 2007
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Placing a loved one in long-term care can be a traumatic event and requires a skilled, informed, multidisciplinary response by staff

Long-term care placement is probably one of the most difficult, heart-wrenching, but necessary decisions of a family's lifetime. The difficulty often originates from decisions made by family members for a loved one who may be denying or intellectually unable to accept that a necessity exists. The persistent stigma of nursing homes, coupled with a family's deep, emotional ties to a parent, evokes a potential array of painful emotions, ranging from guilt and sadness to anger and despair.

Some family members may realize at least temporary comfort after careful, lengthy discussions with friends, relatives, and/or healthcare personnel sharing similar experiences or recommending a long-term care facility. Touring a prospective nursing facility reputed to provide quality care and gathering information from key staff members may further ease the tension and anxiety. But the difficulties of transitioning from the community and positively acclimating to the long-term care facility can persist, for a variety of reasons.

The critical component for successfully guiding families through this trying and tedious process is a professionally and personally competent nursing home staff. Here is what is required of staff each step of the way.


The admissions director will, starting with the original hospital-referred interview and facility tour through the admission itself, enlighten family members and/or the “responsible party” regarding the process. Addressing financial requirements and guidelines early on, and emphasizing that the resident or her representative does not have to relinquish the right to handle her own affairs, will be appreciated. Alleviating such worries affords family members the time and energy to focus more intently on addressing those nursing, dietary, and recreational needs that most crucially affect the resident's quality of life.

Family members require reassurance that their wishes will be honored and their overall needs will be met. Introducing the family to a compatibly selected roommate, for example, will provide solace that their loved one will have appropriate companionship. Encouraging the transfer of personal items, such as a favorite chair, to the facility reinforces that the concept of “home” is strongly promoted, not obliterated.

Introductions to the administrator, director of nursing services, and other appropriate staff able to address major areas of concern in detail is critical. It would also behoove the administrator to personally seek out new family members on the nursing units to assure them that he or she is available at any time for support, impressing upon them that even the chief executive is fully committed to their loved one's well-being.

As family members come to rely on key department managers and supervisors subsequent to admission, this will enhance their sense of structure and afford them the ability to establish a positive emotional foothold in the facility.

Short-Term Approaches

The first week's stay, particularly, is when facility staff must proactively address residents' and families' needs so that they may begin to grow accustomed to the new environment. Accordingly, department managers must diligently seek out family members who can disseminate important background information about the resident requiring priority attention. The food service manager must determine food preferences; the recreation director must ascertain favorite pastimes and activities; and facility staff in general must, of course, collaborate to produce an acceptable, all-encompassing medical care plan tailored to the resident. Family members will require much support throughout this process while nervously anticipating positive signs of resident acclimation.

The appropriate department manager or supervisor must be available and observed as sincerely engaged in resolving specific issues. Also, inviting a family member to share a favorite meal or preferred activity with his or her loved one is a tangible way to project stability and generate positive feedback. Concerted, ongoing efforts by staff through the first 30 days will allow the resident and family to adapt to a consistently successful daily routine.

Long-Term Approaches

Most family members, regardless of the quality of care provided, will require varying degrees of ongoing staff support. The vast majority will remain buoyed by continuing to attend and participate in quarterly care planning and other occasional family meetings, while receiving periodic sincere support from staff they have grown to trust and respect.

A handful of family members will require more intense staff support if they are tormented by, for example, inordinate, persistent feelings of guilt, sadness, anger, or despair. Juxtaposing this with their own family responsibilities, medical and/or personal issues will further heighten their anxiety and exacerbate negative, underlying feelings. In any case, the social service department must play an integral role in assisting family members to deal with such emotions.

By the time the admission is completed, a social service department representative will have already met with the family and documented a social history and other relevant information, thereby establishing mutually helpful, preliminary familiarity and rapport. Subsequent periodic counsel-ing may be necessary. Some family members may benefit from access to a wider range of intervening options, enabling them to ex-plore sometimes complex family dynamics with the social service team to potentially resolve a variety of problems.