The transition to residential care
By: Nick Bruce
Any move is stressful regardless of our age, but when we are elderly it can be a traumatic experience with the potential to adversely affect the person’s health unless handled well. This article explores the issues that impact on whether a transition is successful or not, and how we address them in our two care homes.
Transition factors
According to several studies there are a number of factors that impact on whether a person is likely to settle in residential care. This is an important issue for the obvious reason that we all want our loved ‐ ones to be happy, but getting it wrong can also adversely affect the persons health (Laughlin, Parsons, Kosloski & Bergman ‐ Evans, 2007). Lee (2010:958) identified four variables: the circumstances of the person in terms of their perceived health, abilities and age; their involvement in the relocation decision; how well matched the facility is, and; the social support they receive before, during and after the transition. Laughlin, Parsons, Kosloski & Bergman ‐ Evans (2007:24) believed that choice and predictability were key factors.
Easing the transition
The key lessons from Lee’s research are to encourage a positive perception in the individual of both their own health and the home they have chosen, ensuring they are involved as possible in that decision, and that they receive strong emotional support both before and after the move from family, staff and other clients of the home. Making a plan is not always possible, especially where transitions to residential care have to be made with little notice. However, when it is it can go a long way to encouraging a sense of choice and predictability. Rehfeldt, Steele & Dixon (2000:35 ‐ 37) make a number of recommendations which address these points:
Being informed
Care homes are often perceived in negative terms which can be unhelpful to the transition process, and therefore having accurate and relevant information is essential. In this regard, we have made sure both our website and brochure are detailed, and encourage potential residents to stay with us for a week with our compliments so they really get to know the home before making a decision. A number of our clients have come to us for a few days or weeks at a time, deciding if and when a permanent move is right for them.
Choosing the right facility
Choosing the right facility for each individual is essential to not only help them to settle, but also to minimise the potentially adverse health effects of choosing one in which they are likely to feel stressed. In this regards, the more similar the home is to their previous home, and the other clients to themselves, the less stress they are likely to feel. We address this by being deliberately small and specialising in one category of need, the frail but socially able elderly, but also through encouraging clients to personalise their rooms with their own possessions.
Living choices
Encouraging the person to remain as independent as possible through making choices such as when they get up and go to bed, what they eat, where they spend their time, and what they do with their time all help them to settle. In this regards, our care plans record all of our clients preferences to ensure home life revolves around them, but we also have a very detailed activities programme (see below).
Staff training
Staff being trained in the specific needs of the clients is another predictor of a successful transition. Our staff all participate in a comprehensive, rolling training programme which not only ensures they have the relevant knowledge, but that it is always current.
Meaningful engagement
Staff should be supportive of clients in regards to learning their new environments and supporting them with their emotional needs. As part of our preparations we take as detailed a biography of each client as they are happy to share so that we can understand their past life and therefore have real empathy with their current situation. We also encourage interaction with other residents which can be an important source of peer support.
Meaningful activities
Engaging in meaningful activities has been shown to alleviate the effects of moving to a home. We have a number of activity coordinators and always ensure choices are both varied and tailored to our clients’ individual needs. However, where we really stand out is in having a Residents Car. Minibuses can be useful for group outings, but when used all the time can be institutionalising and mean outings are seldom personal. For our clients, having a dedicated car always on site ensures the outings become an everyday enjoyment rather than a rare pleasure.
Staying in touch with the community
A feeling of isolation can adversely affect new clients, and we therefore encourage families and friends to visit whenever they want, to join in meals, activities and outings, and to be involved as much in the homes as they would like. Our Residents Car is also invaluable in helping our client to remain part of their former communities.
Conclusion
The transition to residential care is often driven by a need to manage a risk of harm or loneliness which cannot effectively be done in another way. However, there are risks associated with the move itself which need careful consideration and planning. The key element of which are involvement, choice, matching the facility to the client, and choosing one that will work with you to minimise the risks.
The facility
A key part of the success of any transition is how well matched the facility is to the person’s needs. Other factors include the level of emotional support from staff and residents.
Further information
If you are considering care for yourself or a loved one, you may be interested to read Choosing the right care, Why small is beautiful, A home for life and Funding care.
About the author
Nick Bruce holds a doctorate from the University of Liverpool and has specialised in care for the elderly for more than thirty-five years.
References
Laughlin, Ann, Parsons, Mary, Kosloski, Karl D and Bergman ‐ Evans, Brenda (2007) ‘Predictors of mortality following involuntary interinstitutional relocation.’, Journal of gerontological nursing , 33(9), pp. 20–6; quiz 28–9, [online] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17899997.
Lee, Ga Eon (2010) ‘Predictors of adjustment to nursing home life of elderly residents: a cross ‐ sectional survey’, International Journal of Nursing Studies , Elsevier Ltd, 47(8), pp. 957–64, [online] Available from: http://ac.els ‐ cdn.com.ezproxy.liv.ac.uk/S002074890900412X/1 ‐ s2.0 ‐ S002074890900412X ‐ main.pdf?_tid=70db1204 ‐ 4079 ‐ 11e2 ‐ bc18 ‐ 00000aab0f01&acdnat=1354890290_6df85e3a92a1a2519a0dc5dbc557fc1c (Accessed 7 December 2012).
Rehfeldt, Ruth Anne, Steele, Amy and Dixon, Mark R. (2000) ‘Transitioning the Elderly into Long ‐ Term Care Facilities : A Search for Solutions’, Activities, Adaption & Aging , 24(4), pp. 27–40, [online] Available from: http://www.tandfonline.com.ezproxy. liv.ac.uk/doi/pdf/10.1300/J016v24n04_03 (Accessed 4 March 2013).