Marriage, spousal caregiving, and a husband's move to a nursing home. A changing role for the wife?

Breaking Up and a New Beginning When One's Partner Goes into a Nursing Home: An Interview Study

In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse’s life. This study aimed to explore the spouse’s experience of their partner’s move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled “Implementation of Knowledge-Based Palliative Care in Nursing Homes”. Thirteen spouses from both urban and rural areas were included, with an age-range of 60–86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.

Decision-making process of nursing home placement among Chinese family caregivers

PURPOSE

To understand the process and difficulties that Chinese family caregivers experience when making a nursing home placement decision for their loved ones with dementia.

DESIGN AND METHODS

Using a grounded theory approach, data were collected through individual interviews with 30 Chinese family caregivers in Taiwan.

FINDINGS

A stage-based framework was generated that described how caregivers went through the decision-making process, what specific challenges they encountered within the process, and how they overcame difficulties to reach their decisions.

PRACTICE IMPLICATIONS

By identifying the stages of the decision-making process and various challenges that caregivers experience, clinicians can enhance discussions with caregivers to decrease the decision-making burden. Clinicians might develop family-centered interventions for the decision-making process through the post-placement stage while taking into account cultural influences.

Continuity and Change in the Study of Family Relationships

Recent work on family life in old age may be considered in several dimensions. First, it encompasses different substantive areas: parentchild relationships, care-giving, changing family forms. Second, it involves different types of discourse, which variously reflect social policy considerations, legal and ethical debates, academic discourses and prescriptive writing for professionals and older people. A third dimension consists of methodological and theoretical variations. These include synchronic and life history approaches, quantitative and qualitative methods, positivistic and phenomenological research paradigms, and cross-cultural and historical comparisons.

Predictors of burden and depression among nursing home family caregivers

This study identified predictors of caregiver burden and depression among family caregivers to nursing home residents. Pearlin's stress process model was used as a theoretical framework. Structured interviews were conducted with 103 family caregivers to nursing home residents. Multiple regression analysis was used to determine the relationship of contextual variables (caregiver age, income, health), caregiving stressors (resident's memory and behaviour problems, caregiving tasks, satisfaction with nursing home), and social support with caregiver burden and depression. All three domains of predictor variables were significantly related to caregiver burden. Only contextual factors and social support predicted depression. Depression levels were elevated in this sample, with the mean falling above the cutoff for clinical depression. Family members of nursing home residents are at risk for caregiver burden and depression and each outcome has unique predictors in this population. Understanding factors associated with greater burden and depression can guide nursing home staff and mental health professionals in working with family members. Older family members, those in poor physical health or with low incomes are at highest risk, particularly for depression; while families of more impaired residents are at higher risk for burden. Social support is an important factor in alleviating burden and promoting positive mental health.

Staff activities and behaviour are the source of many feelings: relatives' interactions and relationships with staff in nursing homes

Family members do not give up their involvement in the life of their older relatives when they move to an institution. Relatives feel that it is they who take the initiative to establish a working relationship with the staff at the nursing home. Relatives want more spontaneous information from staff, particularly about residents' daily lives, and there is a need for relatives to have opportunities to talk with staff under relaxed conditions. Staff behaviour and activities towards residents and relatives are a source of many feelings for relatives. Relatives' understandings of the challenges faced by staff are not communicated to staff, nor are positive or negative experiences explicitly passed on to staff.

Moving them on and in: the process of searching for and selecting an aged care facility

This exploratory, descriptive study examined the search and selection process for an aged care facility following discharge of a family member from an acute setting. Few studies have examined this process and its effects on families. Individuals from 25 families where a family member had been recently admitted to an aged care facility following discharge from an acute setting were interviewed. This article reports participants' perceptions of the search and selection process and its effect on the family. Five major themes emerged from the data: good fortune, wear and tear on the sponsor, dealing with the system, urgency, and adjusting. The results can be used to inform and assist families and health professionals working with families in this situation.

'I really feel I've let him down': supporting family carers during long-term care placement for elders

This paper considers placing a relative in a nursing home from a carer's perspective. A largely structured, interviewer-administered, questionnaire survey was conducted with 48 carers in the United Kingdom and 54 carers in the United States of America. While the data highlight differences between the two countries, shared experiences emerge which suggest that carers often have to make difficult decisions without adequate support. Implications for practice are considered. The need to develop more robust support mechanisms is stressed.

Transition in care: family carers' experience of nursing home placement

This paper explores families' experience of nursing home placement, which emerged as a significant aspect of a larger hermeneutic phenomenological study of family caring in nursing homes. Hermeneutic analysis of 14 family carers' stories of nursing home placement uncovered five shared meanings: experiencing a loss of control; being disempowered; feeling guilt, sadness and relief simultaneously; possessing a sense of failure; and having to make a forced and negative choice. Discussion of the findings focuses upon the importance of family carer support during the transition period from home care to nursing home care and the subsequent benefits realized as a result of having received such support. Particular emphasis is placed upon how such support assists family carers to begin the process of reconstructing a valued and positive identity through which new possibilities for meaningful caring within a nursing home context can be realized.

Comparison of caregivers', residents', and community-dwelling spouses' opinions about expressing sexuality in an institutional setting

Opinions regarding the appropriateness of elderly residents' sexual behaviors in a chronic care hospital and how to respond to inappropriate behaviors were surveyed. Study participation was open to all staff (N = 1,205), eligible residents (N = 182) and community-dwelling spouses (N = 103). Participation rates were 40% (residents), 42% (spouses), 34% (nursing staff), 50% (allied health staff), and 22% (support staff). Staff completed the questionnaire independently, while residents and spouses were offered self-completion or a structured interview. Almost all selected the interview. Residents and spouses were less tolerant than staff of residents' masturbating, engaging in sexual relationships, viewing sexual materials, and making sexual approaches to staff. Privacy was the primary determinant of appropriateness for behaviors for all groups. Staff and spouses were more likely to endorse counseling when behaviors were perceived as inappropriate than residents. Nurses endorsed counseling less frequently than allied health professionals and support staff. Nurses were more likely to have been approached sexually by a resident. Differences of opinion are interpreted in terms of cohort influences on values and contextual influences on behavior.

Searching for new possibilities to care: a qualitative analysis of family caring involvement in nursing homes

This paper explores families' experience of searching for new possibilities to continue caring which emerged as a significant aspect of a larger hermeneutic phenomenological study of family caring in nursing homes. Hermeneutic analysis of in-depth interview transcripts and observation field notes of 14 family carers' experiences of caring uncovered eight shared meanings: feeling duty-bound; setting up possibilities for human connection; possessing special knowledge and skills; providing the personal approach; acting as an advocate; living with hope of improvement and recovery; feeling satisfied when care experienced was deemed to be quality care; and possessing a sense of worth through making a useful and positive contribution. Being engaged in new caring activities and relationships in the nursing home context assisted family members in coping with the changes in their situation. This paper highlights how finding new ways of caring for their relatives was important as everyday involvement in care set up possibilities through which meaning could be attributed to their existence.

Family visitation on special care units

1 With placement of a family member with Alzheimer's disease on a SCU, the family does not relinquish the caregiving role, rather they take on different roles in relation to the residents. 2 Family visitation of the residents on the SCU is an integral part of family involvement in care of individuals with Alzheimer's disease, as well as SCU functioning. 3 Within the context of changing relationships with the residents, family members visited the residents as a sense of duty to "be faithful," to monitor care by "being their eyes and ears," and to foster a sense of family through ongoing relationships and family rituals. 4 Nurses have critical roles in promoting physical, emotional, and interactive environments which foster family visitation on SCUs.

Depressive symptoms among spousal caregivers of institutionalized mates with Alzheimer's: boundary ambiguity and mastery as predictors

The goal of this study was to identify factors that predict whether or not community-dwelling spouses experience depressive symptoms upon institutionalization of a mate with Alzheimer's disease. Eighty-four community-dwelling spouses (50 wives/34 husbands) completed questionnaires. Boundary ambiguity alone accounted for 51% of the variability in the depressive symptoms score, while mastery alone was found to account for 32%. The total explained variance, when controlling for demographic variables, was 68%. In the stepwise regression analysis, it was observed that mastery did not add significantly to the explanation of the depressive symptom score over and above boundary ambiguity. However, boundary ambiguity and mastery were somehow linked together and were powerful in explaining caregiver symptoms of depression. If a goal is to keep caregivers healthy, then interventions and education about how to live with ambiguity and how to be masterful in spite of the ambiguous status of one's mate seem necessary. Clinical implications are discussed. Future research might build upon this study's limitations for an even better understanding of factors that relate to caregiver depressive symptoms.

Caregivers' experiences in making placement decisions

Demographic trends indicate a growth in the older adult population, and in turn, are affecting the availability and use of health services. Although placement of an older adult charge into nursing home care is often described as a logical progression through the continuum of available services, informal caregivers often view placement as a last resort or as an indication of failure. This qualitative study used grounded theory methods to explore the experiences of caregivers actively involved in the process of placing an older adult in a long-term care facility upon discharge from acute care. Four themes (uncertainty, surrendering to the system, urgency, and validating) were interwoven throughout caregivers' perspectives of the conflictive decision to use nursing home care after hospitalization.

Changing life patterns of the resident in long-term care and the community-residing spouse

Fundamental changes occur in the life patterns of a couple when one of them enters an extended care facility. Each of the life patterns influences each of the others, and changes that affect one member of the couple have a significant effect on the other. With time, situations fluctuate and dependency needs change. With preadmission planning and understanding of life patterns by the nurse, many of these issues can be explored and plans made to deal with them before placement. On-going assessments become the basis for interventions that can help the couple cope with additional changes. Emphasis needs to be placed on periodically revisiting the issues and having the nurse monitor, initiate, and facilitate cooperative, collaborative relationships within the health care team. Through careful planning, the nurse can assist in promoting more effective adjustments to residential life and can assist the married couple with maintaining a more satisfying relationship.

Not Gone and Not Forgotten: A Spouse's Experience of Late-Stage Alzheimer's Disease

1. Late-stage caregiving is different from earlier stages, is difficult, and requires an empathic response from staff. 2. Ethical decision-making, supportive care, and the inevitability of death are important late-stage caregiver topics. Staff should understand the concept of palliative care. 3. Current educational programs and family support groups should be assessed for attention to late-stage caregiver issues. Further research is needed on helping families prepare for and cope with late stage caregiving.