Primary Family Caregivers' Definition and Management of Nursing Home Placement

Primary family caregivers face one of the most major and difficult decisions in the trajectory of caregiving when they are unable to maintain care at home and have to consider nursing home placement. Many researchers have described the catalyst for this decision and transition as a “crisis event,” occurring after an unplanned medical event by the older adult that requires immediate attention or a breakdown in the primary caregiver’s ability to manage the relentless demands of care. While previous researchers have demonstrated the importance of caregivers in nursing home placement, few researchers have sought to understand the impact of the decision on the family and address the family context surrounding nursing home placement over time. The purpose of this qualitative descriptive study, guided by the Family Management Style Framework (FMSF), was to understand how caregivers define the situation surrounding care and placement, manage the care and placement, and perceive the consequences of care and placement on the family at initial placement (within the first 30 to 45 days) and 3 months post-placement. Ten primary family caregivers, whose older family member recently entered a nursing home, were recruited from four nursing homes in the Midwest. The caregivers were interviewed within 30 to 45 days of initial placement of the older family member and then again 3 months post-placement. There were a variety of caregiving dyads in the sample. Digitally recorded interviews were transcribed verbatim, processed, and coded using the FMSF dimensions and components. Results of this study were used to understand the viewpoints and needs of the caregiver during the nursing home transition. Overall, there were similarities across caregivers, especially among spousal and non-spousal dyads. All caregivers identified themselves as responsible for care management and placement and acknowledged the importance of remaining involved post-placement. They also noted the significance of ensuring the nursing home staff and older family member recognize that the caregiver continues to be involved in management and available to provide ongoing support. Ultimately, this research will contribute to the development of recommendations about nursing home placement decisions and tailored family-centered programs and interventions to assist in the adjustment for caregivers, older adults, and their families.