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Supporting a Relative’s Move into Long-term Care: Starting Point Shapes Family Members’ Experiences*

  • Tamara Sussman (a1) and Sherry Dupuis (a2)

This grounded-theory study explored family members’ experiences supporting a relative’s move into a long-term care (LTC) home. Each stage in the transition process, and the role of starting point in shaping the experience, were examined. Twenty family members who moved a relative into an LTC home were interviewed within six weeks of the move. The findings revealed that the starting point had a profound effect on family members’ experiences accepting the need for, and timing of, their relative’s move into LTC (pre-move), and on believing that the selected LTC home was a positive environment for their relative (post-move). LTC home policies and processes were also important. However, when pre-move acceptance was compromised by circumstances attributed to the starting point, these policies and processes were not as effective in fostering post-move acceptance. Conditions that support positive transitions before, during, and after the move from each starting point are discussed.

Cette étude fondée sur la théorie a exploré les expériences des membres de la famille qui soutenaient leurs proches qui sont déplacés dans les foyers de soins de longue durée (FSLD). Chaque étape du processus de transition a été examinée, y compris le rôle du point de départ à façonner l’expérience. Dans les six semaines suivant le déménagement, une vingtaine de membres des familles qui avaient quitté un parent dans un FSLD ont été interviewés. Les résultats ont révelé que le point de départ a eu un effet profond sur les expériences des membres des familles en acceptant la nécessité et le moment où il faut faire le déplacement de leur parent en un FSLD (avant le déménagement), et à croire que le FSLD choisi est un environnement positif pour leur parent (après le déménagement). Les politiques et les processus des FSLD sont aussi importants. Cependant, quand l’acceptation du pré-déménagement a été compromise par des circonstances imputables au point de départ, ces politiques et procédures ont été moins efficaces dans la promotion de l’acceptation de l’après-déménagement. Nous discutons des conditions qui soutient les transitions positives avant, pendant et après le déménagement de chaque point de départ.

Corresponding author
Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Tamara Sussman, Ph.D., MSW School of Social Work McGill University 3506 University Room 305 Montreal QC H3A 2A7 (
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This study was funded by the Alzheimer Society of Canada.

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Alexander, T. (2002). The history and evolution of long-term care in Canada. In Stephenson, M., & Sawyer, E. (Eds.), Continuing to care: The issues and challenges for long-term care. Ottawa: CHA Press.
Aneshensel, C.S., Pearlin, L.I., Mullan, J.T., Zarit, S., & Whitlatch, C.J. (1995). Profiles in caregiving. The unexpected career. San Diego: The Academic Press.
Banerjee, A. (2009). Long-term care in Canada. An overview. In Armstrong, P., Boscoes, M., Clow, B., Grant, G., Hawaorth-Brockman, M., Jackson, B., Pederson, A., Seeley., M., & Springer, J. (Eds.), A place to call home. Long-term care in Canada. Chapter 2. Halifax: Fernwood Publishing.
Baldwin, N., Harris, J., & Kelly, D. (1993). Institutionalisation: Why blame the institutions? Ageing in Society, 13, 6981.
Ball, M.M., Perkins, M.M., Whittington, F.J., Connell, B.R., Hollingsworth, C., King, S.V., et al. . (2004). Managing decline in assisted living: The key to aging in place. The Journals of Gerontology. Series B, Psychological sciences and Social Sciences, 59, S202S212.
Berta, W., Laporte, A., & Valdmanis, V. (2005). Observations on institutional long-term care in Ontario: 1996–2002. Canadian Journal on Aging, 24, 7184.
Berta, W., Laporte, A., Zarnett, D., Valdmanis, V., & Anderson, G. (2006). A pan-Canadian perspective on institutional long-term care. Health Policy, 79, 175194.
British Columbia Ministry of Health. (2011). BC’s new residential care access policy. Retrieved March 21, 2012, from
Buhr, G.T., Kuchibhatla, M., & Clipp, E.C. (2006). Caregivers’ reasons for nursing home placement: Clues for improving discussions with families prior to transition. The Gerontologist, 46(1), 5261.
Butcher, H.K., Holkup, P.A., Park, M., & Maas, M. (2001). Thematic analysis of the experience of making a decision to place a family member with Alzheimer’s disease in a special care unit. Research in Nursing & Health, 24, 470480.
Cameron, J.I., & Gignac, M.A.M. (2008). “Timing it right.” A conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home. Patient Education and Counseling, 70(3), 305314.
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada. Tri-council policy statement: Ethical conduct for research involving humans. 1998 (with 2000, 2002 and 2005 amendments).
Caron, C.D., Ducharme, F., & Griffith, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193205.
Castle, N.G., & Engberg, J.B. (2007). Nursing home deficiency citations for medication use. Journal of Applied Gerontology, 26(2), 208232.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Cheek, J., & Ballantyne, A. (2001). Moving them on and in: The process of searching for and selecting an aged care facility. Qualitative Health Research, 11(2), 221237.
Cheek, J., Ballantyne, A., Byers, L., & Quan, J. (2006). Improving the retirement village to residential aged care transition. Australian Health Review, 30(30), 344352.
Coleman, E.A., & Berenson, R.A. (2004). Lost in transition: Challenges and opportunities for improving the quality of transitional care. Annals of Internal Medicine, 141(7), 533536.
Coyne, I.T. (1997). Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? Journal of Advanced Nursing, 26, 623630.
Davies, S. (2005). Meleis’s theory of nursing transitions and relatives’ experiences of nursing home entry. Journal of Advanced Nursing, 52(6), 658671.
Davies, S., & Nolan, M. (2006). ‘Making it better’: Self-perceived roles of family caregivers of older people living in care homes: A qualitative study. International Journal of Nursing Studies, 43, 281291.
Davies, S., & Nolan, M. (2004). ‘Making the move’: Relatives’ experiences of the transition to a care home. Health and Social Care in the Community, 12(6), 517526.
Davies, S., & Nolan, M. (2003). ‘Making the best of things’: Relatives’ experiences of decisions about care-home entry. Ageing & Society, 23, 429450.
Davisson, D.B., & Mosher-Ashley, P.M. (2002). Social workers’ perceptions of family distress at long-term care placement. Activities, Adaptation & Aging, 27(1), 2948.
Dellasega, C., & Nolan, M. (1997). Admission to care: Facilitating role transition amongst family carers. Journal of Clinical Nursing, 6(6), 443451.
Dupuis, S.L., Epp, T., & Smale, B.J.A. (2004). Caregivers of persons with dementia: Roles, experiences, supports, and coping. Literature review prepared for the Ministry of Health and Long-term Care and Ontario’s Senior’s Secretariat as part of Ontario’s Alzheimer Strategy (Imitative #6-Research on Caregiver Needs). Waterloo, ON: Murray Alzheimer Research and Education Program.
Gaugler, J.E., Duval, S., Anderson, K.A., & Kane, R.L. (2007). Predicting nursing home admission in the U.S. A meta-analysis. BMC Geriatrics, 7:13.
Gaugler, J.E., Pearlin, L.I., Leitsch, S.A., & Davey, A. (2001). Relinquishing in-home dementia care: Difficulties and perceived helpfulness during the nursing home transition. American Journal of Alzheimer’s Disease and Other Dementias, 16(1), 32.
Gibler, K.M., Lumpkin, J.R. & Moschis, G.P. (1997). Mature consumer awareness and attitudes toward retirement housing and long-term care alternatives. The Journal of Consumer Affairs, 31(1), 113138.
Glaser, B.G. (1978). Theoretical sensitivity. Mill Valley, CA: Sociology Press.
Glaser, B.G. (1992). Basics of grounded theory analysis. Mill Valley, CA: Sociology Press.
Glaser, B.G., & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine Publishing Company.
Hasson, H., & Arnetz, J.E. (2011). Care recipients’ and family members’ perceptions of quality of older people care: A comparison of home-based care and nursing homes. Journal of Clinical Nursing, 20, 14231435.
Holstein, J.A. & Gubrium, J.F. (1995). The active interview. Thousand Oaks, CA: Sage Publications.
Jones, A. (2002). The national nursing home survey: 1999 summary. Vital and Health Statistics Series, 13, 1116.
Kane, R. (2001). Long-term care and a good quality of life: Bringing them closer together, The Gerontologist, 41(3), 293304.
Kellet, U. (1999). Transition in care: Family carers’ experience of nursing home placement. Journal of Advanced Nursing, 29(6), 14741481.
Lewyeka, M. (1998). Finding and paying for residential and nursing home care. London: Age Concern England.
Luborsky, M.R., & Rubinstein, R.L. (1995). Sampling in qualitative research: Rationale, issues, and methods. Research on Aging, 17(1), 89113.
Lundh, U., Sandberg, J., & Nolan, M.R. (2000). ‘I don’t have another choice’: Spouses’ experiences of placing a partner in a care home for older people in Sweden. Journal of Advanced Nursing, 32(5), 11781186.
MacDonald, L., Higgs, P., MacDonald, J., Godfrey, E., & Ward, M. (1996) Carers’ reflections on nursing homes and NHS long-stay care for elderly patients. Health and Social Care in the Community, 4, 264270.
Mason, S.E., Auerbach, C., LaPorte, H.H. (2009). From hospital to nursing facility: Factors influencing decisions. Health & Social Work, 34(1), 815.
Mead, L.C., Eckert, J.K., Zimmerman, S., & Schumacher, J.G. (2005). Sociocultural aspects of transitions from assisted living for residents with dementia. The Gerontologist, 45(1), 115123.
Ministry of Health and Long-Term Care. (2010). Long-term care home Financial Policy. Retrieved March 21, 2012, from
Montgomery, R.J.V. (1999). The family role in the context of long-term care. Journal of Aging & Health, 11(3), 383416.
National Institute on Aging. (2006). Dramatic changes in U.S. aging highlighted in new census. NIH, report. Retrieved March 21, 2012, from
Nolan, M., & Dellasega, C. (2000). ‘I really let him down’: Supporting family carers during long-term care placement for elders. Journal of Advanced Nursing, 31(4), 759767.
Nolan, M., Grant, G., Keady, J., & Lundh, U. (2003). New directions for partnerships: Relationship-centred care. In Nolan, M., Lundh, U., Grant, G., & Keady, J. (Eds.), Partnerships in family care: Understanding the caregiving career (pp. 257291). Maidenhead: Open University Press.
Nolan, M.R., Walker, G., Nolan, J., Williams, S., Poland, F., Curran, M., et al. . (1996). Entry to care: Positive choice or fait accompli? Developing a more proactive nursing response to the needs of older people and their carers. Journal of Advanced Nursing, 24(2), 265274.
Nova Scotia Department of Health and Wellness. (2011). Facility placement policy, Retrieved March 21, 2012, from
Ontario Long-Term Care Homes Act, 2007, SO 2007, c 8, <> retrieved on 2011/10/16.
Park, M., Butcher, H.K., & Maas, M.L. (2004). A thematic analysis of Korean family caregivers’ experiences in making the decision to place a family member with dementia in a long-term care facility. Research in Nursing & Health, 27, 345356.
Patton, M.Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks: Sage Publications.
Peace, S.M. (1998). Caring in place. In Brechin, A., Walmesley, J., & Peace, S.. (Eds.), Care matters: Concepts, practice and researching health and social care (pp. 107125). London: Sage.
Pearson, A., Nay, R., & Taylor, B. (2003). Relatives’ experiences of nursing home entry: Meanings, practices and discourse. In Nolan, M., Lundh, U., Grant, G., & Keady, J.. Partnerships in family care: Understanding the caregiving career (pp. 183198). Maidenhead: Open University Press.
Reuss, G., Dupuis, S.L., & Whitfield, K. (2005). Easing the transition from community care to long-term care: Family members’ perspectives. Journal of Gerontological Social Work, 46(1), 1746.
Ryan, A. (2002). Transitions in care: Family carers’ experiences of nursing home placement. Nursing Times Research, 7(5), 324334.
Ryan, A., & Scullion, H.F. (2000). Nursing home placement: An exploration of the experiences of family carers. Journal of Advanced Nursing, 32(5), 11871195.
Sandberg, J., Lundh, U., & Nolan, M.R. (2001). Placing a spouse in a care home: The importance of ‘keeping’. Journal of Clinical Nursing, 10, 398405.
Sandberg, J., Lundh, U., & Nolan, M.R. (2002). Moving into a care home: The role of adult children in the placement process. International Journal of Nursing Studies, 39(5), 507516.
Schatzman, L., & Strauss, A.A. (1973). Field research: Strategies for a natural sociology. Englewood Cliffs, NJ: Prentice Hall.
Smith, M. (2004). Commitment to care: A plan for long-term care in Ontario. Final report prepared for the Ministry of Health and Long-Term Care. Toronto, Ontario.
Strang, V.R., Koop, P.M., Dupuis-Blanchard, S., Nordstrom, M., & Thompson, B. (2006). Family caregivers and transition to long-term care. Clinical Nursing Research, 15(1), 2745.
Tomiak, M., Berthelot, J.M., Guimond, E., & Mustard, C.A. (2000). Factors associated with nursing home entry for elders in Manitoba, Canada. The Journals of Gerontology Series A. Biological Sciences and Medical Sciences, 55(5), M279M287.
Victor, C. (1992). Do we need institutional care? (pp. 161172). In Laczko, L. & Victor, C. (Eds.). Social policy and elderly people, Gower: Aldershot.
Wackerbarth, S. (1999). What decisions are made by family caregivers? American Journal of Alzheimer’s Disease, 14(2), 111119.
Whyte, C., Lansfield, J., Dupuis, S., & Smale, B. (2008). Recognizing collaborative processes in the transition to long-term care. Paper presented at the 37th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, London, Ontario.
Zarit, S.H., & Whitlatch, C.J. (1992). Institutional placement: Phases of the transition. The Gerontologist, 32(5), 665672.
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Canadian Journal on Aging / La Revue canadienne du vieillissement
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