Research into practice

Recent studies about people who have decided to assist a family member’s move into a care home reveal that practitioners do have “enormous potential” to influence whether relatives see such a move positively.

Davies and Nolan’s research1 was based on 37 semi-structured interviews with 48 people, each with a relative who had recently moved to a nursing home.

The period that follows a move is often difficult for all concerned. Relatives can be under great stress and often feel hostile and negative about the home and the move. They have to play a significant role, however, both in helping to make the decision on the move and in dealing with practicalities.

The interviews revealed that most relatives felt they had to juggle several competing views, but that most resisted a care home placement as long as they could. This was because they wanted to care, for a variety of reasons, but also because they held negative views about homes.

These views were ameliorated if practitioners suggested that a home was necessary for medical or nursing reasons. However, pressure on relatives continued even when the decision to move had been made. For example, relatives had to find the best home, sometimes quickly, as their relative was in hospital. They had to visit homes, at times without advice or support.

Most relatives were acting on behalf of an older person with mental health problems, and so the responsibility fell on them. They also felt guilty. In hindsight, few could remember any social care support that might have delayed residential care or made it unnecessary. The help that was offered to some relatives was generally too little and too late.

Residential care was often mentioned in discussions after a crisis, such as hospital admission, so for many relatives the decision was medically driven. This did not help them to feel in control. Other organisational arrangements, such as paying care home fees, could also seem outside their knowledge or control. Receiving little information from professionals did not help relatives to feel involved. Although relatives were responsible for finding a home, not many knew where to start and few were given any guidance.

This research suggests that practitioners could play a much more helpful role by raising long-term care as an option earlier. They could provide information and refer relatives to sources of advice, both local and national. They could talk to relatives about their feelings and be more supportive. As the authors conclude, a hospital ward is probably a very inappropriate setting for all this work.

Early contact with carers is also advocated by a Canadian discussion of care networks.2 This study suggests that a family’s first contact with professionals is an important influence on future perceptions of professionals. Families who make ties at early stages seem to find it easier to use services and to manage crises. Thinking about carers’ needs over time can be a way of supporting them more effectively.

Carers’ networks can also be preserved or fall away. Networks differ, for example, in their reaction to illnesses. Some are supportive, but in others conflicts may arise. The researchers suggest that practitioners should think more about networks as well as carers and, if possible, integrate the two systems.

1S Davies and M Nolan, “Making the best of things: relatives’ experiences of decisions about care-home entry”, Ageing and Society Vol 23, 2003

2N Carpentier and F Ducharme, “Care-giver network transformations: the need for an integrated perspective”, Ageing and Society Vol 23, 2003

Jill Manthorpe is reader in community care at the University of Hull.

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