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Family Caregiving In Nursing Homes:
Some Points To Consider
By Lauren Volkmer
Social Work Intern, Columbia University SSW;
Jewish Home Life Care
When a person with dementia moves to long term
care, it does not mean that caregiving
relationships with family and friends have
ended. Family caregivers can continue to have meaningful,
vital relationships with their relatives long after placement
in a nursing home has occurred, even though there is a
natural transition in the caregiving role. Stresses and
burden related to family caregiving can continue as well.
In one study, depression levels in caregivers stayed the same
both before and after their family members were placed in
nursing homes. Here are a few suggestions to help family
caregivers in nursing homes keep stress to a minimum and
navigate this new environment.
Relationships With Staff
Especially for those who cared for a PWD (Person with
Dementia) full-time prior to nursing home placement, it
can be very difficult to hand over the daily tasks of caregiving
to professional staff. Positive relationships with staff can
help ease this transition for the caregiver, decrease stress and
caregiver burden, and enable the sharing of information
that caregivers have about the PWD. Patience, openness,
and understanding on both sides are essential. Introduce
yourself to the staff on all shifts and let them know that
you are there as an ally in the care of your family member.
Offer any helpful tips you have gathered during your time
caring for your family member. Is bathing easier for your
mother in the evening than in the morning? Does she have
a particular food preference? Be sure to listen as well as
give information. If you begin the staff/family relationship
on a positive note it sets the tone for the interactions you
will have in the future.
Managing Expectations
The pace of the day in a nursing home may be different
from what family caregivers have experienced in another
setting such as a hospital or an assisted living facility. This
is dependent on the level of skilled nursing need required
by the residents. If the PWD is on a specialized dementia
care unit, it can be difficult for caregivers to see their family
member in the company of other people who are more
severely impaired. Ideally, you will have visited the nursing
home prior to placement to get some idea of what the unit and the facility are like. Previous newsletters have
discussed the concept of nursing home “culture change:”
the shift from an institutional, medical model to one of
more person-centered, choice-driven care. Many nursing
homes are in the culture-change process, and some may be
further along than others. High quality relationships and
dignified, caring interactions between staff and residents
are generally considered to be the hallmark of a good
facility, as well as an effective treatment for Alzheimer’s
disease.
Taking Time
Not surprisingly, building a new type of family
caregiving relationship in a nursing home takes time.
Both the PWD and caregiver will need time to adjust
to the new environment, people, and schedule of the
nursing home. Each may adapt at a different pace and in
different ways. The staff will need time to get to know the
PWD and to learn what works best for that individual’s
emotional, cognitive, and physical needs. Taking time also
means allowing the caregiver to occasionally step away
from caregiving responsibilities and take care of themselves,
whether by exercising, going to the movies, or enjoying
time with friends. Family members should consider
joining a caregiver support group or the family and friends
advisory council, if it is offered by the facility. With time
and awareness, the family caregiver can continue to play
an integral role in the care of their relative in a nursing
home.
References
Chen, C.K., Sabir, M., Zimmerman, S., Suitor, J., Pillemer, K. (2007). The
importance of family relationships with nursing facility staff for family
caregiver burden and depression. Journal of Gerontology: Psychological
Sciences, 62B (5), 253-260.
Garity, J. (2006). Caring for a family member with Alzheimer’s disease:
coping with caregiver burden post-nursing home placement. Journal of
Gerontological Nursing, 32 (6), 39-48.
Schulz, R., Belle, S.H., Czaja, S., McGinnis, K.A., Stevens, A., Zhang, S.
(2004). Long-term care placement of dementia patients and caregiver
health and well-being. Journal of the American Medical Association, 292(8),
961-967.
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