Examining the Role that Caregivers Play in the Decision to Move to Assisted Living

Researchers at the University of North Carolina, Charlotte recently published results from a study that examined the family caregiver’s experiences while moving relatives with Alzheimer’s disease between their homes to assisted living residences and then later into memory care units. They found a considerable amount of uncertainty regarding move and transfer policies and conclude the long term care industry must improve the support and information they provide to family caregivers regarding the move-in and transfer process.

The decision to move is a difficult one for anyone. The anxiety and stress involved is a natural part of the process. However, acting as a proxy in this decision can be especially difficult for family caregivers caring for an older loved one. Many care recipients resist moves into assisted living residence and only do so when care arrangements become too overwhelming for their care givers. The process can create conflict between the two. Past research has documented this “assisted living as a last resort” phenomenon quite well. Until now, very little of this research had actually focused on the transition period between home and assisted living, and subsequently into memory care units. Knowing more about the family needs during this transitional period, during which the final decisions are being made, will help assisted living and memory care providers attract new residents more successfully.

Below is a brief summary how family caregivers view the decision to move into assisted-living and memory care.

Reasons for Moving into Assisted Living

Nearly all family members move their loved one into assisted living because they feel it is a safer place for them to live. Caregivers believe assisted-living will provide better medication management, meal preparation, help them simplify bill paying, and be better positioned to manage the anxiety, forgetfulness, confusion, and wandering of their loved ones. These concerns were even more important for family caregivers providing long distance caregiving.

Reasons for Selecting a Particular Residence

There are two major themes related to how particular assisted-living residences differentiate themselves from others. The first is the most obvious and it relates to the proximity to the family caregiver. More subtle, was the impact that the first impression of the residence made on both the care recipient and caregiver. For example, one respondent reported “When we walked in, it was bright. It was sunny. There were activities. It was a happy place.” For this reason, the typical strategies for targeting local caregivers must be aligned with initiatives for creating positive impressions that speak to the comfort, safety, and happiness of the residents.

Managing the Transition from Assisted Living and Memory Care

While most family caregivers recognize the potential need for future specialized dementia care, many of them expect their loved ones to age in place in assisted-living. A majority of respondents in this study expressed shock and surprise when an assisted-living provider informed them their loved one needed to be moved to a new residence that could handle Alzheimer’s care. It was common to believe that assisted-living was equipped to provide the care their loved ones would need.  Much of this confusion seems to be coming from misperceptions about what assisted-living provides, about the housing rights of the residents, and from unclear information given during the admissions process. Most caregivers believe they are not informed of care policies and are caught off guard when informed the assisted-living provider is not equipped to handle dementia care. The first time nearly all respondents felt they were informed of this was at the time the recommendation was being made.

It is important to consider that the decision-making process of moving a loved one through assisted-living and into memory care is potentially traumatic and uncertain. Many care providers assume that the information they have provided is clear enough and yet a disconnect still exists that confuses caregivers and makes the decision unnecessarily more difficult. It is important that assisted-living residents that hope to improve upon their services and increase their census pay particular attention to how they can better manage the move-in process and the better answer the dementia care question.

Source: Kelsey, S., Laditka, S., Laditka, J. 2010. Caregiver perspectives on transitions to assisted living and memory care.  American Journal of Alzheimer’s Disease & Other Dementias 25(3): 255-264.

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