The Experience of Transitioning into Assisted Living

Dependence By Richard Shank

New research published in Geriatric Nursing explores the qualitative experiences associated with moving into an Assisted Living (AL) residence. Researchers at the University of Texas and Texas Tech performed an exploratory case study in order to outline the details of the transition experience.

The relocation and transition period into AL is a critical time of personal change. Administrators and health care professionals working in ALs have long documented the need for improving supportive nursing interventions that can help new residents transition into their new environments. This research is meant to further inform AL professionals as to the needs and perspectives of individuals experiencing this important life transition.

There are over 36,000 ALs in the U.S. serving more than 900,000 residents. The relative size of the AL market has made it a critical segment of long-term care (LTC). Given the large number of people living in ALs, it is important to understand how the process of moving and acclimating to the AL environment is viewed from the perspective of the new resident and how it impacts their well-being.

This research found four themes related to the transition process.

Deciding to Move

The researchers discovered considerable levels of angst about the decision to move into an AL. All participants in the study had moved directly to their respective AL from independent living environments. This angst was most represented by the loss of autonomy that each participant felt during their lives prior to their move into the AL environment. In each case, this feeling of independence was threatened by either a singular health event or a gradual decline in physical ability. However, the decision to move was most often made only after these events caused family members too much difficulty in helping to care for the study participants.

Becoming Dependent

By the third month of residency in the AL, each participant expressed a feeling of dependency; specifically that they had lost decision-making power in ways that confirmed their fears of lost autonomy. They often felt frustrated or embarrassed and their loss of independence was taken as a knock to their self-esteem. Although each participant understood their need for care, they did not anticipate the extent to which they would become dependent on staff.

Reminiscing

During the six-month study, residents shared their stories of home. These stories allowed them to remain connected to a sense of place and self that boosted their self-esteem. However, the research implies that these stories of home function as a way of protecting their sense-of-self from newfound feelings of dependency. In addition, the predominance of these stories indicated to the researchers that the participants were not adjusting to their new environment well since they did not develop similar stories about their current environment.

The Importance of a New Community

Throughout the study period, the researchers witnessed the participants discussing the importance of friends and family. The happiness of each individual participant appeared to be dependent upon whether or not they were able to develop supporting relationships with new friends and staff members within the AL residence. Those who did not develop a new support system within the AL felt an overwhelming sense of loneliness and loss. It is important to note that this transition not only involves the resident having to reorient themselves to a new home, they are also in the process of reorienting their relationships with their friends and family. The level of social support and interaction between them and their loved ones will typically change during the transition into assisted living. In short, a new social support system needs to be integrated with the resident’s existing support of friends and family, which will allow each person a greater chance of maintaining a high level of self-esteem during the transition process.

The researchers recommend candid conversations at all stages of the admission and transition process between residents, their family, and residence staff. They also recommend establishing a care team responsible for managing the transition process into the residence. This team should work in every way possible to empower the resident to have a voice in their own care and establish a new sense of place within their new environment.

Source: Saunders, J., Heliker, D. 2008. Lessons learned from five women as they transition into assisted living. Geriatric Nursing 29(6): 369-375.

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