Abstract
Among the various transitions that may occur during the course of family caregiving, one of the more potentially disruptive is a relative’s move to 24-hr residential care (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995; Montgomery & Kosloski, 2000). In earlier research residential care admissions were often treated as endpoints in family caregiving, but both qualitative and quantitative studies since then have demonstrated the ongoing involvement of families (Gaugler, 2005a; Gaugler & Kane, 2007). In response to the prevalence of family involvement following residential long-term care admission, a handful of programs have been designed to help facilitate the placement transition for caregiving families and their relatives (Gaugler, 2005b).
As some of the cited studies above suggest, the topic of family caregiving and institutionalization is of particular interest to me. It is thus with great enthusiasm that this issue of the Journal of Applied Gerontology significantly contributes to existing scholarship on family caregiving and residential long-term care placement. In the first article, Cohen and colleagues explore family visits and involvement across residential long-term care settings. Using data from a subsample of the influential Collaborative Studies of Long-Term Care, Cohen et al. found that while the frequency of family visits did not vary for cognitively impaired and intact residents, the types of family involvement did. Families of more cognitively impaired residents were more likely to engage in care-related activities that were linked to family members’ perceptions of burden. The strong data set and multiple types of care settings help to add to our understanding of variations in types of family involvement (Cohen et al., 2014). An interesting qualitative study by Henkusens and co-authors provides greater detail on how families adapt to a relative’s transition to residential long-term care. Specifically, the adaptation to mealtimes (which may be among the most disruptive routines for newly admitted residents based on scheduling, type of food served, and the congregate meal setting) is explored. The themes that emerged suggested a considerable adjustment on the part of families and residents to congregate meals in residential long-term care. Collectively, the themes highlight the need for person-centered approaches to help construct a smoother adaptation to meals in such contexts (Henkusens, Keller, Dupuis, & Schindel Martin, 2014). Bauer and colleagues utilized focus group and interview data from families and staff from five residential settings to ascertain those dimensions that contribute to constructive family–staff relationships. Positive family–staff relationships were based on communication that built trust, were defined by involvement, and revolved around “keeping the family happy.” In particular, an emphasis on the roles and expectations of families and staff could promote more positive family and staff interactions (Bauer, Fetherstonhaugh, Tarzia, & Chenco, 2014).
The next two articles extend these earlier descriptive efforts to examine the associations of family involvement on quality of care in residential settings. While earlier research has suggested the associations between family involvement and quality of life on the part of residents, both studies in this issue are among the first to demonstrate how family involvement may influence quality of care. Durkin and associates (2014) examined whether family assistance during mealtimes was associated with quality of feeding assistance across 2,713 mealtime observations for 74 nursing residents in two Veterans Affairs facilities. Although family members’ presence during residents’ mealtimes was not frequent (4% of observations), when families were present feeding assistance time was considerably higher (due in part to family help provided during these times). In addition to providing a potential avenue to increase quality of care for residents, Durkin et al.’s findings offer an interesting bookend to the earlier Henkusens et al. (2014) article. Hamann (2014) administered a large mail survey to over 1,000 nursing home employees in 33 facilities and the primary family member contact of each resident (n = 522). Her study provides additional empirical support to the hypothesis that enhancing family involvement could result in improved quality in residential long-term care. Families who reported a 1-point increase on a measure of family empowerment indicated a corresponding 0.16 increased rating of service quality.
The final article highlights research we conducted as part of a National Institutes of Health/National Institute on Aging R21 project (AG025625) and provides an appropriate conclusion to this issue. Relying on longitudinal data from 1,610 family caregivers of persons with dementia who were enrolled in the multi-regional Medicare Alzheimer’s Disease Demonstration Evaluation, we utilized response operation characteristic (ROC) curves to test and validate two brief assessment tools to identify dementia caregivers at risk for clinically relevant burden or depression following a relative’s long-term care placement (Gaugler, Mittelman, Hepburn, & Newcomer, 2014). Of potential use to readers or clinicians, we provide these assessment tools (the Nursing Home Admission [NHA]–Burden and NHA-Depression prognostic tools) as well as scoring guidance to help facilitate their use in everyday practice.
This issue again demonstrates why the Journal of Applied Gerontology is such an exciting outlet for gerontological science and scholarship: the important role of family involvement and visits are initially described, followed by additional research that suggests how family involvement can potentially result in improved quality of care for persons in residential long-term care. The final article then provides readers with usable tools that can potentially enhance or transform clinical practice for families in residential long-term care. As families are a key component in effective chronic disease care, the studies in this issue of the Journal of Applied Gerontology suggest how family involvement during long-term care admission is a critical resource that can improve quality of care in residential environments.