Transitioning from life at home to life in aged care can be challenging experience for the older person, their family and their carers.
But it’s not a unique experience, as many families would find that they share similar stories about how hard it was for them and their loved ones.
It’s important for everyone involved to find their own way to cope with the transition, with strategies that build resilience and maintain wellbeing.
This is what Professor Colleen Doyle from Australian Catholic University spoke about at The Reality of Mental Health: Approaches to Recovery Symposium in Melbourne.
During the session “Mental Wellbeing in Later Life”, Professor Colleen spoke about a study she and colleague Gail Roberts undertook to better understand the experience an older person and their family goes through, and they have now written a practical guide to help such people.
According to the Department of Health and Ageing, the lifetime probability of being admitted into aged care is 20 per cent – that’s 1 in 5 people potentially being sent to aged care.
Moving into aged care can be an unexpected or reluctant process for some, but for a minority it can be pre-planned by the older person.
Australian Institute of Health and Welfare states that 4 per cent of people who are over 65 and admitted to hospital, will be placed in residential aged care upon discharge rather than returning to their own home.
The attitudes of moving to aged care may be heavily influenced by the media portrayals – which have been quite frequent recently – as it perpetuated negative impressions of life in aged care.
When the community is exposed to the “horror stories”, it drives them to feel as though aged care is the worst option available.
As Professor Colleen pointed out, it’s not uncommon for a person to say “I’d rather die before being put in an old folk’s home” – older people fear moving into a nursing home more than they fear death.
One reason for aged care homes having a bad reputation, as Professor Collen pointed out, may be that aged care homes were originally established as institutions for the poor and sick.
Those who had money and resources, would be able to seek care and support at home, and would never have to imagine going into a “home”.
The stress and anguish that moving can cause is so prevalent, it even has a name – Relocation Stress Syndrome. This is where an older person who is transitioning into aged care may go through anxiety, confusion, hopelessness, depression and loneliness.
There is a lot of fear driving the older person when they contemplate life in aged care;
And it’s not just the older people experiencing this, their children are usually well aware that their parents might feel sad about losing their independence.
In light of the negative media stories, the family may be concerned that not only will their parent dislike living htere, but may even be mistreated.
For an older person, the task of moving requires rebuilding perceptions of the new “home”.
As Professor Colleen explains, “home is both a place and a meaning that develops over time…It can be a symbol of who we are and what our identity consists of”.
Moving, for anyone regardless of age, involves setting up a whole new identity and adjusting to this new version of yourself.
Social life can be part of what ‘home’ means. As people age their social interactions are more centered around their home.
Personal possessions take on more importance as their sense of identity is expressed more in surroundings.
“For some people in aged care, they continue to identify with their old home and do not consider the residential aged care as a ‘real home’”.
Moving into aged care can be a stressful life event – and how a person coped with moving earlier in life (whether that be moving homes, schools, jobs) may be an indication on the likely impact it will have later in life.
It’s important to remember that everyone sees the consequences of a stressful life event differently.
“Maintaining a feeling of control can help with better psychological well being following the move,” says Professor Colleen.
People who are excluded from the processes of the decision making are found to have lower psychological well being.
So getting older people involved in making plans and decisions can help their well being – things such as a care plan and an advance care plan are important to have input from the older person.
There are strategies that Professor Colleen suggested through her session, to help people cope.
“Maintain as many habits as possible from previous lifestyle” – these can include routines like when to eat shower and sleep and hobbies that they do at home.
“Reflect on how activities, behaviours, hobbies, routines, relationships, values and attitudes can be continued.”
And in terms of the social aspect, “maintain relationships with the same people as much as possible,” she says.
Professor Colleen explained that thinking of the positives of moving into aged care, such as there are things that they no longer need to worry about, helps some older people
Things such as, “personal care – that was becoming increasingly difficult, house maintenance, chores, bills, possessions”
“What help everyone in aged care”, says Professor Colleen, “is to help them to maintain a purpose in life”.
Ask them “what makes you happy to be alive?” – this could be, feeling involved in the world, or love and connections with other, and then reflect on what activities can the person do to foster this feeling.
Some people who are more social, may find expressing themselves, sharing thoughts and offering wisdom gives them purpose.
While others may enjoy experiencing things that are pleasurable to the senses – like food and art.
This might be challenging for a person in aged care to answer for themselves, but some common things that many people find helps to give them purpose are;
Every person is unique, and it’s important to remember that when helping and supporting them – put them and their needs in the center of their care.
Though it can never be promised that the moving process will go smoothly, with the right support and enough compassion, this challenging transition does not need to have a detrimental impact on the resident and their family.
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