ArticlePDF Available

Use of videophones for distant caregiving - An enriching experience for families and residents in long-term care

Authors:

Abstract and Figures

The objective of this study was to explore the role of videophone technology in enhancing the distant caregiving experience of and communication between residents of a long-term care facility and their family members. Ten participants-4 residents of an independent retirement facility and 6 family members-were recruited. A videophone was installed in each resident's apartment, and another was mailed to the remote family member. Participants were asked to conduct a videocall at least once per week for 3 months. Exit interviews assessed general impressions of videophone communication, the relationship between residents and family members, stress, burden, and isolation. Participants were enthusiastic and emphasized a sense of closeness, the inclusion of the resident in family interactions, and reduced feelings of guilt and isolation as key benefits. New models of care are needed to challenge the existing paradigm, which often excludes distant caregivers from the care process. Technology can facilitate this process by bridging geographic distance.
No caption available
… 
Content may be subject to copyright.
The objective of this study was to explore the role of
videophone technology in enhancing the distant care-
giving experience of and communication between
residents of a long-term care facility and their family
members. Ten participants—4 residents of an indepen-
dent retirement facility and 6 family members—were
recruited. A videophone was installed in each resident’s
apartment, and another was mailed to the remote
family member. Participants were asked to conduct a
videocall at least once per week for 3 months. Exit in-
terviews assessed general impressions of videophone
communication, the relationship between residents
and family members, stress, burden, and isolation. Par-
ticipants were enthusiastic and emphasized a sense of
closeness, the inclusion of the resident in family inter-
actions, and reduced feelings of guilt and isolation as
key benets. New models of care are needed to chal-
lenge the existing paradigm, which often excludes dis-
tant caregivers from the care process. Technology can
facilitate this process by bridging geographic distance.
ABSTRACT
George Demiris, PhD; Debra R. Parker Oliver, PhD; Brian Hensel, PhD;
Geraldine Dickey, MS; Marilyn Rantz, PhD, RN; and Marjorie Skubic, PhD
© 2008 iStock International Inc. /Jaren Wicklund
Use of Videophones for
Distant Caregiving
An Enriching Experience for Families
and Residents in Long-Term Care
50 JOGNonline.com
The decision to move into a long-
term care facility is an emo-
tional struggle for older adults,
as well as their family members. For
families, acknowledging that a loved
one needs more care than can be pro-
vided in a home setting is not easy. This
transition becomes especially stressful
for family members who, due to geo-
graphic distance, become less involved
in the care of their loved one. Informa-
tion technology tools have the poten-
tial to address such geographic barri-
ers; thus, it is essential to explore and
evaluate their use with long-term care
residents and their distant caregivers.
BACKGROUND
The transition of moving a loved
one into a long-term care setting often
results in family members simultane-
ously experiencing loss of control,
guilt, disempowerment, sadness, and
relief (Drysdale, Nelson, & Wineman,
1993; Rodgers, 1997; Whitlatch, Schur,
Noelker, Ejaz, & Looman, 2001). A
prevailing view is that the move into
a long-term care facility dictates the
termination of family caregiving (Kel-
lett, 1999). However, recent literature
has found that when older adults move
to long-term care, family members are
introduced to different, yet still poten-
tially stressful involvement (Dellasega
& Mastrian, 1995; Ross, Rosenthal,
& Dawson, 1993). Although mov-
ing a loved one who needs care into a
long-term care facility relieves some of
the caregivers’ physical and time pres-
sures, caregivers perceive little change
in their well-being after such institu-
tionalization (Dellasega, 1991). In-
stead, perceptions of stress and burden
persist with the same intensity as they
do for those who care for older rela-
tives at home (Dellasega, 1991).
Few published reports address in-
terventions aimed at family members
after their loved one has been insti-
tutionalized (Drysdale et al., 1993).
The distant caregiving experience,
especially for family members who
are geographically separated from the
institution in which their loved one
now lives, has not been investigated
extensively. Although interventions
involving distant caregivers in the
design and delivery of health care ser-
vices to residents are lacking, caregiv-
ers themselves want to continue to be
involved and desire more information
from staff about their loved one’s dai-
ly life (Hertzberg, Ekman, & Axels-
son, 2001).
Sustaining and enhancing relation-
ships and communication between dis-
tant caregivers and residents is impor-
tant not only to the family members
but also to the residents (Bauer & Nay,
2003), as they often struggle with isola-
tion and lack of a social network. The
loneliness resulting from social isola-
tion is significantly higher in nursing
home residents than in community-
dwelling older adults (Pinquart & So-
rensen, 2001). High frequency of social
contact between residents and their
children or grandchildren was found
to have a significant effect on lowering
social isolation (Drageset, 2002).
Geographic distance and time con-
straints often prevent distant caregiv-
ers from frequently visiting their loved
ones. These challenges are even greater
when the caregivers live an extensive
distance from the institution. The use
of videophone technology provides an
opportunity to bridge the geographic
distance between family members
and nursing home residents. Several
studies have indicated the potential of
such technology in the home setting,
for example, for disease management
(Demiris, Speedie, & Finkelstein, 2001),
hospice care (Parker Oliver, Demiris,
& Porock, 2005), and rehabilitation
support (Hauber & Jones, 2002).
Only three studies have investigated
the use of videophones in a long-term
care facility. Mickus and Luz (2002)
conducted a pilot study investigat-
ing the use of videophones to allow
residents to communicate with family
members and found that the technol-
ogy was valuable for both distant fam-
ily and residents. Satisfaction and per-
ception of usefulness were linked to
the individuals’ ability to use the tech-
nology. Another study by Sävenstedt,
Brulin, and Sandman (2003) explored
the use of videophones by residents
with dementia in a nursing home.
With staff supervision and assistance,
residents were able to communicate
via videophone with family members,
despite their cognitive impairments.
The interaction increased the attention
and focus of the residents and gave
family members a greater sense of in-
volvement (Sävenstedt et al., 2003). Fi-
© 2008 iStock International Inc. /Jin Yong
51
Journal of GerontoloGical nursinG • Vol. 34, no. 7, 2008
nally, in a case study by Hensel, Parker
Oliver, and Demiris (2007) involving a
nursing home resident and her niece,
the videophone technology was found
to provide social presence for the fam-
ily member, who expressed that the
experience was “almost like being in
the same room” as her aunt.
STUDY PURPOSE
On the basis of the encouraging
findings of these preliminary studies,
we aimed to further explore the role
of videophone technology in enhanc-
ing the distant caregiving experience
and communication between residents
and family members. Specifically, the
purpose of this study was to identify
potential benefits and challenges of
videophone technology for long-term
care facility residents and their family
members and determine whether the
use of videophones can increase or en-
hance communication between these
individuals. In addition, we aimed to
explore potential psychosocial benefits
of videophone communication for both
residents and their family members.
METHOD
Setting
The study setting was an assisted
living retirement facility in the mid-
western United States. The design of
the facility was based on the Aging in
Place model, offering varied services as
needed rather than forcing older adults
to move to more skilled nursing en-
vironments as their health care needs
increase (Marek & Rantz, 2000).
Recruitment
A graduate research assistant (GRA)
(G. Dickey) attended several weekly
resident meetings in the facility and
explained the purpose of the study.
Individuals interested in participating
scheduled to meet with the GRA at a
later point and discuss the consent form
and study procedures. If residents’ fam-
ily members also agreed to be contacted
by the GRA, they scheduled a tele-
phone conference to discuss the study
procedures. Eligibility criteria included
that both residents and family members
had to be mentally competent, have a
regular telephone line in their residence,
and, in instances of hearing impairment,
still be able to carry out regular tele-
phone conversations.
When both parties (residents and
family members) signed their consent
forms, the GRA installed the video-
phone in the residents’ apartments and
mailed a videophone with detailed in-
structions to the family members. The
study was approved by the participat-
ing university’s institutional review
board.
Videophone
The videophone used in this study
was the Beamer Videophone (Vialta,
Inc., Fremont, CA), which operates
over regular telephone lines and costs
approximately $150 per unit. During
the authors’ preliminary work, this
model was found to be user friendly
for adults age 65 and older (Demiris,
Parker Oliver, & Courtney, 2006). The
videophone can display three kinds of
real-time images during a videocall:
self, other party, and a combination of
both, depending on user preference. It
plugs into a regular telephone and does
not interfere with its use. A videocall is
possible only when both parties have
videophone units and consent to a
videocall (by pressing the video but-
ton). In all other situations, users can
continue making and receiving regular
calls through their telephone without
activating the video feature.
Data Collection and Analysis
Both residents and family mem-
bers were asked to conduct a video-
call at least once per week (or more
if they chose to do so) and complete
a form after each videocall to docu-
ment its technical quality. We used a
previously developed instrument for
assessing the technical quality of a
“virtual visit” in home care (Demiris,
Speedie, Finkelstein, & Harris, 2003),
a video-based interaction between
health care providers and patients or
caregivers.
The form included the date, start
and end times of the videocall, and the
participants’ initials. The main section
of the form contained five items about
the technical quality of the videocall.
The first two items addressed partici-
pants’ observations regarding the fre-
quency of difficulties they experienced
with the videophone’s audio and im-
age. The next two items addressed
problems with video and sound on the
conversation partner’s end, as reported
to the participants. The last item ad-
dressed possible disconnections and
their frequency.
A percentage score for the over-
all technical quality of each videocall
(100% = perfect technical quality
with no problems or disconnections)
is calculated at the end of this sec-
tion. This instrument has been tested
for reliability and validity and used to
rate the technical quality of videocalls
in home care settings (Demiris et al.,
2003; Hensel et al., 2007). The forms
were collected and entered into SPSS,
version 14, for analysis. We entered the
data twice to ensure accuracy.
Participants (residents and fam-
ily members) were interviewed after
using the videophone for 3 months.
The interview protocol addressed six
domains:
l General impressions of video-
phone communication (e.g., perceived
advantages and disadvantages).
l Affective and cognitive dimen-
sions of conversations between
resident and family member (i.e.,
assessing perceptions of the value
of videophones in conversations
conveying factual information and
description, emotional conversa-
tions and discussions of feelings, and
attempts to persuade or convince
and address conflict).
Participants reported
a sense of closeness
during the videocalls,...
and reduced feelings of
guilt and isolation.
52 JOGNonline.com
l Quality and frequency of com-
munication and quality of relationship
between resident and family member
(and the role of videophone in this
context).
l Stress and burden (e.g., feelings
of stress, nervousness, depression,
general anxiety, tension).
l Assisted living facility place-
ment stress (for interviews with fam-
ily members only).
l Isolation and loneliness (for
interviews with residents only).
The protocol was reviewed by two
experts in gerontology and communi-
cation research to address face valid-
ity. Interviews were audiotaped and
transcribed. Transcript data were then
analyzed using a qualitative approach
by which codes were inductively gen-
erated (Miles & Huberman, 1994). The
thematic data analysis was performed
by two members of the research team
(G. Demiris, D.R. Parker Oliver), and
a third member (B. Hensel) confirmed
the validity of interpretations.
RESULTS
A total of 10 individuals participat-
ed in the study: 4 residents and 6 fam-
ily members (2 residents each partici-
pated with 2 family members). All of
the participating family members were
children of the residents except for
one, who was the niece of the resident.
All residents were older than age 65.
The original study plan focused on
the recruitment of family members re-
siding at least 20 miles from the facil-
ity; however, when one daughter who
lived locally became ill and unable to
visit her father, we discovered the value
of the instrument for families who live
locally as well.
Two residents died before study
completion, resulting in a total of eight
exit interviews (2 residents and 6 fam-
ily members). The average duration
of a videocall was 43 minutes (SD =
11.2), with the shortest call lasting 14
minutes and the longest 1 hour and 14
minutes. The average technical qual-
ity was 94.75% (SD = 7.97); the mini-
mum score observed was 57.1% and
the maximum was 100%, indicating
an overall very good level of videocall
audio and video quality.
All respondents stated that they ap-
preciated being able to see their loved
one’s facial expressions and to have a
sense of closeness. One respondent
stated:
It was great to see Dad, and I think
that one of the times we used it [the
videophone], we gave him some good
news and just being able to see the smile
on his face was really good.
Another respondent pointed out
the value of the visual aid in assessing
one’s condition:
I can remember this one time when
I had the flu…. He [participant’s father]
was worried about me being sick, and it
helped him to be able to see me and re-
alize that I wasn’t on my death bed…. I
felt good because I could see that he had
a smile on his face. He could answer the
phone and have that tone of voice that
I could hear he was just feeling down
and depressed, and we could click on
the videophone, and, especially with
Dad’s personality, he would start to get
a grin on his face and start saying hello
and being a clown on the phone. He en-
joyed it, and it was ideal.
A consistent theme in the responses
of both residents and family mem-
bers was the inclusion of the resident
in family interactions, which was fa-
cilitated by the video component. A
family member described how the
videophone was used when the grand-
children would visit, and on one occa-
sion, the resident was able to watch a
football game with the family:
On special occasions it was nice to
have a visual. When kids gathered at
the house, Dad could see them; they
could see their grandfather. When the
kids visited on holidays, when [football
team] beat [football team] we were all
dressed up and yelling, and it was fun.
I could see him laughing. He could see
me wearing a sombrero and a [football
team] shirt.
Another resident stated:
I was amused that my niece had a
grandchild, and they wanted me to see
the grandchild. So I was ready to visit
and I got a kick out of it because every
time they said, “Say hi to Aunt _____,
she would take a little peek at the screen
and then hide behind her mother’s
skirt.
Most family members emphasized
the importance of having the resident
see new family members or friends
over the videophone, as this allowed
residents to feel like they are still part
of the family group. One family mem-
ber stated:
With the videophone, he could see
his granddaughter’s new boyfriend. It
did put him more at the center of fam-
ily gatherings. And we tried harder to
physically show items to him, the way
we dressed, people in the background.
Concerns were also expressed re-
garding the use of the technology.
Four respondents identified occasion-
al audio delays as distracting or con-
fusing. Two family members reported
that videocalls can be time consuming
or inconvenient, as the videophone re-
quired them to sit in front of the camera
during the whole conversation rather
than being able to carry out other tasks
in the house during the conversation,
as they would with mobile phones or
handsets.
When commenting on the affective
and cognitive dimensions of the con-
versation, all respondents saw a benefit
in being able to see their loved one’s fa-
cial expressions and part of their resi-
dence. Three respondents believed the
videophone can be useful in conversa-
tions that involve factual information
(i.e., when one is describing symptoms
or an injury). All respondents saw an
advantage in using the videophone over
the regular telephone in conversations
that involved emotions and feelings
or when trying to persuade or con-
vince the conversation partner. Eight
respondents were unsure whether the
videophone would be more or less
appropriate to address conflict, and 2
believed the videophone was more ap-
propriate than a regular telephone, as
one can assess the emotional status and
sincerity of the conversation partner.
One family member stated:
She [her mother] can be stubborn
at times, and if I can see the expression
53
Journal of GerontoloGical nursinG • Vol. 34, no. 7, 2008
on her face, I know how to go with my
conversation and I know how to get the
point across.
In terms of the quality of com-
munication and frequency of interac-
tion, 4 respondents believed that these
factors did not change because of the
videophone, whereas the remaining
6 respondents stated that the video-
phone made the communication more
personal and comforting. Interest-
ingly, these 6 respondents had also ex-
perienced the highest level of technical
quality of the videocalls, as reported
in the technical quality forms. One
respondent stated that conversations
lasted longer with the videophone and
were more fulfilling.
Three family members stated they
did feel guilt about their loved one mov-
ing into a retirement community and
that the videocalls played a role in re-
ducing this guilt. One participant said:
We don’t live together, and some-
times I could feel guilty about that. This
[the videophone] took away some of
the guilt because I could actually see
him [his father]. I felt very much like I
was closer in proximity, and if he had
taken a turn for the worse…this would
have given me a better way to assess
how he is.
Another family member com-
mented on the sense of connectedness
the videophone provided and wished
she had used that tool for another par-
ent who had passed away in a nursing
home:
The connectedness was great with
the videophone. I wish I had one for
Dad, if I knew they existed, I would
have purchased one for him and me. It
would have so reduced my stress.
The videophone communication
also contributed positively in reducing
feelings of isolation and loneliness for
residents. One resident stated:
I think the videophone was a help
in fighting feelings of depression. Time
just changes depression, it just reduces
it overall, you come to the conclusion
that this is where you are. The visual as-
pect helped me to feel like I was visiting
when we spoke.
Another participant commented:
Oh, yes, the videophone contrib-
uted positively to our relationship. We
developed a way of kind of kissing each
other over the phone or giving each
other a hug over the phone. We would
both always leave it with a big smile
on our face. And a couple of times, my
sons were at my house when we were
having conversations, and they got in
the picture as well, and we were like
three clowns trying to cheer him [her
father] up. But we did it.
DISCUSSION
This was an exploratory study
with a limited sample and, as such,
has limited generalizability. However,
the findings do indicate the potential
of videophone technology to improve
quality of life for long-term care fa-
cility residents and distant family
members. All participants were en-
thusiastic about their ability to con-
duct videocalls. Although technical
issues and challenges were identified,
respondents emphasized the sense
of closeness and the inclusion of the
resident in family interactions as key
benefits of this technology. The vid-
eophone contact could play a role in
reducing social isolation and loneli-
ness of residents in long-term care.
In addition, these experiences sup-
port an earlier finding by Hensel et al.
(2007) that the videophone promotes
a social presence for the resident and
family member. This finding indicates
a need for further exploration of the
relationship between social presence
and social support for long-term care
residents.
The successful implementation of
these commercially available, low-
cost tools needs to be further ex-
plored (Parker Oliver, Demiris, &
Hensel, 2006). For example, such a
video-based tool can also allow staff
to communicate with the family mem-
bers, enhancing their relationship
with distant caregivers. A long-term
care facility may use this technology
to connect family members not only
with their loved ones but also with
the entire care team, allowing distant
KEYPOINTS
Videophones for distant
CaregiVing
Demiris, G., Parker Oliver, D.R., Hensel, B., Dickey, G., Rantz, M., & Skubic, M. (2008). Use
of Videophones for Distant Caregiving: An Enriching Experience for Families and
Residents in Long-Term Care. Journal of Gerontological Nursing, 34(7), 50-55.
1 The decision to move into a long-term care facility is an emo-
tional struggle for older adults, as well as their family members.
2 Enhancing communication between long-term care residents and
distant caregivers is important not only to the family members
but also to the residents, as they often struggle with isolation and
lack of a social network.
3 Long-term care residents and their distant caregivers were greatly
satisfied with regular use of videophones for their communica-
tion and emphasized a sense of closeness, the inclusion of the
resident in family interactions, and reduced feelings of guilt and
isolation as key benefits.
4 New models of care are needed to challenge the existing para-
digm, which often excludes distant caregivers from the care pro-
cess; technology can contribute to this process by bridging geo-
graphic distance.
54 JOGNonline.com
caregivers to be included in the deci-
sion making process.
As Kellett (1999) pointed out, new
models of care are needed that will
challenge the existing paradigm, which
often excludes distant caregivers from
the care process. The ability of fam-
ily caregivers to redefine their caring
roles within the long-term care facility
context will depend on the degree to
which the institutions support family
involvement. Information technology
can contribute to this process by bridg-
ing geographic distance and enriching
existing communication channels and
introducing new ones.
NURSING IMPLICATIONS
This study shows that information
technology can provide useful tools
for nurses as they aim to improve ser-
vices provided to long-term care resi-
dents and assess issues of social iso-
lation. In many cases, commercially
available, low-cost tools can be pow-
erful in including distant caregivers in
the design and delivery of health care
services. Long-term care administra-
tors and nurses can use such technol-
ogy to include distant caregivers in
the decision making process and to
facilitate teamwork. Nurses can re-
define the caring roles of family care-
givers in the long-term care facility
context by empowering residents and
their families and bridging geographic
distance.
SUMMARY
This study explored the role of
videophone technology in enhancing
the communication between residents
of a long-term care facility and their
remote family members. Ten par-
ticipants—4 residents and 6 family
members—were recruited. A video-
phone was mailed to the remote fam-
ily members and installed in residents’
apartments. Participants were asked
to conduct a videocall at least once per
week for 3 months and at completion
of the study discuss their experience
with and impression of videophone
communication. Participants reported
a sense of closeness during the video-
calls, the inclusion of the resident in
family interactions, and reduced feel-
ings of guilt and isolation. Technology
can help redefine the role of distant
caregiving in long-term care facilities.
REFERENCES
Bauer, M., & Nay, R. (2003). Family and staff
partnerships in long-term care: A review
of the literature. Journal of Gerontological
Nursing, 29(10), 46-53.
Dellasega, C. (1991). Caregiving stress among
community caregivers for the elderly: Does
institutionalization make a difference? Jour-
nal of Community Health Nursing, 8, 197-
205.
Dellasega, C., & Mastrian, K. (1995). The pro-
cess and consequences of institutionalizing
an elder. Western Journal of Nursing Re-
search, 17, 123-140.
Demiris, G., Parker Oliver D.R., & Court-
ney, K. (2006). A study of the suitability of
videophones for psychometric assessment.
Behaviour and Information Technology, 25,
233-237.
Demiris, G., Speedie, S., Finkelstein, S., & Har-
ris, I. (2003). Communication patterns and
technical quality of virtual visits in home
care. Journal of Telemedicine and Telecare,
9, 210-215.
Demiris, G., Speedie, S.M., & Finkelstein, S.
(2001). Change of patients’ perceptions of
TeleHomeCare. Telemedicine Journal and
e-Health, 7, 241-248.
Drageset, J. (2002). Loneliness at nursing homes:
Does a network have any importance for
loneliness among nursing home occupants?
Nursing Science and Research in the Nordic
Countries, 22, 9-14.
Drysdale, A.E., Nelson, C.F., & Wineman, N.M.
(1993). Families need help too: Group treat-
ment for families of nursing home residents.
Clinical Nurse Specialist, 7, 130-134.
Hauber, R.P., & Jones, M.L. (2002). Telerehabili-
tation support for families at home caring for
individuals in prolonged states of reduced
consciousness. Journal of Head Trauma Re-
habilitation, 17, 535-541.
Hensel, B.K., Parker Oliver, D., & Demiris,
G. (2007). Videophone communication be-
tween residents and family: A case study.
Journal of the American Medical Directors
Association, 8, 123-127.
Hertzberg, A., Ekman, S., & Axelsson, K. (2001).
Staff activities and behaviour are the source
of many feelings: Relatives’ interactions and
relationships with staff in nursing homes.
Journal of Clinical Nursing, 10, 380-388.
Kellett, U.M. (1999). Searching for new possibil-
ities to care: A qualitative analysis of family
caring involvement in nursing homes. Nurs-
ing Inquiry, 6, 9-16.
Marek, K.D., & Rantz, M.J. (2000). Aging in
place: A new model for long-term care.
Nursing Administration Quarterly, 24, 1-11.
Mickus, M.A., & Luz, C.C. (2002). Televisits:
Sustaining long distance family relationships
among institutionalized elders through tech-
nology. Aging & Mental Health, 6, 387-396.
Miles, M.B., & Huberman, A.M. (1994). Quali-
tative data analysis (2nd ed.). Thousand
Oaks, CA: Sage.
Parker Oliver, D.R., Demiris, G., & Hensel,
B.K. (2006). A promising technology to re-
duce social isolation of nursing home resi-
dents. Journal of Nursing Care Quality, 21,
302-305.
Parker Oliver, D.R., Demiris, G., & Porock, D.
(2005). The usability of videophones for se-
niors and hospice providers: A brief report
of two studies. Computers in Biology and
Medicine, 35, 782-790.
Pinquart, M., & Sorensen, S. (2001). Influences
on loneliness in older adults: A meta-analy-
sis. Basic and Applied Social Psychology, 23,
245-266.
Rodgers, B.L. (1997). Family members’ experi-
ences with the nursing home placement of
an older adult. Applied Nursing Research,
10, 57-63.
Ross, M.M., Rosenthal, C.J., & Dawson, P.G.
(1993). Spousal caregiving following insti-
tutionalization: The experience of elderly
wives. Journal of Advanced Nursing, 18,
1531-1539.
Sävenstedt, S., Brulin, C., & Sandman, P.O.
(2003). Family members’ narrated experi-
ences of communicating via video-phone
with patients with dementia staying at a
nursing home. Journal of Telemedicine and
Telecare, 9, 216-220.
Whitlatch, C.J., Schur, D., Noelker, L.S., Ejaz,
F.K., & Looman, W.J. (2001). The stress pro-
cess of family caregiving in institutional set-
tings. The Gerontologist, 41, 462-473.
About the Authors
Dr. Demiris is Associate Profes-
sor, Biobehavioral Nursing and Health
Systems, School of Nursing, University
of Washington, Seattle, Washington; and
Dr. Parker Oliver is Associate Professor,
Family and Community Medicine, School
of Medicine, Dr. Hensel is Postdoctoral
Fellow of Health Management and Infor-
matics, School of Medicine, Ms. Dickey is a
predoctoral student, School of Social Work,
Dr. Rantz is Professor, School of Nurs-
ing, and Dr. Skubic is Associate Profes-
sor, School of Engineering, University of
Missouri-Columbia, Columbia, Missouri.
This study was supported in part by
the U.S. Administration on Aging (Grant
90AM3013, Marilyn Rantz, Principal
Investigator).
Address correspondence to George
Demiris, PhD, Associate Professor,
Biobehavioral Nursing and Health Sys-
tems, University of Washington, BNHS
Box 357266, Seattle, WA 98195; e-mail:
gdemiris@u.washington.edu.
55
Journal of GerontoloGical nursinG • Vol. 34, no. 7, 2008
... Viele Aspekte sind zudem veraltet angesichts der Rasanz der Technik entwicklung u. a. im Bereich AAL / Smart Home. Einige Autorinnen und Autoren verweisen auf das Potenzial neuer Technologien, die pflegende Angehörige entlasten können und zugleich die Lebensqualität sowohl bei den zu Pflegenden als auch den Betreuenden steigern können (Benefield & Beck, 2007;Bledsoe et al., 2010;Demiris et al., 2008). "Technology interventions, such as user friendly video communication, telehealth services, assistive devices, remote alert systems, and smart home tech no lo gies, are anticipated to help bridge the distance between LDCs [Long Distance Caregiver] and care recipients" (Cagle & Munn, 2012, S. 701). ...
... Wichtigste Tech nologie zur Überbrückung der räumlichen Distanz ist nach wie vor das Telefon, Handy oder Smartphone (Bischofberger, Otto & Franke, 2015;Collins, Holt, Moore & Bledsoe, 2003;Menack, 2009;Parker et al., 2003;Roff, Toseland, Martin, Fine & Parker, 2003). Regelmäßige Anrufe helfen, die Lage vor Ort zu beobachten und zu kontrollieren und gleichzeitig werden die zu Pflegenden emotional unterstützt, Gefühle von Einsamkeit und Iso lation können reduziert werden (Menack, 2009 (Cagle, 2008;Demiris et al., 2008;Menack, 2009). Dabei erlauben Telefon oder Videokonferenzen pflegenden Angehörigen, auch aus räumlicher Distanz an wichtigen Besprechungen mit Personen vor Ort teilzunehmen, sei es mit anderen Angehörigen oder auch professionellen Kräften. ...
... Damit werden sie am Entscheidungsprozess aktiv beteiligt und fühlen sich nicht ausgeschlossen oder isoliert. Gleichzeitig wird die Teamarbeit erleichtert und Absprachen können verbindlich und schnell getroffen werden (Bischofberger et al., 2015;Cagle, 2008;Demiris et al., 2008;Mazanec, 2012). ...
Article
The potential of technological assistance to support distance caregiving - literature review and empirical results Abstract.Background: Due to demographic change, increasing labour mobility and changing family patterns, social relationships often exist over long distances. Supporting relatives over a distance is therefore a highly topical issue but still little discussed, also in Germany and Switzerland. Aim: The project "DiCa" (2016 - 2019) with an interdisciplinary research team from Germany (EH Ludwigsburg) and Switzerland (Careum School of Health, Zurich) aims to investigate different dimensions of "Distance Caregiving". This paper deals with the possible use of new technologies to support these care arrangements. Methods: Based on a literature review, qualitative interviews were conducted with "Distance Carers" and partner companies in Germany to investigate the use of new technologies in the context of "Distance Caregiving". Results: There are initial approaches concerning technical solutions in home care and in companies. So far communication options via telephone and smartphone and flexible working time and workplace regulations have played an important role. However, the potential of new technologies does not seem to be fully explored. Conclusions: In order to make the most of the various possibilities of innovative technologies in the context of "Distance Caregiving" for those affected but also for companies, well-researched information and independent advice and counseling are required for all parties involved in the care process.
... The studies were published between November 2002 and December 2020. They were conducted in different world regions: North-America (United-States of America) (22,24,39,40), Asia (Taiwan) (23,27,41,42), Europe (25,26,(43)(44)(45)(46), and Oceania (Australia) (47). Regarding the type of institution in which the video calls intervention was conducted, different types of geriatric care institutions were cited: "nursing home" (22-24, 27, 39, 41, 42, 44, 45, 47), "care home" (25,43,46), "geriatric hospital" (25,26,44) and "assisted living retirement facility" (40). ...
... They were conducted in different world regions: North-America (United-States of America) (22,24,39,40), Asia (Taiwan) (23,27,41,42), Europe (25,26,(43)(44)(45)(46), and Oceania (Australia) (47). Regarding the type of institution in which the video calls intervention was conducted, different types of geriatric care institutions were cited: "nursing home" (22-24, 27, 39, 41, 42, 44, 45, 47), "care home" (25,43,46), "geriatric hospital" (25,26,44) and "assisted living retirement facility" (40). Most video calls interventions used as a support a "touch-screen tablet" (n = 5) followed by a "videophone" (n = 4), with the remainder using either a "laptop" (n = 2), a "smartphone" (n = 1), a "tabletop" (n =1), or a "TV" (n = 2). ...
... In all the studies included (100%, n = 15), the target population for the interventions using video calls was "OAs living in elderly care facilities." These institutions were: nursing homes (22-24, 27, 39, 41, 42, 44, 45, 47), care homes (25,43,46), geriatric hospitals (25,26,44), and assisted living retirement facilities (40). Target populations in the studies were either healthy OAs, suffering from mild cognitive impairment (MCI) (22-25, 27, 39-43, 46, 47), or a major cognitive impairment, including dementia (26,(44)(45)(46). ...
Article
Full-text available
Social isolation in geriatric institutions is a real threat to older adults' (OAs) well-being. Visits from family members, when they are not impacted by geographical distance or illness, sometimes fail to provide sufficient opportunities for social connectedness and interaction to prevent and/or combat OAs' loneliness and social isolation. Information and Communication Technologies (ICTs) offer promising solutions to this problem. Video calls provide a quick and convenient way for remote communication between OAs and their families, and a complement to face-to-face visits in geriatric settings. Over the last months, during the several confinements imposed to stop the transmission of COVID-19 over the world, several care homes and long-care facilities have equipped themselves with laptops, tablets and video call applications to help OAs remain in contact with their relatives. However, numerous technical and human-related factors may hinder the use of video calls in these settings. The complexity of technological devices, as well as OAs limited digital skills, low confidence and experience in the use of technology are some examples. Furthermore, the specific context of use and the required implication of multiple actors (care professionals, family members) should also be considered when examining the use and implementation of video calls in geriatric institutions. We conducted a narrative review of literature describing the use of video calls in geriatric institutions between 2000 and 2021, especially because of the little information related to OAs' use of video calls in geriatric settings. One thousand one hundred ninety-seven references were screened and 15 studies focusing on the usability, acceptability and effectiveness of video calls were included. A qualitative, deductive thematic analysis inspired by a Health Technology Assessment (HTA) multidimensional model was used to identify barriers, enablers and solutions to video calls implementation in geriatric institutions. The results from the HTA-based analysis provide encouraging evidence for the feasibility of video call use in geriatric settings, and its efficacy on reducing social isolation among residents. However, numerous technical, human-related, ethical and organizational barriers persist and should be addressed in future works. The present analysis has also allowed the identification of potential solutions to overcome these barriers, which are discussed in this publication.
... Prior to COVID-19, ICT use was primarily initiated by LTC facility residents to communicate with friends, family, and supports. Residents have also used ICTs for entertainment (e.g., watching movies), stimulation (e.g., puzzles), and information (e.g., news; Baker et al., 2018;Blaschke et al., 2009;Boeder et al., 2020;Chen & Schulz, 2016;Demiris et al., 2008). Several studies found that ICTs reduce social isolation and loneliness and increase stimulation and social connectedness in LTC facilities (Baker et al., 2018;Chen & Schulz, 2016;Edelman et al., 2020;Ibarra et al., 2020;Kluck et al., 2021). ...
... This pilot study is consistent with previous research that ICT can work for a variety of clients (Ho, 2018;Jones, 2019;Kim, 2021;Masina et al., 2020;O'Brien et al., 2020;Pradhan et al., 2018), while also benefitting caseworkers, facilities, and clients' families. Although, we were unable to measure these constructs directly, these results align with previous research on technology's ability to reduce isolation or loneliness and provide stimulation, engagement, and entertainment for older adults and those with IDDs (Boeder et al., 2020;Demiris et al., 2008). Although we were unable to interview facility staff, such devices have the potential to enhance resident cognitive engagement. ...
Article
Background and Objectives The Centers for Medicare and Medicaid Services (CMS) restricted long term care (LTC) facility visitation to only essential personnel during the COVID-19 pandemic. The Maryland Department of Human Services distributed Amazon Echoshow 8 voice and touchscreen controlled smart speakers (VTCSS) to a sample of their institutionalized guardianship clients to enhance caseworker access during the pandemic. Research Design and Methods This pilot study focused on understanding VTCSS use challenges and the effects on clients’ safety and well-being. Two focus groups were conducted with caseworkers (N=16) who piloted the devices. The interviews were recorded, transcribed, and analyzed using open and axial coding. Results Four themes were identified, including challenges to providing casework during the pandemic (e.g. facility technology gaps), challenges to device installation and use (e.g. privacy concerns), strategies for overcoming challenges (e.g. alert features), and benefits (e.g. stimulation, care monitoring) and uses (e.g. enhanced access, entertainment). Discussion and Implications VTCSS show great promise to engage the client, maintain visual access, and monitor quality of care. However, facilitating access to such technology requires planning and training before installation.
... In intervention studies, researchers or practitioners implement a technology, service, or training programme that is new to the research context and evaluate its impacts on pre-defined aims. Media-related interventions in nursing homes include telepresence robots [43,44], video-calling services [45][46][47][48], hand-held radios [49], augmented newspapers [50], and touchscreen installations [51][52][53]. While outcomes vary, longitudinal studies suggest that the positive influences of interventions on residents' levels of social engagement are often not lasting [54,55]. ...
... Participants of this research would have benefited from more control over when, where, and how they use communication media, and thus from funding for the personal ownership of media technologies and from funding for regular one-on-one support with communication devices. While most research about communication media in care homes has been intervention oriented [43][44][45][46][47][48][49][50][51][52][53], this paper suggests that long-term care service and funding policies will require greater attention to create flexible, diverse, and supportive media environments. The findings presented in this paper reflect the experiences of 12 residents at one site and, while not generalizable, they show that the spatiotemporal contexts surrounding media use can be an important factor for care home residents' social and civic agency. ...
Article
Full-text available
This paper explores the unique relationships care home residents have with communication media. Drawing on findings from an ethnographic case study at a long-term care site in British Columbia, Canada, I describe how care home residents’ everyday media practices are intertwined with their negotiations of longstanding attachments and new living spaces. The research draws connections between the spatiotemporal contexts of media use and residents’ experiences of social agency. Long-term care residents in this research were challenged to engage with the wider community, maintain friendships, or stay current with events and politics because their preferred ways of using communication media were not possible in long-term care. The communication inequalities experienced by care home residents were not simply about their lack of access to media or content but about their inability to find continuity with their established media habits in terms of time and place. While most research about communication media in care homes has been intervention oriented, this research suggests that long-term care service and funding policies require greater attention to create flexible, diverse, and supportive media environments.
... Research on video conference tools and how these are being appropriated by older adults are another area scarcely tackled in the research literature and are mainly located in residential care contexts. Studies show that the opportunity to stay in contact with family members via videoconference tools may provide benefits in reducing loneliness and social isolation and increasing enjoyment and closeness [11,45]. At the same time, a number of challenges are being discussed which emerged with videoconference tool usage, such as technical issues (unstable internet connections), physical limitations (vision and hearing deficits), as well as unfamiliarity with the technology use and related privacy concerns [36]. ...
... This literature builds on supporting older adults' learning in person, by heavily drawing on the physical resources at hand (pointing with hands, looking at the same screen, printouts, non-verbal communication). Literature on video-conferencing tools has shown a potential to benefit older adults [11,36,45]; however this literature also suggests that older adults would require sufficient instructional support in the use of the video-conferencing tools. Our paper addresses this gap, by drawing on the conceptual framework of scaffolding and unpacks what instructional support is necessary for older adults to be enabled to take an active part and contribute to a participatory design online. ...
Article
Full-text available
An extensive literature on participatory design with older adults has, thus far, little to say about the support older adults need when involved in online activities. Our research suggests that to empower older adults in participatory design, scaffolding work has to be done. Scaffolding interactions - creating temporary instructional support to help the learning of participants - is a common approach in participatory design. Yet, when applied in online participatory design with older adults, the traditional understanding of the concept does not match the way older adults' learn. Hence, we argue for a new understanding of this term, which we call situated scaffolding. We illustrate our argument with a case where older adults collaborate online as part of a participatory design project. We unpack the different dimensions of situated scaffolding and discuss how this novel understanding can be used to further inform sustainable participatory design for and with older adults.
... The use of technology to provide services could be effective as non-co-resident caregivers tend to have full-or part-time employment and spend a great deal of time arranging and monitoring the care of their care recipients from their computer or phone (Benefield & Beck, 2007;Edwards, 2014). Video conferencing with community-based practitioners and online support groups have been found to significantly decrease caregiver stress, increase support, and help to assess the condition of care recipients (Demiris et al., 2008;Marziali & Donahue, 2006). In addition, video chatting with care recipients can help non-co-resident caregivers increase the sense of closeness with the care recipient and alleviate stress (Demiris et al., 2008;Sparks et al., 2012). ...
... Video conferencing with community-based practitioners and online support groups have been found to significantly decrease caregiver stress, increase support, and help to assess the condition of care recipients (Demiris et al., 2008;Marziali & Donahue, 2006). In addition, video chatting with care recipients can help non-co-resident caregivers increase the sense of closeness with the care recipient and alleviate stress (Demiris et al., 2008;Sparks et al., 2012). ...
Article
Full-text available
Objectives: The purpose of this study was to examine the prevalence of formal and informal support between non-co-resident and co-resident family caregivers of persons with dementia and to investigate the impact of receiving formal or informal assistance on family caregivers’ residential status and their perceived emotional stress. Method: We used secondary data from the 2018 National Survey of Older American Act conducted by the Administration for Community Living. We selected 751 primary family caregivers of persons with dementia and conducted regression analyses to explore our research questions. Results: Non-co-resident caregivers of persons with dementia were younger, racially and ethnically diverse, employed, and had higher income than co-resident caregivers. They were less likely to utilize formal support, such as caregiver training or education (p = .005) and respite care (p = .019) but more likely to rely on informal support in their social networks (p = .002), compared to co-resident caregivers. Non-co-resident caregivers who had better informal support systems showed less emotional stress than co-resident caregivers (p = .024). Conclusion: Findings from our study suggest the importance of engaging informal networks to alleviate emotional stress of non-co-resident caregivers of persons with dementia. Furthermore, it is critical to help them utilize adequate caregiver training and education as well as respite care before their loved ones experience dramatic functional and health declines.
... • To assess the impact of different models of telephone-based befriending services on older people's health and wellbeing (Cattan et al., 2011). • To explore the role of videophone technology in enhancing the distant care-giving experience of, and communication between, residents of a long-term care facility and their family members (Demiris et al., 2008). • To evaluate an internet-based psychosocial intervention for heart recipients and their carers (Dew et al., 2004). ...
... Whilst there was some anxiety around competence in using the technology, this review concluded that video-communication had a positive impact on older adults' social wellbeing. Within Bennett's review, Demiris et al. (2008) and Schwindenhammer (2013) (2010)) all reported on an intervention where residents were supported by a research assistant to engage in videoconferencing with their family members once a week, for at least 5 minutes, for three months. The qualitative study found that the older adults valued the time that they spent with their family members, increasing their sense of connection. ...
Article
Full-text available
Background : During the 2020 COVID-19 pandemic, millions of older adults are advised to avoid contact with those outside their household. ‘Social distancing’ has highlighted the need to minimise loneliness and isolation through the provision of remotely delivered befriending, social support and low intensity psychosocial interventions. We wanted to know what interventions are effective and how they work to help inform decisions about different approaches. Methods : We followed a systematic ‘review of reviews’ approach and included systematic reviews focussed on the effectiveness or implementation of remote interventions to reduce levels of social isolation or loneliness in adults aged 50+. Searches of 11 databases were undertaken during April 2020 and eligible reviews were critically appraised using AMSTAR2. Narrative synthesis was used at a review and study level to develop a typology of intervention types and their effectiveness. Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) were used at a study level to explore the characteristics of successful interventions. Results : We synthesised evidence from five systematic reviews and 18 primary studies. Remote befriending, social support and low intensity psychosocial interventions took the form of: (i) supported video-communication; (ii) online discussion groups and forums; (iii) telephone befriending; (iv) social networking sites; and (v) multi-tool interventions. The majority of studies utilised the first two approaches, and were generally regarded positively by older adults, although with mixed quantitative evidence around effectiveness. Focussing on processes and mechanisms, using ICA and QCA, we found that the interventions that were most effective in improving social support: (i) enabled participants to speak freely and to form close relationships; (ii) ensured participants have shared experiences/characteristics; (iii) included some form of pastoral guidance. Conclusions : The findings highlight a set of intervention processes that should be incorporated into interventions, although they do not lead us to recommend particular modes of remote support.
... En pilot-og intervensjonsstudie fra USA viste at VK medførte at beboerne opprettholdt kontakten bedre med naere pårørende som bodde langt unna (Siniscarco, Love-Williams & Burnett-Wolle, 2017). En annen kvalitativ studie fra USA viste at beboerne følte seg mindre ensomme og isolert etter at de hadde fått sett sine naere pårørende gjennom VK (Demiris, Oliver, Hensel, Dickey, Rantz & Skubic, 2008). I en aksjonsforskningsstudie fra England kom det fram at personer som bor i omsorgsbolig, kan ha glede av å vaere i dialog med sine naermeste gjennom VK, men at det er barrierer for å få det til, som familienes villighet til å delta, høg turn over og manglende teknologisk kompetanse hos personalet (Zamir, Hennessy & Taylor, 2018). ...
... Denne pilotundersøkelsen viser at VK kan vaere nyttig for å øke muligheten til kontakt mellom de som bor på sykehjem og deres pårørende. Pårørende og ansatte beskrev hvor meningsfulle og viktige møtene gjennom VK var for å opprettholde kontakten og oppleve fellesskap med sine naermeste, noe også tidligere studier har vist (Tsai & Tsai, 2010;Demiris et al., 2008;Siniscarco et al., 2017). Når hukommelse og evnen til å oppfatte ord svekkes, gir bilde og video stor hjelp til forståelse ( Van der Ploeg, Eppingstall & O'Connor, 2016). ...
... De igual forma, fueron útiles las conversaciones ya que involucraron información objetiva como la descripción de síntomas o lesiones. Con este estudio se comprobó que es factible el uso de dicha tecnología para incluir a cuidadores distantes en el proceso de toma de decisiones y facilitar el trabajo en equipo con los profesionales de la salud de estos centros (48). ...
Article
Full-text available
Introducción. Se ha explorado poco sobre el rol del cuidador a distancia o cuidador secundario de las personas con enfermedad crónica, por ello se hace necesario conocer el avance de la evidencia científica sobre este tipo de cuidadores, con el fin de determinar los aportes y los vacíos presentes en la literatura. Metodología. Revisión descriptiva tipo scoping review, en la que se realizó una búsqueda en las siguientes bases de datos: de Embase, Science direct, Pubmed, Medline, Academic search complete y Scopus, limitando el tiempo entre 2005 – 2020. Se utilizaron los términos: DeCS y MeSH de Long distance caregiver, distance caregiver, secondary caregiver y chronic disease. Además, se seleccionaron 20 artículos originales, una vez realizado el proceso de crítica con CASPe. Resultados. Emergieron 4 núcleos temáticos: experiencias y percepciones del cuidador a distancia, características del rol del cuidador a distancia, soporte social del cuidador a distancia por medio de Tecnologías de la información y la comunicación TICs y estrategias de afrontamiento del cuidador a distancia. Conclusión: es un fenómeno poco explorado, por lo que son amplios los vacíos que existen, empezando por su autoreconocimiento en el desempeño de su rol hasta las intervenciones específicas que lo favorezcan.
Article
Background : During the COVID-19 pandemic ‘social distancing’ has highlighted the need to minimise loneliness and isolation among older adults (aged 50+). We wanted to know what remotely delivered befriending, social support and low intensity psychosocial interventions may help to alleviate social isolation and loneliness and how they work. Methods : We followed a systematic ‘review of reviews’ approach. Searches of 11 databases from the fields of health, social care, psychology and social science were undertaken during April 2020. Reviews meeting our PICOS criteria were included if they focussed on the evaluation of remote interventions to reduce levels of social isolation or loneliness in adults aged 50+ and were critically appraised using AMSTAR2. Narrative synthesis was used at a review and study level to develop a typology of intervention types and their effectiveness. Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) were used at a study level to explore the characteristics of successful interventions. Results : We synthesised evidence from five systematic reviews and 18 primary studies. Remote befriending, social support and low intensity psychosocial interventions took the form of: (i) supported video-communication; (ii) online discussion groups and forums; (iii) telephone befriending; (iv) social networking sites; and (v) multi-tool interventions. The majority of studies utilised the first two approaches, and were generally regarded positively by older adults, although with mixed evidence around effectiveness. Focussing on processes and mechanisms, using ICA and QCA, we found that the interventions that were most successful in improving social support: (i) enabled participants to speak freely and to form close relationships; (ii) ensured participants have shared experiences/characteristics; (iii) included some form of pastoral guidance. Conclusions : The findings highlight a set of intervention processes that should be incorporated into interventions, although they do not lead us to recommend specific modes of support, due to the heterogeneity of interventions.
Article
Full-text available
A widely held stereotype associates old age with social isolation and loneliness. However, only 5% to 15% percent of older adults report frequent loneliness. In this study, we report a meta-analysis of the correlates of loneliness in late adulthood. A U-shaped association between age and loneliness is identified. Quality of social network is correlated more strongly with loneliness, compared to quantity; contacts with friends and neighbors show stronger associations with loneliness, compared to contacts with family members. Being a woman, having low socioeconomic status and low competence, and living in nursing homes were also associated with higher loneliness. Age differences in the association of social contacts and competence with loneliness are investigated as well.
Article
DESPITE LONG-STANDING INTEREST in the family as the focal point of nursing care, there are few published reports of clinical interventions with families after they institutionalize an elderly relative. Family members experience loss, guilt, and grief, and report that these emotions continue throughout the time that their older member is in the nursing home. This paper presents the rationale for using a supportive, educational group approach with families of nursing home residents and describes a family group intervention, detailing the role of the geriatic mental health nurse specialist, group goals, and the focus of each session. Evaluations by families and staff are presented, and recommendations for practice are made.
Article
In order to determine whether videophones are appropriate communication tools for psychometric assessments, we need to determine whether the quality of videophones is adequate to enable this type of assessment or whether it places a burden on the communication. The purpose of this study is to measure the subjective quality of video and audio features of commercially available videophones in the context of a psychometric assessment session. We recruited 52 subjects who used the videophone to participate in a psychometric assessment using the Perceived Stress Scale. After each session, participants filled out the ITU-T P.920 that assesses the context-specific quality of the video-call. Findings indicate that the overall audio and image quality of the video-call was satisfactory and participants perceived the videophones as useful in the context of psychometric assessment. These findings strengthen the call for use of video mediated communication in home and hospice settings and disease management.
Article
Nurses in community settings are frequently exposed to elderly persons who receive a significant amount of physical and/or psychosocial support from one or more informal caregivers. Although numerous investigations exist examining stress and coping in persons who provide such care for elderly persons, little is known about the caregiver's status once full-time caregiving ceases. This study describes emotional and physical components of caregiving stress in a convenience sample of 124 caregivers. Of these, 31 had placed their charge in a nursing home, while 93 had not. A multivariate analysis of variance (MANOVA) between placed-nonplaced groups revealed no significant differences in the total score or Role and Personal Strain subscales of the Burden Interview (J. Zarit & S. Zarit, 1983). Implications for community health nursing practice involve providing ongoing counseling and support of the caregiver and his or her charge, preparing both for the placement experience should it be indicated, and continued follow-up care post-placement. Greater collaboration between community-based and institutionally based nurses can facilitate implementation of these strategies.
Article
This qualitative study was conducted to examine the decision-making process and its immediate consequences for family members who placed an elderly loved one in a long-term care facility. To explore issues related to the placement process, in-depth interviews were conducted with 7 individuals who had recently (6 weeks or less) placed an older relative. Content analyses of the interviews were conducted, and several common themes related to the decision-making process and outcomes emerged. Most of the subjects had provided personal care for their elderly relative, so placing their loved one in a nursing home often conflicted with their view of themselves as an ideal caregiver. During the process of making the decision, although family members were given advice and suggestions by health care professionals, this input was viewed as inadequate or even detrimental. Ultimately, subjects described making the decision to place an elderly relative in a long-term care facility as a singular process involving "I" rather than "we." The positive and negative role of friends emerged as an important influence during and after the placement process. The informal validation of the decision to place by peers was the one interaction that family members identified as helpful during this process.
Article
A large body of research reveals the contribution of families to the care of elderly and health-impaired community-dwelling individuals. Less is known about the contribution of families to the provision of care following the admission of elderly relatives to a long-term care institution. Still less is known of the experience of elderly wives following the institutionalization of their husbands. The purpose of this paper is to increase nurses' awareness, through a review of the literature on family caregiving in later life, of the contribution to care made by elderly wives following the institutionalization of their husbands. We also hope to provide direction for clinicians with respect to the needs and concerns of wives, particularly at the time of, and following, the admission of their husbands to long-term care institutions.
Article
Despite long-standing interest in the family as the focal point of nursing care, there are few published reports of clinical interventions with families after they institutionalize an elderly relative. Family members experience loss, guilt, and grief, and report that these emotions continue throughout the time that their older member is in the nursing home. This paper presents the rationale for using a supportive, educational group approach with families of nursing home residents and describes a family group intervention, detailing the role of the geriatric mental health nurse specialist, group goals, and the focus of each session. Evaluations by families and staff are presented, and recommendations for practice are made.
Article
Although there is substantial literature available on a variety of aspects of nursing home placement, relatively little is known about the experiences of family members confronted with this challenge. This study involved in-depth interviews with nine adult family members within 2 weeks of the relocation of the older adult relative. Factors related to recognition of the need for placement, selection of a facility, managing the relocation, and effects of placement on the family decision-makers were explored. Results have significant implications for nursing practice related to the lack of advanced planning, needs for time and information, and supportive interventions.
Article
This paper explores families' experience of searching for new possibilities to continue caring which emerged as a significant aspect of a larger hermeneutic phenomenological study of family caring in nursing homes. Hermeneutic analysis of in-depth interview transcripts and observation field notes of 14 family carers' experiences of caring uncovered eight shared meanings: feeling duty-bound; setting up possibilities for human connection; possessing special knowledge and skills; providing the personal approach; acting as an advocate; living with hope of improvement and recovery; feeling satisfied when care experienced was deemed to be quality care; and possessing a sense of worth through making a useful and positive contribution. Being engaged in new caring activities and relationships in the nursing home context assisted family members in coping with the changes in their situation. This paper highlights how finding new ways of caring for their relatives was important as everyday involvement in care set up possibilities through which meaning could be attributed to their existence.