Decision making in nursing home placement

This manuscript reports the results of an ethnographic study to describe the process rural families used to make nursing home placement decisions. A total of 16 rural family and elder interviews revealed that 3/4 of the decision makers and care givers were women, making decisions for (or with) elder parents or parents-in-law. It was a major life decision, often made in a crisis. Variables of greatest concern were whether the elder could get the care they needed, cleanliness of the nursing home, proximity of the home to the family, and the elder's agreement. Variables of little concern included cost and sources of reimbursement, Family dynamics were described as positive and strong, possibly stronger after placement. Variables affecting the elders' adjustment included whether the stay was permanent or temporary and the extent to which the elder agreed with the decision. Health professionals need to recognize the crisis the family may be in, offer information and referral, be futuristic with families to assist in planning, and address issues directly with the elders.