Relocation to residential care: the psychological implications
A universal aspect of being human is the need to be at home. The home is a place which represents self and forms an integral component of self-identity. Home is associated with independence, privacy, security, affinity to the environment, a place for the expression of functional competence through involvement in activities of daily living and a place of hospitality, therefore, providing a physical and social context for everyday living.
Relocation refers to the change that occurs when people move their primary living space from one environment to another. It involves an adjustment in the person’s wellestablished ways of life and to unaccustomed rules and structures, requiring adaptive efforts to establish new social roles and identities. The psychological implications of the transition can be manifold.
The home serves as a natural repository for treasured objects collected over the course of life and their presence provides a sense of at homeness. Relocation involves a process of downsizing, disinvestment and loss of cherished possessions as they are potentially distributed to family prior to the move due to the new confined space that the older person will now be living in.
Moreover, the act of being separated from home and personal belongings may arouse sentiments of appreciation of the accomplishments and memories lived throughout the years within such environment, consequently arousing greater feelings of loss.
Relocation may be inflicted by family or caregivers on the older persons rather than negotiated with them, or choices are made by the elderly on poor information given to them on the move to the care home. This leads to a greater sense of vulnerability, insecurity and lack of dignity due to a passive involvement in decision-making and limited attention given to their personal wishes of living at home.
Prior to relocation, the elderly may be conscious of their family’s busy lifestyles and feel reluctant to place additional demands on them, so lack of communication by relatives may lead to frustration as older persons confirm their perceptions of being a burden.
Experiencing respite care or a previous visit to the residential care home helps the person obtain an insight of what it would be like to live there before the formal relocation takes place, allowing for a smoother transition and less anxiety. Also, an anticipated, rather than faced with an unforeseen, reality and freedom of choice allows for the necessary planning and processing to take place.
Home is associated with building connections and having access to community services. Relocation may be emotionally tough on older persons as they lose friendships and a familiar environment. Fitting in is a struggle, particularly for persons with dementia who may lack the ability to integrate into the social life of their new residences.
Pursuing new relationships with other residents is challenging but more apparent after settling in, resulting in a sense of relief and belonging. This is a natural process as meaningful relationships need time to develop and until common interests are established.
Relocation is an interpersonal process but also an intra-personal affair; it simultaneously involves introspecting in search of a meaning for the transition to maintain a sense of continuity of self despite the changing realities and multiple losses. The personal journey might involve an internal struggle between the desire to fit in and be accepted by the new residents, and maintain one’s sense of individuality.
Older persons undergo a shift in their perception of self from that of a relatively competent, self-reliant, autonomous person living a rather active, productive and private life in one’s home to an image of self as an old person, living a more structured, protected, dependent and public life in an age-segregated communal setting where disability, sickness and death are inevitable daily realities.
The transition from being an actor to an observer of life in a more confined environment is not easy to digest as nostalgia kicks in, leading one to question the sense of purposefulness in life. For successful relocation, one is encouraged to engage in a life review and self-scrutiny, and to experience a true sense of personhood, meaning feeling at home with oneself and with the community.
Relocation involves a slow and gradual process of adjusting to a new norm. After the initial transitional period, the person needs to engage in a person-place relationship. The psychological adjustment will have a significant impact on the outcome once relocation takes place – failure to adjust will lead to a state of homelessness, while successful adaptation is associated with a sense of relative physical and emotional comfort. Relocation to a new care setting is a continuous process of adjustment and needs to be monitored to address residents’ needs which may change over time.
A welcoming and supportive residential care facility can instil a sense of hominess, offering an opportunity of increased social and cognitive stimulation, a motivation to establish new routines, roles, identities, boost self-confidence and resilience following adaptation. Adjusting successfully to another life challenge, despite one’s physical and cognitive impairments, leads a person to consider himself as a survivor, able to accept different realities while knowing that all will be well.
Furthermore, being surrounded by other frail elderly leads to greater acceptance of one’s own deficits and relief. This familiarity encourages them to converse and brings about a sense of closeness and camaraderie, eventually building a sense of community between residents.
The psychological implications of relocation should not be underestimated as this major life transition can result in adverse outcomes. The effects of relocation, however, depend on how the transition takes place, the person’s personality traits and the person’s present condition or severity of impairment.
When coupled with an emotionally supportive environment and free will, housing transitions are smoother, resulting in positive outcomes, including a greater sense of security and building new friendships.
“The transition from being an actor to an observer of life in a more confined environment is not easy to digest as nostalgia kicks in
Claire Camilleri is a certified public accountant and treasurer of the Maltese Association of Gerontology and Geriatrics.