Abstract
BackgroundFamilies do not fully disengage from care responsibilities following relatives’ admissions to residential long-term (RLTC) care settings such as nursing homes. Caregiver stress, depression, or other key outcomes remain stable or sometimes increase following a relative’s RLTC entry. Some interventions have attempted to increase family involvement after institutionalization, but few rigorous studies have demonstrated whether these interventions are effective in helping families navigate the potential emotional and psychological upheaval presented by relatives’ transitions to RLTC environments. The Residential Care Transition Module (RCTM) provides six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative to a RLTC setting.MethodsIn this embedded mixed methods randomized controlled evaluation, family members who have admitted a cognitively impaired relative to a RLTC setting are randomly assigned to the RCTM (n = 120) or a usual care control condition (n = 120). Primary outcomes include reductions in family members’ primary subjective stress and negative mental health outcomes; secondary role strains; and residential care stress. The mixed methods design will allow for an analysis of intervention action mechanisms by “embedding” qualitative components (up to 30 semi-structured interviews) at the conclusion of the 12-month evaluation.DiscussionThis evaluation will fill an important clinical and research gap by evaluating a psychosocial intervention designed for families following RLTC admission that determines whether and how the RCTM can help families better navigate the emotional and psychological challenges of residential care transitions.Trial registrationClinicalTrials.gov (NCT02915939, prospectively registered).
Highlights
Families do not fully disengage from care responsibilities following relatives’ admissions to residential long-term (RLTC) care settings such as nursing homes
These findings suggest that reducing emotional distress and negative mental health outcomes and enhancing families’ overall perceptions of and relationships with staff can have positive effects on residents’ outcomes
Open-ended data from the Residential Care Transition Module (RCTM) review checklists as well as the semi-structured interviews completed after RCTM intervention delivery will yield in-depth information on aspects of the RCTM intervention deemed helpful by participants; how counseling recommendations were utilized when interacting with the care recipient living in residential long-term care (RLTC), staff, or other family members; and why dementia caregivers felt the RCTM helped them to experience reduced distress and improved well-being
Summary
Determine whether caregivers who receive the RCTM indicate statistically significant decreases in secondary role strains (perceived adjustment of the relative and the caregiver to RLTC placement) over a 12-month period when compared to caregivers in the usual care control group; Specific Aim 3. The initial recruitment strategy included reaching out to members of LeadingAge (a national advocacy organization for longterm care providers with chapters in each U.S state) to describe the study, share materials, and encourage staff to distribute recruitment materials (flyers, information sheets, documentation of permission to contact forms) to potentially interested family caregivers. To partially adjust for the social engagement provided to the RCTM treatment condition, the TCs complete contact calls with each participant following completion of four, eight, and 12-month surveys. Tele-health: Telephone or secure web conference calls are placed to location of primary caregiver’s preference (often their home; cell phone use is common, so location is frequently varied)
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