Prior to admission to a care home the nurse’s role is key in the assessment of the person's needs, support for the family and subsequent care planning.
The role of the nurse is to support the person and their family to communicate their wishes and concerns. The nurse will have knowledge of, and be able to signpost to, additional services and will act as liaison and advocate on their behalf when necessary. Prior to admission the nurse will complete a holistic assessment, complete required documentation and identify nursing needs.
The decision to become a resident in a care home is never made lightly and the journey and emotions as a person makes that transition are individual and complex. Certainly we can all agree it is a major change in anyone’s life, sometime tinged with sadness or fear, sometimes with relief and hope. The issue of choice is very powerful; if someone has chosen to join a care home their views may be very different than someone who has moved by necessity or in their best interests. The RCN has developed some principles for nurses to use to promote a smooth transition for home to care home and NICE has some guidance which is useful if a resident is admitted from hospital.
John - moving into Red Cedars
John understands that despite the increasing care he is having at home his memory loss is impacting on his quality of life and safety. John's respiratory specialist nurse recently examined him and has explained he will now need oxygen therapy. The community nurse Melanie meets with Sue at one of her regular visits to the home to talk through John's nursing needs.
The registered nurse has a lead role in supporting this event and can make the difference between a smooth transition or a move which is distressing. Where possible joining a care home should be carefully planned. Ideally a new resident would have seen the home and perhaps had opportunity to stay overnight, visit for lunch or take part in the activities in order to become familiar with their new home. Many of us experience concerns when moving home and we frequently have time to prepare for the change. It is possible to imagine how the combination of ill health, sensory loss and cognitive impairment will make such moves more unnerving and the nurse's skill in supporting someone through a change is essential. Nurses draw on professional education and demonstrate high level interpersonal skills. They have the ability to adapt and modify their interactions whilst interpreting the physical and psychological needs of the person they are working alongside.
John and Graham - addressing concerns
John is an 86 year old man, a retired mechanic who loves the physical act of fixing things, improving machines, fiddling with clocks and household objects to make them run more smoothly. John is living with chronic respiratory disease and dementia and this has restricted his life outside his home. His memory difficulties mean he sometimes forgets to switch things off or eat properly. John also has an arterial leg ulcer and frequently experiences tremendous pain - recently he has not been able to take analgesia safely.
His neighbours have become aware of his difficulties as he has stopped taking his dog Graham out for walks and now they can see Graham has destroyed John's garden. John is a realistic man and understands that despite the increasing care he is having at home his memory loss is impacting on his quality of life and safety. John's respiratory specialist nurse recently examined him and has explained he will now need oxygen. Following a discussion with a social worker, the district nurse, who has worked with John for a number of years, has asked John if they might all meet together to discuss the options available. Whilst John is sad about leaving his home his overwhelming concern is what will happen to Graham. Fortunately Dave, John's neighbour, is prepared to look after Graham.
Sue Melanie and Dave - making arrangements
When supporting the family/friends of someone moving to a care home it is the nurse’s role to ensure their involvement in care planning, provide information or guidance regarding the process of selecting a care home, and that information is shared regarding access to support agencies and financial assistance/options.
Concerns from family members
For many family members and friends a new resident joining your care home will be the culmination of a long and sometimes difficult journey. Despite the good care and companionship offered in our care homes most residents would rather remain in their own home. This major life transition brings with it a wide range of emotions and this will influence people’s behaviour. Naturally there will be concerns when joining a new environment and as this is often coupled with ill health and cognitive impairment the initial period requires great skill and empathy to set the tone for the new life ahead.
The nurse has a lead role in articulating how important this transition period is and in pacing and planning any assessments or interventions to allow the person to acclimatise to the new environment. You home will have tried and tested methods of accomplishing this and their skills and experience should be used.
Moving to a care home - the experience of family caregivers.pdf (262kb)
Come on in - staying connected (Care Inspectorate)
Moving between hospital and home, including care homes (NICE)
When supporting nursing colleagues the nurse’s role is to provide leadership, support, education, audit and practice development.The RCN supports the professional leadership function with a suite of leadership programmes.
It is increasingly likely that nursing colleagues may be caring for a family member themselves and the senior nurse will have a role in providing access to support in the workplace.
Sue is one of the senior nurses in the team, she is grandmother to Veronica who has recently started school. Sue’s daughter, who is also a nurse, has found it hard to collect Veronica from school in time on the three days a week she goes to work, as her shifts are so busy. This has become particularly difficult since her daughter’s partner has been working away in Hong Kong.
Sue knows her employers have been very flexible with other staff’s hours at the home and she would like to be able to help her daughter on at least one day a week. Sue is keen to understand her rights and responsibilities in relation to a caring role and flexible working so she can negotiate a workable solution with her employer. Sue contacts the RCN for advice by ringing RCN Direct.
Below you will find some further links to resources which are helpful in supporting the transition to a care home.