Transition in care: family carers¢ experience of nursing home placement Ursula M. Kellett RN PhD Lecturer, Queensland University of Technology, School of Nursing, Victoria Park Road, Kelvin Grove, Brisbane, Q 4059, Australia E-mail: u.kellett@qut.edu.au Accepted for publication 29 July 1998 KELLETT KELLETT U.M. (1999) M. (1999) Journal of Advanced Nursing 29(6), 1474±1481 Transition in care: family carers' experience of nursing home placement This paper explores families' experience of nursing home placement, which emerged as a signi®cant aspect of a larger hermeneutic phenomenological study of family caring in nursing homes. Hermeneutic analysis of 14 family carers' stories of nursing home placement uncovered ®ve shared meanings: experi- encing a loss of control; being disempowered; feeling guilt, sadness and relief simultaneously; possessing a sense of failure; and having to make a forced and negative choice. Discussion of the ®ndings focuses upon the importance of family carer support during the transition period from home care to nursing home care and the subsequent bene®ts realized as a result of having received such support. Particular emphasis is placed upon how such support assists family carers to begin the process of reconstructing a valued and positive identity through which new possibilities for meaningful caring within a nursing home context can be realized. Keywords: family caregiving, family nursing, hermeneutic phenomenology, long-term care for the aged, nurse-family relations, nursing home, partnership, placement, transition INTRODUCTION Family caring has traditionally been de®ned in practical and functional terms. The parameters of family carers' existence are understood in terms of how they cope with a particular set of caregivng tasks (Kellett 1997a). Carer exhaustion and burn-out are de®ned and measured in terms of the symptoms of excessive output of effort, of being overworked (van Manen 1990). Studies have been concerned primarily with the ways in which family carers provide a home care service. Their goal has been to improve retention and prolong the care of frail aged people in the community (Whitlatch et al. 1991, Zarit & Teri 1991, Pearlman & Crown 1992, Mittelman et al. 1993, Schultz et al. 1993a, b, Collins et al. 1994). There is a tendency in this research culture to focus upon family carers only when they are stressed and not functioning well (Farran 1997). Furthermore, if carer exhaustion and burn-out occurs it is assumed that the time has arrived for family care to be handed over to professional carers as family care can easily be placed in the hands of another (Leder 1984). However, family caregiving does not always stop at the nursing home door (McFall & Miller 1992, Aneshensel et al. 1995). Entry to care does not necessarily mark the end of caregiving for the family member but rather signals the beginning of a different but still potentially stressful involvement (Nolan et al. 1996, Ade-Ridder & Kaplan 1993, McCullough et al. 1993, Ross et al. 1993, Zarit & Whitlatch 1993, Dellasega & Mastrian 1995, High & Rowles 1995). It has been demonstrated that nine out of 10 family carers continue to care for their relatives beyond simply visiting (Kane & Penrod 1995). The family's experience of nursing home placement has rarely been the focus of research studies. Traditionally the focus upon the resident has screened the needs of family carers at this vulnerable time (Ellis 1993, Duncan & Journal of Advanced Nursing, 1999, 29(6), 1474±1481 Issues and innovations in nursing practice 1474 Ó 1999 Blackwell Science Ltd