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Supporting and facilitating the adjustment of seniors and their caregivers in the transition to a care facility - Interview with a social worker

For 15 years, Nathalie Renaud - social worker - has been ensuring that seniors and their loved ones experience the transition to a care facility as peacefully as possible. She works to build trust, to demystify the fears and apprehensions often associated with placing a senior in a care facility.


What is your role as a social worker in long-term care?

Shortly after a new person is admitted to a care facility, I hold a welcome meeting with this person (if able to participate) and their loved ones. The goal is to provide information on the new living environment, services and care provided, as well as the resource people in the facility to make integration easier. I also use a questionnaire that we call “life story.” It’s a tool that helps me get to know the person living in the facility and their habits. The goal is to understand the person better, so that I can customize my approach based on their life journey. My role is a facilitator between this person, their loved ones and their new living environment. It is important to me that caregivers also feel that they are part of the process. I include them in all my discussions and my exchanges. If the caregiver adjusts well to the situation, this could have a positive influence on the person receiving care and vice-versa.
I also make sure to quickly identify any difficulties inherent to placing a loved one in care. Caregivers often have difficulty accepting the cognitive losses or fragility of their loved one. They also feel guilty and tell themselves that it is their fault if their loved one needs to be placed in a care facility. The care receiver may also feel that it is unfair and angry about this change. For caregivers and residents, time must be taken to explain this stage, to reassure them as much as possible and to inform them. Integration into the new environment can take several months, but it is indispensable for everyone to feel confident.

Once an application for care is approved, how long does the senior have to make their decision? To move?

The time is very short, we’re looking at about 24 hours. However, the time between applying for and obtaining a place can take anywhere from 6 to 12 months or even longer in some areas. So, that time can be used to organize the move and ensure that the decision is still acceptable to the caregiver and care receiver.

During the transition to a care facility, what hesitations or fears do you see with caregivers and with seniors? How do you reassure them?

For caregivers, the main fear is their loved one’s adjustment: they are afraid that they will be bored, that they will not get used to their new environment. I continue to reassure and inform them, to take the time to explain to them all the items implemented by all the services (recreation, care, etc.) to improve the well-being of their loved one on a daily basis.
The hesitations focus mostly on the level of care provided: caregivers want to be certain that the care will be provided with kindness. In this type of situation, the interdisciplinary staff of the facility and I work together with the caregiver in finding solutions, especially by encouraging them to participate in the decision making. In some cases, the caregiver can also participate in certain care if they so desire and the condition of their loved one and the care allow.

How can caregivers help with adjustment to the care facility? How do you integrate them into your processes?

The staff and I give caregivers the possibility to actively participate in decision making, by discussing their ideas or suggestions, by keeping the discussion open on the way care is provided... That said, it is important to respect their limits: caregivers are often tired and don’t realize it. So, I help them set their limits, I reassure them about how their loved one will be cared for. We work to establish a climate of trust to allow caregivers to take time for themselves, which they too often forget to do. This will have a positive impact on their interaction with their loved one and will help them accept the care of their loved one better.

Are there action or support plans to help caregivers have a better experience placing their loved one into care?

There is in fact customized support, to provide short- or medium-term follow-up to the caregiver. The transition into a care facility can, in some situations, bring up other, unresolved issues. Depending on the difficulties identified, I can refer caregivers to appropriate resources in the community, which will continue to support them, by talking with them and informing them.

Who can obtain your services? How can we meet with you?

Anyone can use my services, there is no established order of priority. Sometimes caregivers contact me directly, and sometimes it is their CLSC worker who refers them to me. They have a lot of questions about the different types of care facilities that exist, they want to know whether they can tour them, to find out which one is the most appropriate for their loved one. I try to be as available as possible to give them all the help they need to understand this stage and to make it easier for them and their loved one.

Introduction
Nathalie Renaud has been a social worker since 2003 in various settings within the health network, essentially with elderly clients and adults with loss of autonomy. Since 2013, I have been at the CHSLD de la Côte Boisé and one of my primary roles is to guide new residents and their loved ones as part of the orientation and adjustment/integration process.