Family care-giving and decisions about entry to care: a rural perspective

Assumpta Ryan, Hugh McKenna, Oliver Slevin

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Abstract The aim of this qualitative study was to explore rural family carers’ experiences of the nursing home placement of an older relative. The study was undertaken in a large Health and Social Care Trust in Northern Ireland using a grounded theory approach. Although data collection was an ongoing process, most of the data were collected between October 2003 and October 2006. Purposive sampling was used to initiate data collection and thereafter theoretical sampling was employed. Semi structured interviews were conducted with 29 relatives of nursing home residents and the resultant data were recorded, transcribed and analysed using constant comparisons. The software package, QSR NVivo, was used to facilitate data management and retrieval. Older people had deep attachments to their homes and entry to care was a last resort. Rural family carers had close relationships with health and social care practitioners and felt supported in the decision-making process. The choice of home was a foregone conclusion for carers who had a strong sense of familiarity with the nursing homes in their area. This familiarity was influenced by the relatively rural communities in which respondents resided and by an efficient ‘grapevine’, which seemed to thrive in these small communities. This familiarity, in turn, influenced the choice of nursing home, timing of the placement and responses of family carers. The findings indicate that issues such as rurality and familiarity warrant a more detailed exploration in future research on entry to care.
LanguageEnglish
Pages1-18
JournalAgeing and Society
Volume32
Issue number1
DOIs
Publication statusPublished - 2011

Fingerprint

nursing home
Nursing Homes
Caregivers
Delivery of Health Care
Northern Ireland
Information Storage and Retrieval
Rural Population
health
grounded theory
rural community
decision-making process
Decision Making
Software
Interviews
resident
Recognition (Psychology)
Familiarity
Caregiving
Carers
interview

Keywords

  • mily
  • carers
  • rural
  • nursing home
  • older
  • care-giving

Cite this

Ryan, Assumpta ; McKenna, Hugh ; Slevin, Oliver. / Family care-giving and decisions about entry to care: a rural perspective. In: Ageing and Society. 2011 ; Vol. 32, No. 1. pp. 1-18.
@article{2e9efaecf46942f1bdb67e2ad81bdda5,
title = "Family care-giving and decisions about entry to care: a rural perspective",
abstract = "Abstract The aim of this qualitative study was to explore rural family carers’ experiences of the nursing home placement of an older relative. The study was undertaken in a large Health and Social Care Trust in Northern Ireland using a grounded theory approach. Although data collection was an ongoing process, most of the data were collected between October 2003 and October 2006. Purposive sampling was used to initiate data collection and thereafter theoretical sampling was employed. Semi structured interviews were conducted with 29 relatives of nursing home residents and the resultant data were recorded, transcribed and analysed using constant comparisons. The software package, QSR NVivo, was used to facilitate data management and retrieval. Older people had deep attachments to their homes and entry to care was a last resort. Rural family carers had close relationships with health and social care practitioners and felt supported in the decision-making process. The choice of home was a foregone conclusion for carers who had a strong sense of familiarity with the nursing homes in their area. This familiarity was influenced by the relatively rural communities in which respondents resided and by an efficient ‘grapevine’, which seemed to thrive in these small communities. This familiarity, in turn, influenced the choice of nursing home, timing of the placement and responses of family carers. The findings indicate that issues such as rurality and familiarity warrant a more detailed exploration in future research on entry to care.",
keywords = "mily, carers, rural, nursing home, older, care-giving",
author = "Assumpta Ryan and Hugh McKenna and Oliver Slevin",
note = "Reference text: References Andrews, G. J., Holmes, D., Poland, B., Lehoux, P., Miller, K. L., Pringle, D. and McGilton, K. S. 2005. ‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice. International Journal of Older People Nursing, 14, 8b, 109-20. Barbour, R. S. 2001. Checklists for improving rigor in qualitative research: a case of the tail wagging the dog. British Medical Journal, 322, 1115-7. Beshiri, R., Bollman, R., Clemenson, H., Morgan, A. and McDermott, A. 2000. Defining Rural. Unpublished Work, A draft paper prepared for Statistics Canada, Ottawa. Coburn, A. and Bolda, E. J. 1999. The rural elderly and long-term care. In Ricketts, T. C. (ed), Rural Health in the United States. New York: Oxford University Press, 170-89. Cohen, D. and Prusak, L. 2001. In Good Company. How social capital makes organizations work. Harvard Business School Press, Boston, Ma, 214 + xiii. Congdon, J. G. and Magilvy, J. K. 2001. Themes of rural health and ageing from a program of research. Geriatric Nursing, 22, 5, 234-8. Davies, S. 2001. Wanting what’s best for them. Relatives’ experience of nursing home entry: a constructivist inquiry. Unpublished PhD thesis. Faculty of Medicine, School of Nursing and Midwifery, University of Sheffield. Dellasega, C. and Mastrian, K. 1995. The process and consequences of institutionalizing an elder. Western Journal of Nursing Research, 17, 123-40. Efraimsson, E., Hoglund, I. and Sandman, P. 2001. ‘The everlasting trial of strength and patience’: transitions in home care nursing as narrated by patients and family members. Journal of Clinical Nursing, 10, 813-19. Evason, E., Whittington, D. and Knowles, I. 1993. The Cost of Caring. Equal Opportunities Commission for Northern Ireland, Belfast. Evason, E. 1998. Aspects of informal care in Northern Ireland. In Baldwin, S. (ed.) Needs Assessment and Community Care: Clinical Practice and Policy Making. Butterworth Heinemann, Oxford. Glaser, B. and Strauss, A. 1967. The Discovery of Grounded Theory. Aldine, Chicago. Glaser, B. 1998. Doing Grounded Theory: Issues and Discussions. Sociology Press, Mill Valley, CA. Glover, J. J. 2001. Rural bioethical issues of the elderly: How do they doffer from urban ones. The Journal of Rural Health, 17, 4, 332-5. Gold, R., Kennedy B., Connell, F. and Kawachi I. 2002. Teen births, income inequality and social capital: developing an understanding of the causal pathway. Health and Place, 8, 2, 77-83. Halpern, D. 2008. Social Capital. Polity Press, Cambridge. Heenan, D. 2000. Expectations and attitudes affecting patterns of informal care in farming families in Northern Ireland. Ageing and Society, 20, 203-16. Gurney, C. and Means, R. 1993. The meaning of home in later life. In Arber, S. and Evandrou, M. (eds.) Ageing, Independence and the Life Course. Jessica Kingsley, London. Kawachi, I., Subramanian S. V. and Kim, D. 2008. Social Capital and Health. Springer, New York. Kearns, R. A. 1993. Place and health: towards a reformed medical geography. The Professional Geographer, 46, 67-72. Keefe, J. and Fancey, P. 2000. The care continues: responsibility for elderly relatives before and after admission to a long-term care facility. Family Relations, 49, 3, 235-44. Kellett, U. M. 1999. Transition in care: family carers’ experience of nursing home placement. Journal of Advanced Nursing, 29, 6, 1474-81. Lowe, P. and Speakman, L. 2006. The Ageing Countryside. The Growing Older population of Rural England. Age Concern, London. McCann, S., Ryan, A. A. and McKenna, H. P. 2005. The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation. Health and Social care in the Community, 13, 5, 462-9. McGibbon, M. 1995. The Dromore Carers Survey. Age Concern Northern Ireland, Belfast. Munhall, P. L. and Boyd, C. O. 1993. Nursing Research: A Qualitative Perspective (2nd Edn.). National League for Nursing Press, New York. Nay, R. 1995. Nursing home residents’ perceptions of relocation. Journal of Clinical Nursing, 4, 5, 319-25. Nolan, M. and Dellasega, C. 2000. ‘I really feel I’ve let him down’: supporting family carers during long-term care placement for elders. Journal of Advanced Nursing, 31, 4, 759-67. Organisation of Economic Co-operation and Development 1994. Creating Rural Indicators for Shaping Territorial Policies. OECD, Paris. Office for National Statistics 2004. Rural and Urban area Classification 2004: An Introductory Guide. The Countryside Agency, Department for Environment, Food and Rural Affairs. Welsh Assembly Government: Office of the Deputy Prime Minister. Penrod, J. D. 2001. Functional disability at nursing home admission: a comparison of urban and rural admission cohorts. Journal of Rural Health, 17, 3, 229-38. Poland, B., Lehoux, P., Holmes, D. and Andrews, G. 2005. How place matters: unpacking technology and power in health and social care. Health and Social Care in the Community, 13, 2, 170-80. Putnam, R. D. 2000. Bowing Alone. The collapse and revival of American Community. Simon and Schuster, New York. Reed, J. and Payton, V. R. 1996. Constructing familiarity and managing the self: ways of adapting to life in nursing and residential homes for older people. Ageing and Society, 16, 543-60. Reed, J., Payton, V. R. and Bond, S. 1998. The importance of place for older people moving into care homes. Social Science and Medicine, 46, 7, 859-67. Reed, J., Cook, G., Sullivan, A. and Burridge, C. 2003. Making a move: care-home residents’ experience of relocation. Ageing and Society, 23, 225-41. Richards, L. 1999. Using NVivo in Qualitative Research. Sage Publications, London. Roberts, L. W., Battaglia, J., Smithpeter, M. and Epstein, R. S. 1999. An office on main street: health acre dilemmas in small communities. Hastings Centre Report, 28-37. Rosenthal, K. 2005. Rural Nursing: Flowing Like a River. In Lee, H. and Winters, C. (eds.) Conceptual Basis for Rural Nursing. Springer Publishing Company, New York. Rowles, G. D. 1981. The surveillance zone as meaningful space for the aged. Gerontologist, 21, 3, 304-311. Rowles, G. D. and High, D. M. 1996. Individualizing care: family roles in nursing home decision making. Journal of Gerontological Nursing, 22, 3, 20-5. Ryan, A. A. and Scullion, H. 2000. Nursing home placement: an exploration of the experiences of family carers. Journal of Advanced Nursing, 32, 5, 1187-95. Schutz, S. E. 1994. Exploring the benefits of a subjective approach in qualitative nursing research. Journal of Advanced Nursing, 20, 412-7. Shucksmith, M. 1999. Rural Housing. In Shucksmith, M. and Murphy, C. (Eds.) Rural Audits: A Health Check on Rural Britain, 21-25. Commissioned by The Rural Group of Labour MPS, Arkleton Centre for Rural Development Research, Aberdeen. Stoller, E. P. and Lee, G. R. 1994. Informal care of rural elders. In Coward, R. T., Bull, C. N., Kukulka, G. and Galliher, J. M. (eds.) Health Services for Rural Elders. Springer, New York, 33-64. Strauss, A. and Corbin, J. 1990. Basics of Qualitative Research (1st Edn.). Thousand Oaks, Sage, CA. Strauss, A. and Corbin, J. 1998. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (2nd Ed.). Thousand Oaks, London. Wahl, H. 2001. Environmental influences on aging and behaviour. In Birren, J. E. and Schaie, K. W. (eds.) Handbook of the Psychology of Ageing (5th Edn). Academic, New York, 215-32.. Weinert, C. and Burman, M. 1994. Rural health and health seeking behaviors. Annual Review of Nursing Research, 12, 65-92. Wenger, G. C. 1990. The special role of friends and neighbors. Journal of Ageing Studies, 4, 2, 149-169 Wenger, C. G. 2001. Myths and realities of ageing in rural Britain. Ageing and Society, 21, 117-30. Wenger, G. C. 1999. Choosing and paying for care. Health and Social Care in the Community, 7, 3, 187-97. Wenger, C. G. 2001. Myths and realities of ageing in rural Britain. Ageing and Society, 21, 117-30. Wiles, J. 2005. Conceptualizing place in the care of older people: the contribution of geographical gerontology. International Journal of Older People Nursing, 14, 8b, 100-08. Williams, A. M. and Cutchin, M. P. 2002. The rural context of health care provision. Journal of Interprofessional Care, 16, 2, 107-15.",
year = "2011",
doi = "10.1017/S0144686X11000055",
language = "English",
volume = "32",
pages = "1--18",
journal = "Ageing and Society",
issn = "0144-686X",
publisher = "Cambridge University Press",
number = "1",

}

Family care-giving and decisions about entry to care: a rural perspective. / Ryan, Assumpta; McKenna, Hugh; Slevin, Oliver.

In: Ageing and Society, Vol. 32, No. 1, 2011, p. 1-18.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Family care-giving and decisions about entry to care: a rural perspective

AU - Ryan, Assumpta

AU - McKenna, Hugh

AU - Slevin, Oliver

N1 - Reference text: References Andrews, G. J., Holmes, D., Poland, B., Lehoux, P., Miller, K. L., Pringle, D. and McGilton, K. S. 2005. ‘Airplanes are flying nursing homes’: geographies in the concepts and locales of gerontological nursing practice. International Journal of Older People Nursing, 14, 8b, 109-20. Barbour, R. S. 2001. Checklists for improving rigor in qualitative research: a case of the tail wagging the dog. British Medical Journal, 322, 1115-7. Beshiri, R., Bollman, R., Clemenson, H., Morgan, A. and McDermott, A. 2000. Defining Rural. Unpublished Work, A draft paper prepared for Statistics Canada, Ottawa. Coburn, A. and Bolda, E. J. 1999. The rural elderly and long-term care. In Ricketts, T. C. (ed), Rural Health in the United States. New York: Oxford University Press, 170-89. Cohen, D. and Prusak, L. 2001. In Good Company. How social capital makes organizations work. Harvard Business School Press, Boston, Ma, 214 + xiii. Congdon, J. G. and Magilvy, J. K. 2001. Themes of rural health and ageing from a program of research. Geriatric Nursing, 22, 5, 234-8. Davies, S. 2001. Wanting what’s best for them. Relatives’ experience of nursing home entry: a constructivist inquiry. Unpublished PhD thesis. Faculty of Medicine, School of Nursing and Midwifery, University of Sheffield. Dellasega, C. and Mastrian, K. 1995. The process and consequences of institutionalizing an elder. Western Journal of Nursing Research, 17, 123-40. Efraimsson, E., Hoglund, I. and Sandman, P. 2001. ‘The everlasting trial of strength and patience’: transitions in home care nursing as narrated by patients and family members. Journal of Clinical Nursing, 10, 813-19. Evason, E., Whittington, D. and Knowles, I. 1993. The Cost of Caring. Equal Opportunities Commission for Northern Ireland, Belfast. Evason, E. 1998. Aspects of informal care in Northern Ireland. In Baldwin, S. (ed.) Needs Assessment and Community Care: Clinical Practice and Policy Making. Butterworth Heinemann, Oxford. Glaser, B. and Strauss, A. 1967. The Discovery of Grounded Theory. Aldine, Chicago. Glaser, B. 1998. Doing Grounded Theory: Issues and Discussions. Sociology Press, Mill Valley, CA. Glover, J. J. 2001. Rural bioethical issues of the elderly: How do they doffer from urban ones. The Journal of Rural Health, 17, 4, 332-5. Gold, R., Kennedy B., Connell, F. and Kawachi I. 2002. Teen births, income inequality and social capital: developing an understanding of the causal pathway. Health and Place, 8, 2, 77-83. Halpern, D. 2008. Social Capital. Polity Press, Cambridge. Heenan, D. 2000. Expectations and attitudes affecting patterns of informal care in farming families in Northern Ireland. Ageing and Society, 20, 203-16. Gurney, C. and Means, R. 1993. The meaning of home in later life. In Arber, S. and Evandrou, M. (eds.) Ageing, Independence and the Life Course. Jessica Kingsley, London. Kawachi, I., Subramanian S. V. and Kim, D. 2008. Social Capital and Health. Springer, New York. Kearns, R. A. 1993. Place and health: towards a reformed medical geography. The Professional Geographer, 46, 67-72. Keefe, J. and Fancey, P. 2000. The care continues: responsibility for elderly relatives before and after admission to a long-term care facility. Family Relations, 49, 3, 235-44. Kellett, U. M. 1999. Transition in care: family carers’ experience of nursing home placement. Journal of Advanced Nursing, 29, 6, 1474-81. Lowe, P. and Speakman, L. 2006. The Ageing Countryside. The Growing Older population of Rural England. Age Concern, London. McCann, S., Ryan, A. A. and McKenna, H. P. 2005. The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation. Health and Social care in the Community, 13, 5, 462-9. McGibbon, M. 1995. The Dromore Carers Survey. Age Concern Northern Ireland, Belfast. Munhall, P. L. and Boyd, C. O. 1993. Nursing Research: A Qualitative Perspective (2nd Edn.). National League for Nursing Press, New York. Nay, R. 1995. Nursing home residents’ perceptions of relocation. Journal of Clinical Nursing, 4, 5, 319-25. Nolan, M. and Dellasega, C. 2000. ‘I really feel I’ve let him down’: supporting family carers during long-term care placement for elders. Journal of Advanced Nursing, 31, 4, 759-67. Organisation of Economic Co-operation and Development 1994. Creating Rural Indicators for Shaping Territorial Policies. OECD, Paris. Office for National Statistics 2004. Rural and Urban area Classification 2004: An Introductory Guide. The Countryside Agency, Department for Environment, Food and Rural Affairs. Welsh Assembly Government: Office of the Deputy Prime Minister. Penrod, J. D. 2001. Functional disability at nursing home admission: a comparison of urban and rural admission cohorts. Journal of Rural Health, 17, 3, 229-38. Poland, B., Lehoux, P., Holmes, D. and Andrews, G. 2005. How place matters: unpacking technology and power in health and social care. Health and Social Care in the Community, 13, 2, 170-80. Putnam, R. D. 2000. Bowing Alone. The collapse and revival of American Community. Simon and Schuster, New York. Reed, J. and Payton, V. R. 1996. Constructing familiarity and managing the self: ways of adapting to life in nursing and residential homes for older people. Ageing and Society, 16, 543-60. Reed, J., Payton, V. R. and Bond, S. 1998. The importance of place for older people moving into care homes. Social Science and Medicine, 46, 7, 859-67. Reed, J., Cook, G., Sullivan, A. and Burridge, C. 2003. Making a move: care-home residents’ experience of relocation. Ageing and Society, 23, 225-41. Richards, L. 1999. Using NVivo in Qualitative Research. Sage Publications, London. Roberts, L. W., Battaglia, J., Smithpeter, M. and Epstein, R. S. 1999. An office on main street: health acre dilemmas in small communities. Hastings Centre Report, 28-37. Rosenthal, K. 2005. Rural Nursing: Flowing Like a River. In Lee, H. and Winters, C. (eds.) Conceptual Basis for Rural Nursing. Springer Publishing Company, New York. Rowles, G. D. 1981. The surveillance zone as meaningful space for the aged. Gerontologist, 21, 3, 304-311. Rowles, G. D. and High, D. M. 1996. Individualizing care: family roles in nursing home decision making. Journal of Gerontological Nursing, 22, 3, 20-5. Ryan, A. A. and Scullion, H. 2000. Nursing home placement: an exploration of the experiences of family carers. Journal of Advanced Nursing, 32, 5, 1187-95. Schutz, S. E. 1994. Exploring the benefits of a subjective approach in qualitative nursing research. Journal of Advanced Nursing, 20, 412-7. Shucksmith, M. 1999. Rural Housing. In Shucksmith, M. and Murphy, C. (Eds.) Rural Audits: A Health Check on Rural Britain, 21-25. Commissioned by The Rural Group of Labour MPS, Arkleton Centre for Rural Development Research, Aberdeen. Stoller, E. P. and Lee, G. R. 1994. Informal care of rural elders. In Coward, R. T., Bull, C. N., Kukulka, G. and Galliher, J. M. (eds.) Health Services for Rural Elders. Springer, New York, 33-64. Strauss, A. and Corbin, J. 1990. Basics of Qualitative Research (1st Edn.). Thousand Oaks, Sage, CA. Strauss, A. and Corbin, J. 1998. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (2nd Ed.). Thousand Oaks, London. Wahl, H. 2001. Environmental influences on aging and behaviour. In Birren, J. E. and Schaie, K. W. (eds.) Handbook of the Psychology of Ageing (5th Edn). Academic, New York, 215-32.. Weinert, C. and Burman, M. 1994. Rural health and health seeking behaviors. Annual Review of Nursing Research, 12, 65-92. Wenger, G. C. 1990. The special role of friends and neighbors. Journal of Ageing Studies, 4, 2, 149-169 Wenger, C. G. 2001. Myths and realities of ageing in rural Britain. Ageing and Society, 21, 117-30. Wenger, G. C. 1999. Choosing and paying for care. Health and Social Care in the Community, 7, 3, 187-97. Wenger, C. G. 2001. Myths and realities of ageing in rural Britain. Ageing and Society, 21, 117-30. Wiles, J. 2005. Conceptualizing place in the care of older people: the contribution of geographical gerontology. International Journal of Older People Nursing, 14, 8b, 100-08. Williams, A. M. and Cutchin, M. P. 2002. The rural context of health care provision. Journal of Interprofessional Care, 16, 2, 107-15.

PY - 2011

Y1 - 2011

N2 - Abstract The aim of this qualitative study was to explore rural family carers’ experiences of the nursing home placement of an older relative. The study was undertaken in a large Health and Social Care Trust in Northern Ireland using a grounded theory approach. Although data collection was an ongoing process, most of the data were collected between October 2003 and October 2006. Purposive sampling was used to initiate data collection and thereafter theoretical sampling was employed. Semi structured interviews were conducted with 29 relatives of nursing home residents and the resultant data were recorded, transcribed and analysed using constant comparisons. The software package, QSR NVivo, was used to facilitate data management and retrieval. Older people had deep attachments to their homes and entry to care was a last resort. Rural family carers had close relationships with health and social care practitioners and felt supported in the decision-making process. The choice of home was a foregone conclusion for carers who had a strong sense of familiarity with the nursing homes in their area. This familiarity was influenced by the relatively rural communities in which respondents resided and by an efficient ‘grapevine’, which seemed to thrive in these small communities. This familiarity, in turn, influenced the choice of nursing home, timing of the placement and responses of family carers. The findings indicate that issues such as rurality and familiarity warrant a more detailed exploration in future research on entry to care.

AB - Abstract The aim of this qualitative study was to explore rural family carers’ experiences of the nursing home placement of an older relative. The study was undertaken in a large Health and Social Care Trust in Northern Ireland using a grounded theory approach. Although data collection was an ongoing process, most of the data were collected between October 2003 and October 2006. Purposive sampling was used to initiate data collection and thereafter theoretical sampling was employed. Semi structured interviews were conducted with 29 relatives of nursing home residents and the resultant data were recorded, transcribed and analysed using constant comparisons. The software package, QSR NVivo, was used to facilitate data management and retrieval. Older people had deep attachments to their homes and entry to care was a last resort. Rural family carers had close relationships with health and social care practitioners and felt supported in the decision-making process. The choice of home was a foregone conclusion for carers who had a strong sense of familiarity with the nursing homes in their area. This familiarity was influenced by the relatively rural communities in which respondents resided and by an efficient ‘grapevine’, which seemed to thrive in these small communities. This familiarity, in turn, influenced the choice of nursing home, timing of the placement and responses of family carers. The findings indicate that issues such as rurality and familiarity warrant a more detailed exploration in future research on entry to care.

KW - mily

KW - carers

KW - rural

KW - nursing home

KW - older

KW - care-giving

U2 - 10.1017/S0144686X11000055

DO - 10.1017/S0144686X11000055

M3 - Article

VL - 32

SP - 1

EP - 18

JO - Ageing and Society

T2 - Ageing and Society

JF - Ageing and Society

SN - 0144-686X

IS - 1

ER -