Background: Primary research, including qualitative research, as well as experts working in social services and aged care have identified the mixed feelings carers experience when the person they have been caring for is admitted into a residential aged care facility permanently. They have raised the importance of understanding these experiences as a means to implementing policies and programs that enhance carers' well-being. This systematic review was motivated by the need to use evidence to inform effective and feasible interventions to support carers, and the absence of a systematic review synthesizing the qualitative evidence on how carers experience this transition.
Objectives: The objective of this qualitative systematic review was to identify and synthesize the evidence on the experiences of carers of older people when the person they had been providing care for is admitted permanently into a residential aged care facility, and to draw recommendations from the synthesis of the evidence on these experiences to enhance policy and programming aimed at supporting affected caregivers.
Inclusion criteria: Types of participants
All carers of people who had experienced the person they had been caring for at home being moved into a residential aged care facility permanently.
Phenomena of interest
Experiences of the caregiver of the older person when the person they have been caring for at home is admitted into a residential aged care facility permanently.
Types of studies
The review considered qualitative studies, including but not limited to designs such as phenomenology, grounded theory, ethnography and action research.
Types of outcomes
The outcomes are in the form of synthesized findings pertaining to carers' experiences when the person they have been caring for is admitted into a residential aged care facility permanently.
Search strategy: A comprehensive search of leading databases which are sources of qualitative published and unpublished studies was conducted between 18 September 2013 and 10 November 2013. The search considered studies reported in English and published from the database inception to 10 November 2013.
Methodological quality: Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.
Data extraction: Data were extracted from identified papers using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. The data extracted included descriptive details about the phenomena of interest, populations and study methods.
Data synthesis: The Joanna Briggs Institute meta-aggregative approach for synthesizing qualitative evidence was used. Research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Study findings that were supported by the data in primary studies were organized into categories on the basis of similarity of meaning. These categories were then subjected to a meta-synthesis to produce a set of synthesized findings.
Results: Fourteen studies matched the inclusion criteria and were included in the review. From these 14 studies a total of 71 study findings about how carers experience the transition when the person they have been caring for is admitted permanently into a residential aged care facility were organized into seven categories. From the seven categories created on the basis of similarity of meaning, the following three synthesized findings describing the experience were produced: (i) Carers experience mixed feelings (including guilt, loss of control, failure, and relief) when the person they have been caring for moves permanently into a residential aged care facility, which often occurs after a crisis. Carers seek validation about the decision and often display a need for support before, during and after the move to a residential aged care facility. (ii) Carers may experience the separation as sudden and unplanned, and feel that maintaining continuity in care after admission of the person they have been caring for into the residential aged care facility is important for alleviating the loneliness and changed sense of identity they experience. (iii) Planning and building familiarity with the residential aged care facility prior to the move may help carers to minimize the experience of loss of control that is common when moving a person one has been caring for permanently into a residential aged care facility, which is made worse by those involved focusing on administrative issues and not being mindful of the carers' psychosocial needs during the admission process.
Conclusions: The findings of this review highlight the importance of interventions being implemented to provide support for carers prior to the person being admitted into a residential aged care facility, at the decision making time, during the move and post-move. Carers experience mixed feelings and have difficulty coping with the separation and visit the residential aged care facility to maintain the relationship. Pre-planning prior to the move is important as the evidence suggests that when there is a sense of familiarity with the choice of residential aged care facility there is a more positive perception of the transition from the carer's perspectives. The findings call for health care professionals and residential aged care facility staff to assess the psychosocial needs of carers, and where feasible, promote steps that enable the carers to continuing to have a caring relationship after separation.