THE PLACEMENT PROCESS:
DECISIONS AND TRANSITIONS
We all jive sisters and brothers talked and they said whatever I would do would be all
right with them. Everybody agreed except me. For me, it was a terrible thing to do.
—A resident's daughter, nine months after her mother's admission
THIS CHAPTER BEGINS with a description of issues regarding the health and living situations of the Acacia residents this resulted in the decision for nursing home placement. Discussion of the decision-making process follows, including comparison of the experiences of families in this study with those of families who participated in odier studies that have addressed these same issues. Specific points explored here include the extent and nature of participation of relatives, residents, and social service and health care providers; emotional reactions of residents and relatives; and reasons for choosing this nursing home.
The beginning of the transit stage of nursing home placement is the part of the placement process that occurs between the premigration and departure stage and the resettlement stage. As indicated previously, the stage-ofmigration framework for nursing home placement is a theoretical approach to understanding the process, modeled after Drachman and Ryan's stage-ofmigration approach developed to explain a process experienced by migrants and immigrants (Drachman 1992; Drachman and Ryan 1991; Kolb 1999). Some of the families wanted the residents to continue to live at home, but this was not possible because of the residents' health problems and the lack of adequate informal and formal services to meet the residents' needs. Changes in functioning increased the need for care provided by others, and the decision was made by relatives and/or the older adult who needed assistance that adequate care could be provided only in a nursing home setting. The placement process often occurred rapidly, was extremely difficult emotionally, and was frequently contrary to role expectations among the older adults and their relatives. Within some of the families, placement defied cultural expectations and was experienced as a major disappointment and betrayal.