The term ‘transition’ implies a change, and change has implications for the identity of the person who experiences it. It is likely to require a period of adjustment to assimilate and respond to it. Hopson and Adams (1976) suggest that a major transition, however triggered, can result in a cycle of changes to an individual's self-esteem. For example, moving into residential care is a major transition in anyone's life, yet older people are often assessed for, or seek, residential or nursing care in an atmosphere of crisis with little time to prepare (Youll and McCourt-Perring, 1993). A move may occur when someone is ill and therefore particularly vulnerable. A number of stresses may arise from such a transition, caused by:
change of place (loss of home)
changing relationships (for instance, death of a partner, gaining and losing friends or local community connections, making new relationships)
change of role or status (moving into care is a change in status from householder to resident)
loss of independence, possibly increased dependence
feelings of loss of dignity, for instance, if support is needed for physical care.
Lee et al. (2002) suggest that the magnitude of the changes associated with this kind of transition accounts for why the perceived likelihood of entering a residential care home is one of the most pervasive sources of fear affecting older people. Therefore, Activity 1 focuses on feelings of loss that service users and their families may experience following a move into residential care and ways that professionals may support them. It also considers some of the tasks that social workers may undertake with service users, their families and other professionals who are involved with the admission of people to residential care.
Activity 1: Supporting people with transitions
In this activity you will consider the impact of moving into residential care on service users and their families. You will also consider how professionals can provide support. Make notes on the following:
The issues to consider when working with people moving into residential care.
The feelings of loss that individuals may experience when they enter residential care.
The feelings a new resident's family may have about the move.
Watch Video 1 below, focusing on the transitions.
Click to view the video clip (6 min 57 sec)
Transcript: Focusing on the transitions
Now listen to the audio below as Maria Hutchinson, the home manager, and Rose Guthrie, the home's counsellor, talk about some of the feelings and anxieties of residents and their families. (We apologise for the background noise on this recording.)
Click to listen to the audio clip (5 min 58 sec)
Transcript: Feelings and anxieties
Feelings of loss are not experienced just by the person entering residential care, but may also be felt by those involved in their care. Carers and relatives can also experience the transition as painful, and are sometimes overwhelmed by feelings of guilt because they cannot support their relative or fulfil their sense of family obligation (Phillips and Waterson, 2002).
Social workers are involved in preparing for and carrying out the assessment of need and supporting transitions into care. The information that the social worker provides about the service user when planning admission can help make the transition into residential care a more positive experience. In assessing and then planning changes with older people, social workers should be aware of how ageism affects them. For example, it is ageist to assume that all older people's needs and expectations are similar: it should be remembered that each person has their own distinctive biography (see Aids to Practice card on ‘Biographical Work’).
Click to view ‘Biographical Work’.
Listening carefully to what people say about their needs, and involving them and their families in planning their own care, helps to overcome ageist practice. If the social work assessment incorporates some biographical details of a new resident and notes their preferences, staff at the home are able to consider how they can help them maintain links – their social networks – and continue to engage in activities that interest them. This is particularly important for service users from minority ethnic groups, where maintaining cultural links helps to smooth the transition to care. Taking into account service users' backgrounds and preferences also helps to preserve their identities and sense of self-worth.
Hopson and Adams (1976) developed a model to explain personal responses to major transitions. They suggest that individuals may pass through seven identifiable stages in a major transition:
Immobilisation (a sense of being frozen, unable to act or understand).
Minimisation (denial that change is important).
Acceptance (realisation that there is no going back).
Testing (trying out new behaviours to cope with the situation).
Seeking meanings (reflecting on change).
Internalisation (the new meanings discovered become part of behaviour and a new identity).
This work has influenced practitioners' understandings of the feelings about loss that arise not only from the death of a close friend or relative (Parkes, 1993), but also in relation to failing health and mobility. Importantly, the identification of these stages may also help practitioners to understand the experiences of people moving into residential care and to recognise the emotions that can be aroused by such transitions. However, the stages outlined may not always be experienced by people in the sequence outlined here, and the model does not provide explanations for variations in people's experiences. There are numerous variables which affect personal responses to transitions. It is important to listen carefully to how each individual experiences the process and expresses their feelings about it.
Korbasa et al. (1981) examined why some people appear to cope more readily with stressful life events than others. Their conclusion was that differences in coping may be due to the presence of certain individual characteristics. They studied two groups of executives: one group had become ill after stressful life events; the other, although subject to similar life events, did not. Their findings led them to develop the concept of ‘hardiness’ to explain why, in similar circumstances, some individuals become ill and some do not. They accounted for differences by the presence of certain personality traits which they claimed make people ‘hardy’ enough to cope. These include:
control: feeling that they can influence their lives
commitment: valuing strong social bonds with family, friends and people in the community
challenge: viewing change as a challenge rather than as a threat.
For social workers who meet adults and children in transitions, hardiness is a useful concept, closely linked to some ideas in the literature on resilience in adversity (Gilligan, 2001). Activity 2 further explores the value of the concept of ‘hardiness’ for gaining an understanding of individual responses to change.
Activity 2: Responses to change
If you have just completed Activity 1, you may want to take a break before continuing.
In this activity, you will consider the concept of ‘hardiness’, which Korbasa et al. (1981) suggest enables some individuals to cope with major changes.
Watch the video clips below in which Elizabeth, Bill and Eric talk about the experiences of living in residential care. For each of these residents, and Elizabeth's husband, make notes of their responses under the following headings:
Control – feeling that they can influence their lives.
Commitment – valuing strong bonds with family, friends and people in the community.
Challenge – viewing change as a challenge, not a threat.
You might also note other factors, such as personality, degree of optimism and good general health.
Click to view Video 2: Elizabeth's story (8 min 03 sec)
Transcript: Elizabeth's story
Click to view Video 3: Bill's story (6 min 54 sec)
Transcript: Bill's story
Click to view Video 4: Eric's story (5 min 22 sec)
Transcript: Eric's story
You may have noted the similarity between the concepts of ‘hardiness’ and ‘resilience’ as both ideas identify how some individuals have a capacity to resist or rebound from difficulties. While these concepts include psychological characteristics, social resources also matter. Research studies suggest that resilience in older people is connected to a number of protective factors, including the physical, psychological, social and spiritual domains of their lives (Nakashima and Canda, 2005). In situations where social and economic factors threaten an individual's capacity to cope effectively with a major transition, social workers can explore the service user's strengths and build on them. This may involve helping the person to strengthen their personal support networks.
Pearlin and Schooler's (1978) analysis of individuals' ability to cope with change also acknowledges the importance of personal and social resources (Korbasa et al., 1981). Pearlin and Schooler distinguish between coping responses and coping resources. Coping resources can be seen as what is available to the individual in developing their coping repertoires. Coping resources are sub-divided into psychological and social resources. Psychological resources that the individual possesses can be employed to respond to change, and are analogous to Korbasa et al.'s three Cs. Social resources are the interpersonal networks in which the individual is embedded. Coping responses refers to what a person does in response to change. For example, the ability to mobilise social networks at times of stress is seen as a coping response. Pearlin and Schooler also stress the significance of negative social and economic factors, such as poverty, discrimination, unemployment and social exclusion, on an individual's ability to cope effectively with change. Exploring these three areas with service users is part of the ecological assessment framework.
Sometimes older people enter care as a temporary measure for respite stays and intermediate placements following discharge from hospital. Thinking about coping resources and coping responses is useful when supporting a new resident to ‘settle in’. Reed et al. (1998) suggest that the key to successful adjustment to life in a residential home is social relationships. Residents who have inner personal resources and effective social skills are more likely to have the ability to establish new friendships.
Children and young people and other adults may also move into supported accommodation. It is often temporary and for a short stay, but is sometimes over a longer term, and often people experience several moves. Social workers who support people leaving care and moving on to different living arrangements, perhaps to independent living, find that assisting in developing service users' life skills can be helpful. Whatever kind of changes a person experiences, social workers need to appreciate how each individual interprets and feels about the event. By their insight into what is involved, social workers can help the person manage more successfully. Working with service users to identify what they perceive as making the move more or less difficult provides an opportunity to consider sources of support that may smooth their transition.