# Experiences of members of the care triad on transitioning from home to a nursing home: a qualitative study

## TL;DR

This study explores the challenges faced by older adults, caregivers, and healthcare professionals during the transition from home to a nursing home, highlighting the need for better support and planning.

## Contribution

The study provides a comprehensive qualitative analysis of the care triad's experiences across all three transition phases, identifying specific support needs and strategies for improvement.

## Key findings

- Key problems include limited care options, complex decision-making, and reduced autonomy for older adults.
- Informal caregivers often avoid discussing nursing home admission to prevent conflict and require emotional and collaborative support.
- Proactive planning and early professional involvement are recommended to improve transitions and maintain autonomy.

## Abstract

The transition from home to a nursing home is an emotionally and organisationally challenging process for the care triad, consisting of older adults in need of care, their informal caregivers, and health professionals. Although this transition is known to occur in three phases, no study has comprehensively examined the experiences of care triad members across all phases, and evidence-based interventions to support informal caregivers and older adults through this highly stressful process are lacking. This study aimed to explore the experiences of care triad members, with a focus on identifying problems, strategies, required support, and suggestions for improvement across all three transition phases. These insights will serve as a basis for developing an intervention to enhance the transition.

We conducted a qualitative study using semi-structured interviews with participants representing the care triad in Germany. The interview guides were informed by a transitional model and prior literature. Data were analysed using qualitative content analysis.

A total of 29 interviews were conducted. Key problems included limited care options, complex and often unsuccessful decision-making processes, transitional gaps, and a reduction in both autonomy and participation for older adults. Healthcare professionals showed limited and inconsistent involvement in decision-making and providing support. Informal caregivers often used indirect communication to avoid the sensitive topic of nursing home admission, aiming to prevent conflicts. Essential support needs were collaborative decision-making, adequate preparation time, and emotional support. Recommendations emphasized the importance of initiating care discussions early in the transition process.

Transitions from home to nursing homes are often delayed due to postponed decisions, family disagreements, and a lack of support from healthcare professionals. Informal caregivers frequently shoulder the burden, feeling overwhelmed and unsupported. As a result, transitions are often rushed, leading to a loss of autonomy and identity among older adults. Proactive planning and counselling could help prevent these negative outcomes. Interventions should focus on encouraging the early engagement of older adults and informal caregivers in planning their care situation, with consistent professional support throughout the process to ensure their participation and autonomy are maintained.

The online version contains supplementary material available at 10.1186/s12877-025-06586-1.