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

Abstract Background 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. Methods 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. Results 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. Conclusion 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.