Abstract

Background: Relocation to a nursing home represents a significant and unique residential change for older adults (Theurer, Mortenson & Stone, 2015). Although individual nursing home relocation experiences may wary, an active older person's involvement in the decision-making, planning of the move, or high level of support during the move may have a positive impact on nursing home adaptation and overall life satisfaction after the move (Marshall & Mackenzie, 2008; Aminzadeh et al., 2009; Jungers, 2010; Fraher & Coffey, 2011; Brandburg et al., 2013; Brownie, Horstmanshof & Garbut, 2014; Rijnaard et al., 2016). Although ageing in place (in one's home) is a preferred care option for most older people and family care often is a priority of social policy in many European countries, relocation to a nursing home becomes an increasingly common experience.

Objectives: Knowledge about older people's care and nursing home relocation decision-making can inform the policy and practice to better address their needs, reduce the relocation stress and foster the social services system that enables older people to stay at their homes for as long as possible. Thus, the aim of the research was to explore the nursing home relocation decision-making of Lithuanian older adults.

Methods: 18 semi-structured interviews with nursing home-dwelling older adults (8 males and 11 females) were collected from 2017 to 2019. For the purposes of this presentation data analysis focused on nursing home relocation rationalization, personal role in and control of the decision-making process (i.e., planning of the relocation), and reflections on the relocation decision and its outcomes. The results were interpreted through the lenses of Ryan and Deci's (2000) self-determination theory.

Results: A combination of various factors, such as insufficient support with daily living activities, disabling physical environment, a sense of vulnerability and relationships within the family come into play when older adults consider nursing home relocation. In the context of these factors older adults' autonomy in the relocation decision-making process varied. Interestingly, in some cases, the relocation decision type characterised by the highest level of older person's autonomy led to disagreements with children about the future care. Among the advantages of living in a nursing home, older adults mentioned various opportunities provided for them after relocation, such as higher accessibility to a variety of social services, increased mobility as the built environment of the nursing home was better adapted to their needs, more frequent social interactions, and increased opportunities to engage in meaningful leisure activities. Despite the circumstances of the relocation, many research participants concluded that nursing home relocation in their case was the "right decision'.

Conclusions: The results of the study provided insights into the care decision-making process and revealed the importance of the social and individual context for the nursing home relocation and further adaptation. Despite the prevailing negative image in Lithuania, the nursing homes can have the potential to foster an environment that satisfies residents' needs for competence, autonomy and relatedness, thus promoting their wellbeing.

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