Transition into a Nursing Home: Theoretical Framework on the Influence of Cultural Factors

OBJECTIVES: To create a theoretical framework for analyzing cultural influences on older people’s transition into a nursing home (NH).
THEORIES: Action theories in cultural and developmental psychology (Boesch, 2001; Brandtstädter, 2006), social representations theory (Marková, 2012), theory of culture as a semiotic regulation system (Valsiner, 2007).
METHODS: (1) Conceptualization of NH care and family care as alternative action paths for meeting the needs of older persons and their relatives. (2) Conceptualization of culture as a product of human actions and as offering different possibilities of care-related actions. (3) Systematization of care-related goals and instrumental values of NH care versus family care. (4) Theoretical mapping of cultural factors on proximal determinants of elder care decisions and actions.
RESULTS: The framework contains the following propositions. Older people and family caregivers hold multiple goals (e.g., welfare of family carers, welfare of old person). NH care can meet some goals and simultaneously frustrate others. The effects and choice of NH care depends on a variety of cultural factors: Legal regulations for warranting care quality (e.g., nursing home laws), economic concepts and practices (e.g., business models of elder care) and professionalization (e.g., staff training). Family care depends on institutionalized options for reconciling job-, care- and other family-related duties (e.g., mobile care services, day care units) and for compensating expenses (e.g., care insurance). Cultural concepts of care dependency influence the meanings that individuals attribute to NH care.
CONCLUSIONS: The framework specifies cultural factors relevant for older peoples’ transition into a NH and delineates mediating paths. It invites other sciences specialized on relevant cultural factors (e.g., law, political science, social economics) to further refine the analysis. An identification of cultural factors affecting NH care opens new options for improving care quality or living conditions of older persons, family and professional carers.