Navigating a Skilled Nursing Facility Stay Together: A Dyadic Qualitative Study of Dually Eligible Patients and Care Partners.

BACKGROUND AND

OBJECTIVES

Shared stressors are co-experienced by dyad members and increase each's psychological distress. This study analyzes dyadic qualitative data with dually eligible (i.e., Medicare and Medicaid beneficiaries) residents and their care partners during a subacute/postacute skilled nursing facility (SNF) stay. We aimed to (1) identify shared stressors that affect both dyad members and (2) explore differences between dyad relationship types.

RESEARCH DESIGN AND

METHODS

Seventeen dyads (N = 34 individuals) participated in semistructured interviews during a SNF stay, separately. There were no exclusion criteria based on relationship type. The dyadic framework method was used to analyze dyads as a single unit, rather than the sum of separate narratives.

RESULTS

The sample consisted of adult child (n = 9, 53%), friend (n = 6, 35%), sibling (n = 1, 6%), and parent (n = 1, 6%) care partners. Four themes emerged, providing insight into shared stressors: (1) balancing autonomy and support; (2) long-term care decision-making; (3) cognitive concerns requiring attention; and (4) preexisting relationships. Care roles and shared stressors were mostly similar across relationship types; although, some inter-dyad differences were noted in decision-making processes and interpersonal dynamics.

DISCUSSION AND IMPLICATIONS: This study identified multiple shared stressors that occur during SNF stays, as dyads must navigate changes to autonomy-support structures as well as the care environment, caregiving role, and existing relationship, together. We discuss implications for research, practice, and policy, including dyadic psychological intervention; care partner training for psychological, behavioral, and case management; cognitive symptom assessment, education, and management; and support for long-term care decision-making and transitions.