Adjusting to residential care placement: A grounded theory study of Chinese elders

Researchers have struggled for years to untangle the challenges elderly people encounter in making the transition from life on the 'outside' to life in a residential care home. However, the substantial volume of research literature in this field focuses heavily on the outcomes of such placement. The actual transaction and the unfolding of experiences and events as elders make their day to day adjustment with residential living is not very well understood. In particular, very little is known about how Chinese elders adjust to the changes associated with living in residential care homes.;The purpose of this study was to develop a theory that explained the process of how Chinese elders adjust to residential care placement. The grounded theory methodology was employed. Data were collected from 18 newly admitted elders who could understand and speak Cantonese, were permanent residents of the home and consented to participate in the study. Audio-taped in-depth interviews were conducted with each elder one week after admission and then monthly until no new information about their adjustment experiences could be discovered. Each elder was therefore interviewed more than once and the number of interviews varied according to the different data saturation points. 98 interviews were conducted in total and the focus was to elicit rich detailed data relating to the elders' ongoing adjustment experiences.;Constant comparative analysis of data resulted in the development of a theory of regaining normality that explains the process as Chinese elders adjust to living in residential care homes. This theory reveals that newly admitted elders adjust through the four stages of orienting, normalizing, rationalizing and stabilizing as they struggle to regain normality i.e. a life that is as close to that lived before admission as possible. 'Regaining normality' is therefore the core category that explains the activities and processes involved as elders adjust to residential living. Throughout this complex process, elders deliberately assess actual or potential threats to establishing normality and then plan and implement normalizing strategies. This adjustment process lasts for three to seven months. None of the elders in this study was able to regain full normality and they had to come to terms with the re-established life in the residential care home.;The significance of socio-cultural influences in the adjustment process has also been uncovered. A number of experiences suggested in the literature as barriers to adjustment, such as living with rules and regulations, lack of privacy and autonomy are not regarded as important by Chinese elders. The Chinese values of balance, harmony and collectivism enable them to remain open and to accept the communal way of living. However, these same values also restrict the elders in developing relationships with staff and other residents. This appears to be the particular challenge facing Chinese elders in the course of adjustment to living in residential care homes. Implications for residential care practice in assisting elders to go through the residential care experience are suggested.