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Managing Change: Transition Trauma

Updated: Dec 3, 2023

Transition trauma is a widely used term amongst community leadership during pre-move-in discussions and initial care plan meetings. It is also known as relocation stress syndrome. Often, the community may reference this during an initial care plan meeting to explain undesired resident behaviors following a move-in. We want to offer brief guidance on the unique challenges the resident may face following a move and offer insight on what should be expected from the community and the challenges impacting them.

What is Transition Trauma?

Transition trauma refers to the group of symptoms that occur following a change in living environments. Whether it’s a college student moving into a dorm, a family relocating, or even a temporary housing change, we are all susceptible to certain symptoms that characterize transition trauma. The act of moving creates a high level of stress and anxiety for even those who are welcoming and embracing the change. Imagine the impacts of that stress and anxiety on a senior who may not be enthusiastic about the move. Feelings of helplessness and hopelessness surface the underlying depressive causation if the new resident perceives the transition as a loss of autonomy. The concern is compounded for those with mild cognitive impairments or diagnosed dementia who may not even realize the change until a transition into an Assisted Living or Memory Care Community has occurred.

Complications of Transition Trauma

Transition Trauma encompasses mood, behavior, and physiological symptoms. Feelings of sadness, anger, anxiety and depression are common primarily due to a perceived loss of autonomy. The new resident may feel angry toward family members and other decision-influencers and even the community staff. Theoretically, these mood symptoms are natural and common.

The behavioral symptoms are more concerning and noticeable. Some of these behavioral symptoms include periods of social withdrawal, combative behaviors, complaining, and attention-seeking. The resident may allege that he/she is not being checked on, that the staff is giving wrong medications, that the food is never good, etc. To instill and demonstrate autonomy, the resident may choose to “shut down,” refusing care and/or medications. Memory care residents may exit-seek, meaning that they will wander the facility, looking for a way to get out of the unfamiliar environment. The resident may even scream for help, allege mistreatment, demand to be “let out,” or call 911. These concerns should be routinely monitored and investigated by the community. Allegation of abuse or neglect should always be investigated and in most instances reported to the licensing office.

Physiological symptoms include restlessness, sleeplessness, weight changes, increased pain, and confusion. These physiological symptoms will require the guidance of trained clinicians. A physician may be able to adjust medications, a dietician may be involved to revise meal preferences, etc.

The Role of Family Members in Reducing Transfer Trauma

Be patient and communicate. Family members and loved ones should anticipate these potential symptoms and manage frustrations that can arise as a result. This is a time to be supportive and patient. Families should commit to open dialogue and routine communication with the community leadership.

The first weeks of the transition are also opportune to focus on relationship building with the community staff and other residents. It’s helpful to inform them of the routine behaviors of your loved ones and set an expectation of what their mood may be during certain parts of the day. Share the specifics with the team. For example, if dad is used to watching the nightly news on a particular channel, let the community staff know that. The more information you can share, the easier the transition adjustment becomes, presuming that the community follows through. A small dry-erase board in the room to exchange messages with staff is a good idea.

Complete the social history form. Some communities may require a social history form as part of the admission packet. A social history form will seek information about the residents’ non-clinical personal lives, including previously held jobs, cities the resident may have lived in or traveled to, favorite foods, current hobbies, etc. This is a great tool to share with the team.

Care Plan Meeting: Communities are regulated and required to have care plan meetings to discuss the identified needs of the resident and outline how the community plans on meeting those needs. While it does not mandate family or POA participation, the law in the Commonwealth of Virginia requires that either is invited. This is an important meeting to discuss healthcare and social issues. Families should participate in care plan meetings and ask questions regarding the adjustment process.

Make allies. Working in a senior living community, regardless of title, is a challenging job on a good day. It is important to get to know and build trust with the caregivers and other team members that you will trust with the care of your loved one. Families should make an effort to build relationships with these employees. Think of these team members not only as mere employees on a shift but as one of your loved one’s new neighbors. They will be monitoring their health and addressing their needs and should feel comfortable talking to the appropriate family members with candor and transparency.

Clarify visitation expectations. One of the behavioral changes related to transition trauma is attention-seeking or exit-seeking (for memory care residents). A family member’s routine visits may trigger these behaviors. It may be appropriate to take a break from visitations and allow the new resident to adjust without family “hovering”. Have a dialogue with the community leadership and request guidance on visitation and, if necessary, take a hiatus. During this absence, families can contact the community staff and allies directly for updates on their loved ones.

Work with experienced guidance: Working with an experienced advisor can offer insight into the community’s system and resources. Selecting a community that is comfortable engaging in transparent discussions can help minimize stress and anxiety and enable building a foundation for better communication and positive relationships between the community and the family.

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