A Parallel Process of Staff-Family Distress in Long-Term Care: A Challenge to Collaboration

Supporting persons living with advanced dementia in long-term care (LTC) homes requires strong collaborative partnerships between staff, family members, and residents. Yet, relational tensions-such as differing expectations around care decisions-can inhibit the implementation of collaborative partnerships at this critical point in the trajectory of care.

This study aims to explore the emotional experiences of families and staff during shared decision-making processes for individuals with advanced dementia in LTC.

Guided by interpretative description, this qualitative study investigated the experiences of staff (n = 12) and families (n = 16) collaborating in two Canadian LTC homes. Data was collected through semistructured interviews lasting 45-60 min, which facilitated a detailed exploration of participants' narratives. The interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis facilitated by a combination of inductive and deductive approaches.

Our analysis revealed a complex parallel process of trauma and grief including accumulated distress, isolation, and feelings of devalue that worked together to create distance between staff and families at a time when connection was critical. Our findings further suggested that a lack of time and space for reflection and validation for staff and family, resulted in a cycle whereby staff and families engaged in a push and pull dynamic with each viewing the other as adversaries rather than allies.

Our findings highlight the critical need for reflexive opportunities in LTC homes to overcome and attend to the emotional barriers that interfere with true collaboration between staff and families. We hope that the proposed cycle serves as a preliminary framework to support staff in navigating difficult conversations and emotions, and fosters reflexive care that enhances, rather than obstructs, connections.