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

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.

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.

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.

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.