“Invisible Voices”: A Critical Incident Study of Family Caregivers’ Experience of Nursing Homes After Their Elder Relative’s Death

Purpose: The literature provides few examples of family caregivers’ retrospective evaluation of nursing home services. This study aimed at analyzing narratives of Italian family caregivers of elders who experienced nursing home placement. Design and Methods: Data were gathered through in-depth interviews with family members after their relatives’ death. The interviews were based on the Critical Incident Technique, which allowed the categorization of the most memorable positive and negative events from the perspective of family members of elders deceased in nursing homes. Interviews were interpreted with a phenomenologically inspired thematic analysis approach. Participants were screened for complicated grief disorder as a confounding variable in relatives’ accounts of the treatment. Results: Results suggested that positive long-term recollection of the nursing home was associated with different themes emerging from the interviews: medical reliability and expertise, active demonstrations of care that extend beyond the contract with the facility, individualized attention, responsiveness, openness to dialog with family members about routines, management of the first impression, and family engagement. Lack of professionals’ expertise and medical failures, lack of care for patients’ personal goods, lack of family involvement, lack of individualized attention, lack of responsiveness, poor patient surveillance, and structural limits of the facilities were the themes that were more frequently negatively associated with the nursing home experience. Implications for Practice: Focusing on the key dimensions connected to the quality of the experience of family members can enrich the quality of existing nursing home services and allow healthcare policymakers and managers to design better facilities for the patients.