Morality in the Making: The Collaborative Relationship Between Formal Caregivers, Informal Caregivers, and Nursing Home Residents

The Gerontologist, vol. 65

Abstract

BACKGROUND AND OBJECTIVES: Collaboration between formal and informal caregivers is essential for providing good care to nursing home residents. Yet, ambiguity regarding mutual roles and responsibilities often impedes effective collaboration. To address this issue, we examined how formal caregivers, informal caregivers, and residents establish a moral understanding of their responsibilities, and how these understandings affect their triadic relationship. RESEARCH DESIGN AND METHODS: We conducted a responsive evaluation including 28 semistructured interviews with formal caregivers, informal caregivers, and residents. We used the Walker's (2007) expressive-collaborative model of morality as a theoretical lens to identify identities, values, and roles in the triad. RESULTS: Formal caregivers were assigned more moral responsibilities in the care process than residents and informal caregivers, particularly regarding decision-making authority. Formal caregivers considered this justified, while informal caregivers generally desired more influence. The attitude of residents on this matter remained relatively unclear. The diverging views on moral responsibilities between formal and informal caregivers led to relational tensions, affecting mutual trust and recognition between them. DISCUSSION AND IMPLICATIONS: Walker's model of morality provides a deeper understanding of the moral dynamics underlying the collaboration between formal caregivers, informal caregivers, and residents. Traditional hierarchies and a mismatch between healthcare and family ethics are implied to hinder informal caregiver involvement. Our findings call for practical and cultural adaptations on different levels within and outside nursing home organizations to improve the triadic collaborative relationship.

Authors 5

1. Marleen D. W. Dohmen corresponding Aachen Public Health & Primary care

   Leiden University · Leiden University Medical Center · Leyden Academy on Vitality and Ageing

   Affiliation as printed

   Leyden Academy on Vitality and Ageing , Leiden ,

   Public Health and Primary Care, Leiden University Medical Centre , Leiden ,

   Leyden Academy on Vitality and Ageing, Leiden, The Netherlands

   Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands

2. Mandy Visser
   Affiliation as printed

   Department of Research, Topaz , Leiden ,

   Department of Research, Topaz, Leiden, The Netherlands

3. Johanna M. Huijg Aachen Public Health & Primary care

   Leiden University · Leiden University Medical Center · Leyden Academy on Vitality and Ageing

   Affiliation as printed

   Leyden Academy on Vitality and Ageing , Leiden ,

   Public Health and Primary Care, Leiden University Medical Centre , Leiden ,

   Leyden Academy on Vitality and Ageing, Leiden, The Netherlands

   Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands

4. Barbara C. Groot

   Amsterdam University of Applied Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam University of Applied Sciences , Amsterdam ,

   Vrije Universiteit Amsterdam , Amsterdam ,

   Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

5. Tineke Abma Aachen Public Health & Primary care

   Leiden University · Leiden University Medical Center · Leyden Academy on Vitality and Ageing · Erasmus University Rotterdam

   Affiliation as printed

   Erasmus School of Health Policy & Management, Erasmus University Rotterdam , Rotterdam ,

   Leyden Academy on Vitality and Ageing , Leiden ,

   Public Health and Primary Care, Leiden University Medical Centre , Leiden ,

   Leyden Academy on Vitality and Ageing, Leiden, The Netherlands

   Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands