The missing family: Staff perspectives on and responses to familial noninvolvement in two diverse nursing homes

Although the continuum of familial involvement with nursing home residents includes those who are deeply engaged and those who are totally absent, little is known about how staff perceive and react to family noninvolvement. This article explores staff perspectives on and responses to family absence. Semistructured interviews were conducted with 52 employees and 18 residents from two NHs, one an urban facility with a largely chronic mentally ill population and the other a rural, tribally owned facility with a predominately cognitively impaired American Indian clientele. Medical record reviews were also conducted. Staff theories of family absence were informed primarily by dominant American and American Indian cultural values regarding kinship, psychiatric disorders, and institutionalization. In each facility, metaphoric kinship relationships between staff and residents compensated somewhat, but not entirely, for perceived family noninvolvement. This research highlights the cultural variability of staff perspectives on family absence but also points to similar strategies for coping with it.