Transfer Trauma: The Emotional Toll of Moving to a Care Facility

It happens unexpectedly — an urgent call that Dad can no longer live alone. Within weeks, he finds himself relocated to a long-term care facility. His familiar surroundings are gone. He knows no one. He's concerned about fitting in and unfamiliar caregivers.

The move is jarring, leaving him plunged into sadness, anxiety and isolation. Instead of engaging in activities and meeting new neighbors, he withdraws to his room, meals forgotten. 

Though well-intentioned, relocating to a setting with more support can profoundly disrupt an older adult's sense of individuality and autonomy. Research found that moving to a long-term care facility is challenging for many older adults. The transition is often perceived as ending their independence and losing control. 

The same study noted that older adults frequently receive little advance notice or preparation before relocating to an unfamiliar environment. This gives them almost no time to prepare emotionally or physically, which often leads to feelings of fear and uncertainty. 

How well an older adult adjusts depends on their physical and mental health before the move. Another critical factor is whether they chose to move or were forced to. The effects of late-life relocation have been dubbed transfer trauma or relocation stress syndrome. 

While transfer trauma may not always be preventable, you can help turn this challenging transition into a fresh start for your aging loved one. 

Ellen Finney, Director of Memory Care at Inspir Carnegie Hall defines transfer trauma as "another term used to describe the emotional and psychological impact of moving older adults to a new living situation, especially when the move is sudden, involuntary or against their will." 

This phenomenon highlights the strong responses older adults may experience when uprooted from their established environment. The percentage of older adults encountering transfer trauma is notable. 

According to Dr. Nicholas Carte, Faculty Lead and Team Lead of Nursing at Southern New Hampshire University, between 20% and 30% of older adults relocating to assisted living or nursing homes show symptoms of transfer trauma. 

"This change is often difficult for several reasons," says Carte. Older adults form deep emotional bonds with their homes, which often are security, comfort and identity sources. "So, leaving their home can be very unsettling for them. They often feel the loss of independence," he adds.

The stress of relocating takes a significant toll on many older adults' mental health. Moving into an aging facility can trigger or worsen anxiety and depression. Finney notes additional common symptoms like "confusion, agitation and a general sense of disorientation" as older individuals are forced to leave behind their familiar homes and social connections. 

Look for changes in your loved one that may indicate they're struggling with the move. For example, do they seem more withdrawn or spend a lot more time confined in their room? Have those laughter-filled afternoon chats turned to mumbles of missing their old home? Is their mood more deflated? Subtle shifts like fatigue, loss of appetite or disrupted sleep could also indicate the move has taken an emotional toll. 

According to Finney, the impact of transfer trauma can be wide-ranging, from intense emotional distress to deteriorating physical health. Pre-existing medical conditions may worsen under the strain and trauma of relocating. Cognitive function may also be affected, particularly for those already facing challenges with memory and reasoning skills before the move.

Certain factors can heighten an older adult's risk of struggling with relocation stress. Dr. Gary Small, Professor and Chair of Psychiatry at Hackensack Meridian School of Medicine in New Jersey, explains the disruption of a move may exacerbate pre-existing conditions like depression, anxiety or personality disorders. Small adds, "If people are unprepared, it can make matters worse." 

A lack of control over the decision-making process can also intensify feelings of trauma and loss, Finney notes, adding those with a history of prior losses or traumatic transitions may have a more challenging time coping.  

Carte points out that people with cognitive impairment face additional challenges as they may have difficulty understanding the changes. The quality of the new facility itself matters — restrictive policies, noise and inadequate staffing increase the chances of transfer trauma. 

Relocating can be highly distressing for many older adults. But you can take meaningful steps to ease the transition and mitigate transfer trauma's impacts. 

• Communicate early: Small emphasizes the importance of communicating with the older adult early and clearly. Keep communication open, honest and tailored to their level of understanding. Explain what is happening in a way that makes sense to them. 
• Encourage participation: To make the transition less daunting, encourage the older adult to participate in decision making. "Change in life is much more difficult if the individual feels that it's forced upon them [and] if they're not engaged in the decision making," Small says. This could include touring facilities, talking to staff and selecting their new living space.
• Create a sense of home: Allow your loved one to personalize their new living space by bringing familiar items from home. As Finney suggests, involve them in decorating and making the space their own for comfort. "Establishing a routine and encouraging social interactions can also ease the transition," Finney adds. Take time to walk your loved one through the layout of their new residence. Show them where their things are located and how to navigate the space.
• Grant autonomy: Small advises to give your loved one as much autonomy as possible regarding their new daily life. Try to facilitate activities and routines tailored to their interests at home. If they appreciate fresh air, arrange for regular time outdoors. Connect them early with the facility's card group if they like card games. Introduce them to the facility's staff and residents with shared interests to build community.
• Address concerns: Openly discussing concerns upfront can help fix problems early. Small advises checking in about specific worries. Ask questions like, "What are your concerns about the new facility?" Allowing your loved one to talk about their worries helps you avoid potential issues before the transition occurs. Proactive steps to address apprehensions can smooth the adjustment process.
• Avoid ageism: Remember that your aging loved one is a unique individual. Avoid assumptions. Instead, value their distinct personality and interests. Take the time to know them honestly. Small recommends connecting with them and sharing meaningful conversations. Recognizing their individuality will help nurture your relationship through this transition.
• Seek professional assistance: If signs and symptoms of transfer trauma persist or worsen over time, request help from medical and mental health professionals at your loved one's new facility. Finney says, "Seeking support can provide peace of mind and allow you to continue to be the son, daughter, wife, etc. that you have always been." 

Relocating generally involves adjustments in environment, routine and social connections that can be emotionally challenging. With care, understanding and proactive support, you can help your loved one view a transition to an aging facility as hopeful new beginnings rather than traumatizing disruptions. 

Maggie Aime, MSN, RN, is a freelance health, wellness, and medical personal finance writer. Her work has appeared in GoodRx Health, HealthNews, Nursing CE Central, and elsewhere. When she's not writing, she's either relishing a breathtaking sunrise, making memories with her children, or rekindling her love of the piano. Connect with her at The Write RN. Read More