The first days in a care home: settling in

For the staff, a new resident's admission is a working day with extra paperwork. For the person arriving, it may be one of the hardest days of their life. They have left behind a home, a neighbourhood, routines of decades. And often it was not their decision.

The first days and weeks weigh heavily on how the person will live the rest of their stay. There are no formulas, but there are things teams do well, and signs worth not ignoring.

What the person loses on arrival

It is easy to think of the move as an exchange: out goes a house, in comes a room with care. For the person arriving, the list of losses is longer:

• The home, with its smells, sounds and familiar corners. That is where the memories are.
• The routines: the time they woke up, coffee on the balcony, the radio programme, the walk round the block.
• The objects: the furniture, the photographs, the blanket on the sofa. They rarely fit into a shared room.
• Control: over what they eat, when they bathe, who comes into the room.
• Neighbours and place: the grocer's, the church, the bus stop, the people who greeted them by name.

Nursing literature has a name for the set of reactions this can provoke: relocation stress syndrome. It includes anxiety, confusion, sadness, withdrawal and a sense of losing control. Studies disagree on how common it really is, and some authors warn that the label can hide a depression that needs to be assessed as such. But the underlying idea is sound: moving home in old age is a loss, and should be treated as one.

What the family feels

For the family, the decision is rarely simple. It often comes after months or years of caring at home, a hospital stay, a fall. It mixes relief with guilt, and tiredness with doubt. We wrote about that care at home in the family carer.

Some things families usually need to hear:

• That adjustment takes time and has good days and bad days, especially at the start.
• That there is no right number of visits. Alzheimer's associations note that some people need frequent visits in the first weeks and others need some space. It is a conversation to have with the team.
• That what they know is precious. Nobody knows the person like the family does, and that is what lets the team care well.
• That they can go on caring, in a different way: bringing objects, joining activities, being the bridge to the life before.

What teams do well

In homes where admissions go best, the same practices nearly always appear, and none of them is expensive.

Knowing the life story beforehand. Knowing where the person comes from, what they did, what they like, what annoys them, the names of the grandchildren and the dog. The Alzheimer's Society recommends that families pass on lifelong habits, likes and daily routines to staff, and there are simple tools for this. Our free Life story tool, at /ferramentas/, helps gather important themes, places and people so the team has them to hand from day one. We covered others in free tools for carers.

Bringing things from home. A photograph on the bedside table, the blanket, a clock, a chair. A familiar object says "this is mine too" in a way no decoration can.

Keeping old routines wherever possible. Someone who bathed in the evening for sixty years does not need to switch to mornings because that is how the rota works. Someone who woke at seven can keep waking at seven. Small adjustments make a big difference.

A named key worker. One member of staff who accompanies the admission, introduces themselves by name, explains how the home works and is the family's first contact. For someone who arrives disoriented, a face that keeps reappearing is a fixed point.

Introducing, not leaving. Show the lounge and the timetable, introduce two or three residents the person might get on with. Ask what they would like to do, instead of signing them up for everything.

These practices are also the questions we suggest families ask when they are choosing a care home.

Signs that adjustment is not going well

Some sadness at the start is expected. What is worrying is when the signs persist or worsen:

• persistent refusal to eat or drink;
• prolonged withdrawal to the room, refusing all contact;
• sleep problems that do not improve;
• a marked increase in confusion or agitation, especially if it comes on suddenly;
• statements of hopelessness, such as "there's no point any more";
• weight loss, new falls, giving up on personal care.

These signs justify talking to the home's clinical team and the GP. Persistent sadness may be depression, and depression can be treated. Prolonged isolation also has costs of its own, which we discussed in loneliness and social isolation.

Where RVer can fit, and where it can't

Not in the first days, and never by force. Someone who has just arrived needs people, routines and time, not a new activity with a device on their head.

Later on, if the person wants, a place from their home town, the village square, the church where they married or the holiday beach, can be a good starting point for conversation with those getting to know them. The life story helps choose, and if their place is not in the library that is said honestly, as we explain in when the person's place is not in the library. The session is short, accompanied, and stops whenever the person wants.

In summary

• Moving into a care home is a loss: of home, routines, objects and control. It deserves to be treated as such.
• The family feels relief and guilt at the same time; they need information, time and a role.
• Knowing the life story beforehand, bringing things from home, keeping old routines and having a named key worker are simple practices that help.
• Refusing food, prolonged withdrawal, sudden confusion or hopelessness are signs to raise with the clinical team.
• New activities, virtual reality included, come later, when and if the person wants.

This article is for information only and does not replace clinical assessment. If someone who has moved into a care home shows persistent sadness, refusal to eat or confusion, talk to the clinical team or the GP; in Portugal, SNS 24 (808 24 24 24) can advise and, in an emergency, call 112.

RVer is a virtual reality system for clinical use designed for healthcare settings, whose base product is registered as a Class I Medical Device in EUDAMED (Basic UDI-DI 56006195127RVERTZ) and with INFARMED (Portugal, CDM 94571546) and bears the CE mark under MDR 2017/745. The RVer Motion, RVer Neuro and RVer Exposure modules are in development and are not covered by that registration.