What is Transfer Trauma?

Transfer trauma is a term used to describe the stress that a person with dementia may experience when changing living environments. Transfer trauma is more commonly seen in the person with early stage dementia and when one is moving into a facility from their lifelong home. The length of time and severity of the transfer trauma is quite individual. For some, the stress associated with the move may be fairly significant, and for others mild or not at all. For some, the stress may last for a few days, and for others a few weeks.

This stress is usually temporary in nature and relieved as the individual builds friendships, gains trust, and develops a sense of purpose and belonging in their new community.

Complications of Transfer Trauma

If transfer trauma is not immediately identified and reduced, there can be significant negative consequences such as the person being a very high elopement risk. And if this trauma extends for any period of time the person may be at risk for isolation and depression, anxiety, resistance to care, and similar behavior disturbances.

These behavior disturbances may then be treated with the typical psychotropic drug therapies which come with many side effects.

Therefore, our recommendation is for all communities to be aware that many individuals with dementia will experience transfer trauma when they move in to long-term care, and therefore there should be a proactive plan in place to minimize its effects and duration.

Recommended Interventions

All staff must be trained to both build a strong relationship with the new resident and to help residents build peer relationships. We must also try to facilitate a sense of real purpose and belonging by encouraging the residents to do as much for themselves as desired and to make themselves at home.

For example, residents should be encouraged to use the laundry facilities, make themselves a cup of coffee, get their own cereal in the morning, straighten up their room, turn the TV on to watch the baseball game, host a family party in the private dining area, tend the garden, deliver the mail, etc. Whatever they desire, they should be enabled to do. This is what helps make the facility their home.

The family may also experience stress and guilt during the first couple of weeks after they have made the decision to move their loved one into the community. This is quite normal.

Often in the early stage of dementia, a person does not recognize their own deficits. In fact, they believe that they're still capable of caring for themselves, when in reality they are not. Lack of safety is usually an initial sign and a reason many families choose to move their loved ones into a community.

This lack of awareness and recognition of deficits by the person with dementia puts added stress on the family. I have seen many residents call their families and say, "Why have you done this to me? I disagree with this decision. I am fully capable of living at home. I don't want to stay here anymore."

The family has the tall task of staying the course. A lot of resolve is required to not bend or waiver in the decision. Families often know the time has come for their loved one to live in a supervised, specialized community. However, staying true to this decision can be challenging.

Therefore, at the same time that we provide the new residents with a living environment which promotes their individuality and their functional and emotional potential, the family must be educated and supported. We recommend communicating with the family early and often on a one-to-one basis. And, we recommend that your facility host an Alzheimer's Support Group in which families can receive support and guidance from others who have experienced the guilt and stress of moving someone into a long-term community. There is much power in families sharing with one another.

The Role of the Therapist in Reducing Transfer Trauma

If the transfer trauma causes a decline in function or safety, this opens a window of opportunity for the therapist to serve.

An occupational, physical, or speech therapist may be required to perform an assessment followed by establishing a plan to maximize the person's functional potential with emphasis on reducing the behaviors.

This of course requires the therapist to get to know the person inside the patient. The person's complete Life Story should be obtained in order to determine how to build a customized treatment plan that encompasses their individuality. [Download the Life Story Questionnaire [PDF]

For example: A resident may withdraw and refuse ADL care. This may lead to maximum or total assist. The therapist should evaluate and observe the person in the environment, as that might identify that the care staff is not incorporating the person's routines and preferences and therefore is feeding into the concept of "this is not your home" or "you have no control or choice here."

Treatment would therefore include educating caregivers on how to create a daily routine that mirrors the person's past preferences and routines, in addition to teaching the caregivers how to adapt the task and the environment for maximum self-performance (incorporating Allen Cognitive Level assessment results).

In my experience in which the interdisciplinary team understood the steps to reduce transfer trauma, we were very successful. Rarely did a person's transfer trauma symptoms last longer than 30 days. During these 30 days we were on high alert for elopement risk and we also worked hard to create an individualized plan of care and a daily routine that had meaning and purpose for the new resident. We were almost always successful.

One of the greatest elements to our successful intervention protocol was friendship. Just as WE all need a friend to share conversation, laughter, and sorrow, so does the person with dementia. And, they will need this even more when thrust into an unfamiliar place to live.

Yes, we helped the new resident establish friendships with other residents of the community. This was a big part of our team's efforts. But most importantly, it all began with the recognition that any time any of us had to spend with the new resident was first and foremost an opportunity to make a new friend.

Originally posted November 2010. Updated July 2015.

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