Understanding and Preventing Relocation Stress Syndrome

Stress is typical during a move, but when it starts to drastically impact mental and physical health, it becomes an acute stress disorder commonly referred to as relocation stress syndrome (RSS). RSS, also called transfer trauma, is a set of symptoms that occur when an individual moves from one environment to another. The syndrome goes beyond normal stress and may cause significant health complications.

Read on to learn more about relocation stress syndrome, its symptoms, and how to prevent it while relocating senior loved ones.

RSS is a condition that can affect older adults moving to senior living facilities, according to the Journal of Psychosocial Nursing and Mental Health Services. Seniors with a previous history of depression, anxiety, pain, PTSD, and general health problems, as well as those who have pre-existing health conditions, have lived through traumatic events, or those who tend to avoid stressors or experience neuroticism (negativity, self-doubt, etc.) could be more prone to developing RSS.

For example, if a senior had a traumatic experience prior to their move, such as the loss of a loved one, a violent encounter, or a serious medical diagnosis, they could already be experiencing an acute stress disorder, making them more susceptible to developing RSS. Seniors with chronic physical pain and also women are more susceptible to developing RSS.

RSS was first discovered by nurses who witnessed it manifest while they cared for seniors in nursing homes and senior living facilities. The condition became recognized as distinct enough a syndrome to be classified on its own in 1992, when it was added as an official nursing diagnosis by the North American Nursing Diagnosis Association (NANDA), according to the journal Geriatric Nursing.

Typical RSS reactions include stress, depression, anxiety, or confusion, and they usually occur in the initial month after a person is exposed to what they perceive as a traumatic event, e.g., a move into a senior living facility. Ongoing symptoms can be as major as anxiety and depression, or as minor as changes in eating or sleeping habits. These symptoms can influence your loved one’s overall behavior, mood, and physiological well-being.

RSS can present itself in various ways. It’s important to recognize the signs of transfer trauma to prepare your loved one for their move to a senior living community. According to the journal Geriatric Nursing, the stress of relocating can look different for everyone, but here are a few common psychological symptoms to keep an eye out for:

• Anger
• Anxiety
• Apprehension
• Confusion
• Dependency
• Depression
• Insecurity
• Loneliness
• Withdrawal

According to this helpful pamphlet on RSS awareness published by the State of Wisconsin Board on Aging and Long Term Care, the physical signs of stress in the older person experiencing RSS could include the following:

• Body aches
• Changes in eating habits
• Difficulty sleeping
• Falls
• Headaches
• Stomach problems
• Weight change

Dangers of a misdiagnosis

“The effects of stress on the mind and body are well known,” said Tracy Mintz, a California-based social worker and a nationally recognized expert in relocation stress syndrome.

“This particular stress is a little bit different in that it is so easily misdiagnosed as a problem to do with aging. When people have stress, they tend to get angry or irritable, they can’t focus, they can’t think clearly, they have trouble making decisions. These are all also symptoms of dementia.”

The symptoms of dementia and RSS can overlap, which may cause a misdiagnosis, according to Mintz. RSS can often go unseen, with symptoms instead attributed as delirium or dementia. A senior may not have dementia but may simply be confused by waking up in a long-term care facility they don’t remember choosing.

This is why it’s important to be prepared when moving your loved one to a senior living community and to support their continued involvement — so the necessary precautions can be taken to avoid confusing them to a point of delirium, risking a dementia misdiagnosis.

Let our care assessment guide you

For seniors already with a dementia diagnosis, the risk of RSS is greater as they are unable to participate in decision-making and have difficulty assimilating new information. Their limitations in short-term memory and new learning memory disrupt their ability to cope with change, said Kim Warchol, founder and president of Dementia Care Specialists.

You can be proactive about your loved one’s move and take preventative measures to lessen the chance of RSS and transfer trauma. The hardest part about moving your elderly loved one is getting them to feel at home.

“Even if a move is eagerly anticipated, anxiety and depression can hit a senior suddenly, much like post-partum depression can surprise a new mom,” Mintz said. “I tell people [that] home is a feeling. You should be able to achieve the feeling of home anywhere, but when you yank people out of what their concept of home is, it can be very traumatic.”

Sometimes the stress of a move can overshadow the positives. It’s important to show your loved one that moving also comes with opportunities to refresh an old routine, pick up new hobbies, make new friends, and more. Shifting the perspective to the positives can help ease the transition for seniors to avoid any added trauma or stress.

To help the transition go smoothly, you can try the following steps with your loved one:

1. Talk to hospital advocates. If your loved one is being released from a hospital, the hospital will typically have advocates or “navigators” on staff to help make the transition into a senior living facility as smooth as possible.
2. Involve your loved one in the decision-making. If they insist on going home, allow them to try it out. When the need to move to a long-term care facility becomes obvious, work to include them in the decision process to help ensure their preferences are accounted for.
3. Make sure your loved one knows exactly what’s happening. Keep them in the loop. Never just drop them off at a facility they haven’t vetted. “I don’t believe in infantilizing seniors,” Mintz said. “They are adults and they deserve the dignity of being told honestly what’s going to happen.”
4. Acknowledge your loved one’s fears. If they ask, “What if I don’t like anybody there?” Mintz suggested not to lie or sugarcoat the situation. Instead say, “I’m not sure. We’re going to find out.” Try to keep an open mind, remain flexible, and present it as a process you are going through together.
5. Validate their feelings. “Allow them the space to feel whatever they’re going to feel. Maybe they’ll feel excited. Maybe they’ll feel relieved because they were just barely holding it together at home. Maybe they feel nervous and terrified. These are all perfectly valid feelings,” Mintz said.
6. Where possible, try to recreate their old home in their new home. “We don’t invest enough time in recreating that [home] feeling at the new location,” Mintz said. Take pictures of their bedside set-up and the top of their dresser, and work with them to recreate it with the same items.
7. Encourage them to get involved in their new community. Communities offer a range of activities, so make sure to coordinate with staff to help your loved one continue their favorite hobbies and pastimes. This will also help them form new friendships and get familiarized with staff.

“There are two magic words in all of this and they are ‘you’re right,’” Mintz said. Your elderly loved one wants to feel heard more than anything, so make sure not to dismiss their thoughts and complaints.

If you can afford it, consider hiring a senior move manager. There are more than 900 move management companies in the U.S. devoted to moving seniors and setting up the perfect space for them, according to the National Association of Specialty & Senior Move Managers. Move managers can even help your loved one clean out their old home.

Read more:5 Tips to Help Your Parent Transition to Assisted Living

“So what to do if you suspect a loved one has RSS? You can connect them with a therapist to help them work out the underlying issues with the move. Larger assisted living communities may have groups to welcome new members. Sign your parent up and encourage them to mingle with others,” Mintz said.

Perhaps the biggest thing you can do is change the way you address the issue with your loved one. Instead of forcing them to embrace the change, acknowledge their personal fears and sadness related to the change.

The best way to help your loved one overcome RSS is to get everyone involved. The senior’s family, friends, caregivers, and staff members should learn to recognize the signs of transfer trauma, so they can be prepared to help them through it, according to the journal Canadian Nursing Home and the Journal of Practical Nursing.

Here are specific ways that caregivers, staff, friends, and family can help:

• Professional guidelines. Some professional staff may have been trained to recognize RSS symptoms and best practices, so they are equipped to work with new residents, their families, and caregivers to develop a plan to keep transfer trauma at a bay.
• Workshops. Communities may set up workshops that incorporate the topic of RSS. This gives the senior, their caregivers, family, and staff an outlet to express their feelings, which can help residents feel less alone in their situation.
• Control and self-identity. It’s important for staff and loved ones to help seniors feel in control by enabling them to make decisions when it comes to organizing their personal space, picking out what to wear, choosing what to eat, and more. Staff should also take time to learn what residents prefer to be called – some prefer their first name or nickname, while others prefer Mr., Mrs., or Dr.
• Privacy. It’s hard for some residents to feel a sense of privacy in senior living communities, especially if they’re sharing a room or apartment. It’s important for families and staff to help roommates establish boundaries so everyone can live harmoniously together.
• Making friends. Many senior living residents experience loss prior to their move, such as the loss of a spouse, their previous good health, or the many possessions that filled their home. These losses can delay their interest in making new friends, so it’s important to acknowledge these losses while consistently presenting them opportunities to get involved in activities they love.
• Celebrate contentment. It’s important to celebrate small pleasures and joys. If you or a staff member sees the senior enjoying themselves, positively comment on it so they can see how far they’ve made it. Staff and family should remember to celebrate progress, too, since they’ve played an integral role in the senior’s well-being.

Transfer trauma will typically subside within a few months. The first six to eight weeks are typically the most difficult for new residents, according to the Journal of Gerontological Nursing. Difficulty can last up to several months for some, according to The Gerontologist. What you don’t want to do in the meantime is move them again.

“That is just layering trauma on top of trauma. Moving again is not the anecdote to moving,” Mintz said. “If, after six months, your loved one hasn’t been able to settle in — or is constantly sick or very depressed or there’s some really big significant change like they used to be independent in toileting and now they’re not — then that’s significant.”

In this case, Mintz recommends seeking out the help of your loved one’s family doctor, the Family Caregiver Alliance, or, if your loved one has Alzheimer’s disease or dementia, the Alzheimer’s Association.

Talk with a Senior Living Advisor

Whether your loved one has transitioned to assisted living or independent living, it’s crucial to involve them in any way possible. Including them in small and big steps can help ease relocation stress and help them adjust sooner.

Sources:

Bryant, R. (2019, April 12). Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. UpToDate.

Grant, P. R., Skinkle, R. R., Lipps, G. (1992, December 1). The Impact of an Interinstitutional Relocation on Nursing Home Residents Requiring a High Level of Care. The Gerontologist, 32(6), 834–842.

Melrose, S. (2004). Reducing relocation stress syndrome in long term care facilities. Journal of Practical Nursing, 54(4), 15-17.

Melrose, S. (2013). Relocation stress in long term care: How staff can help. Canadian Nursing Home, 24(1), 16-19.

Manion P. S., Rantz M. J. (1995, June). Relocation stress syndrome: a comprehensive plan for long-term care admissions. Geriatric Nursing, 108-12.

Mikhail, M. L. (2021, May 5). Psychological responses to relocation to a nursing home. Journal of Gerontological Nursing, 18(3), 35-39.

Walker, C., Curry, L. C., Hogstel, M. O. (2007, January 1). Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality?Journal of Psychosocial Nursing and Mental Health Services, 45(1).

Williams, Amber Lois. (2013, May 9). On the environmental factors that alleviate relocation stress syndrome in residents of long-term care facilities. Master’s Theses and Doctoral Dissertations, 457.

State of Wisconsin Board on Aging and Long Term Care Ombudsman Program. (2005, April). Awareness: Relocation Stress Syndrome.