Navigating A Skilled Nursing Facility Stay Together: A Dyadic Qualitative Study of Dually Eligible Patients and Care Partners

Shared stressors are co-experienced by dyad members and increase each's psychological distress. This study analyzes dyadic qualitative data with dually eligible (i.e., Medicare and Medicaid beneficiaries) residents and their care partners during a subacute/post-acute skilled nursing facility (SNF) stay. We aimed to: (1) identify shared stressors that impact both dyad members; and (2) explore differences between dyad relationship types. Seventeen dyads (N=34 individuals) participated in semi-structured interviews during a SNF stay, separately. There were no exclusion criteria based on relationship type. The dyadic framework method was used to analyze dyads as a single unit, rather than the sum of separate narratives. The sample consisted of adult child (n=9, 53%), friend (n=6, 35%), sibling (n=1, 6%), and parent (n=1, 6%) care partners. Four themes emerged providing insight into shared stressors: (1) balancing autonomy and support; (2) long-term care decision-making; (3) cognitive concerns requiring attention; and (4) pre-existing relationships. Care roles and shared stressors were mostly similar across relationship type; although, some inter-dyad differences were noted in decision-making processes and interpersonal dynamics. This study identified multiple shared stressors that occur during SNF stays, as dyads must navigate changes to autonomy-support structures as well as the care environment, caregiving role, and existing relationship, together. We discuss implications for research, practice, and policy, including: dyadic psychological intervention; care partner training for psychological, behavioral, and case management; cognitive symptom assessment, education, and management; and support for long-term care decision-making and transitions.