Characteristics and unmet care needs of unbefriended residents in long-term care: a qualitative interview study

Objectives: This study explored the impact of being 'unbefriended' for residents in Canadian long-term care (LTC) homes. Residents are 'unbefriended' if they lack decision-making capacity and family or friends to act as their legal representative. Research suggests that unbefriended individuals may have unmet needs and experience poor quality of care due to their limited social support. Our specific objectives were to identify resident characteristics, their unmet care needs, and implications for quality of care and quality of life. Methods: We conducted semi-structured interviews with 39 LTC staff and 3 public guardians. Interviews took place between March 2017 and September 2017. All interviews were audio recorded and transcribed verbatim. We analyzed the interviews using content analysis. Results: We found two groups of unbefriended LTC residents: (1) individuals with no living conjugate partner or children and (2) individuals with histories of substance use, homelessness, and estrangement from family. Unbefriended residents have no one to help meet needs for social interaction and engagement or to assist in purchasing needed personal items and uninsured services. LTC staff report significant care issues with unbefriended residents at end of life, including more aggressive behaviors and inappropriate care practices. Conclusion: Our findings demonstrate alarming issues in quality of life and quality of care for unbefriended residents. Unbefriended residents had limited social support and difficulty accessing even basic personal items. We discuss implications for policy and practice.