Senior Care Coalition

networking for senior services in greater Seattle

Reducing Relocation Stress

December 12, 2011
Annie Jacobsen, MA

How to get moving without getting the moving blues

We all have moved our primary home at least once or twice in our lives; many of us more times than we care to count. Moving is often cited as one of life’s largest stressors. As a Move Management service, we at Assisted Transitions often meet people who respond with, “Oh, I hate moving!” This is then frequently followed with their personal “nightmare move” story. I expect some of you reading this have visions of broken glass, boxes with things falling out of the bottom, family arguments, and huge dollar signs running through your mind. So, whether you or your parents are looking at an upcoming move, here is a guide to help identify and hopefully minimize or prevent Relocation Stress Syndrome.

Stress-related ailments reportedly account for at least 75% of all doctor visits in the U.S. Relocation Stress Syndrome (RSS), also referred to more casually as “Transfer Trauma” or “Moving Blues,” was recognized by the Journal of the North American Nursing Diagnosis Association as an official nursing diagnosis in 1992 ("Relocation Stress Syndrome", Barnhouse AH, Brugler CJ, Harkulich JT., Nursing Diagnosis, 1992 Oct-Dec; 3(4): 166-8). Defined as “the physiological and psychosocial disturbances that result from a transfer from one environment to another.” Studies on RSS have primarily focused on seniors in nursing homes, often a population 70 years and older. However, we see each week how the process of moving can create great stress for people of any age.

WHAT IS RSS?
The 5 primary symptoms of Relocation Stress Syndrome, as defined by Nursing Diagnosis, are:
· Anxiety
· Confusion
· Dependency
· Depression
· Withdrawal
Additional common symptoms may include: loneliness, stress, lack-of-sleep, hopelessness, financial strain, and a need for “excessive” reassurance.

Besides the increase in tension and emotionality that RSS can bring, there is significant reported increase among seniors in:
· Falls, which can lead to all levels of injury
· Self-care deficits, such as forgetting to take medications and poor hygiene habits
· Rapid weight loss
· Fear of social situations, isolation, hermiting, anti-social behavior

Loss may also be experienced in relation to:
· Familiar routines - simply finding the silverware or stamps
· Familiar friends and neighbors - even the cat who visits from across the street
· Familiar lifestyle - coffee shops in walking distance
· Familiar structure - room layout, TV stations, neighborhood sounds

TOOLS TO MINIMIZE RELOCATION STRESS SYNDROME
Each of our personal experiences in life highlight and inform how we perceive situations, and an emotionally inflamed experience of moving often can seem melodramatic, difficult or unnecessary to the outside observer.

By being aware of and addressing these common emotional responses to changing one’s home, move managers can help ease this process and minimize the intensity and/or duration of RSS. There is often a sense of loss of personal and environmental control when changing one’s home. Simply moving from two basins to a single one in a bathroom can require a big shift in the bedtime habits for a long-married couple.

One of the best preventative steps is to involve family, move managers and caregivers in the earliest stages of the move process, so they become familiar with normal patterns, personality and moods of the individual or couple. They then will be able to watch for signs of unusual behavior. Additionally, this period will enable the individual or couple to become familiar with their new caregiver and service providers at a gradual, more comfortable pace. Once any signs of RSS appear, steps may be taken to adjust the pace or method of the move to lessen the anxiety.

Anxiety is often heightened when the relocation is rushed – often the case if there has been an injury or illness that necessitates going to assisted care from the hospital, rather than being discharged to their long-time home. In this situation, the person managing the move can help make their new environment feel much more familiar and much like their prior home. Move Managers can help select similar paint colors for the walls, reposition treasured items in curio cabinets as they were previously found, hang favorite paintings or photos on the walls and take care of other small, but important, details. The individual or couple will find comfort and a sense of “homecoming” when their favorite items are visible and thoughtfully displayed.

A lack of choice, or even the sense that their choice is limited, may increase stubbornness, fear of loss, and apprehension about the many components of an imminent change. When decisions need to be made during the downsizing process and an individual cannot return to their home to participate, it helps to take photos of items and bring them to the individual. Just seeing their possessions can help make decisions easier and increase confidence in the results. Also helpful is to sort items based on defined groupings (all blue pottery separate from all red pottery; or all magazines can go except the National Geographic collection). We all keep our possessions for differing reasons. When you are helping in the downsizing or moving process, it’s better not to try to understand the underlying logic for their decisions, but rather allow individuals the opportunity to make choices for themselves. We all would want the same respect.

The degree of change may be from a 3,500 sf home of 40 years to a 350 sf apartment with no yard, no view and “all these unfamiliar people around all the time.” It can feel quite daunting. A good starting point is finding where you or your loved one will live even a year or two ahead of when you plan to move. This allows the best opportunity to find a home that feels welcoming and desirable. And, it allows for a more gradual timeline to accept the coming change.

One final catalyst for higher likelihood of RSS is a lack of predictability or control over one’s environment. The perceived lack of predictability can lead to stress and fear. Often families try to minimize these feelings of lack of control. However, their underlying urgency belies their words. This may cause even more fear and apprehension as the senior now has a feeling they are being lied to, as well as forced to make a change.

ASSISTANCE FROM MOVE MANAGERS
Relocation Stress Syndrome, in the worst case may last from several months to more than year. Some seniors never quite recover from the change. In the best case scenario, effects of RSS last 4 weeks or less. Any change has its challenges and period of adaptation. The goal is to make these as easy, brief and pain-free as possible.

The qualified and experienced Move Manager can provide relief and tools to minimize RSS, and enhance a sense of optimism surrounding a senior move. At Assisted Transitions we work with families as much as 2-3 years preceding their move. Even 2-3 months is a much more empowering and calming option than a move occurring within a month or even less. Our specialty is reducing and, ideally, avoiding RSS and chaos and planning, with a focus on details (finding the right retirement community; paint colors; furniture layout; pet care during move; meals, medications, change of clothing on move day, etc.). Many Move Managers offer free initial visits, which can help address concerns and answer questions, which begins the relocation process positively.

In our years of personalized Move Management experience, we have found these additional considerations to be extremely useful for our clients.
· Get “buy in” from the person moving! Ask the individual or couple what it is they want from the move
· Take an Appreciative Inquiry approach; consider discussing what makes it feel like home (“describe your ideal day in 3 months”)
· Take time to consider, not rush the move
· Be flexible – let changes happen, if necessary – indecision is not the enemy
· Consider best roles for family roles and responsibilities
· Retain daily routine as much as possible
· Specific care and attention to move favorite items and personal treasures
· Arriving at the new home – would the individual or couple prefer to be part of where things go or prefer their home be completely set up?
· Engage them to verbalize their fears and desires for this move
· As much as possible, prepare, prepare, prepare
· Minimize differences in environment
· Make this a team approach, including both physical and mental support

At Assisted Transitions, we embrace that opportunity to work with our clients as unique and wonderful individuals, and treat them as we would our own loved ones. For more information, call 206-841-6440, email us at info@assistedtransitions.net or visit our website at www.assistedtransitions.net.

Annie Jacobsen, MA
· 1995 Founded Assisted Transitions
· 2001 Masters in Whole System Design – Focused on Family Systems and Change Management, Antioch University, Seattle Campus