Ambiguous Loss and Meaning Reconstruction Following Dementia Nursing Home Placement

When a spouse with dementia enters a nursing home, the transition entails not only changes in caregiving responsibilities but also ambiguous forms of loss. Despite physical separation, spouses often remain deeply involved, confronting relational, role-based, and identity disruptions. Yet little is known about how these intersecting losses are experienced over time. Using a constructivist grounded theory approach, in-depth interviews were conducted with nineteen spousal caregivers aged 65 and older whose partners had been placed in a nursing home within the previous 3 to 30 months. Data were analyzed iteratively using constant comparison. Findings conceptualize meaning reconstruction as a dynamic process through which caregivers continually reinterpret the self amid ambiguous loss across time. This process comprises three interrelated patterns: (1) fracture and dislocation, marked by loss of role clarity, moral distress, and relational rupture; (2) ambivalence and negotiation, characterized by tensions between loyalty and autonomy, emotional bonds, and ongoing grief; and (3) reclamation and emergence, involving tentative reconstitution of identity beyond caregiving. These patterns are non-linear and do not culminate in resolution; rather, caregivers move between them over time, repeatedly reconstructing identity and relational meaning amid cumulative loss. These findings highlight the ongoing nature of loss following nursing home placement, positioning spousal caregiving as a site of indeterminate loss experience. The study advances understanding of ambiguous loss in later life by showing how identity and relational meaning are continuously reconstructed without resolution. Implications underscore the need for supportive interventions addressing the persistent and morally complex nature of loss after institutionalization.