EXPLORING THE SOCIO-EMOTIONAL EXPERIENCES OF ADULTS WITH 

CEREBRAL PALSY IN A RESIDENTIAL CARE FACILITY IN 

JOHANNESBURG, SOUTH AFRICA 

 

A report on a project presented to 

 

The Department of Social Work 

School of Human and Community Development 

Faculty of Humanities 

University of the Witwatersrand 

 

In partial fulfilment of the requirements 

For the Degree Bachelor of Social Work 

 

By 

 

Dimpho Tsiane 

 

January, 2017 



 

DECLARATION 

I hereby declare that this report is my own unaided work and that the assistance obtained has 

been only in the form of professional guidance and supervision, that neither it nor any part 

of this report has been previously submitted to any other university for any degree save the 

one for which I am presently registered as a student; that the information used in this report 

has been obtained by me while working under the aegis of the Department of Social Work, 

University of the Witwatersrand; and that all references used have been acknowledged and 

appropriately cited. 

 

                                                                 

         Signature           Date  



 

 

 

ACKNOWLEDGEMENTS 

To my research supervisor, Ms Laetitia Petersen, for your patience, support, dedication and 

commitment, thank you. This paper benefitted so much from your gentle guidance, without 

you, it would not have been complete. 

To Ms Amanda du Toit and the residential care facility, thank you so much for allowing me 

to use the wonderful residents. Their contribution is what made this paper possible. 

To friends, family, my wonderful mother Felleng Tsiane and amazing fiancé Bhekisisa 

Nyanda, through all the tears and low moments, thank you for the support and 

encouragement. 

And lastly to the Almighty for keeping me strong throughout my darkest hours and providing 

the friends, family and staff who helped me complete this research paper. 

  



 

ABSTRACT 

There has been much written on the biomedical concerns of cerebral palsy, yet there has 

been very little researched or reported on the socio-emotional aspects of cerebral palsy in a 

residential care facility. This study aimed to explore the socio-emotional experiences of 

adults with cerebral palsy in a residential care facility. The study made use of an exploratory 

qualitative design and employed semi-structured interviews with a purposive sample of 10 

cerebral palsied adults. Some important findings that emerged from a thematic qualitative 

analysis of the data included being overwhelmed by the new environment; feelings of 

freedom, happiness and independence; support from various role players; age and 

communication challenges; and residents accepting circumstances and remaining positive. 

The main conclusion drawn from the study was that despite the challenges the residents 

faced, they were resilient enough to employ coping methods that assisted them through the 

process. 

Key words: cerebral palsy, socio-emotional, transitioning, residential care facility 

  



 

TABLE OF CONTENTS 

 

Declaration ............................................................................................................................ i 

Acknowledgements .............................................................................................................. ii 

Abstract ............................................................................................................................... iii 

Table of contents ................................................................................................................. iv 

CHAPTER ONE: INTRODUCTION 

1.1 Introduction ................................................................................................................... 1 

1.2 Statement of the problem .............................................................................................. 1 

1.3 Rationale ......................................................................................................................... 2 

1.4 Aim of the study ............................................................................................................. 3 

1.5 Research Objectives ...................................................................................................... 3 

1.6 Definition of key terms .................................................................................................. 3 

1.7 Research Design and Methodology .............................................................................. 3 

1.8 Limitations of the study ................................................................................................ 4 

1.9 Overview of the research report................................................................................... 4 

CHAPTER TWO: LITERATURE REVIEW 

2.1 Introduction ................................................................................................................... 5 

2.2 The challenges of caring for a cerebral palsied individual ........................................ 5 

2.3 Relocating ....................................................................................................................... 6 

2.4 Transitioning .................................................................................................................. 7 

2.5 Residential care .............................................................................................................. 7 

2.6 Social experiences .......................................................................................................... 8 

2.6.1 Social support .............................................................................................................. 8 

2.6.2 Social isolation ............................................................................................................ 8 

2.6.3 Family and friends ...................................................................................................... 8 

2.7 Emotional experiences ................................................................................................... 9 



 

2.7.1 Loneliness .................................................................................................................... 9 

2.7.2 Loss ............................................................................................................................ 10 

2.8 The role of staff ............................................................................................................ 10 

2.9 Protective methods and/or interventions ................................................................... 11 

2.9.1 Organised activities .................................................................................................. 11 

2.9.2 Pets and animals ....................................................................................................... 12 

2.10 Theoretical framework.............................................................................................. 12 

2.10.1 Transition process framework .............................................................................. 12 

2.10.2 Biopsychosocial theory ........................................................................................... 14 

2.11 Summary of chapter .................................................................................................. 15 

CHAPTER THREE: METHODOLOGY 

3.1 Introduction ................................................................................................................. 16 

3.2 Aim ................................................................................................................................ 16 

3.3 Objectives ..................................................................................................................... 16 

3.4 Research Questions ..................................................................................................... 16 

3.5 Research Approach and Design ................................................................................. 17 

3.6 Population and Sampling ............................................................................................ 17 

3.7 Research Instrument ................................................................................................... 18 

3.8 Pretesting of the research instrument ........................................................................ 18 

3.9 Data collection .............................................................................................................. 19 

3.10 Data analysis .............................................................................................................. 20 

3.11 Trustworthiness ......................................................................................................... 21 

3.12 Ethical considerations ............................................................................................... 21 

3.13 Summary of chapter .................................................................................................. 23 



 

CHAPTER FOUR: PRESENTATION AND DISCUSSION OF FINDINGS 

4.1 Introduction ................................................................................................................. 24 

4.2 Participant demographics ........................................................................................... 24 

4.3 Overview of objectives and themes ............................................................................ 25 

4.4 The socio-emotional experiences of residents about transitioning and adjusting to 

the facility ........................................................................................................................... 26 

4.5 Post-admission challenges experienced in the residential care facility ................... 30 

4.6 Recommendations on residential improvements to make residents’ transitions 

easier ................................................................................................................................... 32 

4.7 Recommendations for self to improve the socio-emotional experiences of adjusting 

and transitioning ................................................................................................................ 34 

4.8 Chapter Summary ....................................................................................................... 35 

CHAPTER FIVE: MAIN FINDINGS, CONCLUSIONS AND 

RECOMMENDATIONS 

5.1 Introduction ................................................................................................................. 36 

5.2 Summary of key findings ............................................................................................ 36 

5.2.1 The socio-emotional experiences of residents about transitioning and adjusting to 

the facility ........................................................................................................................... 36 

5.2.2 Post-admission challenges experienced in the residential care facility ................ 36 

5.2.3 Recommendations on residential improvements to make residents’ transitions 

easier ................................................................................................................................... 37 

5.2.4 Recommendations for self to improve the socio-emotional experiences of 

adjusting and transitioning ............................................................................................... 37 

5.3 Conclusions .................................................................................................................. 38 

5.4 Recommendations ........................................................................................................ 38 

5.4.1 Recommendations for social work practitioners ................................................... 38 



 

5.4.2 Recommendations for residential care facilities .................................................... 38 

5.4.3 Recommendations for future research ................................................................... 39 

5.5 Concluding comment ................................................................................................... 39 

References........................................................................................................................... 40 

Appendix A ......................................................................................................................... 43 

Appendix B ......................................................................................................................... 44 

Appendix C ......................................................................................................................... 45 

Appendix D ......................................................................................................................... 46 

Appendix E .....................................................................................................................................48 

 

LIST OF FIGURES 

Figure 2.10.1: Transition Process Framework ..................................................................................13 

LIST OF TABLES 

Table 4.2.1: Demographic Profile of Participants .............................................................................24  

Table 4.3.1: Objectives and Themes .................................................................................................25 

 

 

 

  

 

  



1 
 

CHAPTER ONE 

INTRODUCTION 

1.1 Introduction 

There are 7.5% of people living with disabilities in South Africa (Statistics South Africa, 

2011). Despite disability not being an inherent reason not to participate in socio-economic 

and recreational activities, the World Health Organisation (2011), hereafter referred to as 

WHO, acknowledges that people living with disabilities are often marginalised and their 

lives are often characterised by prejudice, social isolation, poverty and discrimination in all 

societies. It is this South African demographic that inspired the study. 

Cerebral Palsy is a common neurological problem in children and is reported as occurring 

in approximately 2-2.5 of 1000 live births globally (Donald et al., 2014). It was originally 

reported by Little in 1861 and initially called “cerebral paresis” (Rosenbaum et al., 2006). 

For the past one hundred years, cerebral palsy has been the subject of books and papers by 

some of the most distinguished medical minds (Rosenbaum et al., 2006). Although not 

extensively so, the scope of the study of cerebral palsy, both in South Africa and globally, 

has been of a medical focus. This condition begins very early in childhood and persists right 

through to adulthood.  

Adults with cerebral palsy have been documented to participate less in in areas such as social 

interactions, employment, marriage, and independent living (Liptak, 2008). As a result of 

their disability, some people with cerebral palsy end up living in residential care facilities 

where they receive round the clock 24-hour care. 

This chapter will highlight, very briefly, the research problem, the rationale for the study as 

well as the aims, objectives and definitions of key terms. A basic description of the 

methodology, research design, as well as an overview of the research report will be 

discussed. 

1.2 Statement of the Problem 

Moving to a new environment can be distressing and bring with it a plethora of social and 

emotional challenges. Relocation is a transition that can disrupt existing social networks and 

it can be challenging for the individual affected to reconstruct the social networks (Dupuis-

Blanchard, Neufeld & Strang, 2009). According to Jungers (2010) loneliness is a risk of 

anticipated transitioning from one environment to another and for some people the feeling 



2 
 

of loneliness is strongest during the beginning of the adjustment phase and for others the 

loneliness never goes away.  

There seems to be limited research on the socio-emotional experiences of adults with 

cerebral palsy in residential care. According to Hubbard, Tester and Downs (2003) residents 

living with disabilities tend to be excluded in research and they are more likely to experience 

social and emotional isolation in institutional care. Their study on the meaningful social 

interactions between older people in institutional care settings found that the most common 

activity amongst residents is talking and most conversations are centred on feelings about 

living in the facility (Hubbard et al., 2003).  

Furthermore, South African research around cerebral palsy is medically focused. Cerebral 

palsy in South African research is seen mainly as a condition that requires treatment, as with 

the biomedical model. According to a review by Donald et al. (2014) that aimed to establish 

what has been reported about cerebral palsy on the African continent, the results showed 

sixteen publications on the prevalence and aetiology of cerebral palsy, four of which were 

from South Africa. This shows how limited research into cerebral palsy is, not only in South 

Africa, but on the continent as well. A look at these studies showed that they were medically 

oriented and were concerned with the condition itself and not how people live with it beyond 

the hospital, especially within residential care settings.  

1.3 Rationale 

The rationale for this study was that the study could have the potential to fill a portion of the 

knowledge gap on cerebral palsy and the socio-emotional experiences of residents living 

with this disability in a residential care facility. This study further hoped to provide an 

understanding of the social and emotional experiences of adults with cerebral palsy that have 

transitioned from their homes into a long term residential care facility. It was anticipated that 

this study would help social workers tailor interventions that will help residents adjust and 

transition into residential settings appropriately, as well as to give social workers working in 

such settings an understanding of the socio-emotional experiences that residents may have 

with regards to moving in. It is also expected that the study will yield recommendations that 

may contribute to helping service professionals in the relevant settings and field to tailor 

appropriate, future programs that will help residents adjust to and experience being in a 

residential care facility positively.  

 



3 
 

1.4 Aim of the Study 

To explore residents’ socioemotional experiences with regards to transitioning and adjusting 

to a residential care facility 

1.5 Research Objectives 

 To understand the socio-emotional experiences of residents about transitioning and 

adjusting to a residential care facility. 

 To explore the challenges that residents experience whilst in a residential care 

facility. 

 To identify the participants’ recommendations on how transitioning and adjusting to 

a residential care facility can be made easier for them 

 To identify the participants’ recommendations on what they can do to improve their 

socio-emotional experiences of adjusting and transitioning into a residential care 

facility. 

1.6 Definition of Key Terms 

Cerebral palsy - “Cerebral palsy is primarily a disorder of movement and posture. It is 

defined as an umbrella term covering a group of non-progressive, but often changing, motor 

impairment syndromes secondary to lesions or anomalies of the brain arising in the early 

stages of its development” (Sankar & Mundkur, 2005, p. 865)  

Socio-emotional - Santrock (2007) defines socioemotional experiences as a process that 

occurs in a person’s emotions, personality and relationships with others during one’s 

lifetime. 

Transitioning - is defined as “a psychological process where people gradually accept the 

details of the new situation and the change that comes with it” (Bridges, 2013, p. 4). 

Residential Care Facility - is defined as a licensed facility that provides 24-hour care to 

residents who are semi-dependent and supervises residents’ diets, prepares meals, organises 

social activities, assists with personal care, provides housekeeping, stores and distributes the 

residents’ medication and supervises healthcare under the direction of a licensed health 

professional (Alzheimer’s Association, 2005; Older Persons Act, 13/2006). 

1.7 Research Design and Methodology 



4 
 

The methodology for the study was exploratory qualitative research. Qualitative research “is 

a means for exploring and understanding the meaning individuals ascribe to a social human 

problem” (Creswell, 2014, p. 4). The research design was exploratory research design which 

is used to gain insight into a phenomenon, situation or individual due to either a lack of 

information on a new area of interest or to get acquainted with a situation (Fouché & de Vos, 

2011). The participant sample was recruited through the application of a non-probability, 

purposive sampling method. 10 semi-structured interviews were conducted with 10 

participants who were between the ages of 22 and 69. The data that was collected from the 

study was analysed using thematic analysis. 

1.8 Limitations of the Study 

Due to the small, non-probability, purposive sample size of 10 participants, the knowledge 

that may be produced from this study might not be able to be generalised to other populations 

with cerebral palsy in residential care and may only be unique to the population included in 

the study. The results of the study relied heavily on the answers of the participants, it is 

possible that the researcher may have gotten socially desirable answers; it may also be 

difficult to independently verify the data collected. 

1.9 Overview of the Research Report 

This research report is comprised of a total of five chapters. Chapter One gives a summary 

of all the main elements of the study comprised of the problem statement, the rationale of 

the study, the aims and objectives of the study, definition of key terms as well as the 

methodology employed for the study. Chapter Two discusses the literature that underpins 

this study. Chapter Three details the research design and methodology used for the study. 

The findings of the research will be presented and discussed in Chapter Four and Chapter 

Five is based on the discussion of the main findings and will also present and discuss the 

conclusion as well as recommendations that emanated from the study. 

  



5 
 

CHAPTER TWO 

LITERATURE REVIEW 

2.1 Introduction 

There has been much written on the biomedical concerns of adults with cerebral palsy, 

however there has been very little written on the psychosocial, let alone socio-emotional, 

aspects of cerebral palsy (Horsman et al., 2010). A review by Donald et al. (2010) found that 

the estimated prevalence for cerebral palsy in South Africa is 10 per 1000 children born. 

This is much higher than the global prevalence rate, yet there is very little, beyond the 

biomedical, that we know about this particular population. Much of cerebral palsy research 

is centred around children, mainly because cerebral palsy is diagnosed after a child turns one 

and for many people, it is seen as a paediatric condition (Sankar & Mundkur, 2005). 

However, according to Haak et al. (2009) children with cerebral palsy almost always grow 

up to be adults yet little is known about how the experience of aging and quality of life in 

people with cerebral palsy differs from the experience of adults without known disabilities. 

Hubbard, Tester and Downs (2003) say that existing work on people’s social interaction in 

institutions has tended to exclude those with severe disabilities and with whom 

communication is difficult due to sensory or cognitive impairments. Furthermore, Hubbard 

et al. (2003) go on to say that it is the very same residents with disabilities that tend to be 

excluded that are the ones whom are likely to experience social and emotional isolation in 

institutional care facilities.  

2.2 The challenges of caring for a cerebral palsied individual 

Although children are blessings from God, caregivers with cerebral palsied children appear 

to face more challenges than caregivers of children who are not cerebral palsied (Dambi et 

al., 2015). According to the study conducted on caring for a child with cerebral palsy, 

caregivers reported experiencing inconvenience, physical strain, confinement, family 

adjustment, disrupted personal plans, work adjustments, financial strain and simply being 

overwhelmed (Dambi et al.,2015, p. 4). Dambi et al. (2015) further go on to list the factors 

that cause caregiver strain to be the age of the child, the age of the caregiver, the caregiver’s 

relationship with the child, and the severity of the cerebral palsy. 

 The older the child, the more strain caused on the caregiver due to the increased needs of 

the child (Dambi et al., 2015). The age of the child also correlates with that of the caregiver 



6 
 

as well as the severity of the cerebral palsy. The severity of the cerebral palsy plays a role in 

the limitations that the children face, which may lead to the children requiring assistance 

completing their daily activities of living (ADLS) (Dambi et al., 2015). Severity of disability 

is considered as one of the main factors affecting functional status and thus independence in 

cerebral palsy (Brooks et al., 2014). This would then require lifting and carrying of the 

children by the caregiver which may subsequently result in pain for the caregiver (Dambi et 

al., 2015). The heavy lifting of the children will also affect the caregiver adversely due to 

reduced physical strength that comes with age. 

Although this study has been done with children, it would not be unreasonable to presume 

that the challenges can become more difficult to cope with as time goes on, considering that 

two of the factors that contribute to caregiver strain are related to both the age of the 

caregiver and that of the child. As the child grows older, so does the caregiver and as they 

become more frail with age, they may no longer be able to provide adequate care for the 

individual with cerebral palsy. Some caregivers may die because of old age and this will 

leave the individual with cerebral palsy without a caregiver. 

More often than not in South Africa, the responsibility may be passed on to someone else 

who is capable of taking care of the cerebral palsied individual and this may be family, 

siblings or friends. However, caring for a cerebral palsied individual has the potential to 

result in changes in the caregiver’s personal plans and this may further influence their social 

life and social networks (Dambi et al., 2015). However, those fortunate enough to have the 

means, are able to find alternative institutional care for their loved ones so that they too can 

continue with their lives. 

2.3 Relocating 

According to Brandburg (2007), the preadmission process is important in defining the 

severity of some of the post admission issues that a potential resident may face. The 

preadmission process consists of analysing the number of basic conditions which are being 

met for the potential resident (Brandburg, 2007). The basic conditions which are being 

referred to may be the desire to move, legitimate reasons for moving and voluntary control 

(Brandburg, 2007).  This speaks to the potential resident being consulted about the move to 

the care facility as well as their active involvement in choosing the facility. This can only be 

achieved through communication in which the desire to move can be explored or legitimate 

reasons for the move discussed. This continues to make the potential resident feel like they 



7 
 

are in control of their life and they have not lost their sense of autonomy (Grenade & Boldy, 

2008). 

 According to Chenitz (as cited in Brandburg, 2007) there is a relationship between the pre-

admission process and how well a resident will adjust. The more basic conditions met, the 

higher the likelihood of the potential resident accepting the move into the residential care 

facility (Brandburg, 2007). The less basic conditions met, the more likely the resident will 

feel dumped and this increases the likelihood of the resident resisting the move into the home 

or resigning themselves helplessly to their situation. 

2.4 Transitioning 

Transitions occur throughout the lifespan and they mark the stages of an individual’s life 

and are often associated with uncertainty (Brandburg, 2007). According to Grenade and 

Boldy (2008) this may be due to the impact of moving from a familiar environment to an 

unfamiliar one. As such, a move to a residential care facility may bring with it significant 

changes to a person’s social networks (Grenade & Boldy, 2008). 

Brandburg (2007) speaks of transitioning in three phases: being overwhelmed, adjustment 

and initial acceptance. Being overwhelmed involves being emotional, crying, feeling lonely 

and focusing of self – this is the initial phase when the resident arrives at the facility; The 

second stage is after some time where the resident begins to establish new social networks 

and begins to realise that there is a future; the last stage of acceptance arrives when the 

individual decides to focus on more than just the self (Brandburg, 2007). 

2.5 Residential care 

Given the nature of the residential care environment, it is presumed that the likelihood of 

loneliness would be reduced because residential care offers communal living, onsite care 

and support (Grenade & Boldy, 2008). However, Cacioppo and Hawkley (2009) say that 

adults who are institutionalised are lonelier than their community-dwelling counterparts. 

Dupuis-Blanchard, Neufeld and Strang (2009) also point out that institutional care settings 

are not barren domains of solitude and emptiness. 

Cacioppo and Hawkley (2009) acknowledge that it is also loneliness that influences the 

likelihood of institutionalisation, considering that loneliness has been found to be higher in 

adults with cerebral palsy than in people without cerebral palsy (Haak et al., 2009). 

Individuals who are living alone can be protected from loneliness by participating in 



8 
 

institutional care centre activities (Cacioppo & Hawkley, 2009). Despite moving to a new 

environment being distressing, some people felt that being in institutional care provided a 

form of support (Jungers, 2010). Given the literature, one can conclude that the residential 

care setting can be both a welcomed or stressful transition for different people. 

2.6 Social experiences 

2.6.1 Social support 

According to Horsman et al. (2010), a study by King and colleagues showed that social 

support plays a significant role in how individuals with disabilities adapt to events and 

experiences that are challenging. This study revealed three types of support: emotional, 

instrumental and cognitive support (Horsman et al., 2015). Emotional support involves 

making people feel better about themselves whereas instrumental support refers to the tools 

and strategies used to address issues and cognitive support speaks to how being understood 

helps an individual to not feel alone in facing situations and processes (Horsman et al., 2015). 

2.6.2 Social isolation 

Relocating to a residential facility, not knowing anyone, carries the risk of exposing residents 

to social isolation. Although social isolation is often confused and sometimes erroneously 

used interchangeably with loneliness, they are two different concepts all together. “Social 

isolation is usually regarded as an objective state where an individual has minimal contact 

with others and/or a generally low level of involvement in community life” (Grenade & 

Boldy, 2008, p. 469). Factors that contribute to social isolation are a person's social networks, 

for example, the number and frequency of contacts (Grenade & Boldy, 2008). This poses 

questions about whether friends and family from the community come to visit the resident 

and if so, how often? The living arrangements at the institution can also contribute to social 

isolation in residential care because before the residents moved into residential care, they 

were living at home in their communities, surrounded by the people they loved and have 

long known (Grenade & Boldy, 2008). Being in their own room, not knowing anyone around 

them and lacking a confidant can lead to social isolation (Grenade & Boldy, 2008). 

2.6.3 Family and friends 

Although research has shown that family and significant others continue to play an important 

role in a resident’s life after they have been admitted, the frequency and/or nature of contact 

between residents and family members may change significantly (Grenade & Boldy, 2008). 



9 
 

According to Grenade and Boldy (2008) a study by Port and colleagues found that the degree 

of contact with family and friends was reduced by half after admission compared to reported 

pre-admission contact. The frequency of contact and relationships is also negatively affected 

more especially if the resident had children or was married as studies have shown that the 

kind of support the spouse provided for the resident changes as does the level of intimacy 

(Grenade & Boldy, 2008).  

Given the research, this may have negative implications on the resident because their contact 

with their loved ones reduces more than what they are used to and this may contribute to 

feelings of increased loneliness for the resident because according to Ballin and Balandin 

(2007) having a family reduces feelings of loneliness in residents. However, a study that was 

conducted in the US showed that social relationships of residents formed with other residents 

appeared to be more protective against loneliness than their existing relationships with their 

friends and family outside the residential care facility (Grenade & Boldy, 2008). This shows 

that although family is important, the relationships which residents can make in the 

residential care facility may be more significant in protecting them from loneliness 

2.7 Emotional experiences 

2.7.1 Loneliness 

Loneliness is generally a more subjective experience that is usually negative and unwelcome 

(Grenade & Boldy, 2008). It is related to how a person perceives their social relationships 

or level of social engagement as being deficient in some way (Grenade & Boldy, 2008). The 

subjective aspect of loneliness speaks to the fact that a person with many social networks 

can still feel lonely and conversely, one with limited social networks may not experience 

loneliness at all (Grenade & Boldy, 2008). This explains why people can still feel lonely 

despite the fact that they are surrounded by many people. It is for this reason that the 

frequency of contact of contact with friends will not determine a person’s feelings of 

loneliness (Ballin & Balandin, 2007). 

Given this knowledge, it is understandable why loneliness is an experience that residents 

may go through during transitioning into a residential care facility and it may continue to go 

on beyond the transition phase. The residents have been removed from an environment 

where they felt accepted and they were comfortable in, a safe space. It is usually the absence 

of a confidant that contributes to feelings of loneliness in residents in a residential care 

facility (Grenade & Boldy, 2008). This further supports the cognitive support aspect by 



10 
 

Horsman et al. (2015), which was discussed earlier, which stated that being understood helps 

a person not feel alone in facing situations and processes. It is expected that a confidant is 

someone who aims to understand the person confiding in them, thus assisting the person not 

to feel alone. 

2.7.2 Loss 

(Many residents may experience some form of loss following moving into a residential care 

facility as a result of having to leave their home, family and friends (sometimes pets), local 

communities and previous lifestyles (Grenade & Boldy, 2008). The sense of loss comes from 

‘losing’ everything that they knew, loved and felt comfortable with to going to an 

environment they know nothing about. Residential facilities also have rules and routines that 

the residents are not accustomed to (Grenade & Boldy, 2008). At home, life was a little 

different for the residents, there may have been very little structure as opposed to what there 

was at home, and now being in a residential care facility, the rules have changed. This may 

have a major negative impact on a person’s sense of autonomy, control over their lives and 

individuality (Grenade & Boldy, 2008).  

Being dependent on others for care and support may also have a negative impact of the 

residents in the sense that it may lead to reduced self-esteem, loss of identity and depression 

(Grenade & Boldy, 2008). This may be due to the fact that at home, they may have had a 

role to play in assisting with their care as opposed to the fact that it is offered and wholly 

catered for in a residential care facility. They may begin to feel that they are no longer able 

to do things and could possibly cause the residents to feel useless. 

2.8 The role of staff 

Being in a residential care facility puts one in a position of increased dependency (Grenade 

& Boldy, 2008). Being in this position implies that residents will have frequent contact with 

staff, with some residents having more contact than others, and these interactions may have 

the potential to reduce the risk of isolation and or loneliness (Grenade & Boldy, 2008). 

Murphy (as cited in Ballin & Balandin, 2007) found that 72% of cerebral palsied adults with 

little or no functional speech were with staff. This may be due to the fact that the residents 

find confidants within the staff that they interact with on a daily basis as they are the people 

that the residents see more often.  



11 
 

However, one relates to staffing based on factors such as staff retention, turnover and the 

increasing reliance on casually employed agency staff (Grenade & Boldy, 2008). This means 

that a resident could find a confidant in one of their care workers, only to discover a few 

months later that the staff member is no longer available because they were a casual worker. 

This may negatively affect the resident because they would have to start afresh in finding a 

confidant and perhaps this time they may be more reserved for the fear of being ‘abandoned’ 

once again. 

In South Africa, we have 11 official languages and often, staff is made up of a multitude of 

different cultural representations. The diversity of language and or cultural backgrounds of 

the care staff may limit the extent to which meaningful relationships can develop (Grenade 

& Boldy, 2008). This can make communication between the care staff and the residents very 

difficult because they do not understand each other fully or because meanings have been lost 

in translation. Despite the possibility of staff becoming residents’ confidants, a study 

conducted in Australia showed that most staff-resident interactions are mainly of a task-

orientated nature (Grenade & Boldy, 2008). This means that despite the frequent contact, it 

is more likely that the contact the staff have with the residents is focused on providing the 

service that they have been hired to do. 

2.9 Protective methods and/or interventions 

The following are two protective methods which are currently being used in residential care 

facilities to help ensure that residents are not socially excluded or do not feel lonely. They 

are organised activities and the introduction of pets and animals. 

2.9.1 Organised activities 

According to Grenade and Boldy (2008), evidence suggests that participation in organised 

social activities can help reduce social isolation, as well as increase the self-esteem of 

residents and build a sense of empowerment. Residential care facilities usually offer 

organised activities which support social interactions between residents, ‘family-friendly’ 

policies and practices and strategies which will help residents maintain their links with the 

wider community such as outings and organising visits from outside groups (Grenade & 

Boldy, 2008). This gives the residents an opportunity to interact with other people outside 

of the people that they live with at the residential care facility. This could also help the 

residents not feel disconnected from the outside world. 



12 
 

2.9.2 Pets and animals 

Some residential care facilities have implemented policies or strategies that allow residents 

to have contact with animals- such as owning a pet or introducing a ‘communal’ pet or 

providing animal assisted therapy (Grenade & Boldy, 2008). Kruger, Trachtenberg and 

Serpell (as cited in Jackson, 2012, p. 2) define animal assisted therapy as “a goal-directed 

intervention in which an animal that meets specific criteria is an integral part of the treatment 

process”. The aim of animal assisted therapy is to improve the human physical, mental, 

emotional and social functioning (Jackson, 2012). Animal assisted therapy come in many 

forms, but the most popular is canine-assisted therapy which is used across a variety of 

populations (Jackson, 2012). Feline-assisted therapy however, is found typically in long term 

care facilities as the presence of an animal may give the facility a more comfortable and 

home-like feeling (Jackson, 2012). This is important because Brandburg (2007) days that 

residents may initially experience feelings of homelessness and a home-like feeling provided 

by the presence of a cat may assist in adjusting. 

2.10 Theoretical framework 

This study is guided by two theoretical frameworks, namely: the transition process 

framework and the biopsychosocial theory. 

2.10.1 Transition process framework 

Brandburg (2007) developed a transition process framework that would act as a guide to 

assist residential staff develop interventions that will support residents during transition. 

According to Brandburg (2007) the transition process framework consists of four 

components, namely: initial reaction, transitional influences, adjustment and acceptance 

which can be viewed as either adaptive or maladaptive. Figure 2.10.1 on the following page 

depicts the transition process framework. 

 

 

 

 

 



13 
 

Figure 2.10.1: Transition Process Framework 

 

Extracted from (Brandburg, 2007, p. 54) 

The initial phase of the transition framework is marked by the initial reaction to being in the 

residential care facility. Whether the transition was planned or not, most residents will 

exhibit an emotional reaction of some sort (Brandburg, 2007). The second and third stages 

of transition go together and work in a back and forth pattern whilst residents adjust and 

readjust to being in the residential care facility (Brandburg, 2007). A person’s life history 

may influence how easily they make friends and whether the resident will have a future 

oriented attitude will depend on the admission circumstances (Brandburg, 2007).The 

acceptance stage comes at the end of the transitional process and it may be adaptive or 

maladaptive (Brandburg, 2007) When the acceptance is adaptive, the residents begin finding 



14 
 

new meaning in life at the residential care facility, however, when it is maladaptive it can 

lead to depression, withdrawal and helplessness (Brandburg, 2007). 

This framework was considered appropriate because it had the potential to assist in 

understanding the transitional experiences that the residents had when they first arrived at 

the residential care facility. It also had the potential to help in understanding where the 

residents currently stand post the transitional process. 

2.10.2 Biopsychosocial theory 

To supplement Brandburg’s transition framework and further understand the experiences of 

the residents, biopsychosocial theory will also be used as the study looked largely into the 

social and emotional experiences the residents had that could have played a role in the 

residents’ transitioning.  According to Rassool (2011) biopsychosocial theory takes into 

consideration factors such as genetic inheritance, psychological differences, family, 

community, peer, or social pressure. 

 There are three elements that must be taken into consideration in order to understand the 

person in perspective using biopsychosocial theory. The first element speaks to how one 

must have knowledge of a person, meaning that things such as individual characteristics, 

biological conditions, development, behaviour, patterns of adaptations and beliefs need be 

taken into cognisance (Compton, Galaway & Cournoyer, 2005). The second element speaks 

to the knowledge that one has acquired about a situation, which is made up of groups, 

organisations, communities, cultures, formal and informal social systems assets and 

resources (Compton, Galaway & Cournoyer, 2005). The last element speaks to possessing 

knowledge about interpersonal relationships (Compton, Galaway & Cournoyer, 2005). 

Biopsychosocial theory aims to assist in understanding the nature of human beings as 

individuals and as members of families, groups, communities and societies (Compton, 

Galaway & Cournoyer, 2005). This framework was considered appropriate for this study 

because it had the potential to assist in understanding the participants’ background and it 

may or may not have played a role in the participants’ transition. It was also considered 

appropriate because it helped with understanding the experiences the participants’ had with 

regards to transitioning. 

2.11 Summary of chapter 



15 
 

This chapter discussed the challenges of caring for individuals with cerebral palsy, relocation 

and transitioning, as well as the various emotional and social experiences cerebral palsied 

adults experience in residential care. The chapter went on to further discuss the protective 

factors that are currently being employed to assist residents in residential care. The chapter 

concluded with the theoretical frameworks relevant for the study. Against this backdrop, the 

methodology underpinning this study is discussed in Chapter Three.  

 

 

  



16 
 

CHAPTER THREE 

METHODOLOGY 

3.1 Introduction 

This chapter gives a detailed discussion of the methodology used in this study. The research 

approach and design, sampling methods and data collection instruments used in the data 

collection process of this study will also be discussed in detail. This chapter will further go 

on to discuss and describe the manner in which the trustworthiness of this study was 

strengthened during the analysis of data. The ethical issues concerning this study as well as 

how they were addressed will also be discussed in this chapter. 

3.2 Aim 

The research aim was to explore residents’ socioemotional experiences with regards to 

transitioning and adjusting to a residential care facility. 

3.3 Objectives 

 To understand the socio-emotional experiences of residents about transitioning and 

adjusting to a residential care facility. 

 To explore the challenges that residents experience whilst in a residential care 

facility. 

 To identify the participants’ recommendations on how transitioning and adjusting to 

a residential care facility can be made easier for them 

 To identify the participants’ recommendations on what they can do to improve their 

socio-emotional experiences of adjusting and transitioning into a residential care 

facility. 

3.4 Research Questions 

 What are the socio-emotional experiences of residents about transitioning and 

adjusting to a residential care facility? 

 What are participants’ recommendations on how transitioning and adjusting to a 

residential care facility can be made easier for them? 

 What can the participants’ do to improve their socio-emotional experiences of 

adjusting and transitioning into a residential care facility? 



17 
 

 

3.5 Research Approach and Design 

“Research designs are plans and procedures for research that span decisions from broad 

assumptions to detailed methods of data collection and analysis” (Creswell, 2009, p. 3). The 

research method used for this study was qualitative. Qualitative research “is a means for 

exploring and understanding the meaning individuals ascribe to a social human problem” 

(Creswell, 2009, p. 4). The research design that was employed for this study was exploratory 

research design which was used to gain insight into a phenomenon, situation or individual 

due to either a lack of information on a new area of interest or to get acquainted with a 

situation (Fouché & de Vos, 2011). 

 The exploratory may be the first of a series of studies and it attempts to answer the ‘what’ 

questions of a study (Fouché & de Vos, 2011). The reason for this choice of design in a 

qualitative approach is because this study is interested in asking ‘what’ questions. It is also 

because there is very little research on the phenomenon of interest, thus the choice of design. 

However, sadly qualitative research is not objectively verifiable, is labour intensive and 

relies heavily on the participants’ responses (Choy, 2014). 

On the contrary though, qualitative designs offer a broad and open-ended inquiry approach 

which allows participants to issues which are important to them (Choy, 2014). This is why 

approach was considered appropriate to explore the socio-emotional experiences of the 

participants about being in a residential care facility.  

3.6 Population and Sampling 

The study used non-probability purposive sampling which entails selecting a sample “on the 

basis of your [researcher] own knowledge of the population, its elements and the nature of 

your research aims” (Babbie, 1990, p. 97). Payls (2008) goes on to further break down 

purposive sampling to criterion sampling which was used in this study. Criterion sampling 

involves looking for cases or individuals who meet a certain criterion (Payls, 2008). As such, 

the participants were not selected by random chance as they were selected based on particular 

characteristics (MacNealy, 1999). 

Ten participants were selected for the study based on the following criteria: 



18 
 

 Residents who have been residing in the residential care facility for a minimum of 

two years. This criterion was chosen because the focus of the study was the 

transitional experiences of cerebral palsied residents in a residential care facility over 

a long period of time. 

 Residents who have intelligible speech as according to agency classifications. This 

criterion was chosen because the research tool and data collection method chosen for 

the study requires verbal communication. The criteria of intelligible speech, would 

assist in capturing data as effectively as possible. 

 Residents who are cognitively higher functioning and have minimal memory 

problems as according to agency classifications. The reason for this criterion was to 

ensure that the participants that take part in the study will understand the questions 

that are being asked, as well as being able to answer them. As the study focused on 

the long term experiences of the residents, minimal memory problems would be 

important for the study. 

 The participants could be male or female between the ages of 22 and 69. The reason 

for the huge age gap was because the facility catered for residents of various age 

groups with no obvious modal age. The pre-requisite was that they are adults with 

cerebral palsy. 

3.7 Research Instrument 

The research instrument used to collect data from participants in this study was a semi-

structured interview schedule. A semi-structured interview schedule is comprised of a set of 

questions that guide the researcher (Harrell & Bradley, 2009). The order in which the 

questions are asked is to the researcher’s discretion, however the questions are standardised 

and probes may be used to ensure that the researcher covers the correct material (Harrell & 

Bradley, 2009). The standardised nature of the semi-structured interview schedule ensure 

that every participant will get asked the same question, which may have a positive effect on 

the study’s reliability (Monette, Sullivan & DeJong, 2011). The reason this research 

instrument was chosen is because it allows the researcher to gather detailed information in a 

some-what conversational manner and because interviews are used to gather information on 

past and present experiences (Harrell & Bradley, 2009) which was the focus of this study. 

3.8 Pretesting of the research instrument 



19 
 

A pretest was conducted with two participants to see whether the interview questions were 

clear and appropriate for the envisioned sample population. Although conducting a pretest 

does not guarantee the success of a study, it is still important to conduct one as doing so may 

give the researcher an advance warning about where the research study could fail, where 

research protocols may not be followed, or if the research instrument and proposed methods 

may be complicated or inappropriate (van Teijlingen & Hundley, 2001). The two pretest 

participants were given the opportunity to express their opinions on the appropriateness and 

clarity of the interview questions. No questions were amended because according to the 

participants, the questions were found to be clear and appropriate. The duration of each 

pretest interview was approximately half an hour. 

3.9 Data collection 

Data was collected through individual, one on one interviews with the duration of each 

interview ranging from 45 minutes to an hour, which was significantly longer than the time 

it took to conduct the pretest interviews. This method gave the researcher the opportunity to 

ask the participants a series of open-ended questions. This method of data collection was 

considered appropriate because it allowed the interviewer a degree of flexibility which other 

methods did not. According to Monette et al. (2011) semi-structured interviews allow for 

probing, rephrasing of questions as well as asking them in any order fitting the particular 

interview. 

The study had the risk potential of inducing emotional distress. The researcher used the 

following strategies identified by Draucker, Martsolf and Poole (2009) to minimise distress: 

 Consistent monitoring of participants’ emotional reactions 

 Providing frequent breaks during stressful data collection procedures where it was 

necessary 

 Providing the participants with information on available psychological or social 

services. 

All interviews were arranged by prior appointment and were conducted at a time and venue 

that was convenient for the respondents. Although permission was sought to audio record 

the interviews, due to the participants’ disability and various agency structures, the 

interviews were not recorded. The researcher instead, took verbatim handwritten notes to the 

best of their ability. Although this method was not preferable and the study’s accuracy and 



20 
 

credibility could have benefitted more from audio recording the interviews, often all that 

researchers need to record are the key points that a respondent makes (Monette et al., 2011). 

3.10 Data analysis 

The qualitative data gathered from the interviews was analysed using thematic analysis. 

Braun and Clarke (2006) define thematic analysis as a method of identifying, analysing and 

reporting patterns or themes within data. Thematic analysis requires that the researcher 

familiarise themselves with the data (Braun & Clarke, 2006). This is achieved through first 

transcribing the data, then reading and re-reading it, noting down initial ideas (Braun & 

Clarke, 2006). By doing this, one will begin generating a code that will eventually bring the 

themes that are contained within the data to the fore. 

The raw data was analysed according to the six-phase guide to thematic analysis as outlined 

in Braun and Clarke (2006). 

 Phase 1: familiarising yourself with the data – the researcher familiarised 

themselves with the data by reading and re-reading the transcriptions. 

 Phase 2: generating initial codes – once the initial data was read and re-read, the 

researcher worked systematically through the entire data set, giving complete and 

equal attention to each data item and identifying and noting interesting aspects in the 

data which may have formed repeated patterns/themes. The researcher then used 

coloured pens to indicate potential patterns in order to assist with coding the data. 

 Phase 3: searching for themes – once all the data was coded, the different codes 

were sorted into potential themes. Some codes went on to form main themes and 

others were discarded completely or temporarily stored under a theme named 

miscellaneous. 

 Phase 4: reviewing themes – once a set of candidate themes was devised, the 

researcher went back to refine them. This phase assisted the researcher in noticing 

that some candidate themes were not really themes and that others needed to be 

further subdivided into themes and sub-themes. This phase focused on reviewing and 

refining the themes. 

 Phase 5: defining and naming themes – once the researcher was satisfied with the 

thematic map of the data, they began to ‘define and refine’ the data by identifying 

the essence of each theme as well as determining which aspect of the data each theme 

addressed. 



21 
 

 Phase 6: producing the report – the final phase involved the final analysis and the 

write-up of the research report. 

3.11 Trustworthiness 

Trustworthiness is related to establishing the truth value, applicability, consistency and 

neutrality of a study (Anney, 2014). There are four constructs of trustworthiness which are 

transferability, confirmability, dependability and credibility (Shenton, 2004). 

Credibility speaks to how a researcher has done their research and how they tell others about 

the way they have done their research (Morrow, 2005). It speaks to the truth of the research 

findings (Anney, 2014). To enhance the credibility of the study, the researcher had prolonged 

engagement with the research site. Data collection requires that one immerse themselves in 

the participants’ world (Anney, 2014). This assisted the researcher in gaining an insight into 

the context of the study which, in turn, minimised the distortion of the information gathered 

because of the researcher’s presence in the field (Anney, 2014). 

 An attempt to provide a thick description of the phenomenon under study was also made, 

this allows readers to have a proper understanding of the phenomenon and may enable them 

to compare the instances of this phenomenon to those that they have seen emerge in their 

own situations (Shenton, 2004). This contributed positively to the transferability of the 

study. Although the study comprised of a small non-probability sample size, the 

generalisability of the study to similar contexts was reduced, however it does not completely 

exclude it.  

An attempt to report the processes of the study in detail has been made, not only does this 

allow the study to be repeated should the need arise but this may allow the reader to assess 

if proper research practices were followed. This enhanced the dependability of the study. 

Confirmability speaks to ensuring that the findings are, as far as possible, the participants’ 

ideas and experiences and not the researcher’s (Shenton, 2004). To ensure all this, the 

researcher kept a self-reflective journal from the onset of the data collection process until 

the end, which contained an ongoing record of the researcher’s experiences, reactions, 

assumptions or biases that the researcher noticed. This helped in maintaining subjectivity as 

it made the researcher aware of any biases they may have held.  

3.12 Ethical considerations 



22 
 

Ethics are the responsibilities that the researcher holds towards the participants, sponsors 

and potential beneficiaries of a study (Monette et al., 2011). They are considered very 

important because they are meant to protect the participants of the study (Monette et al., 

2011). Efforts were made to comply with the following ethical principles:  

Review by Ethics Committee 

Ethical clearance from the University of the Witwatersrand’s Non-Medical Human Ethics 

Committee was applied for by the researcher and the Research Ethics Certificate which is 

set out in Appendix E was granted. 

Confidentiality 

Confidentiality means that the information or data gathered from those that choose to 

participate in the study will not be shared with the public in a way in which it can be linked 

to the participant (Monette et al., 2011). This was explained to the participants in the 

participant information sheet and was further explained and elaborated by the researcher 

face. The participants were informed that their names will not be used and they were made 

aware of a pseudonym that the researcher used in the transcriptions and the research report. 

The participants were informed that the data gathered would be kept in a safe and that the 

information gathered would only be seen by the supervisor. 

Informed Consent 

This involves telling the participants about all aspects of the research which may affect their 

decision to participate in the study (Monette et al., 2011). Due to the different cognitive 

abilities of the potential participants, information about all aspects of the research was given 

in simple English, avoiding research jargon that the participants may not understand. The 

participants were told about the study i.e. that they were taking part in research, the purpose 

as well as the procedure of the research was explained to the participants before they were 

requested to consent forms to participate in the study. A copy of the consent form for 

participation in the study is set out in Appendix B and a copy of the consent form for audio 

recording is set out in Appendix C. 

Voluntary Participation 

Voluntary participation requires that people are not coerced into taking part in the research 

study (Trochim, 2006). None of the participants were coerced to participate in the study. The 



23 
 

participants were informed that they were taking part in a study and that they are allowed to 

withdraw from the study at their own discretion and at any time they wished to do so without 

recourse. They were given a participant information sheet, set out in Appendix A, containing 

information about the study. 

Doing no harm 

 According to Monette et al. (2011) a researcher should avoid exposing participants to 

physical or mental distress and if the potential for such distress exists in the research study, 

then the participants should be informed of this. Due to the nature of the research, there was 

a potential for emotional distress that could have come from participating in the study. 

Debriefing and counselling services were arranged with the organisation’s resident social 

worker for the participants to use should they need to. This was communicated to the 

participants and they were informed of this potential so that they were able to choose if they 

were interested in participating in the research study or not and they were made aware of the 

availability of debriefing afterwards, should they need it. 

3.13 Summary of chapter 

This chapter outlined and discussed the research design and methodology employed in the 

study. Considering this, the results are presented and discussed in the following chapter. 

  



24 
 

CHAPTER FOUR 

PRESENTATION AND DISCUSSION OF FINDINGS 

4.1 Introduction 

This chapter presents and discusses the research findings according to the research 

objectives. In order to analyse and present the demographic information, descriptive 

statistics were used. The participant’s responses to the open-ended questions, which formed 

the qualitative data, were analysed using thematic analysis. The emerging themes from 

analysing the data are shown by the use of participants’ verbatim responses. 

4.2 Participant demographics 

Table 4.2.1 gives a visual summary of the demographic profile of cerebral palsied adults in 

the residential care facility who participated in the study. 

Table 4.2.1: Demographic Profile of Participants (N=10) 

Demographic Factor Sub Category No of Participants 

Age (years) 20 – 29 1 

 30 - 39 2 

 40 - 49 3 

 50 - 59 1 

 60 - 69 3 

Gender Male 4 

 Female 6 

Participant number Number of years at the facility 

1 6 

2 13 

3 40 

4 6 

5 3 

6 6 

7 43 

8 7 

9 26 

10 9 



25 
 

 

 

Table 4.2.1 illustrates that 10 participants were interviewed. One participant fell within the 

20-29 age category, two in the 30-39, 3 within the 40-49, one in the 50-59 and three 

participants fell within the 60-69 age category. Four of the participants were male whilst the 

remaining six were female. Each participant has been identified with the corresponding 

number of years that they have spent at the facility. 

4.3 Overview of objectives and themes 

The analysis of the data assisted in identifying many significant themes which are illustrated 

in table 4.3.1 

Table 4.3.1: Objectives and Themes 

Objectives Themes 

The socio-emotional experiences of 

residents about transitioning and adjusting 

to the facility. 

Feeling overwhelmed by new environment 

and levels of disability 

Feelings of freedom, happiness and 

independence 

The role of staff in social support 

Friends and family Support 

Development of residential relationships 

and friendships 

Post-admission challenges experienced in 

the residential care facility. 

Age dynamics 

Different levels of cognitive and 

communication abilities 

Teasing, residential gossip and social 

exclusion 

Recommendations on residential 

improvements to make residents’ 

transitions easier. 

General satisfaction with the facility 

Installation of more assistive devices 

More room for personal space 

Recommendations for self to improve the 

socio-emotional experiences of adjusting 

and transitioning. 

Coping 

Accepting circumstances and remaining 

positive 

 



26 
 

4.4 The socio-emotional experiences of residents about transitioning and adjusting to 

the facility 

The first objective was to understand the socio-emotional experiences of residents about 

transitioning and adjusting to a residential care facility. 

The participants’ responses to the questions aimed at exploring this objective, the following 

themes emerged: 

Theme one: Feeling overwhelmed by new environment and levels of disability 

When asked about their initial feelings about moving into the facility, 5 of the participants 

expressed that they felt overwhelmed by being in a new and strange environment and by the 

levels of disability that they were seeing at the facility. The participants had mild cases of 

cerebral palsy and when they arrived at the facility, they were faced with residents that had 

varying levels of disability and they reported this as part of the reasons they felt 

overwhelmed. The following responses illustrate this theme: 

“At first to be honest, it was all freaky because I didn’t know anybody and I have never seen 

people the way that they are. Some of it was overwhelming” (Participant 2, aged 31). 

“How do you explain freaked out? I got a bit scared. Some people here, I have never seen 

that kind of disability in my life, so I got a bit scared and uncomfortable” (Participant 5, 

aged 22). 

This theme is strongly supported by Brandburg’s (2007) ‘initial reaction’ phase of her 

transition framework. The initial reactions when moving into residential care are marked by 

emotional responses (Brandburg, 2007). Thus reports of residents feeling overwhelmed, 

disorganised and emotional have been identified as initial responses to the facility 

(Brandburg, 2007). According to Grenade and Boldy (2008) these feelings could be brought 

on by the impact of moving from a familiar territory to an unfamiliar one. This is illustrated 

by how the participants’ responses clearly state that they have never had experiences like 

they were having at the facility before. 

Theme two: Feelings of freedom, happiness and independence 

Not all residents felt negatively about being in the facility. The 5 participants of the sample 

group expressed happiness about being in the residential facility. The participants further 

went on to say that moving into the facility has given them independence and the freedom 



27 
 

of movement that they did not have at home. The satisfaction came from doing things the 

way that they wanted to, however and whenever they wanted to. The following responses 

encapsulate this theme: 

“… coming here makes me happy because there is more ground for me to cover and I was 

never able to do that at home you know what I mean? I don’t have to be picked up and I like 

that” (Participant 6, aged 43). 

“… I can be independent and show them that even though I am cerebral palsied, I can 

interact with the outside world” (Participant 2, aged 31). 

“I’m now knitting and I’m my own boss and work at my own pace and time.” (Participant 

9, aged 63). 

Disability has been defined as “…the expression of limitations in individual functioning 

within a social context that represent a substantial disadvantage to the individual” (Buntinx 

& Schalock, 2010, p. 284).  The social context that the participants came from was disabling 

them so much that they could not be independent. The facility made many significant 

changes to the context to improve the residents’ independence and this has worked positively 

as the participants felt more independent in the facility than they did at home or in the 

community. 

Theme three: The role of care staff in transitioning and adjusting 

When participants were asked about how they felt about the care staff and what they thought 

the care staff could have done differently for them to make their move into the facility more 

comfortable, nine participants said: nothing. The participants expressed general satisfaction 

with the way the care staff was treating them and most expressed gratitude. This theme is 

highlighted in the following responses: 

“They listen if you got a problem, if you sad they’re always there. They never push you away 

and say they’re busy. Of course they are busy, but they make time” (Participant 1, aged 43). 

“When I was getting weak, they allowed me to move to another cottage where I could get 

more help. They were treating me nicely” (Participant 4, aged 40). 

Contrary to all the positive responses about the staff, one participant felt that the staff 

contributed to the gossip that was going on at the facility. As opposed to minimising the 



28 
 

gossip, she felt that they were involved and escalated the matter and as a result, she lost her 

trust for the staff. This is encapsulated in the following response: 

“I just don’t trust the care workers because they contribute to the gossip around here” 

(Participant 5, aged 22). 

According to Ballin and Balandin (2007) adults with cerebral palsy live and interact mostly 

with staff who are paid to support them. It could be for this reason that some residents 

develop fulfilling relationships with staff (Perkins et al., 2013). This is why most facilities 

have introduced and implemented policies that ensure that relationships between staff are 

professional and support oriented (Ballin & Balandin, 2007). Research has shown that 

positive, supportive social relationships between staff and residents can be more effective in 

reducing loneliness and social isolation more than relationships with friends and family in 

the community (Ballin & Balandin, 2007). However, like those living outside the facility, 

staff have competing demands (Perkins et al., 2013). This can explain why although 

supportive relationships with staff reduce social isolation, they don’t eliminate it due to the 

fact that the staff are not always readily available. 

Theme four: Friends and family support in relation to transitioning and adjusting 

In their responses, four participants reported changes in their relationship with their friends 

and family. Friends and family did not contact or visit them as often as they did pre-

admission. Relations are strained and they no longer know what is happening at home. For 

some, their relationships improved and they spoke more often with their family post-

admission as opposed to pre-admission. Five participants reported no changes in their 

relationships with friends and family. They kept constant contact and would see one another 

often. One participant reported no changes with family, yet changes with their friends in the 

community. The responses were a combination of both positive and negative aspect for those 

whose relationships changed and those whose relationships did not. 

“I always had issues, I wasn’t a good person but I try my best to be a better person now and 

I am a good person… and now I am an inspiration for my friends and family” (Participant 

1, aged 43). 

“They say to me: ‘John what will happen to you when we go?’ and my sister called this place 

and I come here end of 2009 to take part in the holiday sports. And then I come here in 2010 

when the world cup come here, is when I first came” (Participant 4, aged 40). 



29 
 

“It’s always been kind of messed up [relationship with family] so I wouldn’t say that it’s 

changed. They’ve always been caught up in their own lives and I would be the last to know. 

It’s still my brother who comes and picks me up occasionally … I would say more my friends 

because they wrote me off. We drifted apart because we didn’t get the opportunity to see 

each other often” (Participant 5, aged 22). 

Family ties remain very important for residents in care facilities, however not all residents 

have family support (Perkins et al., 2013). Even when the support the residents are receiving 

from family is significant, the frequency and nature of contact between family and the 

resident may get cut by up to 50%, with family members typically available on a weekly 

basis at most (Perkins et al., 2015; Grenade & Boldy, 2008). According to Grenade and 

Boldy (2007) the levels of intimacy change and they just don’t visit as often as they used to. 

This explains why some residents who used to see their family and go home often are usually 

reduced to seeing one or a few regular members of their family and going home every now 

and then. 

Theme five: Development of residential relationships and friendships in relation to 

adjusting 

One of the themes that emerged was the development of residential relationships and 

friendships. The facility allows the residents to have romantic relationships amongst 

themselves and some participants expressed their happiness about this whilst one participant 

was heartbroken by the departure of his girlfriend. Others were able to make friends with 

whom they can form social networks. This theme is captured in the following responses: 

“I have about three people as friends here” (Participant 2, aged 31). 

“… sometimes I do sit with my girlfriends and that makes me happy. Even when I see her it 

makes me happy” (Participant 8, aged 36). 

“… when my girlfriend left here my heart was very sore.” (Participant 3, aged 63). 

According to Grenade and Boldy (2008) relationships among residents appeared to be more 

protective against loneliness than any existing relationships with friends and family outside 

the facility. This may explain why one participant felt very happy when they saw their 

girlfriend and the other felt heartbroken when their girlfriend left the facility. The 

relationships appear to be significant enough for the presence and/or absence of the other 

party to cause emotional reactions. 



30 
 

4.5 Post-admission challenges experienced in the residential care facility 

The second objective was to explore the challenges that the residents experienced whilst in 

a residential care facility. 

Nine participants reported having faced challenges. Most of the challenges highlighted were 

very general and from analysing the participant’s responses to the questions aimed at 

addressing this objective, these were the themes that emerged: 

Theme one: Age dynamics 

Age appeared to play a significant role in how the participants felt about how they could 

relate to others as well as their general feeling about being at the facility. The participants 

felt that the different age groups made it difficult for them to find people that they could 

relate to and interact with. The following responses illustrate this theme: 

“It’s just I wish there were more people who were grown up like me, who can talk a bit of 

sense, you know what I mean” (Participant 1, aged 43). 

“I hate it. I feel I am too young for this place. The workshop bores me, I feel I am capable 

of so much more than screws and plastics. You know, people my age don’t stay in on 

Saturday nights and I feel that I am missing out on so much. You don’t get to meet people 

who are your age and brain set” (Participant 5, aged 22). 

According to Perkins et al. (2013) residents often form bonds along lines of commonality 

based on race, class, gender, health, functional ability, culture, religion and even age. This 

explains why one participant wished that there were residents who were in their age bracket 

so that they can talk about things that they have in common. It further explains why the other 

participant feels that they are too young for the facility and that there is no one they can 

relate to let alone have conversations with. This shows that age plays a very important role 

in how people relate to one another, especially in residential settings. 

Theme two: Different levels of cognitive and communicative abilities 

 participants expressed different levels of cognitive and communicative levels as a challenge. 

Due to the difficulty involved in communicating with residents who have communication 

impairments and are cognitively challenged, the participants are challenged in attempting to 

build social relationships with them. The following responses encapsulate this theme: 



31 
 

“I think the biggest one was to find someone I could get along with, you know, to make 

friends, especially since there are many people who are not on the same level as I am on. 

Finding some I could actually relate to” (Participant 5, aged 22). 

“And to this day I still distance myself because unfortunately they are at a lower 

communication level than me. Look I’m not trying to bad mouth them, it’s just that if the 

communication was the same, all would be fine” (Participant 2, aged 31). 

In the social context of residential care facilities, stigma associated with disability and 

decline, especially if it relates to cognitive impairments, is among the key relationship 

barriers (Perkins et al., 2013). Any differences, especially amongst residents with significant 

impairments, limited those residents’ opportunities for social interaction (Perkins et al., 

2013). This means that residents who have more difficulties than others tend to be excluded 

and for some participants having the vast majority of people you are expected to form social 

relationship with have significant impairments was challenging for them. 

Other participants did not express any difficulty communicating with or relating to other 

residents based on their cognitive abilities. This was not important for them and was not 

considered a challenge, others were indifferent about the varying cognitive and 

communicative abilities. 

Theme three: Teasing, residential gossip and social exclusion 

Three participants expressed that there was a lot of gossiping going on at the facility and 

sometimes they were victims of this gossip. They pointed out that being victims of the gossip 

was the challenging part as lies were spread about them and people ended up having incorrect 

impressions about them. The following responses capture part of this theme: 

“For a while I was fine but Jennifer* started gossiping about me and spreading lies” 

(Participant 5, aged 22). 

“Sometimes people put me down but I got back up and sometimes people gossip behind your 

back. Whoo, they can gossip these people” (Participant 1, aged 43). 

The participants in the sample group were victims of the gossip, they expressed never 

retaliating, however the gossiping affected them in a negative way, especially because one 

participant was so desperate for the gossiping to stop, she contemplated suicide. 



32 
 

“I almost committed suicide but I gave my heart to the Lord and got support from my family” 

(Participant 1, aged 43). 

A further three participants stated that their challenge was experiencing teasing and being 

socially excluded. One participant felt that the others left him out and when they had general 

information to share with everyone else, the other residents did not share this information 

with them. This theme is apparent in the following responses: 

“… people used to tease me but I decided to rise above from that” (Participant 10, aged 57) 

“The other residents I was angry with them before because some residents won’t share news 

of any meetings” (Participant 8, aged 36). 

Social exclusion is a hugely contested term which not only refers to phenomena and 

processes that are related to poverty, deprivation and hardships, but categories of excluded 

people as well as places of exclusion (Peace, 2001). In this context, social exclusion is “the 

inability to participate in the normal relationships and activities available to the majority of 

people in a society” (Levitas et al., 2007, p. 9).  Exclusion affects an individual’s quality of 

life as well as the cohesion of society (Peace, 2001). Although the facility is not a society 

per se, it is a community in which the participants spend a lot of their time and should be 

involved in the decision making processes and be made aware of any information that affects 

them. By not receiving the news about meetings, he was denied the opportunity to take part 

in resident affairs/politics. 

The teasing and social exclusion affected the residents negatively. According to one 

participant, it elicited feelings of anger in him towards the other residents. The other two 

participants reported being upset. In order to cope they either turned the other cheek because 

they felt that management did very little to address their problems or they prayed about 

things.  

4.6 Recommendations on residential improvements to make residents’ transitions 

easier 

The third objective was to identify the participants’ recommendations on how transitioning 

and adjusting to a residential care facility can be made easier for them. 

Theme one: General satisfaction with the facility 



33 
 

Six participants expressed general satisfaction with how the facility was run and the way that 

the staff treated them. They did not expect any changes because they felt that the staff had 

done the best that they could have done to make their transition into the facility as easy as 

possible. The following response captures this theme: 

“It’s fine as it is. I haven’t got anything to say because they are great in my life. I just wish 

that we can get more people like these staff members that are so good for us” (Participant 

1, aged 43). 

Contrary to the feelings of general satisfaction, the other four participants thought the facility 

could benefit from some improvements. One participant felt that the facility could install 

more assistive devices so that shower time could be easier for them. They found that bath 

time could be very challenging for them because he needs to get help getting in and out the 

bath. It appears that the participant wants more independence than what he was already 

getting and the facility enables that.  

 The following responses encapsulate the contrary thoughts: 

“I’m asking… they help me here but they can make it more easier for me by getting one of 

those machines that they can pick you up and put you in the bathtub” (Participant 8, aged 

36). 

One participant also felt that the facility could benefit from changing the management 

structure and staff of the facility. This resident has been at the facility for 63 years and has 

seen different management teams come and go but, in his opinion, this management team is 

the worst he has seen. He feels they (management) treat residents like children and they 

restrain the residents’ freedom too much. This is evident in his response: 

“A lot of us old people, I tell you the facility got worse… they must change the top” 

(Participant 3, aged 63). 

Theme two: More room for personal space 

Three participants wished that there were more rooms at the facility so that they could have 

their own rooms and privacy. Most of the residents may be at the facility indefinitely and 

they would like it if they did not have to share a room for the remainder of their lives. The 

following response encapsulates this theme: 



34 
 

“I initially had to share and it would have been nice to have my own room” (Participant 9, 

aged 63). 

4.7 Recommendations for self to improve the socio-emotional experiences of adjusting 

and transitioning 

The fourth and final objective was to identify the participants’ recommendations on what 

they can do to improve their socio-emotional experiences of adjusting and transitioning into 

a residential care facility. 

Theme one: Coping 

Three of the participants, who were Christian, expressed using religion to cope with the 

adjustment process and the emotional responses to transitioning. This for them, was an 

effective way to cope and it is still a method for coping with the stresses of residential life. 

One participant even expressed that he prayed for other residents to cope. The following 

responses encapsulate this theme: 

“I almost committed suicide but I gave my heart to the Lord and I got support from my 

family. I made it through” (Participant 1, aged 43). 

“I feel I can pray for people” (Participant 4, aged 40). 

One participant expressed that she would remain sceptical not believe everything that she 

heard. Usually rumours made their rounds at the facility and more often than not they were 

not true. These rumours caused her panic and eventually got her into trouble. In order to not 

be an easy target for rumours and gossip, she felt that it was best to take everything she heard 

with a pinch of salt. This may be effective because according to Perkins et al. (2013) setting 

boundaries is important in ensuring that one is not the target of residential gossip. The 

following response highlights this coping method: 

“Don’t listen to everything I hear… or don’t believe everything I hear” (Participant 5, aged 

22). 

The other four participants cope with being in the residential facility by either engaging in 

social activities with others, working on improving themselves and becoming better people 

or doing their favourite things/hobbies.  They do things that they find joy in. This is evident 

in the following response: 



35 
 

“…sometimes I do sit with my girlfriend and that makes me happy.” (Participant 8, aged 

36). 

Theme two: Accepting circumstances and remaining positive 

Although some participants did not like being at the facility, nine participants expressed 

acceptance of their current circumstances and one participant even expressed attempting to 

remain positive by looking at life at the facility from a different perspective and being 

grateful for what they have. This theme is evident in the following responses: 

“It couldn’t have been better. This was the best option for me” (Participant 9, aged 63). 

“Well at the moment there is nothing I want to change. I have accepted. So there is nothing 

I can change or want to change” (Participant 10, aged 57). 

“Maybe also not be so negative about things and see things positively, even though it’s the 

hardest thing to do in this place, but it’s worth a shot” (Participant 5, aged 22). 

According to Brandburg (2007) acceptance is the outcome of the transitional process and it 

may be adaptive or maladaptive. With adaptive acceptance, residents tend to find meaning 

in life at the facility, whilst maladaptive acceptance may lead to depression, withdrawal and 

helplessness (Brandburg, 2007). Although not all the participants have reached adaptive 

acceptance, they all seem to be working towards it. This is especially noticeable through 

their willingness to be positive throughout their residential experience. 

4.8 Chapter Summary 

The socio-emotional experiences of being in a residential care facility saw residents being 

overwhelmed by being in a new environment as well as by the level of disability they were 

faced with. Feelings of freedom and independence and the roles of staff, family and friends 

in support were also significant themes. Participants were challenged by age dynamics, 

varying levels of communication and cognitive abilities as well as residential gossip and 

teasing. A majority of the participants expressed general satisfaction with the facility, 

however, a few suggested the need for more space and the installation of more assistive 

devices. Participants suggested remaining sceptical, religion and prayer and acceptance of 

circumstances as effective ways of coping with the process of transitioning and adjustment. 

 

  



36 
 

CHAPTER FIVE 

MAIN FINDINGS, CONCLUSIONS AND RECOMMENDATIONS 

5.1 Introduction 

This chapter gives a summary and conclusion of the main findings which emerged from the 

study’s objectives. It will also give recommendations based on the main findings. 

5.2 Summary of key findings 

5.2.1 The socio-emotional experiences of residents about transitioning and adjusting to 

the facility 

Brandburg (2007) states that most residents will have some form of emotional reaction to 

relocation and Grenade and Boldy (2008) say that relocating can disrupt a person’s existing 

social networks. Participants who were interviewed about their socio-emotional experiences 

of transitioning and adjusting spoke about feeling overwhelmed by the levels of disability 

they encountered, experiencing feelings of freedom, happiness and independence and the 

role of care staff in helping the transition and adjust to the facility. They further went on to 

discuss the changes or lack thereof of their relationships with the families during the 

transitioning and adjusting process, as well as the importance of developing residential 

relationships and their role in assisting with adjusting. 

These findings drew heavily on the biopsychosocial theory in that they spoke of family and 

friends, as well as the community and the changes that the residents experienced in these 

factors. The findings give a better understanding of the socio-emotional experiences of 

adults, post-admission. Some residents had positive experiences, some had negative 

experiences and other had mixed experiences. 

5.2.2 Post-admission challenges experienced in the residential care facility 

The literature review highlights that social isolation and loneliness are risks of transitioning 

and adjusting to residential care facilities. The findings of this study do not highlight 

loneliness as a challenge, however they do speak of social exclusion, gossiping and teasing 

as presenting challenges. Teasing and social exclusion have the potential to result in an 

individual feeling socially isolated as social isolation may be regarded as a subjective state 

where one has a generally low level of community involvement (Grenade & Boldy, 2008). 



37 
 

Being in a facility with a variety of ages posed as a challenge for some residents with regards 

to their ability to relate to one another. The differences in cognitive and communicative 

abilities among different residents posed as a challenge for some residents as this limited the 

amount of people they could create social relationships with. These findings assist in 

understanding the potential challenges linked to interpersonal relationships, which are a part 

of biopsychosocial theory. 

5.2.3 Recommendations on residential improvements to make residents’ transitions 

easier 

When asked about what the facility can change to make transitions easier, most of the 

participants expressed general satisfaction with the services that the facility offered. They 

were grateful for the staff and the opportunity to be at the facility. One participant felt like 

the participant could benefit from adding more assistive devices to help improve his 

independence, whilst another felt that the management structures had to be changed so that 

he could have the possibility of enjoying his autonomy again. 

Other participants felt that they could benefit from being in their own rooms without having 

to share. Although the literature review suggests that being alone in a room without anyone 

to talk to could contribute to feelings of loneliness, this study’s participants were more 

concerned with having privacy. This is understandable because Brandburg (2007) 

recommends alone time for reflecting in the early phases of the transition process as well as 

throughout the transitional influences and adjustments phase so that residents can come to 

grips with living life in the residential care facility. 

5.2.4 Recommendations for self to improve the socio-emotional experiences of 

adjusting and transitioning 

The participants had various ways of coping, form using prayer to being sceptical of 

residential gossip and maintaining healthy social and romantic relationships or doing things 

that simply made them happy. This supports the notion that using organised activities could 

act as a protective method against the challenges of transitioning and adapting. 

The participants agreed that working on positively accepting one’s circumstances at the 

facility by looking to the future positively and beginning to take the facility as one’s home 

goes a long way in positively assisting with the transitioning and adapting process. After all, 

according to Brandburg (2007) acceptance marks the end of the transition period. Working 



38 
 

on acceptance in a positive way has the possibility to lead to adaptive acceptance and 

possibly many joyous years at the facility. 

5.3 Conclusions 

Through data analysis, many significant findings which were in line with the objective were 

identified. The residents’ social-emotional experiences with regards to the transitioning and 

adapting to the residential care facility were comprised of initial feelings of freedom and 

independence as well as being overwhelmed. The residents experienced a variety of 

challenges and all had different expectations of the facility. However, to cope they each did 

what made them happy and they all agreed that working towards positive acceptance is the 

best thing any new resident can do to improve their experience of transitioning and adapting 

to the facility. The findings highlighted that although some findings are in line with the 

current literature, others contradict the literature proving that context is very important. 

5.4 Recommendations 

Taking into consideration the findings of the study, the following recommendations have 

been developed. 

5.4.1 Recommendations for social work practitioners 

Cerebral palsied adults transitioning and adapting into residential care facilities experience 

a variety of socio-emotional experiences and challenges. It is recommended that social 

workers working in these settings endeavour to explore new residents’ experiences and tailor 

interventions that will assist them in transitioning smoothly into the facility. The findings 

suggest that residents should find their own way around solving problems, it is thus 

recommended that social workers assist residents with problem solving, perhaps even 

equipping them with the skills to be able to do it themselves. 

5.4.2 Recommendations for residential care facilities 

Residential care facilities need to be aware of their position of authority and how the power 

imbalances between themselves and the residents affect the residents’ transition and adapting 

process. It is recommended that they implement obvious and simple communication 

channels so that residents can give them feedback on what they think the residential care 

facilities can do to improve their experiences. It is recommended that the feedback be 



39 
 

acknowledged and a response delivered to the residents. This illustrates mutual respect 

between both parties. 

5.4.3 Recommendations for future research 

Given that some family relationships with residents change post-admission and relatives and 

friends don’t visit often, a worthwhile area of research would be exploring the challenges 

friends and family face with regards to maintaining relationships with loved ones in care 

post-admission. Another area of research would be exploring how residents’ various 

methods of coping assist in the adaptation process. 

A limitation of this study was that it did not explore the residents’ social activities at the 

facility. It wold be beneficial to conduct research on how these social activities impact and 

shape the residents’ social experiences. It would also be beneficial to replicate this study in 

different residential care facilities for cerebral palsied adults in South Africa. 

5.5 Concluding comment 

The findings show that cerebral palsied adults encounter a variety of socio-emotional 

experiences and challenges throughout the transition and adaption process. Despite their 

difficulties, they are resilient enough to employ positive coping methods that will assist them 

through the process and they know they need to be working towards achieving adaptive 

acceptance. 

 

 

 

 

 

 

 

 

 

  



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Ballin, L. & Balandin, S. (2007). An exploration of loneliness: communication and the social 

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