“I thought he had longer than that”: family caregivers’ experiences of grief, loss, and bereavement in residential aged care

Abstract

Background

Residential aged care is increasingly becoming the final place of care for many older adults in high-income countries. For many families, grief begins well before the death of their loved one, emerging as early as the time of entry into residential care. This grief often continues as they witness ongoing decline and deterioration and extends into bereavement following the resident’s death. While caregiver grief is well recognised, there is limited understanding of how these experiences unfold across this full journey and the specific challenges families face at each stage. This study explored the grief, loss and bereavement needs of family caregivers of people who are about to enter, living in, or have died in a residential aged care facility.

Methods

This qualitative study used semi-structured interviews and focus groups with family caregivers and residential aged care staff. Data were managed using NVivo and analysed using reflexive thematic analysis approach.

Findings

Thirty eight participants (n = 28 staff members; and n = 10 family caregivers) from nine residential aged care services participated in the study. Five themes developed from the data: (i) grief manifests early and is associated with the loss of caregiver role; (ii) grief and emotional strain arise in transition, creating support needs; (iii) timely communication and tailored care shapes grief experience at end-of-life; (iv) inclusive after-death rituals support meaningful closure; and (v) relational support and community sustain families in grief. Participants highlighted the complexity of grief and loss experienced by family caregivers throughout their loved one’s journey in residential aged care, from admission to death.

Conclusions

Establishing culturally sensitive, timely, and open conversations about death and dying while fostering strong and supportive relationships between staff, caregivers, and residents is crucial in helping family caregivers navigate their grief, loss, and bereavement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-025-01929-6.

Background

Globally, the ageing population is growing rapidly, with the proportion of people over 60 expected to double from 12% to 22% between 2015 and 2025 [1]. Australia is among the countries experiencing the fastest population ageing [2], with a high prevalence of complex comorbid conditions among older adults [3]. This demographic shift is placing increasing pressure on the health, aged care, and social care sectors, driving greater demand for long-term and continuous care services, including residential aged care [4]. As in other high-income countries [5], for most older Australians who enter residential aged care, it becomes their final place of residence, with more than 80% of residents leaving residential aged care due to death [6].

Transitioning into aged care is a complex, emotional process for both the older person and their family [7]. While many family caregivers wish to remain actively involved in their loved one’s care after placement [8], the emotional and physical toll of prolonged grief and loss can hinder this engagement [9]. Witnessing a loved one’s decline in institutional aged care can deepen feelings of helplessness and anticipatory grief [10]. This cumulative distress not only affects caregivers’ mental health but impacts their overall well-being, relationships, and quality of life [11].

As aged care facilities increasingly serve as the final residence for many older adults in high-income countries [5, 12], caregivers often experience significant emotional challenges throughout this journey. Evidence indicates that grief can begin long before death, often emerging during the difficult transition into care and deepening as loved ones experience ongoing decline and deterioration [10]. Despite this, families frequently report limited access to information and support to help them prepare emotionally and practically for end-of-life changes [13–15]. Within this context, loss is understood as the experience of being separated from someone or something of personal significance [16, 17], while grief encompasses the multidimensional emotional, cognitive, and behavioural responses to this loss. Bereavement describes the state of having lost a loved one through death [18]. These interconnected concepts underpin the experiences of family caregivers in residential aged care and provide the foundation for understanding how grief and support needs evolve from entry into care through to death and bereavement.

While caregiver grief has been widely studied [19], there remains limited understanding of the specific challenges families encounter during the transition from home to residential care, how grief unfolds across the resident’s journey, and the types of support that best meet their needs at different stages. Addressing this knowledge gap is essential to inform resources and interventions that can better support families emotionally and practically throughout the entire residential aged care journey [20].

Methods

Aim

This study aimed to explore the grief, loss, and bereavement needs of family caregivers of older people transitioning into, living in, and dying in residential aged care setting.

Research design

This study used both qualitative interviews and focus groups to gain deeper insight into experiences of grief and bereavement in residential aged care. Aged care staff were given the option to participate in either one-on-one interviews or focus groups, providing flexibility around their work schedules while also supporting opportunities for in-depth and personal reflection. Focus groups with aged care staff facilitated the exploration of shared and differing perspectives among participants with similar experiences, supporting collective meaning-making and discussion. One-on-one interviews with family caregivers provided a private and supportive setting which enabled deeper exploration of unique and nuance experiences that may not have surfaced in focus groups. Combining these methods enriched the data and helped capture both individual and group-level experiences [21], enhancing the overall depth and breadth of understanding.

Theoretical orientation

This study was guided by a constructivist worldview which recognises that knowledge is co-constructed through the interaction between researcher and participant, and that meaning is shaped by social and relational contexts [22, 23] This perspective is particularly suited to exploring grief and bereavement, as these experiences are deeply personal, context-dependent, and socially mediated.

While not used as a formal analytic framework, this study’s design and interpretation are conceptually aligned with the Meaning-Making Theory [24, 25]. This model complements the constructivist approach by highlighting adaptive processes such as sense-making, benefit-finding, and identity change, providing a conceptual framework for understanding grief and bereavement in caregiving contexts.

Participants and setting

Aged care staff and family caregivers of individuals entering, residing in, or dying in residential aged care were recruited through services across South Australia. Staff participants were eligible if they held a clinical or caregiving role within a residential aged care facility and had direct experience supporting residents and their families. Non-clinical staff (e.g., administrative or hospitality roles) were excluded. Family participants were eligible if they had a relative who was either newly admitted, currently residing in, or had died in residential aged care. Family members without direct involvement in the resident’s care journey were excluded.

Family caregivers were intentionally included across the aged care journey, from entry to post-death, to reflect evidence that grief often begins before death and evolves over time [19, 26, 27]. Including families with varied experiences enabled exploration of how grief may arise at admission, shift during care, and continue after death. Residential aged care staff were included to provide essential contextual insights, as their roles in emotional support, communication, and care delivery significantly influence how families understand and experience loss [28].

Recruitment approach

A pragmatic recruitment strategy was used across residential aged care services in metropolitan and regional South Australia. CEOs were contacted via email with an invitation and Participant Information and Consent Forms (PICFs). Interested services provided organisational consent and, in consultation with the research team, identified potential staff and family caregiver participants. To maintain an arm’s-length approach and reduce power imbalances, CEOs had no further role once they supplied contact lists. The research team directly invited potential participants, providing PICFs and emphasising that participation was voluntary, confidential, and would not affect employment or resident care. Interested individuals returned signed consent forms and were then contacted to schedule interviews or focus groups.

Data collection

Data were collected in the form of virtual, one-on-one semi-structured interviews and focus groups. Participants were recruited and interviewed between October and November 2020 by two members of the project team [co-author 3] (female – researcher with research experience in qualitative methodology and palliative care) and [co-author 2] (male – public health and health services researcher).

Separate interview guides (see Appendices C & D) were developed specifically for family caregivers and staff who participated. The interview and focus group guides were informed by a review of current literature [20]on grief, bereavement, and family experiences in residential aged care, including recent systematic reviews and qualitative studies. This helped ensure the guides reflected key themes and addressed identified gaps. During early data collection, the research team met regularly to assess the clarity and relevance of questions. While no formal pilot was conducted, minor adjustments were made to wording and sequencing to improve flow and support rich participant responses aligned with the study aims. The data collected were recorded via audio and/or video. For the focus group sessions, a dedicated scribe took detailed observational notes. All data was transcribed verbatim using a professional transcription service. Participants were given the opportunity to review their transcripts and provide feedback. No repeat interviews or focus groups were conducted.

Data management and analysis

Data was managed using the NVivo 12 software [29] and analysed using reflexive thematic analysis [30]. Two researchers (co-author 2 & 3) read and reviewed the transcripts to familiarise themselves with the data which allowed for the generation of recurring themes enabling coding of the content. A hierarchical coding structure was developed where branching arrangements of sub-codes (child nodes) were created under each code (parent nodes). To ensure rigour in data analysis, the coding process was cross validated. Any inconsistencies during coding were discussed and resolved under mutual agreement of the team. Reflexivity was maintained through research team’s reflexive journaling, regular discussions to reflect on personal assumptions and interpretations, iterative revisiting of data and themes, and transparent documentation of the analytic process. These practices supported critical self-awareness and rigor throughout the study. A constant comparison method was used to develop recurring themes [31].

Data saturation was used as the guiding principle, with recruitment ceasing when no new themes or relevant insights emerged [32]. This approach was appropriate given the exploratory aims of the study, the need to capture diverse experiences of grief and bereavement among family caregivers and staff, and the pragmatic constraints of applied health research. While the concept of information power is acknowledged in reflexive thematic analysis, saturation was considered a suitable and contextually relevant benchmark for thematic completeness.

Ethical considerations

Ethical approval for this study has been received from Flinders University Social and Behavioural Research Ethics Committee (Project No: 2302). All participants in this study provided written informed consent.

Findings

A total of 38 participants (n = 28 staff members; and n = 10 family caregivers) from nine residential aged care facilities took part in this study. One-on-one interviews were conducted with 18 participants [staff (n = 8) and family caregivers (n = 10)] and two focus groups (n = 10 participants each) were conducted with staff. The duration of interviews and focus groups ranged between 30 and 45 min. Of the 28 residential aged care facility staff who participated in the study, 86% (n = 24) were females; 35% (n = 10) were working in a clinical nursing role, followed by managerial 21% (n = 6), lifestyle 17% (n = 5) and personal care worker 17% (n = 5) roles. Of the family caregivers participants, majority were spouses, or adult children. Half of the family caregivers 50% (n = 5) were bereaved, 20% (n = 2) had one parent die in a residential aged care facility and had one parent currently living in a residential aged care facility, and the remainder 30% (n = 3) were caregivers whose family member currently resided within a residential aged care facility.

The following themes developed from the data: [1] grief manifests early and is associated with the loss of caregiver role; [2] grief and emotional strain arise in transition, creating support needs; [3] timely communication and tailored care shapes grief experience at end-of-life; [4] inclusive after-death rituals support meaningful closure; and [5] relational support and community sustain families in grief.

At the end of each quotation, the following key conventions are used: (F = Focus group, I = Interview, the numeral cited is reference to the participant number, SM = Staff member, FC = Family caregiver).

Theme 1: grief manifests early and is associated with the loss of caregiver role

Participants highlighted that grief was both deeply personal and shaped by cultural and familial contexts. While individual differences in how people experienced and navigated grief were evident, many emphasised that cultural background and family dynamics played a significant role in shaping these processes. As one participant explained:

You will get such a variation of their own process whether it be from a cultural perspective or the family dynamic. It’s very wide and varied how people will grieve and accept ageing and dying. [I:24, SM]

Despite the individuality of grieving experiences, participants consistently described the presence of anticipatory grief that began well before the resident’s death. This often emerged during the early stages of decline or even before the transition into residential aged care:

…sometimes people are experiencing grief and loss prior to the death of their loved one…I think sometimes they’re struggling with losing the person that they’ve known, especially if it’s their wife or their husband. [I:3, FC]

… there is the grief around death and dying, but families experience the grief - especially if the resident has a dementia diagnosis- there is grief all along the journey as the resident declines. [FG:2, SM]

Participants noted that the transition into residential aged care often brought a profound sense of loss, particularly related to changes in their caregiving role. Many described feelings as though their identity as a caregiver had been diminished or taken away, which contributed to a deep emotional impact. This was frequently accompanied by guilt, stemming from an inability to continue providing care in the way they had previously:

The impact [of residential aged care placement] was devastating [for me]. … I saw my role as being her protector, her advocate, her person, her primary –carer… I saw myself as her primary person to advocate and care for her. [I:9, FC]

Sometimes it comes to the family feeling guilty, sometimes they feel like they want Mum and Dad to have good care which they can’t provide at home because they are working so it’s a difficult process [I:25, SM].

Theme 2: grief and emotional strain arise in transition, creating support needs

Participants described the move into a residential aged care facility as a catalyst for an array of difficult emotions for families, including a sense of separation, loss, abandonment and guilt:

… there’s a real stigma about going into a nursing home. A lot of denial, anger at family, the families are worried are they doing the right thing, there’s a lot of guilt involved for the families. [I:24, SM]

It’s hard. It’s hard for at least six or seven months. Because you’re going home. You’re coming here and you see them and then you’re going home to four walls. It’s hard. And you do have days where you get really, really upset. I had one the other Monday. I went in there and he seemed to be … terrible. And I just cried and didn’t like it. [I:27, FC]

For many older people and their family caregivers, the transition to residential aged care often occurs at a time of crisis, leaving them with limited choice and insufficient information

Dad was in hospital, and they didn’t give me any information [about transition into a residential aged care facility] …no-one said “this is what’s going to happen” …it would have been good to have more information because I didn’t really know the process of what was going to happen. [I:13, FC]

Participants identified several strategies that effectively supported family caregivers experiencing difficult emotions during their relative’s transition into residential aged care. These included reinforcing the positive aspects of the placement and facilitating ongoing meaningful involvement of families in the resident’s care

…if she [Mum] was on her own now in the house it would be really hard…at least knowing that she’s now there, she’s taken care of, it does take…some of that stress off my shoulders. [I:13, FC]

I think having them [family caregivers] involved decreases any …potential feelings of loss of control as well, because they are giving up that care. So, if they are involved in care and care decisions as much as possible then that really assists. [FG:1, SM]

Theme 3: timely communication and tailored care shapes grief experience at end-of-life

Participants emphasised the importance of clear and timely communication about changes in a resident’s health or decline, alongside meaningful family involvement. However, such communication was not always forthcoming:

All you can do, really, is keep people informed, and I think that is the greatest comfort. It’s when family members are left in the dark - and there’s lots of families that have issues… when people are informed, they’re less likely to find it harder to cope with, if they know what they’re dealing with [I:15, SM].

The hospital didn’t give me any information and that was a bit hard … it wasn’t until the nursing home sat me down and said, “your dad’s actually dying now, he hasn’t got long to live” and that was a bit of a shock because I didn’t think he had weeks left to live, I thought he had longer than that … it would have been nice for the hospital to have sat me down or rang me and said “we’re discharging him back to the nursing home and this is what you need to know” …. that would have been helpful at the time. [I:13, FC]

Both staff and family caregivers highlighted the importance of care that was responsive to the individual needs of the dying resident. A culturally appropriate and tailored approach was seen as essential component of good quality end-of-life care:

Putting things of significance like pictures or special things in the room of a resident. It can be around lifestyle activities, such as playing music that they enjoy. I guess other cultural things, if they have a language other than English it can be about using words that they relate to. [I:22, SM]

My husband was reasonably religious, so I got the chaplain to come and bless him before he did die. [I:10, FC]

As residents approached the dying stage, the need for family support increases. Participants emphasised the growing need for family support. Ensuring that families were emotionally supported, and given the opportunity to be present during the dying process was seen as critical to both the resident’s comfort and the family’s experience of care:

When the resident is in the palliative [dying] state, the family will visit frequently and …, we just have to keep giving them emotional support and providing reassurance. Every time I see a family member waking up in tears when they are seeing their loved ones in that [dying] state, I do give them emotional support… [I:18, SM].

They allowed us to stay in the room and the extended family were all in [the Resident’s] room with him… And I was seeing them doing the same with other people up there…it made a difference to all of us…it made it easier to go there and be there and know that they had your back all the time. [I:19, FC]

Theme 4: inclusive after-death rituals support meaningful closure

Participants highlighted the importance of shared activities and rituals in providing closure, facilitating healing, and offering both families and staff a meaningful way to say farewell to the resident after death:

If there was a funeral service, there would be music or readings, eulogies that would celebrate that person’s life. It assists with the process of saying goodbye [I:3, SM].

And the staff made a guard of honour, which was just unforgettable. [I:19, FC]

Families valued the participation of residential aged care facility staff in after-death rituals, finding their involvement meaningful and an important part of honouring the resident’s life:

Sometimes the staff will go to the funeral because they might have been attached to that resident. One of the ladies that we’ve recently lost, her daughter wanted the staff to come along, and she wanted the girls to carry the ‘The pallbearers’. [I:4, SM]

And at the viewing of mum’s body…the carer that mum loved the most and she loved mum the most she came to the viewing with me and my brother…she brought a beautiful African piece of cloth…she draped it over mum’s body in the coffin…we let her have time on her own with mum. [I:9, FC]

Participants also noted that a resident’s death not only impacts their families but also fellow residents and staff, emphasizing the importance of including all in the conversations and rituals to support collective grieving:

If they [Care staff] just want to sit and reflect on how they cared about mum. Because what happens is people die, and they never see them again. And they might have cared for them for years. And they might have loved them. [I:9, FC]

We share our memories about that [deceased resident] person, and sometimes we light candles and play music and listen to stories of that resident, what they meant to the staff or what they meant to the other residents. It can give closure to other residents, because there’s nothing worse than not being told that your neighbour for one or two years, has died. [I:3, SM]

Theme 5: relational support and community sustain families in grief

Participants highlighted the need for ongoing support for family caregivers. This support ranged from organising coordinated referrals to services and providers, to more personalised approaches, such as empathetic communication and offering a compassionate listening ear.

Maintaining open and empathetic communication was particularly valued as a source of reassurance and support during the challenging transition into the residential aged care facility by participants:

When it comes to settling [into the facility] and helping the resident and the family, I just try to be very empathetic…, to show that I understand… “This must be hard, but here you’re in good hands, you’re safe, … you’ve got nursing staff on hand”. Just really trying to focus on the positives and reassure families that they are doing the right thing … [I:24, SM].

Empathetic communication was considered particularly important as the resident neared the dying stage. Staff participants emphasised the value of active listening and emotional presence in supporting families. Families similarly acknowledged that timely and honest conversations about what to expect were essential, despite the emotional difficulty, as they helped them feel more supported:

Listen[ing] to them is the best thing, they probably have so much to say, they cry, they speak out. I think listening has always been a good thing and then they feel good, I would offer them tea and coffee and all that. [I:21, SM]

The Care Manager had a conversation with me because my dad was dying …which was difficult, but I guess it was to let me know what would happen… That was really hard, …I didn’t want to think that my dad was going to die. I knew he was going to die but I didn’t want to really hear it, but I knew I had to, and it was very well done. [I:13, FC]

In addition to empathetic communication, staff participants emphasised the importance of structured input from the broader allied health team, including social workers, pastoral care, lifestyle staff and volunteers, in supporting families. Guiding family caregivers toward appropriate external resources and services was also seen as a valuable way to extend support beyond the facility and help families navigate the complexities grief, loss and bereavement:

In many cases, family would request end of life support for their loved one and sometimes request support for themselves … A lot of people wouldn’t particularly have a religious need, but they would have a spiritual need, or they feel they just need support from pastoral care which reaches out to all groups. [I:3, SM]

They [family caregivers] can research on [the] internet, on Google, that death and dying process, how to cope with the grief and loss, and also, we can refer them to Beyond Blue, and those sites. So, with those organisations which provide emotional support and kind of mental health help. [I:18, SM]

Both staff and family participants recognised the importance of ongoing relational support throughout the end-of-life journey and beyond. Staff noted that many families formed lasting bonds with aged care staff and services, often continuing after the resident’s death. Family participants, meanwhile, highlighted the value of their personal support networks in navigating the grief and emotional transitions.

Some of the resident’s families, after their loved one passed away, some of them come in as a volunteer. [I:11, SM]

They [some family caregivers] have made friends with some of the other residents… then they become visitors to those people [after their own loved one dies], so it’s actually really a nice thing. They maintain their friendships, and it’s comforting for them [I:15, SM].

I had lots of phone calls from friends and visits from friends. And [family member’s] brother came every Thursday.…And members of [the] family were dropping in all the time. [I:19, FC]

Discussion

This manuscript contributes to the growing empirical literature on the needs of family caregivers of older residents in residential aged care, highlighting how these needs are currently being addressed and identifying existing gaps. Caregivers experience grief and loss well before a resident’s death, especially as the resident loses independence and moves into a residential aged care facility. This transition is often emotionally complex, financially stressful, and overwhelming. The study highlights the value of aged care staff in recognising the long process of loss and grief and fostering a relational, collaborative approach with family caregivers. This enables family caregivers to meaningfully engage in the resident’s care and activities, while maintaining a continued connection and sense of value in the resident’s life.

In line with the published literature [10, 26, 27], our study found that caregivers often begin experiencing grief and loss earlier than expected, particularly when recognising the need for their loved one to move into residential aged care. Losses experienced during the decline, transition and death may cause grief and distress to family caregivers [27]. This transition is widely recognised as an emotionally challenging period, marked by complex and conflicting feelings [33]. Family caregivers in our study reported experiencing guilt, shame, loss, and abandonment, alongside a simultaneous sense of relief, a response also noted in prior literature [15, 34]. As grief and loss are not confined to the period leading to and following death, but emerge and persist throughout the decline trajectory, transition, and subsequent end-of-life care period, care providers need to acknowledge and support the ongoing, cumulative losses experienced by both residents and their families [11, 35].

Research on dementia and nursing home transitions highlights the value of supporting family caregivers in staying connected with their loved ones, allowing them to take on a modified caregiving role [36]. Our study shows that this experience is not limited to families of people with dementia but is also relevant for all those moving into residential aged care. Ongoing family involvement enhances care by allowing caregivers to assist with routines, advocate for the resident, and share key information with residential aged care staff for personalised care [37–40]. A strong partnership between family caregivers and aged care staff can also improve communication, ensure continuity of care, and build trust. This approach benefits residents while easing the burden on caregivers, helping them stay engaged in their loved one’s care without the stress of full-time responsibility [5, 41].

Effective communication and a strong partnership between family caregivers and aged care staff are critical in managing expectations, facilitating end-of-life care planning, and supporting families as they navigate the progressive nature of grief and loss [42]. Our study highlights the importance of collaboration between residential aged care staff and family caregivers to ensure that caregivers remain engaged in their loved one’s care, even as their role shifts within the aged care setting [43]. As death and dying increasingly take place in residential aged care homes, timely and transparent communication about a resident’s decline, along with explicit acknowledgment that death is an expected outcome, are essential in preparing families for bereavement [43, 44]. Prior research suggests that caregivers who receive clear information about their loved one’s prognosis experience lower levels of distress and better bereavement outcomes [27, 45, 46]. However, consistent with previous findings, our study indicates that communication from aged care staff is often delayed, ambiguous, or insufficiently direct, leaving family caregivers feeling uncertain and unprepared [45, 47]. The lack of timely and compassionate discussions about death can exacerbate caregiver distress and complicate the grieving process. To address this, open and ongoing conversations about death, dying, and bereavement should be embedded within routine care practices, ensuring that caregivers feel supported and informed throughout the resident’s final stage of life [33]. These conversations can help minimise the risk of complicated grief, and other bereavement-associated morbidity among family caregivers [48].

While acknowledging death as an expected outcome and preparing for it is important, ensuring personalised and tailored care during the final stages of life remains a critical component of high-quality end-of-life care [49]. Evidence highlights the importance of creating an environment that maintains privacy, fosters connections with family, and aligns with the preferences of the dying individual [50]. This study found that individualised support for the resident, along with empathetic engagement from staff, played a key role in alleviating grief responses among family caregivers. Similar findings have been reported in studies involving bereaved families of individuals who died in hospitals [51] and at home [52], where emotional support from healthcare providers was associated with improved bereavement outcomes. Given that residential aged care facilities are increasingly the final place of residence for many older adults, integrating structured, individualised, and compassionate end-of-life care strategies is essential to supporting both dying residents and their families.

Consistent with existing literature, this study underscores the importance of post-death rituals in supporting the grief and bereavement needs of families, staff, and residents [53]. This finding is particularly relevant given the growing demographic in postmodern societies identifying as “spiritual, but not religious” [54], a trend also reflected in Australian statistics, with the Australian Bureau of Statistics reporting that 39% of Australians are non-religious [55]. In response, nondenominational rituals are increasingly being incorporated into palliative care settings, though empirical studies on their impact remain limited [56]. Small, ritualised activities create structure, meaning, and value for patients and carers. They foster human connectedness, compassion, and help honour the deceased, while supporting coping and resilience in grieving families, staff, and fellow residents [57, 58]. The significance of post-death rituals was strongly affirmed by families in this study, aligning with findings from a New Zealand study of 49 residential aged care facilities, where these practices were identified as integral to a positive death experience. However, considerable variation exists in how residential aged care facilities implement these informal rituals, with some facilities lacking consistent practices to support grieving families and staff [53]. Given that these rituals also significantly impact staff and other residents’ grief experiences [59], residential aged care facilities should establish and maintain approaches supportive of post-death rituals that respect cultural and individual preferences .

Strengths and limitations

A key strength of this study is its inclusion of both family caregiver and residential aged care staff perspectives, offering a comprehensive view of grief and loss across the aged care trajectory. The diverse timing of participants’ experiences enabled insight into how grief evolves and the ongoing nature of support needs. Staff perspectives illuminated how organisational factors shape family experiences, reinforcing the importance of staff-family relationships in bereavement outcomes.

There are, however, some limitations that should be considered when interpreting the findings of this study. Firstly, this study recruited from a single Australian state, which may limit generalisability. Secondly, the self-selected sample may reflect views of those more willing to share their experiences. Thirdly, the sample lacked cultural diversity, potentially overlooking culture-specific understandings of grief and bereavement. Additionally, while reflexive thematic analysis emphasises the influence of researcher perspectives, this study provided only brief reflections on the research process. More explicit reflexive accounts could have further strengthened transparency and alignment with this approach.

Finally, demographic information such as age, education, occupation, and the bereavement period of family caregivers was not collected. While this decision helped reduce participant burden, it may also have limited the contextual understanding of the findings, as experiences of grief and bereavement are shaped by socio-demographic and temporal factors. Future research would benefit from including such information to enhance contextual depth and support the transferability of findings.

Conclusions

Family caregivers of people who are about to enter, or living and dying in, residential aged care facilities have complex grief and bereavement-related needs. A sense of grief and loss is experienced by family caregivers throughout the resident’s journey of decline and transition to living, ageing and dying at the residential aged care facility. By building a strong partnership between residential aged care staff and family caregivers, encouraging open conversations about death, and providing culturally responsive support during and after a residents’ death - can alleviate and assist caregivers grief and loss. Consistent and standardised support as well as resources for the grief and bereavement needs of family caregivers are necessary at both residential aged care facilities and primary care levels to reduce the risk of complicated grief. Recognition of family caregivers needs as partners in aged care at the end-of-life is needed to ensure appropriate levels of support to address the ageing population. Further research on ways to integrate caregivers roles and needs in health care has been advocated. It is clear that timely end-of-life planning, support, post-death rituals, and ongoing ties with the care facility can help family caregivers cope with grief.

Authors’ contributions

**PV: ** Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Funding acquisition, Formal analysis, Conceptualisation. **AC** : Methodology, Formal analysis, Data curation. **GR** : Methodology, Formal analysis, Data curation. **JT** : Writing – review & editing, Writing – original draft, Methodology, Funding acquisition, Conceptualisation.

Funding

The Department of Health and Wellbeing, South Australia.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due [to the data used to support the findings of this study not being part of the approval of the participant consent process] but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study has adhered to the World Medical Association Declaration of Helsinki and ethical approval for this study has been received from Flinders University Social and Behavioural Research Ethics Committee (Project No: 2302). All interview participants were informed that participation was voluntary and could be withdrawn at any time. Informed consent to participate was obtained from all the participants in the study. Each participant was given a $25 gift card to thank them for their time. All data collected were deidentified to ensure confidentiality and anonymity.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.