Introduction
Aging is a natural and inevitable phenomenon, and is of great importance from a social perspective. Older adults are among the most vulnerable groups in various crises. Iran is experiencing a rapid increase in its aged population, surpassing the rate observed in many other countries. Investigations have indicated that the aged population of Iran will reach 10% by 2025 and more than 30% by 2050. The transfer of older parents to nursing homes is becoming increasingly common in Iran. This transfer can be a complex and emotionally challenging experience for children, often leading to conflicting emotions and potential psychological distress. Given the growing number of older people and the significant challenges faced by their children, research on children’s adaptation to the transfer of parents to a nursing home is crucial. Therefore, this study aimed to explore the process of adapting to nursing home placement of parents among adult children in Iran.

Methods & Materials
This is a qualitative study based on grounded theory. The participants were 13 individuals from Ahvaz and Lorestan provinces of Iran who had placed their parents in a nursing home. Purposeful sampling was used for their selection, and data were collected through semi-structured interviews, continuing until theoretical saturation was achieved. The inclusion criteria were the parents’ transfer to a nursing home at least within the past two years, responsibility for the transfer of parents to a nursing home, cognitive and educational abilities to participate in the interview, and willingness to participate in the research. Data analysis was done using Strauss and Corbin’s three-stage coding process: Open, axial, and selective coding.

Results
The main phenomenon identified was “A challenging path and a prudent decision to have peace and stability.” From among 64 initial codes, 19 axial codes emerged during the coding stages. Causal factors included the child’s inability to meet the needs of an elderly parent and the child’s perception of parents’ ongoing suffering. The contextual factors included cultural/religious barriers, the child’s insecure attachment, and physical/mental/financial limitations. Intervening factors (facilitators and inhibitors) included parents’ unusual and inconsistent behaviors, caregiving-related injuries, siblings’ lack of responsibility in caregiving, family consensus on transferring the parents, parents’ consent to transfer, fear of inadequate acceptance and care for the elderly parent, and difficulties/conflicts during the transfer process. To address these challenges, participants employed strategies such as ensuring the maintenance and improvement of parents’ health, approval of parent transfer from others, committing to maintaining continuous relationships with the elderly, and engaging in positive self-talk. The outcomes of the phenomenon included satisfaction of both parent and child with the transfer, improvement in the parent’s condition post-transfer, and the persistence of the child’s internal conflicts post-transfer.

Conclusion 
Cultural beliefs significantly influence decisions regarding the placement of elderly parents in nursing homes. Religious beliefs, in particular, play a crucial role in many families’ resistance to nursing home placement of elderly parents. Caring for elderly parents is often viewed as a religious obligation. Furthermore, various practical limitations contribute to this decision for nursing home placement, including physical, mental, and financial limitations experienced by children. The risk of caregiving-related injury further complicates the situation. Also, the parents exhibiting challenging behaviors, such as those with dementia, can generate feelings of shame and social pressure in children, ultimately contributing to the decision to place them in a nursing home. The child’s style of attachment to their parents can also significantly impact the decision-making process. Insecure attachment styles may increase the likelihood of nursing home placement. Social support plays a critical role in the adaptation process. Approval and support from other family members, specialists, relatives, and community members can significantly facilitate the transition. Conversely, the fear of social judgment and negative feedback from others can act as a significant barrier to nursing home placement of older parents. Finally, the elderly parent’s own satisfaction with the nursing home placement can significantly influence the transition and adaptation process. In conclusion, the children’s decision to place an elderly parent in a nursing home is a challenging path with both positive and negative consequences. The findings of this research can assist counselors, psychologists, and therapists in geriatrics by exploring the decision-making process of nursing home placement and facilitating the caregivers’ adaptation process. 

Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval from Shahid Chamran University of Ahvaz (Code: IR.SCU.REC.1402.003). The voluntary participation, confidentiality of information, and informed consent of participants were observed.

Funding
This article was extracted from a master’s thesis in rehabilitation counseling funded by Shahid Chamran University of Ahvaz. 

Authors' contributions
Conceptualization and study design: Zabihollah Abbaspour; Data collection, validation and analysis: Zabihollah Abbaspour and Amir Mohammad Tavakhosh; Writing, methodology, review & editing, and final approval: All authors.

Conflicts of interest
The authors declare no conflict of interests.

Acknowledgments
The authors would like to thank all participants in this study.

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