Living and dying are inextricably associated in nursing homes. It is not unusual for old nursing home residents to express a wish to die. This article examines interwoven patterns of family responses to resident's wish to die. As part of a multi-site ethnographic study of bereavement in long-term care, we analyzed themes in audio-transcribed in-depth qualitative interviews with 20 family members in two religiously and culturally diverse nursing homes. Rooted in the contexts of the nursing home, the family system, and the socio-cultural milieu, three patterns of family responses emerged: avoidance, disconfirmation, and acceptance of the wish to die. The family members' responses reflect their efforts to make meaning of the resident's wish both for the resident and for themselves. Rather than viewing the wish to die as a symptom of mental health problems, they perceive it as reflecting the existential situation of the resident.
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