The impact of the social environment on nursing home residents

This study contrasted the experienced quality of life of residents living on one of two nursing home units: a unit for those considered socially intact and a unit combining residents who had moderately impaired cognition or physical function with those requiring skilled nursing or therapy. Qualitative interviews were held with residents of both units. The findings indicate that the social environment of each of the units played a fundamental role in the residents' quality of life. The social environment affected the residents' conceptions of self, their interactions with other residents and their interactions with the nursing staff. The article suggests the processes behind the social environment of each floor that may have resulted in different perceptions of the quality of life.     

Resident and Family Perspectives on Assisted Living

Abstract

This research describes and compares the relative importance residents and family members place on attributes of the environment, the programs, and the policies of assisted living; describes their satisfaction with these features; and identifies factors associated with congruence between residents' and family members' ratings of importance and satisfaction. Both residents and their family members had high importance and satisfaction ratings. Family members gave the assisted living setting lower satisfaction ratings on all features than did residents. Congruence ranged from 34% to 71% for importance items and from 29% to 63% for satisfaction. Female residents, affectionate family relationships, and residing in an AL owned by a chain were positively associated with congruence on importance items, while resident and family education, resident income, and family involvement were negatively associated with congruence on importance items. For congruence on satisfaction items, having an affectionate relationship was positively associated and higher ADL dependency, more family involvement at the facility, and family members who viewed the facility as a safe place were negatively associated with congruence. This study makes a major stride forward because cognitively intact residents' perspectives are compared and contrasted with their own family members' perspectives, thus showing that residents and family members are two distinct groups, each with a unique set of preferences.     

A Stage of Migration Approach to Understanding Nursing Home Placement in Latino Families

ABSTRACT

This article introduces a dual application of Drachman and Ryan's stage of migration framework by applying the framework to an analysis of experiences of 25 nursing home residents with a prior history of migration from Cuba, the Dominican Republic, Ecuador, Mexico, and Puerto Rico. The stages of premigration and departure, transit, and resettlement are discussed in relation to research findings about the residents' earlier migration to the mainland United States and more recent move into a nursing home. Implications for social work practice with residents, families, and as members of interdisciplinary teams are addressed.     

Chapter 2 Residents in Assisted Living Facilities and Visitation Patterns

Abstract

Resident visitation patterns within an assisted living facility provide insight into a resident's life satisfaction. This study investigated residents' perceptions of family and friend visitation. Thirty assisted living residents from Oklahoma participated in a comprehensive interview that included demographics, life satisfaction, visitation frequency, and perceptions of visitation patterns. A majority of the respondents (90%) perceived family and friend visitation as “important” to “very important” in their life. Visitation allows residents to reminisce with family members and friends, to fulfill the need to have outside contact, and to be reassured that they have not been forgotten. Results indicate residents do desire continued relationships with family and friends through visitation. Facilities should encourage activities involving outside members of a resident's support network and be aware of residents less visited, developing programs creating social contact and involvement.     

Quality of Life in Nursing Homes

Abstract

The Nursing Home Reform Act (NHRA) of 1987 established nursing home requirements and dually emphasized quality of care and quality of life outcomes. We researched elders' perceptions of quality of life in nursing homes using focus groups. Analysis revealed four major themes important to residents: generativity, spiritual well-being, homelike environment, and privacy. Themes were used to analyze the disparity between NHRA's goal of dual emphasis and the dominance of quality of care in the treatment of frail elders living in nursing homes. Policies and procedures must be developed that promote decisional control in everyday matters of an older person's life.     

Outdoor Environments at Three Nursing Homes

Abstract

This study investigated how the outdoor environments at nursing homes for older persons were experienced and used to gain knowledge with implications for design. Focus group methodology was used to explore staff's view of how the residents experienced and used the outdoors. Two main themes and ten sub-themes were the result when the focus group interviews were analyzed. Theme one, being comfortable in the outdoor environment, describe the residents' special needs to be able to and dare to use the outdoors. The theme suggests a precautionary design, which promotes security and safety and protects from disturbance and negative impressions. The second main theme, access to surrounding life, describes the residents' needs for change and variety in the everyday situation and suggests an inspiring design, which promotes stimulation of senses and mind and provides positive impressions.     

Wildfire Perception and Community Change

Given increasing political and financial commitments to wildfire preparedness, risk policy demands that risk identification, assessment, and mitigation activities are balanced among diverse resident groups. Essential for this is the understanding of residents' perceptions of wildfire risks. This study compares wildfire‐risk perceptions of Pennsylvania residents with those of Minnesotans living in natural‐amenity‐rich communities. Natural‐amenity‐driven migration shifts land‐use patterns and social conditions, making it important to understand if and how such changes affect residents' perceptions of wildfire. Key informant interviews suggest land use and contrasting values associated with sociodemographic shifts were intertwined with wildfire‐risk awareness, concern, and mitigation. In both study areas, local social interactions were impaired by geospatial and sociocultural barriers related to land use and population change. Barriers included perceived threats to quality of life, conflicting needs for economic development, and homes built in isolated locations. As a result, residents did not agree on community‐wide notions of wildfire risk and response. Further, residents' ideas about the potential for a wildfire disaster did not correspond to those of risk managers. Although some places were attempting to overcome these challenges, many informants said their communities were overwhelmed with the effects of change. Finding common notions of wildfire risk is critical precisely because resident participation is crucial to hazard management. In these localities, rural community development can facilitate capacities to address wildfire risk in the context of landscape and social change.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

Preservation of self in the nursing home: Contradictory practices within two models of care

Researchers have identified several aspects of nursing home care that interfere with residents' preservation of self. This paper examines how different models of care shape residents' opportunities for preserving a sense of self, adult identity, and agency. Using ethnographic data, I analyze staff practices in two facilities that reflect the contrast between the home and hospital models of long-term care. Previous research on long-term care suggests that an informal, “home-like” approach to care creates more opportunities for residents to preserve a sense of self-identity, whereas a formal, “institutional” approach fosters depersonalizing practices that interfere with residents' psychosocial well-being. My research suggests, however, that both approaches can have contradictory effects on residents' preservation of self. I analyzed patterns of objectification and infantilization that emerged in the social interactions between residents and staff members, as well as practices that mitigated these patterns. This study highlights how a larger culture of ageism and stigma surrounding dependency can become embedded in micro-level practices and underscores the challenges of defining and implementing “good” care.     

Seeking exemptions from nursing home routines: Residents' everyday influence attempts and institutional order

Using ethnographic data collected from a Swedish nursing home, this article analyzes residents' everyday or subtle influence attempts relative to the maintenance of institutional routines. Residents' efforts to carve out some autonomy or fulfill personal preferences in everyday matters could be categorized as (1) disruptions, (2) disturbances, or (3) “good matches” relative to ongoing and up-coming nursing home routines. Striking disruptions were often fruitless, while attempts rendered as disturbances were typically postponed or modified. In general, the outcomes of residents' maneuvers were shaped by brief and situational negotiations of whether (and how) temporary exemptions from the institutional order were deemed accountable or not by the staff. Although the staff sometimes arranged situations in which residents were given some defined or symbolic decision-making authority, the findings of this study show how an inflexible local routine culture can constitute a constraining and only occasionally porous framework for residents' self constructions and everyday life.     

Designing an Ageless Social Community: Adapting a New Urbanist Social Core to Suit Baby Boomers in Later Life

ABSTRACT

Since 90% of older adults prefer aging in place (Wang, Shepley, & Rodiek, 2012), it is important that neighborhood design supports successful aging. Beyond basic needs, research indicates quality interaction is associated with positive health and well-being benefits, particularly for older adults. In this, design supporting social relationships plays an essential role. This study's purpose was to identify New Urbanist neighborhood and social space design attributes supporting older residents' physiological and social needs. This case study used keyword-in-context analysis with focus group interview data to identify domains supporting social interaction for residents aging in place including: location factors, social factors, design factors, and programmatic factors.     

The Mobility of Elderly Residents Living in Suburban Territories

Abstract

Many authors have observed die elders' unanimous aspirations to age in place. Such residential aspirations echo theoretical concepts such as “environmental-fit.” Aging residents adapt to their residential environment according to their autonomy level, their financial and social resources, as well as the meanings they invest in both residential situations and lifestyle (Lord, 2004; Wagnild, 2001). Therefore, the suburbs constitute a challenge for aging residents' intentions to remain in their home for as long as possible. These low-density environments encourage car dependency for almost every daily activity. In that regard, many studies have investigated the daily mobility patterns of elders living in such areas. However, most of them have focused on aspects linked to transportation and driving security (Rosenbloom, 2003). In this context, with a socio-anthropological (in-depth interviews) method, the elders' daily mobility is explored in a complex layering of issues. Two interdisciplinary qualitative researches on the daily and residential mobility of elderly suburbanites have been used: a group living in Quebec City's Post-War suburbs in Canada (n = 56) and another in Marseille's periurban suburbs in France (n = 36). The results show that we must investigate beyond the elders' “emotional attachment”to their “home” in order to explain the everyday tensions underlying accessibility and daily mobility. Aging in a single-family house is more than a deliberate choice. Moving away from one's neighborhood is considered a last resort alternative by the majority. Instead, the elderly from both milieus will adapt their lifestyles to the environment by redesigning their daily activities and their mobility practices in order to age in place. Therefore, adapting daily mobility practices to social interactions and social representations all become a sine qua nonecondition.     

Neighborhood Scale and Collective Efficacy: Does Size Matter?

The theory of collective efficacy emphasizes the role of the neighborhood as a unit of social control that can deter crime. The neighborhood unit is most often defined as a census tract or a similar administratively defined measure. These neighborhood definitions are not always sociologically meaningful. That is, administratively defined geographical areas do not necessarily align with residents' perceptions of their neighborhood's boundaries, which incorporate the familiarity with an area and interactions with other residents. Officially defined neighborhoods often present an inaccurate representation of collective efficacy, as these areas are not likely to function as a cohesive social unit. An alternative measure of “bespoke” neighborhoods is presented in geographical research. The bespoke neighborhood identifies a neighborhood area as the distance from a specific point or the number of people situated nearest to a specific location. This concept takes into consideration each resident's unique definition of the neighborhood. In addition, the bespoke neighborhood can be assessed on different scales to identify the most appropriate neighborhood size, where patterns of behavior are most meaningful. Bespoke neighborhoods can be used to identify sociologically meaningful neighborhoods that can inform the theory of collective efficacy.     

Nearby Nature and Long-Term Care Facility Residents

Abstract

As the population in North America continues to age, long-term care facilities for housing the elderly are likely to become even more important. Because one of the primary foci of these facilities is on sustaining and enhancing quality of life while eventually helping patients and families cope with the dying process, both the physical and social environments are critical to the facilities' success and the users' well-being. Healing, or restorative gardens and other designed green spaces have been suggested by many academics and practitioners as important components of these environments, yet there has been relatively little systematic research on the use and benefits of nature in this context. Do elderly residents of long-term care facilities benefit from access to outdoor areas? What are the design characteristics that are most important for this unique population?

Forty elderly residents of three different urban long-term care facilities were interviewed about the importance of outdoor green spaces and views within the facility, their use of the facility's outdoor spaces, benefits they derive from those spaces, and barriers to using the spaces. Facilities differed both in terms of the amount of nature in their outdoor spaces and in the design of, scale of, and access to those spaces. Results show that overall residents place a high value on access to green spaces and derive a number of benefits from these spaces, yet they spend relatively little time in these settings. Barriers to greater use of outdoor spaces included physical limitations, lack of staff assistance, and design issues. Implications for the value of nature spaces in long-term care facilities are discussed, along with specific design recommendations.     

Health insurance literacy: A mixed methods study of college students

Objective: This study examines the health insurance literacy, or the ability to use health insurance effectively, of college students. Participants: A total of 455 students from a large, public university completed an online questionnaire in November 2016. Methods: A questionnaire examined students’ knowledge of commonly encountered health insurance terms and ability to apply that knowledge to determine cost-sharing in a clinical setting. Results: The majority of students were able to correctly identify the most commonly encountered terms, but could not identify terms related to plan types and options. Eighty-eight percent of students could not determine their cost-sharing for two presented scenarios. Approximately half of the students indicated they had been confused about their health insurance plan, with one-quarter of students stopping or delaying medical care due to confusion. Conclusions: Outreach and education for students should target specific deficits in knowledge such as those identified in this study.     

“Such Trivial Matters:” How staff account for restrictions of residents' influence in nursing homes

National policies emphasize older people's right to autonomy, yet nursing home residents often have restricted opportunities to make decisions about everyday matters. We use qualitative interview data to analyze staff members' explanations of actions that conflict with both social norms and national policies. Two types of problematic actions are discussed: restrictions of elderly residents' influence in decision making and neglect of residents' complaints. While staff members describe residents' influence as desirable, they simultaneously formulate accounts that justify their inability to live up to this ideal. Further, we demonstrate how certain complaints are “made trivial” when they are described and treated in specific ways by the staff. We argue that the accounts offered by staff members draw on an implicit folk logic, a logic in which residents are allowed to exercise influence only as long as it does not conflict with the efficient running of the institution as a whole.     

TigerPlace,A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

ABSTRACT

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.     

“It’s a Dignity Thing”: Nursing Home Care Workers’ Use of Emotions1

This article examines how nursing home care workers use emotions to construct dignity at work. Previous scholarship has shown how the financial and organizational characteristics of nursing homes shape and constrain emotion work among staff. Using evidence gathered during 18 months of participant observation in two nursing homes and 65 interviews with staff, this article analyzes how, despite obstacles, nursing home care workers generated authentic emotional attachments to residents. Surprisingly, some staff members said they particularly appreciated working with residents difficult to control. They felt accomplished when such residents successfully transitioned from life at home to life in institutional care. Emotions created dignity for staff and induced compliance among residents. Emotions are not only generated by organizations and imposed on workers; staff themselves produced emotions—sometimes in ways consistent with organizational demands, and sometimes not—and they consistently found in their emotions a resource to manage the strains of their work lives.