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.     

Autonomy and Control in Everyday Life in Care of Older People in Nursing Homes

Self-control and autonomy are not guaranteed when people age and are in need of help from others, especially in institution-based housing. This occurs despite the fact that it is a generally accepted belief that care should be delivered with the greatest possible degree of independence and autonomy. This article discusses older people's experiences with and the opportunities for autonomy in institution-based housing. Through focus group interviews and observations, the daily lives of residents at two nursing homes in Sweden were studied through a comparative approach using the theoretical framework of organizational culture. Three themes emerged showing how autonomy was not a reality for the residents. The first theme revealed an ambivalent mission, indicating ambiguity as to whether the nursing home was a place to live in or a place in which to be cared for. The second theme was symbolic power, which encompassed the staff's power embedded in the organization. The third theme was the ageist approach to care, which was noted in the way staff considered the residents to be old people who were unable and unwilling to strive for autonomy. The three themes were embedded in the organizational culture and were created and recreated in the interaction between residents and staff. A key question for further research is how to change the culture to strengthen the residents’ autonomy.     

What do Potential Residents Need to Know about Assisted Living Facility Type? The Trade-off between Autonomy and Help with More Complex Needs

The current study surveyed 74 assisted living facilities to examine the effect of facility type on resident autonomy and the willingness of providers to admit residents requiring complex services. Facility types included adult family homes, residential care facilities, and traditional assisted living facilities. Adult family homes were more willing to admit residents with higher care needs. By contrast, assisted living facilities’ policies did not support the provision of intensive services, but their policies promoted higher resident autonomy, suggesting that consumers may have to choose between autonomy and help with complex needs when exploring assisted living for long-term care.     

“Would You Do That in Your Home?” Making Nursing Homes Home-like in Culture Change Implementation

Qualitative interviews with nursing home administrators reveal innovative and cost-conscious ways to physically modify facilities that help institute culture change practices. Telephone interviews were conducted following a national survey of nursing home nursing directors and administrators. In this cross-sectional snapshot of administrator experiences, motivations for making facilities more home-like and less institutional and creative responses to challenges are described. State and corporate support and regulator encouragement are noted that help their reform efforts. Administrators note that small steps to create a more home-like environment can result in a positive impact that minimizes disruption to existing care processes. They describe how they respond to challenges, such as the physical plant and high costs, and note how comparative shopping, cost-conscious physical improvements, and continuous involvement of staff and residents contribute to successful efforts. Their examples illustrate novel ways to humanize long-term care facilities that other nursing homes can emulate.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

Nursing Home Innovation in the Public Arena

Nursing homes in urban Boston during the early 1970s were dependent on emergency wards and outpatient departments for primary medical care of their residents. The Boston City Hospital Telemedicine program, later to become part of the Urban Medical Group, was an innovative approach to dealing with this problem through the use of teams consisting of nurse practitioners, physician assistants, and physicians. This approach, which emphasized the delivery of primary medical care at the nursing home, reduced the use of hospital-based services and improved continuity of care. This article describes the development of the concept and the challenges encountered at the state and federal levels in expanding the program.     

The Influence of Agency Staffing on Quality of Care in Nursing Homes

ABSTRACT

Data from a large sample of nursing homes were used to examine the cross-sectional association between use of agency staff, regular staff, and quality. Agency use data came from a survey conducted in 2003 (N?=?1071 nursing homes). The agency and regular staff measures were for nurse aides, licensed practical nurses, and registered nurses. We used a single quality factor constructed from the 14 quality measures in Nursing Home Compare. More agency nurse aides resulted in a smaller increase in quality, compared to the use of an equivalent number of regular nurse aides. Agency registered nurse staff were associated with better quality factor scores, especially in the presence of high levels of regular licensed practical nurses. Our results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.     

An Exploration of Adjustment Needs and Efforts of Persons with Dementia After Relocation to a Residential Care Facility

This study examined the adjustment needs and efforts of individuals with dementia after relocation to a residential care facility. This was a qualitative prospective study that involved in-depth face-to-face interviews with 16 individuals with dementia and their family caregivers at 2 and 6 months post-relocation. In their efforts to recreate a sense of home, individuals with dementia had to meet three major highly interrelated and overlapping categories of needs to settle in, fit in, and find meaning in this transition. The satisfactory fulfillment of these adjustment needs resulted in a sense of comfort, connection, and continuity associated with feeling at home. Participants’ efforts to place themselves in their new living environments created a simultaneous need to integrate relocation into their overall sense of self. The results support earlier research indicating that place making is a critical process in the overall psychosocial adjustment to old age. The findings inform supportive interventions to assist individuals with dementia to reconstruct home in a residential care environment.     

Becoming institutional bodies: Socialization into a long-term care home

This paper reports the findings from a phenomenological study examining the lived experience of moving to a long-term care facility and the process of socialization for new residents into the nursing home culture and environment. Three residents were followed over the first six months after moving to a long-term care facility using a series of in depth interviews and participant observation with residents themselves, staff members and family members. This paper focuses on the five institutional level processes related to socialization into the long-term care environment as they were experienced by the new residents. These included: placing the body, defining the body, focusing on the body, managing the body, and relating to the body. The findings point to the importance of place in the construction of institutional bodies in the long-term care context.     

Disabling Spaces and Spatial Strategies: Feminist Approaches to the Home Environment of Family Caregivers of People with Dementia

ABSTRACT

The home environment becomes very important for family caregivers of people with dementia as a place of safety, retreat and care provision. Using a gender-based perspective, the authors analyzed thirteen interviews with family caregivers to understand how they perceived their home space. The data was analyzed thematically with the help of adjacency diagrams. Our analysis identified three main themes: compact layout, spatial flexibility, and the wider neighborhood. Given the gendered nature of caring, the findings are discussed drawing on the work of feminist architects regarding the home environment. The authors argue that feminist architectural approaches can usefully inform spatial strategies regarding dementia, ageing friendly housing, accessible living and the wellbeing of the caregiver. Different bodies and users’ needs should be at the epicenter of design, as opposed to conventional design and the current practices by developers, which may create a series of disabling spaces.     

Punishing Children for Caring: The Hidden Cost of Young Carers

SUMMARY. This paper examines the lives, experiences and needs of children who care - those children under the age of 18 who provide primary care for a sick, disabled or elderly adult in the home. It presents data from a recent study into the lives of these children, their responsibilities, their commitments, their pain and their fears. It paints a picture of neglect both by professionals paid to care as well as by other family members. It suggests that child carers are effectively punished for caring. The paper goes on to examine the implications for child carers of the Community Care Act, finally implemented on 1 April 1993, to raise a number of critical questions about the rights of children who care, and to suggest a number of innovative ways forward, based upon the expressed needs of young carers.     

Using tax parcels to select a location-based sample: an illustration that examines residents' awareness of sex offenders in neighborhoods

Social science research is increasingly considering place when examining social programs and policies with a spatial component. A specific research challenge involving spatial policies is how to select a sample of individuals based on their geographic locations. This article illustrates the use of geographic information systems, tax parcels, and mail surveys to target residents in varied geographic areas. A provided example demonstrates how researchers obtained a sample of respondents living within one tenth of a mile of multiple registered sex offenders. The challenges of using tax parcels to obtain addresses for apartments and mobile home parks are also explored.     

Questions I now ask: Spirituality in the liminal environment of assisted living

This article analyzes, through two case studies, how elders in a secular, urban, assisted living facility (ALF), use their spirituality to manage change and loss, and to answer questions concerning the meaning of life and death. This article asks: how does personal spirituality help elders deal with the liminal environment of assisted living in the latter stage of life?This article is based on research that explored the cultural construction of dying and death in long-term care facilities. In-depth interviews were conducted with 22 residents living in an ALF. We offer case studies concerning elders' lived experience of spirituality in order to demonstrate the significance of individual and cohort history and the elder's embeddedness in the culture of assisted living.A key finding of this paper is that elders' spirituality becomes both miniaturized and expanded in the assisted living environment. The miniaturization mirrors the diminishment of their physical world. The expansion reflects the need for a belief system expanded enough to contain the questions asked in this place, at this time of life.     

Choosing Privacy over Interaction: Restructuring Expectations and Interpretations of Community Integration in Canadian Small-House Long-Term Care Settings

In Nova Scotia, Canada, the small-house model of care has been introduced as an alternative to institutional care settings, and the province has funded and built 11 new long-term care (LTC) communities in the small-house model. Each of the new facilities was built with multiple cottages housing 12 to 15 residents; each cottage features private bedrooms and a residentially scaled kitchen and dining area. Through smaller numbers of residents living in home areas, the goal of the Provincial Department of Health was to encourage relationship building, as well as to provide opportunities for autonomy and choice in resident daily living. A qualitative case study was conducted in one of these small-house communities, focusing on the model's impact on resident interaction and community integration. Thematic analysis revealed that while resident social patterns were directly impacted by the physical environment and culture of care in the new model, interpretations of these patterns by staff and family members were influenced by preexisting expectations of community integration rooted in institutional care models of the past.     

Going home: migration careers of southern Nigerians

Using data on the career migration histories of 533 residents (over 60 years old) of 3 southern Nigerian cities and 471 residents (over 60 years old) of 21 villages within 30 km of these cities, this study compares nonmigrants, returnees, and immigrants on educational and occupational background and ages at 1st and last migration. Findings show that 1) a large majority intend to return home, but many never do; 2) the majority of returnees go home before retirement; 3) migrants over age 65, and especially over age 75, are unlikely to return home; 4) as education and opportunities expand, it is likely that the majority of present cohorts of migrants will spend most of their working lives away from home; 5) economic success may be used to build a house in the city to which one has migrated or to retire in one's home village; 6) most Nigerians look forward to self-employment which facilitates migration and a return home; 7) more widespread wage-employment, with compulsory retirement at age 60, may greatly change the age pattern of returns; and 8) automatic village care is declining as a large proportion of villagers spend their mature years away and those who remain behind may be unable to cope with the increasing number of old people, returnees, and nonmigrants; thus, movement to towns in old age is increasing, especially among women.     

Intergenerational Community Action and Youth Empowerment

Abstract

Empowerment theory can provide a useful framework for the design and evaluation of intergenerational community-building programs. Using an intervention research approach that draws heavily on empowerment theory, the author designed, facilitated, and evaluated an innovative model for intergenerational community engagement involving undergraduate students and older adult residents of an assisted living facility. This “Intergenerational Community Action Group” met at the assisted living facility throughout a school year to engage in group-building activities, to discuss and choose an issue of concern to them in the community, and to plan and implement an action project to address the issue. This article discusses the use of empowerment theory in intergenerational community action and similar programs, and reviews the empowerment outcomes for youth participants in the Intergenerational Community Action Group.     

Nursing home satisfaction,biography, and the life worlds of psychiatrically disabled residents

The stereotype of nursing home life as a uniformly dismal experience is pervasive in American culture, but this examination of the attitudes of psychiatrically disabled residents calls this generality into question. Residents in this study exemplified a range of opinions about the nursing home — some were clearly satisfied or dissatisfied, but most were ambivalent. In this paper, I explore the relationship between nursing home satisfaction and individual interpretive activity through the biographies of three residents. I find that how residents made sense of their lives was powerfully linked to their perspectives on nursing home residence. In particular, satisfaction was linked to how each resident viewed his or her illness, institutionalization, and life purpose. Understanding the phenomenological contributors to the meaning of nursing home life is essential to appreciating how it is that residents in the same environment can have vastly different outlooks on their surroundings.     

“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.     

Aging in Place in a Retirement Community: 90+ Year Olds

Aging in place, an image of growing old in one's home and maintaining one's daily routine, is desired by most older adults. To identify variables promoting such independent living in the oldest-old, we examined the association between living situation of a population-based cohort of 90+ year olds with health and lifestyle variables. Of 1485 participants, 53% still lived in their home at a retirement community designed to foster wellness. Those living at home tended to be healthier, with smaller proportions having chronic diseases or hospitalizations in the preceding year and a greater proportion having normal functional ability. Dementia was the chronic disease most significantly related to living situation. In addition to not having dementia, not using a wheelchair or bath aid, receiving meals on wheels, and being married were jointly related to living at home. With the help of family and friends and with a medical and social support system, many 90+ year olds can age in place. This is often because they have a caregiving spouse or paid caregiver.