Stratified structural and epistemic aspects of the care manager's discretion—a theoretical approach to social work related to older people's potential relocation to a residential home

By applying a theoretical point of departure, the overarching aim of this article is to describe, analyze, and try to understand why care managers in their everyday occupational practice normalize the restrictive approach when older people consider relocation to a residential home. While earlier research to a large extent has drawn attention to how the care managers carry out the restrictive approach, this article pays attention to the circumstances paving its way. The focus is on influences from different sociological levels, thereby ‘stratified’, and from two aspects of discretion, where ‘structural aspects’ refer to choices between permitted alternatives and ‘epistemic aspects’ to practical reasoning under conditions of indeterminacy. With this combination, a multitude of circumstances contributing to the restrictive approach is revealed. Thus, the theoretical model includes levels as well as discretionary powers where formulas constitute the foundation at each level, subsequently related to multidisciplinary references in order to get the practice into perspective. The findings show that the priority given to home-based care in contrast to residential care is repeated and confirmed at each level and besides in an interchange between structural and epistemic aspects.     

Factors Predicting Relocation Among Older Adults

Having a greater understanding of what influences the older adults decisions to move and the characteristics of older adults who are more likely to move is valuable to help plan for the housing needs of the expanding older adult population. The authors examined how contextual, push and pull factors influence preferences of older adults to relocate. A total of 1,015 community-dwelling older adults completed a survey. Results of logistic regression analysis indicated the following variables as significantly related to relocation: gender, age, household income, province resided in, driving status, whether the current home met the older adult's needs, and unmet heavy cleaning needs. Policies and services need to focus on identification of those at most risk of relocation and support them either in their preference to age in place or through the relocation process.     

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT

The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.     

Official conceptualizations of person-centered care: Which person counts?

Numerous studies have indicated that a “psycho-social” person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a “consumer-based” rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the “Fourth Age”. This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia.     

Chapter 3 Decision-Making and Satisfaction with a Continuing Care Retirement Community

Abstract

We draw on both life course and decision-making theories to examine decision strategies prior to moving to a continuing care retirement community (CCRC) and subsequent satisfaction following the move. Multivariate analyses drawing on panel data for a sample of 92 older adults (age 64 to 94) before and after their move to a CCRC show that frequent residential relocation in the adult years reduces the odds of considering staying in one's own home. Cognitive orientations at time 1 predict subsequent satisfaction with the move to a CCRC: mastery increases the odds, desiring age-integrated housing reduces the odds.     

Homemaking,Temporality and Later Life

Abstract

While much literature has focused on the meaning of home, relatively little has been conducted on homemaking in later life. This paper demonstrates the importance of time in conceptualizations of home. Using an extensive case study from a multi-interview study with eight older people in England, it is shown that gardening can form the basis of a temporal framework which structures a life. Importantly, gardening can seem essential in homemaking and a reason not to move to residential living. This paper builds on literature that suggests home is a process and that people’s conceptualization and experience of home develop throughout their lives. As ageing and dying have become long and complicated processes, it is argued older people may find this challenging as this makes it difficult to prepare for the end of life.     

Staff responses to age‐related health changes in people with an intellectual disability in group homes

The purpose of this study was to explore how supervisors in group homes caring for people with intellectual disability responded to the development of age‐related health changes in their residents. Ten group home supervisors working in the disability sector were interviewed once. Data were analysed using Dimensional Analysis. The study identified several factors related to whether a resident could stay ‘at home’ or would need to be moved to residential aged care (nursing home) including: nature and extent of group home resources, group home staff comfort with residents’ health changes, staff skill at navigating the intersection between the disability and ageing sectors, and the supervisor’s philosophy of care. The ability of older people with an intellectual disability to ‘age in place’ is affected by staff knowledge about and comfort with age‐related illnesses, staff skills at navigating formal services, staffing flexibility, and the philosophy of group home supervisors. Despite the growing international concern for the rights of people with disability, particularly in relation to decision making, questions about the older person’s choice of residence and participation in decision making about what was best for them, were almost nonexistent. Rather, decisions were made based on what was considered to be in ‘the best interest’.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Young,anchored and free? Examining the dynamics of early housing pathways in Australia

Young people are remaining in the parental home for longer, and returning there more often, before attaining residential independence. In Australia, these patterns have prompted concerns about a ‘boomerang generation’ whose housing aspirations and decisions have either been directly questioned, or viewed as symptomatic of broader affordability issues. Employing a longitudinal perspective, we argue that early residential pathways reflect a mix of stable and dynamic influences involving individuals, their families, and their broader relationships. Using data from a large cohort (n = 2082) of young Australians participating in the ‘Our Lives’ research project, we examine housing pathway formation between the ages of 12/13 and 21/22. Events such as parental union dissolution or partnership formation were found to encourage home leaving, whilst being employed at a younger age and having grown up rurally predicted both leaving and remaining out of home. Close, supportive relationships with family and friends served to ‘anchor’ respondents at home for longer, and parental socioeconomic resources enabled respondents to leave home and return if needed. The findings suggest that early residential independence reflects various factors, not all of which are in young people’s control, and some of which may hinder the longer term sustainability of their living arrangements.     

Family members' strategies when their elderly relatives consider relocation to a residential home - Adapting, representing and avoiding

The aim of this article is to reveal how family members act, react and reason when their elderly relative considers relocation to a residential home. Since family members are usually involved in the logistics of their elderly relative's relocation, yet simultaneously expected not to influence the decision, the focus is on how family members experience participation in the relocation process in a Swedish context. 17 family members are included in 27 open, semi-structured interviews and follow-up contacts. Prominent features in the findings are firstly the family members' ambition to tone down their personal opinions, even though in their minds their personal preferences are clear, and secondly, the family members' ambivalence about continuity and change in their everyday lives. Family members are found to apply the adapting, the representing, or the avoiding strategy, indirectly also influencing their interaction with the care manager. Siblings applied the adapting strategy, spouses the representing strategy, while family members in the younger generation at times switched between the strategies.     

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.     

“I've been independent for so damn long!”: Independence, masculinity and aging in a help seeking context

This paper draws on semi-structured interviews conducted with 36 older men to examine how older men's understandings of independence relate to their help seeking behaviours and health service use. We argue that discourses of masculinity and successful aging are both represented in men's talk about independence. Recognising that these discourses are intertwined is important for understanding how older men seek help and use health services. We outline the practice and policy implications of viewing older men's help seeking behaviours in this way, and how it might be useful for promoting older men's health.     

Meaning of Home in Later Life as a Concept to Understand Older Adults’ Housing Needs: Results from the 7 Age-Friendly Cities Pilot Project in Québec

To support older adults’ desire to age in place, their housing needs must be well understood. However, little research has explored housing needs from older adults’ point of view. This article, based on the results of 49 focus groups (n = 392) and one case study from the Age-Friendly Cities Project in Québec, Canada, uses the concept of meaning of home in later life to explore older adults’ housing needs. An overview presents how older adults express meaning of home and what their needs are regarding housing and relocation. Finally, the implications for decision makers and stakeholders are discussed.     

Young people's views on safety and preventing abuse and harm in residential care: “It's got to be better than home”

Young people who live in residential care are at greater risk of experiencing sexual abuse and other forms of abuse than those living in other out of home care placements. To better understand how young people perceive and experience safety in residential care, and the things that they most need to be and feel safe, a qualitative study was conducted with 27 Australian children and young people for the Royal Commission into Institutional Responses to Child Sexual Abuse. This paper describes young people's perspectives on what makes residential care safe: supportive relationships, stability and predictability, fair rules, and having some control over their environment. Young people said that safety could be improved with: better appreciation of the risks in residential care; better matching, staffing and oversight; and better-designed responses that involve young people themselves. The findings provide critical insights from young people themselves and argue that adults and institutions need to appreciate their views of safety so as to adequately respond.     

Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality?

Relocation stress syndrome is a nursing diagnosis characterized by symptoms such as anxiety, confusion, hopelessness, and loneliness. It usually occurs in older adults shortly after moving from a private residence to a nursing home or assisted-living facility. The primary purpose of this study was to validate the symptoms of relocation stress syndrome. Eight nursing home residents and 8 assisted-living facility residents were interviewed 2 to 10 weeks after admission, when symptoms of relocation stress syndrome are most likely to appear. Results of this study indicate that the incidence of relocation stress syndrome may be overestimated. More accurate diagnosis and treatment of depression in older adults is needed.     

Designing a “Think-Along Dwelling” for People With Dementia: A Co-Creation Project Between Health Care and the Building Services Sector

Ageing-in-place is the preferred way of living for older individuals in an ageing society. It can be facilitated through architectural and technological solutions in the home environment. Dementia poses additional challenges when designing, constructing, or retrofitting housing facilities that support ageing-in-place. Older adults with dementia and their partners ask for living environments that support independence, compensate for declining and vitality, and lower the burden of family care. This study reports the design process of a demonstration home for people with dementia through performing a literature review and focus group sessions. This design incorporates modifications in terms of architecture, interior design, the indoor environment, and technological solutions. Current design guidelines are frequently based on small-scale studies, and, therefore, more systematic field research should be performed to provide further evidence for the efficacy of solutions. The dwellings of people with dementia are used to investigate the many aspects of supportive living environments for older adults with dementia and as educational and training settings for professionals from the fields of nursing, construction, and building services engineering.     

The use,role and application of advanced technology in the lives of disabled people in the UK

Disabled people are excited by the potential benefits of using advanced technologies at home. However, many devices are abandoned early and lie unused. This research project aimed to explore why this happens, what the users of such technologies require, how advanced technologies can rise to the challenges of flexibility and user choice, which applications enhance independence and improve quality of life and what the barriers are to take‐up and future utilization. It was found that disabled people wish to use advanced technology to increase independence in and beyond home but the cost of both mainstream and ‘specialist’ devices are prohibitive. The role of advanced technology should be to enhance independence and provide mainstream solutions that disabled people request, rather than designing and engineering ‘specialist’ expensive products. Furthermore, the application of advanced technology for use in the home should be directed by disabled people, collectively and individually.     

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.     

Enhancing the Quality of Care in Residential and Nursing Homes: More than Just a Professional Responsibility

ABSTRACT

This article highlights a range of issues considered essential to improving the quality of care received by older people in residential and nursing home settings. It is argued that improving such care represents a societal as well as a professional responsibility and that remedial action is needed at a number of levels. Five ‘routes’ to achieving quality are outlined, and it is suggested that these are not simply alternatives but that each requires attention if genuine progress is to be made.