Elders' Decisions To Enter Assisted Living Facilities: A Grounded Theory Study

ABSTRACT

The purpose of this qualitative study was to develop a substantive theory of elders' decision-making process to relocate to an assisted living facility. The researchers interviewed a purposive sample of 28 elders who resided in assisted living facilities. The theory of elders' decisions to relocate to an assisted living facility is a story about elders weighing and balancing gains and losses to go to where the help is. Decision makers weigh and balance gains and losses before, during, and after relocating to an assisted living facility. Elders stay at their current residence if gains outweigh losses and they relocate if losses outweigh gains. Understanding the process of decision-making in this segment of the population may lead to the development of interventions that can promote positive relocation experiences among elders and increase the effectiveness of their decision-making behaviors.     

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.     

The Role of Environmental Features in Social Engagement Among Residents Living in Assisted Living Facilities

The objective of this study was to describe how physical and social environmental features of assisted living facilities influence social engagement behaviors of older residents. A secondary objective was to identify the environmental features that were important to residents’ social engagement based on their perspectives. Using a qualitative approach, the authors depicted the environmental features and the social engagement patterns of older residents in two assisted living facilities in urban Saint Louis, Missouri. A stratified sample of 10 participants participated in in-depth interviews and 16 participant observations were conducted. Five physical and social features were identified as factors that influenced residents’ social engagement patterns. Environmental features that supported social engagement appeared to differ according to participant activity level. Findings from this study have the potential to inform design guidelines that will enhance social engagement in future assisted living facilities.     

Affordable Clustered Housing-Care: A Category of Long-Term Care Options for the Elderly Poor

ABSTRACT

What we label as affordable clustered housing-care options are making it increasingly possible for poor and frail older Americans to age in place comfortably and securely in residential-like settings combining both affordable shelter and long-term care. The hallmark of these housing arrangements is their sizable population clusters of low-income frail persons in need of supportive services. Despite their greater availability and the compelling factors underlying their growth, the diversity of their supportive services and operations cloud their identity resulting in uncertainty as to whether they have a common mission. In response to the need for a more careful delineation of this aging in place option, this paper describes the distinguishing features of these hybrid settings and constructs a typology of their representative exemplars or prototypes.     

Interactions of Behavior and Environment as Contributing Factors in the Discharge of Residents with Dementia from Assisted Living Facilities

While retirement communities have existed for over fifty years, they have received relatively little analysis. A clear consensus on definition does not even exist. Based on a literature review, we offer a definition that includes several criteria related to the housing units, boundaries, services and/or leisure amenities, age restrictions, voluntary relocation, and shared space. We delineate the variety of types of retirement communities and address the current and future challenges facing retirement communities. Such a discussion is urgent, given the lack of current housing policy, when both the potential demand and pertinent financial challenges are greater than ever.     

A GIS Analysis of East Asian Care Gaps in Residential and Assisted Living Facilities in Vancouver,Canada

Residential care and assisted living services provide support to seniors who may not have the ability to live independently. However, East Asian residents often do not have sufficient access to culturally specific activities, which may result in psychosocial stress and isolation. This study presents a geographic analysis method to evaluate spatial distribution of culturally tailored senior care facilities in Metro Vancouver. We identify geographical disparities, indicating that many East Asian seniors have poor local access to a culturally tailored facility. We recommend the use of geographical analysis techniques to improve the analysis and planning for senior care in an increasingly diverse population.     

The Impact of Economic,Demographic, and Cultural Changes on Preferences for Independent Living Arrangements and Seniors Housing in South Korea

Abstract

Asian countries are experiencing demographic, economic, and cultural changes that are altering housing and living arrangements. Many South Korean baby boomers will enter retirement with sufficient financial resources to live independently of their children if they choose to do so. Using a derivation of push-pull and life-course movement models, regression analysis results indicate that preference for both independent living arrangements and seniors housing is related to availability of pension resources, sex, presence of a son, and attitudes about intergenerational living, in-home care, and seniors housing. Pensions are an enabling factor; however, the cultural expectation of the eldest son providing housing for his aging parents may continue to moderate the demand for seniors housing developments. [Article copies available for a fee from The Haworth Document Delivery Service:     

Medicaid Funding for Assisted Living Care: A Five-State Examination

Medicaid waiver programs financing assisted living care are examined in five states to gain insights about program implementation, accomplishments, and challenges. Documents, augmented with stakeholder interviews, are used to describe income eligibility, options for supplementing payments to facilities, risk adjustment payment levels, and participation. Needs determination and waiver-based payments are in place. Eligibility and funding levels are complicated by room and board allocations that are linked to the federal benefit rate for Supplemental Security Income. Provider participation may be diminishing. Many recipients have to accept shared occupancy as program payments are insufficient for single units.     

Use and Usability of Assisted Living Facilities for the Elderly: An Observation Study in Gothenburg Sweden

To meet the demographic development, measures were initiated by the Swedish government entailing changed conditions for municipal eldercare, such as assisted living. Participant observation is used to study the daily use of common spaces in 14 assisted living units in Gothenburg. The results show examples where the current use diverges from the intended use and suggest diverging objectives and conflicts of use. The observations indicate that the degree of usability is determined by the physical environment itself in some cases, by the users and by changes in use in other cases, and by a combination of both in some cases.     

Older Adults Developing a Preference for Living Apart Together

What is understood about late life partner relationships is largely based on long‐term marriage, with little attention given to understanding the process of forming new partnerships in older adulthood. However, marked growth in cohabitation and greater awareness of living apart together (LAT) suggests a need for further investigation. The purpose of this grounded theory study was to explore how decisions about LAT are made among later‐life men and women. Twenty‐five participants completed life history calendars and semistructured interviews that examined how their current relationships evolved into LAT. Seven contributing factors were identified: relational and personal goals, age, caregiver burden, partner factors, relationship histories, and shifts in social mores. What participants were “doing” during the process of deciding to live apart together was working to resolve their long‐held and often ingrained beliefs about romantic relationships. Three preferences for LAT emerged from this study: opposing, ambivalent, and advocating. Future directions for research are discussed.     

Effects of an Assisted Living Facility Specifically Designed for Individuals with Memory Disorders: A Pilot Study

Despite evidence suggesting the physical environment can enhance mood and quality of life (QoL) of dementia patients, this issue has not been examined extensively within the setting of an assisted living (AL) facility. This study investigated cognition, QoL, and neuropsychiatric symptoms in 39 individuals with a memory disorder during their initial 6 months at an AL facility designed specifically for this population. Despite continued decline in cognition, participants reported lessening of several negative emotions. No significant changes in QoL or neuropsychiatric symptoms were reported. Findings suggest that moving from home to an AL facility designed specifically for individuals with memory disorders has potential positive implications.     

Multidimensional Demand Strength of Recreational Activity Programming in Assisted Living: A Conceptual Model and Prototypical Rating Scale

ABSTRACT

This article describes a framework for measuring activity demands and the psychometric properties of a related measurement tool, the Multidimensional Activities Demand Strength for Assisted Living (MADS-AL). Nine experts—three in physical, cognitive, and social domains, respectively—rated demands of 37 common assisted-living activities. Interrater reliability and internal consistency for physical, intraclass correlation coefficient (ICC)(2, 3) = .96, Cronbach's α = .97, cognitive, ICC(2, 3) = .71, α = .93, and social, ICC(2, 3) = .80, α = .86, scales give preliminary support for reliability of the MADS-AL tool. Overall, this article moves the field toward considering task demands as a relevant variable to inform future activities research and practice.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Lighthouse Independent Living Program: Predictors of client outcomes at discharge

This study examined clinical risk factors and their association with client outcomes at discharge among 385 emancipating foster youth in Cincinnati, Ohio, who entered the Lighthouse Independent Living Program during the period 2001-2005. These youth averaged 18 years of age and remained in the program an average of 10 months. At the time of discharge at age 19, 58% of these young adults had completed high school, 32% were employed, and 38% were living independently; 11% had achieved all three aforementioned outcomes. An exploratory principal components factor analysis of nineteen dichotomous risk factor items assessed by clinical staff at the time of admission yielded four types of risk: mental health problems, delinquency issues, teen parenting, and cognitive impairment. Logistic regression analysis revealed a number of significant relationships between each of these four clinical risk factors and client outcomes after adjusting for demographic and program characteristics. Those with mental health problems were only half as likely as others to have attained all three outcomes. Parenting youth were only half as likely to have completed high school or to be employed as others. Those with delinquency issues were only one-fourth as likely than others to be independently housed at discharge. Finally, older youth and those remaining in the program longer showed more favorable outcomes than others. Implications for child welfare policy and practice pertaining to independent living are discussed.     

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.     

Number of People in the United States Experiencing Ambulatory and Independent Living Difficulties

Estimating the characteristics of the “disabled” population is necessary for some governments and of interest to health researchers concerned with producing disability prevalence rates. Because generating easy-to-understand estimates of disability in the population is important, this article provides U.S. population estimates for two disability-related measures by using the 2009 to 2011 American Community Survey Public Use Microdata Sample file. The number of people who have “independent living” and “ambulatory” difficulties is calculated from a sample of 9,204,437 (representing >309 million people). The percentage for “disabled” is found to vary by racial and ethnic category, sex, age, citizenship status, educational attainment, and state-level regions divided by weather.     

The Prospect for the Future of Continuing Care Retirement Communities in New York State

No abstract available for this article.     

A Dynamic Model of Work Satisfaction: Qualitative Approaches

Traditional work satisfaction research iscriticized for its personalistic approach inconceptualization and measurement. Its results aredoubted because of the artificially high proportions ofsatisfied. In order to overcome some of theseshortcomings, the extended model of different forms ofwork satisfaction originally proposed by Bruggemann(1974) is validated. Six forms of work satisfaction(progressive, stabilized, resigned satisfaction;constructive, fixated, resigned dissatisfaction) arederived from the constellation of four constituentvariables: comparison of the actual work situation andpersonal aspirations, global satisfaction, changes inlevel of aspiration, controllability at work. Resultsfrom semistructured interviews, a free Q-sort, and aquestionnaire for differentiating forms of worksatisfaction for 46 nurses provide support for the model.Various methods proved useful in accessing particularaspects of the underlying cognitive and evaluativeprocesses in the formation of different forms of work satisfaction. Implications for personnelmanagement and studies in organizational behavior(performance, intervention strategies) arediscussed.     

Advancing Program Theory for Licensed Assisted Living Services in Independent Housing

Assisted living programs (ALPs) embed licensed assisted living services within independent housing. To advance nascent research on this type of housing plus services, this study aimed to develop empirically grounded program theory on the processes through which ALPs benefit residents within independent housing. Eighteen in-depth interviews were conducted with current and prospective consumers of an ALP in northern New Jersey, including residents and family caregivers. The setting for the ALP was a federally subsidized independent housing building, which had introduced the ALP approximately 1 year prior to the study. Themes emerging from an iterative coding process indicated the most valued aspects of the ALP’s service delivery, including the comprehensiveness of the service options, the flexible timing for their delivery, and the relational aspects of care. Participants further described the ways in which the structure of the ALP facilitated prevention, such as preventing the occurrence and escalation of adverse health events. The study concludes by presenting a program model that integrates these findings, which suggests that ALPs deliver care in ways that make long-term services and supports more accommodating and acceptable to consumers. This, in turn, can enhance their preventive value to facilitate aging in place among independent housing residents in clinical need of such supports.     

An Assessment of Sheltered Housing Design in Belfast,Northern Ireland

This article presents a UK-based research that has studied the existing sheltered or assisted living housing population and its future housing options and preferences. This meets an identified need to know and understand users' needs and requirements in much more detail that outlines what is liked and disliked by older people about sheltered housing, so that those who plan and design such housing can be aware of their views. The study also sought to understand the architects' challenges in designing and adapting this type of housing. The sheltered housing managed by housing associations in Belfast, Northern Ireland, was assessed through a series of site visits, structured interviews, and a focus group with stakeholders. Findings revealed older users' keen interest in participating in their housing needs assessment, identified building design concerns and provided recommendations for potential design guidelines.