The effects of organizational context on autonomy-enhancing policies in assisted living

This study examines the effects of facility size, ownership, chain membership, and residents' characteristics on autonomy-enhancing policies in assisted living. The theoretical framework for the study is based on the open systems perspective, which views organizations as being influenced by environmental context (e.g., ownership and chain membership). Data were collected from interviews with administrators of 60 facilities in Maryland. Autonomy-enhancing policies were assessed with the MEAP Policy Choice and Resident Control scales. Facility size and residents' disability were strong predictors of autonomy-enhancing policies (R² = .39, p < .001). Higher levels of policies that foster resident autonomy were associated with larger facility size (β = .54, p < .001) and lower residents' disability (β = .23, p < .05). Chain membership had an indirect influence on autonomy-enhancing via facility size and residents' disability. Chain-related facilities were larger, and their residents were less disabled. The study contributes to a better understanding of the mechanism through which organizational factors influence resident-oriented policies.     

Perceptions of physical activity among elderly residents and professionals in assisted living facilities

Background

Physical activity is often described as being important for people of all ages, but what different people mean when they talk about physical activity is unclear.

Method

A phenomenographic method was used to analyze how 13 older people and 17 professionals answer the question, “If I say physical activity, what does the concept mean to you?” as part of semi-structured interviews conducted in four assisted living facilities in two different municipalities.

Results

We identified a number of different perceptions of physical activity, with the older people and professionals having different responses. Elderly and professionals alike, define physical activity as a requirement for life and as an opportunity to maintain the body although they define the concepts in different ways. Elderly define the concept as a way to create meaning and the professionals have the attitude that the concept means everyday activities.

Conclusion

The concept of physical activity may be defined in many different ways. This study has shown that elderly and professionals do not define physical activity in the same way. Therefore, professionals need to be aware of these differences when talking with elderly about individual needs in everyday life.

     

Opting out while fitting in: How residents make sense of assisted living and cope with community life

This paper explores how assisted living residents construct personal understandings of congregate settings through the stories they tell. Using the narratives of Dorothy and Estelle, two 91-year-old participants, we examine how linkages between past experiences and present conditions enable residents to make sense of assisted living and cope with membership in a community comprised of diverse interests, backgrounds, and impairments. Our narrative analysis focuses on how individuals strive for continuity or new meaning in the face of chaos or disruption. Both participants characterize life in the facility in terms of prior personal and professional experiences that then inform their current behavior and feelings toward fellow residents. Although they profess to have little in common with these residents, both constitute assisted living in ways that enable them to enjoy their lives within the facility. Implications for studies using narrative analysis to examine transition into and satisfaction with congregate living are examined.     

Identifying the barriers and challenges to voting by residents in nursing homes and assisted living settings

To ascertain the need for and to inform development of guidelines for voting in long-term care settings, we conducted a telephone survey of Philadelphia nursing (n = 31) and assisted living (n = 20) settings following the 2003 election. Substantial variability existed in procedures used for registration and voting, in staff attitudes, and in the estimated proportion of residents who voted (29%+/-28, range 0-100%). Residents who wanted to vote were unable to do so at nearly one-third of sites, largely due to procedural problems. Nearly two-thirds of facilities indicated they assessed residents' voting capacity before the election. However, methods differed and may have disenfranchised residents who were actually competent to vote. Current procedures in many facilities fail to protect voting rights. These data suggest that rights might be better protected if election officials took charge of registration, filing absentee ballot requests, ballot completion, and trained LTC facility staff on voters' rights and reasonable accommodations.     

Internet lives: social context and moral domain in adolescent development

The author examines the thinking and behavior of adolescents within the digital world. What does all this instant messaging and blogging outside school hours mean? Why do adolescents do it? How much time do they spend doing it? How does it shape their social, emotional, and moral development? Bradley describes the phenomenon and explores some moral development ramifications of a new context of social experience for adolescents. It proposes that the digital world creates its own social context, with a different set of social conventions from the adult-mediated "real" world that adolescents also inhabit. It is a social context that most adults are aware of but do not understand. Adolescents' experiences in the online world influence their experiences in the face-to-face world and play an important role in the development of their social and moral knowledge. This chapter places the discussion within the context of literature on youth ethics that has been developed based on more traditional settings.     

Communication in assisted living

This study of communication in an Assisted Living Facility (ALF) focuses on staff's interpretive frameworks and situational tactics for managing elderly residents. It is based on interviews with staff and residents in an ALF together with ethnographic fieldwork. As in other quasi-total institutions, staff members engage in control as well as care, monitoring residents for compliance with rules and directives. Residents, aware of the threat of being moved to a nursing home, also monitor their own behavior and cognition in comparison to other residents. Other communication issues include the infantilization of the elderly by staff, and the race, class, and ethnic prejudices of residents.     

Independence in assisted living

The aims of this study were to understand the meaning of independence for residents of assisted living and to identify factors influencing the operationalization of independence in this setting. Qualitative interviews were conducted with 17 providers and 55 residents in 17 assisted-living facilities in Georgia. Data were analyzed by using the grounded theory method. Findings show that assisted-living residents retained a strong value for independence and that independence had multiple dimensions of meaning. Whereas independence in most cases was reduced to performing everyday activities of daily living (ADLs), the multidimensional nature of meaning allowed residents with significant disability both to continue to perceive themselves as independent and to find satisfaction in their remaining abilities. Resident self-care requires significant effort from both residents and providers, but it also has far-reaching potential to help residents maintain intact identities and may hold the key to extending their stay in the assisted-living facility (ALF) environment.     

Lost in transition: the lives of African lifeguards

A study of 11 African surf lifeguards in Durban in 1997, as they were entering employment on the beachfront, revealed their aspirations for a confident and respectable masculinity. A study of the remaining 10 in 2012 instead demonstrated the extent to which their transition into employment was caught up in violence. It is argued that three key elements contributing to this have been the racist hostility that undermined the sense of possibility, the strength and nature of peer-group relationships and a masculinity focused on the display of women and possessions. Thus, some lifeguards replicated the same patterns of violence that they had hoped to leave behind in the township, while others severed connections and left. Following Walkerdine, this underlines the significance of the relationship between space and affect and the role of safety in developing imaginative possibilities. In a context of continued structural violence, spaces need to be developed within which people can reflect on their lives and the transitions they are making.     

Therapist Personal Agency: a model for examining the training context

This study reviews the creation and testing of a model of Therapist Personal Agency during MFT training. A model including self-efficacy, trainee developmental level, supervisor working alliance, family of origin relationships, and psychological states was supported by data collected from a national sample of MFT students. The model supported by the data was consistent with much of the previous research regarding the correlates of therapist self-efficacy. Furthermore, the model accounted for 20% of the variance in therapist performance as measured by therapist reports of the working alliance. The results also highlighted the importance of attending to the relationships, interactions, and experiences that take place within the training environment and secondly, the added value that may accrue from focusing on the trainee's extended network of family relationships. A brief case example serves to illustrate the importance of tending to Therapist Personal Agency. In sum, this study provides preliminary support for holistic training methods that focus upon the whole person of the therapist.     

Policy and research issues for small assisted living facilities

Dramatic growth in Assisted Living (AL) has resulted in increasing research and policy interest. This analysis compares smaller and larger AL facilities in four states to determine whether extant measures of four key concepts, used to distinguish the AL sector, give advantage to larger facilities. Quantitative comparisons predominantly show differences favorable to larger facilities; qualitative information raises the prospect that current measures overlook beneficial aspects of smaller facilities. If small facilities are included under the AL banner. both policy provisions and quality assessment must be carefully crafted to avoid placing small homes in funding and oversight jeopardy as AL develops.     

Resident and family perspectives on assisted living

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.     

Health in household context: living arrangements and health in late middle age

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.     

Provider dilemmas with relocation in assisted living: philosophy vs. practice

Support for increasing tenant frailty in assisted living (AL) is a complex and challenging issue. Philosophically, older persons, families, providers, and policymakers want to avoid unnecessary relocation. However, there is considerable opportunity for inconsistency in practice. We examined provider perspectives related to implementing aging-in-place, using information obtained from an evaluation of a three-year AL demonstration project in Illinois. We found differences in approaches to explicit move-out criteria, the actual application of move-out criteria, and provider willingness to develop flexible service plans. These findings raise questions for consideration in all states confronted with implementing the philosophy and intent of AL.     

Ergonomics and design for sustainability in healthcare: ambient assisted living and the social-environmental impact of patients lifestyle

This work presents considerations on Ergonomics and Design for Sustainability in the healthcare field based on research experiences of the Technology and Design for Healthcare (TeDH) research group of INDACO (Industrial design, communication, arts and fashion) department of Politecnico di Milano. In order to develop a multidisciplinary approach to design able to answer to specific user needs such as elderly in an environmental sustainable way (1) this paper shows the results we achieved concerning ergonomics and environmental impact in product development (2), the extension of this approach to interior and home design and the advantage of the application of Information Communication Technologies (ICT). ICT can help people with special needs to make their everyday life easier and more safe, at the same time, ICT can make social-environmental impact of everyday behavior evident and can be applied to manage sustainability. The specific theme is thus to integrate ergonomics and sustainability competences in the development of Ambient Assisted Living through a Product- Service System approach. The concept of product service system has the potential to improve product performances and services, establish new relations and networks with different actors in order to satisfy user needs and apply a systems approach considering environmental, social and economic factors in the users' environment.     

Disablism in the lives of people living with a chronic illness in England and Portugal

This article is based on research about the daily lives of people living with chronic illnesses in England and Portugal. Through the first-person narratives of participants, I argue that the lives of people living with debilitating chronic illnesses are affected by disablism, discrimination and exclusion. These aspects affect them in several important realms of life such as lack of or poor social support, difficulties in obtaining reasonable adjustments or the inability to obtain any kind of state support at all. These aspects are also widespread and compound and greatly influence their lives, beyond or in addition to the physical experience of the illness itself. I conclude that it is fundamental to change these structural and policy aspects and that people should have access to what I have termed a paradigm of sustained well-being, despite the illness.     

Bringing assisted living services into congregate housing: housing directors' perspectives

The purpose of this research is to explore the impact of an Assisted Living Services (ALS) program on directors of state-funded congregate housing. Using focus groups, we interviewed congregate housing directors about how adding the ALS program to their facilities impacted their management experiences. Four themes emerged from the analysis of the focus group data: (1) importance of assisted living services for promoting aging in place; (2) "costs" of offering ALS; (3) differences in how the ALS program was implemented; and (4) organizational issues emerging from the merger of housing and health-care models. Based on the present findings, we propose a number of policy issues that need to be addressed when services are added to existing housing.     

When women veterans return: The role of postsecondary education in transition in their civilian lives

Objective: The purpose of this study was to assess the current state of postsecondary educational settings’ outreach to military women who become students postservice. Participants: Data for the present cross-sectional study were obtained from the American College Health Association’s (ACHA) 2011–2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with Fisher’s exact test, maximum likelihood multiple logistic regression, as appropriate. Results: Women service member and veteran students received health information from their university/college less often than women students with no military experience on the following topics: alcohol and other drug use, depression and anxiety, sexual assault and relationship violence prevention, and stress reduction. Conclusions: The findings of this research identified clear gaps in service provision for women student veterans on college campuses and provided some possible models for intervention development.     

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.     

From the streets to assisted living: perceptions of a vulnerable population

The rapid growth of assisted-living facilities is paralleled by the necessity to understand the needs of the people living in them. A hallmark challenge for individuals who are poor and disabled, and often marginalized from mainstream society, is maintaining integrity and being a whole person, rather than a sum of broken parts. A key to maintaining this integrity is the ability to find stable housing and support systems. The inner-city assisted-living facility in this study is unique in that all of its residents are funded by Medicaid. The residents have complex needs related to histories of homelessness, mental illness, drug and/or alcohol addiction, and chronic illness. The purpose of this study was to explore the needs of this vulnerable population as they adapt to a new home and a new concept of assisted, yet independent, living. Structured interviews with key informants and oral survey questionnaires with residents provided quantitative and qualitative data about physical and mental health status, social support, perception of control, psychological wellbeing, and life satisfaction. This study provided valuable insights into the challenges inherent in providing a high quality of life in assisted living for a vulnerable population with diverse needs.