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Johnson IM, Light MA. Pathways of Individuals Experiencing Serious Illness While Homeless: An Exploratory 4-Point Typology from the RASCAL-UP Study. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:209-228. [PMID: 37331000 DOI: 10.1080/15524256.2023.2223772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The shifting age demographics of those experiencing homelessness in the United States expose shortcomings and barriers within homelessness response services and safety-net healthcare to address serious illness. The purpose of this study is to describe the common trajectories of patients concurrently experiencing homelessness and serious illness. As a part of the Research, Action, and Supportive Care at Later-life for Unhoused People (RASCAL-UP) study, the study uses patient charts (n = 75) from the only specialty palliative care program in the U.S. specifically for people experiencing homelessness. Through a thematic mixed-method analysis, a four-point typology of care pathways taken by people experiencing homelessness while seriously ill is introduced: (1) aging and dying-in-place within the housing care system; (2) frequent transitions during serious illness; (3) healthcare institutions as housing; and (4) housing as palliation. Implications of this exploratory typology include targeted, site-specific interventions for supporting goal-concordant patient care and assisting researchers and policy makers in appreciating heterogeneity in experience and need among older and chronically ill people experiencing homelessness and housing precarity.
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Affiliation(s)
- Ian M Johnson
- University of Tennessee College of Social Work, Knoxville, Tennessee, USA
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2
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Regier NG, Parmelee PA. Perceived Decisional Control as a Mediator between Moving to Assisted Living Due to Caregiver Burden and Relocation Adjustment. Clin Gerontol 2022; 45:1144-1154. [PMID: 33448255 PMCID: PMC8879405 DOI: 10.1080/07317115.2020.1869132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The rapid growth of the older population in the United States has led to increased utilization of assisted living facilities (ALFs), and it is important to understand what factors may facilitate better adjustment. This study examined the mediating role of perceived decisional control in the relationship between moving to assisted living (AL) to prevent/alleviate caregiver burden and post-relocation adjustment. METHODS Participants were 91 newly-transitioned residents of ALFs in Alabama and Maryland. Data were gathered through in-person interviews and questionnaires. Mediation analyses were done using the PROCESS macro for SPSS, applying 5,000 bootstrap resamples with 95% bias-corrected confidence intervals estimated around the indirect effect. RESULTS The effect of moving to AL to prevent/alleviate caregiver burden on post-relocation depression and socialization was indirect and dependent on the degree of perceived decisional control. CONCLUSIONS Perceived decisional control may be a key factor in adjusting to AL, even when the move is catalyzed by such a complex and emotionally laden construct as caregiver burden. CLINICAL IMPLICATIONS Greater perceived decisional control over potential relocation may facilitate better adjustment, and other parties involved in the decision-making process should strive to involve the older adult in question in this process to the greatest extent possible.
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Affiliation(s)
- Natalie G Regier
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Patricia A Parmelee
- The University of Alabama, Alabama Research Institute on Aging, Tuscaloosa, Alabama, USA
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3
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Shippee TP, Fabius CD, Fashaw-Walters S, Bowblis JR, Nkimbeng M, Bucy TI, Duan Y, Ng W, Akosionu O, Travers JL. Evidence for Action: Addressing Systemic Racism Across Long-Term Services and Supports. J Am Med Dir Assoc 2022; 23:214-219. [PMID: 34958742 PMCID: PMC8821413 DOI: 10.1016/j.jamda.2021.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Long-term services and supports (LTSS), including care received at home and in residential settings such as nursing homes, are highly racially segregated; Black, Indigenous, and persons of color (BIPOC) users have less access to quality care and report poorer quality of life compared to their White counterparts. Systemic racism lies at the root of these disparities, manifesting via racially segregated care, low Medicaid reimbursement, and lack of livable wages for staff, along with other policies and processes that exacerbate disparities. We reviewed Medicaid reimbursement, pay-for-performance, public reporting of quality of care, and culture change in nursing homes and integrated home- and community-based service (HCBS) programs as possible mechanisms for addressing racial and ethnic disparities. We developed a set of recommendations for LTSS based on existing evidence, including (1) increase Medicaid and Medicare reimbursement rates, especially for providers serving high proportions of Medicaid-eligible and BIPOC older adults; (2) reconsider the design of pay-for-performance programs as they relate to providers who serve underserved groups; (3) include culturally sensitive measures, such as quality of life, in public reporting of quality of care, and develop and report health equity measures in outcomes of care for BIPOC individuals; (4) implement culture change so services are more person-centered and homelike, alongside improvements in staff wages and benefits in high-proportion BIPOC nursing homes; (5) expand access to Medicaid-waivered HCBS services; (6) adopt culturally appropriate HCBS practices, with special attention to family caregivers; (7) and increase promotion of integrated HCBS programs that can be targeted to BIPOC consumers, and implement models that value community health workers. Multipronged solutions may help diminish the role of systemic racism in existing racial disparities in LTSS, and these recommendations provide steps for action that are needed to reimagine how long-term care is delivered, especially for BIPOC populations.
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Affiliation(s)
| | - Chanee D. Fabius
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - John R. Bowblis
- Miami University, Farmer School of Business and Scripps Gerontology Center, Oxford, Ohio, USA
| | - Manka Nkimbeng
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Taylor I. Bucy
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Yinfei Duan
- University of Alberta Faculty of Nursing, Edmonton, Alberta, Canada
| | - Weiwen Ng
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Odichinma Akosionu
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jasmine L. Travers
- New York University Rory Meyers College of Nursing, New York, New York, USA
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4
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Regier NG, Parmelee PA. Selective optimization with compensation strategies utilized by older adults newly-transitioned to assisted living. Aging Ment Health 2021; 25:1877-1886. [PMID: 33325267 PMCID: PMC8879395 DOI: 10.1080/13607863.2020.1856776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Admission to assisted living (AL) is on the rise in the United States, and adjustment to this new environment can be challenging for older adults. To date, few studies have explored the ways in which older adults may be able to ease the transition to AL by minimizing relocation-related losses. Consequently, we explored the potential for the components of the framework Selective Optimization with Compensation (SOC) to facilitate successful adjustment to AL.Method: Ninety-one recently-relocated residents of eight assisted living facilities in Alabama and Maryland were interviewed about their transition and adjustment to AL. Using the SOC framework as an analytical lens, directed content analysis identified emergent themes.Results: Fifty-six participants were identified as using SOC-based strategies. Five major themes emerged: Relationships with Others, Health and Wellness, Normalcy, Entertainment, and Growth and Meaning. The theme of Health and Wellness was reported by nearly half of SOC users. Fifty-five percent reported at least one instance of elective selection, 51.8% reported loss-based selection, 48.2% reported optimization, and 41.1% reported compensation.Conclusion: These findings offer insight into strategies that may facilitate successful adaptation to AL and other long-term care settings. This represents an important first step in identifying ways older adults might cope with the different forms of loss and role adjustment that accompany the move from a private residence to assisted living.
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Affiliation(s)
- Natalie G. Regier
- Johns Hopkins University School of Nursing, Baltimore, MD, USA;,Johns Hopkins Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Patricia A. Parmelee
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
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5
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Ciofi JM, Kemp CL, Bender AA. Assisted Living Residents with Dementia: Being Out in the World and Negotiating Connections. THE GERONTOLOGIST 2021; 62:200-211. [PMID: 34370003 DOI: 10.1093/geront/gnab113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to: 1) identify residents' opportunities for, and experiences with, getting out; 2) understand the significance of getting out; and 3) explain influential factors. RESEARCH DESIGN AND METHODS Guided by grounded theory methods, we analyzed qualitative data collected over a one-year period in four diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review. RESULTS We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of 'working out' engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, convoy-, AL community-, and neighborhood-level factors. DISCUSSION AND IMPLICATIONS We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.
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Affiliation(s)
- Joy M Ciofi
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA.,Department of Sociology, Georgia State University, Atlanta, Georgia, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Emory School of Medicine, Atlanta, Georgia, USA
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6
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Bucy T, Carder P, Tunalilar O. Dying in Place: Factors Associated with Hospice Use in Assisted Living and Residential Care Communities in Oregon. JOURNAL OF AGING AND ENVIRONMENT 2021. [DOI: 10.1080/26892618.2021.1942382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Taylor Bucy
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | - Ozcan Tunalilar
- Institute on Aging, Portland State University, Portland, Oregon, USA
- Portland State University, Nohad A. Toulan School of Urban Studies and Planning, Portland, Oregon, USA
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7
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Gonzalez L. Long-Term Care Options in Florida: Their Availability by County Demographics. J Racial Ethn Health Disparities 2021; 9:698-707. [PMID: 33751483 DOI: 10.1007/s40615-021-01005-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
Older people express a preference for home and community-based care over skilled nursing, realizing that preference, however, is dependent upon having those options available. The present exploratory study uses publicly available data to understand if the geographic availability of long-term care options-skilled nursing, assisted living, home health, and homemaker/companion services-are equally distributed by demographics in Florida. Regression analyses showed that the percent 65 and older and the percent in poverty in a county were not related to long-term care availability or quality. Findings indicate that Hispanic older people have less access to nursing home beds, greater access to home health and homemaker/companion agencies, and tend to live in counties with a greater number of assisted living facility (ALF) deficiencies while Black older people have greater access to homemaker services. Rural counties had lower rates of home health and homemaker/companion agencies and fewer ALF deficiencies. The 65 and older population would benefit from the increased availability of long-term care options near the communities in which they live.
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Affiliation(s)
- Lori Gonzalez
- Research Faculty III, Florida State University, Claude Pepper Center, Tallahassee, FL, 32306, USA.
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8
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Travers JL, Hirschman KB, Naylor MD. Adapting Andersen's expanded behavioral model of health services use to include older adults receiving long-term services and supports. BMC Geriatr 2020; 20:58. [PMID: 32059643 PMCID: PMC7023712 DOI: 10.1186/s12877-019-1405-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 12/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Andersen's Expanded Behavioral Model of Health Services Use describes factors associated with the use of long-term services and supports (LTSS). This model, however, has only been tested on the intent to use such services among African-American and White older adults and not the actual use. Given the increasing diversity of older adults in the U.S., the ability to conceptualize factors associated with actual use of LTSS across racial/ethnic groups is critical. METHODS We applied Andersen's Expanded model in the analysis of 2006-2010 qualitative data using multiple methods to understand both the relevancy of factors for older adults who currently use LTSS vs. those who intend to use LTSS (as described in Andersen's original exploration). We additionally explored differences in these factors across racial/ethnic groups and included Hispanic older adults in our analyses. RESULTS Four additional constructs linked with actual LTSS use emerged: losses and changes, tangible support, capability to provide informal support, and accessibility of informal support. Racial differences were seen in level of participation in decisions to use nursing home services (Not involved: 45% African-Americans vs. 24% Whites). Reports of LTSS use to avoid burdening one's family were greater among White older adults compared to African-American older adults. CONCLUSIONS Findings around decision-making and burden along with other constructs enhance our understanding of determinants that influence actual LTSS use and require targeted interventions.
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Affiliation(s)
- Jasmine L. Travers
- Yale University School of Medicine, 333 Cedar Street, SHM I-456, PO Box 208088, New Haven, CT 06510-8088 USA
- Yale University School of Nursing, 333 Cedar Street, SHM I-456, PO Box 208088, New Haven, CT 06510-8088 USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Karen B. Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Mary D. Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104 USA
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9
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Penning MJ, Cloutier DS, Nuernberger K, MacDonald SWS, Taylor D. Long-term Care Trajectories in Canadian Context: Patterns and Predictors of Publicly Funded Care. J Gerontol B Psychol Sci Soc Sci 2019; 73:1077-1087. [PMID: 27558402 DOI: 10.1093/geronb/gbw104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 08/02/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Drawing on a structural life course perspective (LCP), we examined the most common trajectories experienced by older long-term care (LTC; home and community-based care, assisted living, and nursing home care) recipients. The overall sequencing of care transitions was considered along with the role of social structural location, social and economic resources, and health factors in influencing them. Method Latent class and latent transition analyses were conducted using administrative data obtained over a 4-year period for clients aged 65 and older (n = 2,951) admitted into publicly funded LTC in 1 Canadian health region. Results Four main LTC trajectories were identified within which a wider range of more specific or secondary subtrajectories were embedded. These were shaped by social structural factors (age, gender, rural-urban residence), social and economic resources (marital status, income, payment for services), and health factors (chronic conditions, functional and cognitive impairment and decline, problematic behaviors). Discussion Our findings support the utility of a structural LCP for understanding LTC trajectories in later life. In doing so, they also reveal avenues for enhancing equitable access to care and the need for options that would increase continuity and minimize unnecessary, untimely, or undesirable transitions.
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Affiliation(s)
- Margaret J Penning
- Department of Sociology, British Columbia, Canada.,Institute on Aging and Lifelong Health (IALH), British Columbia, Canada
| | - Denise S Cloutier
- Institute on Aging and Lifelong Health (IALH), British Columbia, Canada.,Department of Geography, British Columbia, Canada
| | - Kim Nuernberger
- Institute on Aging and Lifelong Health (IALH), British Columbia, Canada
| | - Stuart W S MacDonald
- Institute on Aging and Lifelong Health (IALH), British Columbia, Canada.,Department of Psychology, University of Victoria, British Columbia, Canada
| | - Deanne Taylor
- Fraser Health Authority, Surrey, British Columbia, Canada
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10
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Fabius CD, Thomas KS. Examining Black-White Disparities Among Medicare Beneficiaries in Assisted Living Settings in 2014. J Am Med Dir Assoc 2018; 20:703-709. [PMID: 30448156 DOI: 10.1016/j.jamda.2018.09.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assisted living (AL) provides housing and personal care to residents who need assistance with daily activities. Few studies have examined black-white disparities in larger (25 + beds) ALs; therefore, little is known about black residents, their prior residential settings, and how they compare to whites in AL. We examined racial differences among a national cohort of AL residents and how the racial variation among AL Medicare Fee-For-Service (FFS) beneficiaries compared to differences among community-dwelling and nursing home cohorts. STUDY DESIGN Retrospective cohort study. PARTICIPANTS We included (1) a prevalence sample of 442,018 white and black Medicare beneficiaries residing in large AL settings, (2) an incidence sample of new residents (n = 94,741), and (3) 10% random samples of Medicare FFS community-dwelling and nursing home beneficiaries in 2014. MEASURES The Medicare Master Summary Beneficiary File was used to identify AL residents and provided demographic, entitlement, chronic condition, and health care utilization information. We used the American Community Survey and prior ZIP code tabulation areas of residents to examine differences in prior neighborhoods. Medicare claims and the Minimum Data Set yielded samples of Medicare FFS community-dwelling older adults and nursing home residents. RESULTS Blacks were disproportionately represented in AL, younger, more likely to be Medicaid eligible, had higher levels of acuity, and more often lived in ALs with fewer whites and more duals. New black residents entered AL with higher rates of acute care hospitalizations and skilled nursing facility utilization. Across the 3 cohorts, blacks had higher rates of dual-eligibility. CONCLUSIONS Black-white differences observed among AL residents indicate a need for future work to examine how disparities manifest in differences in care received and residents' outcomes, as well as the pathways to AL. More research is needed to understand the implications of inequities in AL as they relate to quality and experiences of residents.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI; Center of Innovation in Long-Term Services and Supports, US Department of Veterans Affairs Medical Center, Providence, RI
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Beeber AS, Zimmerman S, Madeline Mitchell C, Reed D. Staffing and Service Availability in Assisted Living: The Importance of Nurse Delegation Policies. J Am Geriatr Soc 2018; 66:2158-2166. [PMID: 30325003 DOI: 10.1111/jgs.15580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To examine the health services provided in residential care and assisted living (RC/AL), the staff providing these services, and the degree to which the services relate to state-level nurse delegation policies and other correlates of service provision. DESIGN This cross-sectional study descriptively examined the relationships among RC/AL characteristics, services, staffing, and nurse delegation regulations/policies. SETTING RC/AL settings (N=245) in 8 U.S. states (CA, FL, IL, KS, NC, NH, NJ, OR). PARTICIPANTS Administrators and healthcare supervisors (individuals overseeing health care and services provided to residents). MEASUREMENTS Using a telephone survey, we examined how delegation policies related to staffing and the availability of 26 health services. RESULTS Significantly more services were available in RC/AL settings that permit delegation (delegation states) than states that do not permit delegation (nondelegation states) (19.7 vs 18.1, p < .001). Delegation states also had more medication technicians administering, assisting with, or observing self-administration of prescribed and as-needed medications (p < .001), whereas nondelegation states had staff with fewer qualifications handling medications (p < .001). In 2-way comparisons of categories of nurse staffing (none, licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) only, registered nurses (RNs) only, LPN/LVNs and RNs), RC/AL communities with no nurse staffing offered significantly fewer services than all other categories. Those with RNs only also offered a significantly fewer services than those with LPN/LVNs only. CONCLUSION This study is a first step in identifying how staffing and availability of services in RC/AL are related to statewide nurse delegation practices, forming the basis for further exploration of how these characteristics may relate to quality of care. J Am Geriatr Soc 66:2158-2166, 2018.
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Affiliation(s)
- Anna Song Beeber
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - C Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Carder PC. State Regulatory Approaches for Dementia Care in Residential Care and Assisted Living. THE GERONTOLOGIST 2018; 57:776-786. [PMID: 28077453 DOI: 10.1093/geront/gnw197] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/22/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose This policy study analyzed states' residential care and assisted living (RC/AL) regulations for dementia care requirements. Estimates suggest that at least half of RC/AL residents have dementia, and 22% of settings provide or specialize in dementia care. Residents with dementia might benefit from regulations that account for specific behaviors and needs associated with dementia, making states' RC/AL regulations address dementia care an important policy topic. Design and Methods This study examined RC/AL regulations in all 50 states and the District of Columbia for regulatory requirements on five topics important to the quality of life of RC/AL residents with dementia: pre-admission assessment, consumer disclosure, staffing types and levels, administrator training, and physical environment. Results Sixteen states license or certify dementia care units within RC/AL settings. All states had at least one dementia care requirement, though only four states had requirements for all five of the topics reviewed. Most states addressed administrator training, consumer disclosure, and physical environment, 17 addressed staffing types and levels, and 14 addressed pre-admission assessment for dementia. Thus, most states rely on general RC/AL regulations to cover dementia care policies and practices. Implications This policy study provides a resource for researchers who do cross-state studies of dementia care in RC/AL settings and state policymakers who are updating RC/AL regulations, including those responding to a 2014 Centers for Medicare and Medicaid Services rule change.
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Affiliation(s)
- Paula C Carder
- Oregon Health & Science University-Portland State University School of Public Health and Institute on Aging, Portland State University, Oregon
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13
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Kelly C, Craft Morgan J, Kemp CL, Deichert J. A Profile of the Assisted Living Direct Care Workforce in the United States. J Appl Gerontol 2018; 39:16-27. [DOI: 10.1177/0733464818757000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: The purpose of this article was to develop a profile of direct care workers (DCWs) in assisted living (AL). Research Design and Methods: We used data from 2014 American Community Survey (ACS) to identify the demographic and employment characteristics of AL DCWs. We collected state training requirements for AL DCWs from the administrative rules of state agencies and interviews with state officials. Results: AL DCWs were more likely than other DCWs to be younger, male, White, English speaking, U.S.-born, never married, and to have attended college. Two Affordable Care Act (ACA)–designated training topics (self-care and the role of the personal care aide) were not required in any state. Discussion and Implications: AL has tapped a unique pool of workers (i.e., younger, male as well as female, and with some college education) but needs to address its workforce needs via training, improvements to overall job quality, and the development of career opportunities.
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14
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Lepore M, Knowles M, Porter KA, O'Keeffe J, Wiener J. Medicaid Beneficiaries' Access to Residential Care Settings. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1335669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Molly Knowles
- RTI International, Research Triangle Park, North Carolina, USA
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15
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Skinner MW, Winterton R. Interrogating the Contested Spaces of Rural Aging: Implications for Research, Policy, and Practice. THE GERONTOLOGIST 2017; 58:15-25. [DOI: 10.1093/geront/gnx094] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/18/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark W Skinner
- Trent Center for Aging and Society, Trent University, Peterborough, Ontario, Canada
| | - Rachel Winterton
- John Richards Initiative, La Trobe University, Wodonga, Australia
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16
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Fields NL, Richardson VE, Schuman D. Marital Status and Persons With Dementia in Assisted Living. Am J Alzheimers Dis Other Demen 2017; 32:82-89. [PMID: 28084096 PMCID: PMC10852950 DOI: 10.1177/1533317516688299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the prevalence of dementia among residents in assisted living (AL), few researchers have focused on the length of stay (LOS) in AL among this population. Little is known about the factors that may contribute to LOS in these settings, particularly for residents with dementia. In the current study, a sub-set of AL residents with dementia (n = 112) was utilized to examine whether marital status was associated with LOS in AL as this has received sparse attention in previous research despite studies suggesting that marital status influences LOS in other health-care and long-term care settings. The Andersen-Newman behavioral model was used as a conceptual framework for the basis of this study of LOS, marital status, and dementia in AL. We hypothesized that persons with dementia who were married would have longer LOS than unmarried persons with dementia in AL. Cox regression was used to examine the association between marital status and LOS in AL of residents with dementia and whether activities of daily living were related to discharge from AL settings among married and unmarried residents with dementia. Main effects for marital status and the interaction between marital status and mobility with LOS were examined. Study findings provide information related to the psychosocial needs of AL residents with dementia and offer implications for assessing the on-going needs of vulnerable AL residents.
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Affiliation(s)
- Noelle L. Fields
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
| | | | - Donna Schuman
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
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Fields NL. Exploring the Personal and Environmental Factors Related to Length of Stay in Assisted Living. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2016; 59:205-21. [PMID: 27104838 DOI: 10.1080/01634372.2016.1181129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This study explored to what extent personal and environmental factors, as defined by the ecological model of aging, help us to understand length of stay in assisted living (AL). A convenience sample (N = 218) of administrative records of AL residents admitted between the years 2006 and 2011 was collected and included AL residents' demographic and healthcare information as well as dates of admission and discharge. Cox regression was used to determine which personal and environmental factors influenced length of stay in three AL programs. Number of medical diagnoses, level of care score, and facility were found to be significant predictors of length of stay. The analyses identified a median survival time of 32 months as well as critical periods for discharge from AL. Implications for future research and social work practice are presented.
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Affiliation(s)
- Noelle L Fields
- a School of Social Work , University of Texas at Arlington , Arlington , Texas , USA
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Zylberman R, Carolei A, Sacco S, Mallia P, Pistoia F. An Innovative Model of a Home-Like Environment for People in Vegetative and Minimally Conscious States. Neurohospitalist 2016; 6:14-9. [PMID: 26753053 DOI: 10.1177/1941874415596747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Many forms of assisted living have been proposed for people who have a loss of autonomy in activities of daily living. Despite the increasing prevalence of vegetative and minimally conscious states, no dedicated residential accommodation has been implemented for patients with chronic disorders of consciousness (DOCs). METHODS This is a descriptive study addressing an innovative model of in-house assistance, named Casa Iride, which has recently been implemented in the attempt to ensure health, safety, and well-being for people with DOCs and their families. RESULTS Our findings show that Casa Iride enables severely disabled individuals to live with dignity within a customized domestic environment. At the same time, it provides support for caregivers from both a practical and a psychological point of view. CONCLUSIONS The results so far indicate a virtuous cycle that brings health, social, psychological, ethical, and economic advantages: the individuals receive all the assistance needed; the families share a place with other people with similar challenges, become more aware of their situation, and learn to cope with it and to maintain their productivity at work; and the care flow of patients through intensive care units and intensive rehabilitation wards is not delayed by a lack of post discharge services.
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Affiliation(s)
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - Pierre Mallia
- Bioethics Research Programme, Faculty of Medicine & Surgery, University of Malta, Msida, Malta
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
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19
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Speller B, Stolee P. Client safety in assisted living: perspectives from clients, personal support workers and administrative staff in Toronto, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:131-140. [PMID: 25175102 DOI: 10.1111/hsc.12120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 06/03/2023]
Abstract
As the population ages, the demand for long-term care settings is expected to increase. Assisted living is a suitable and favourable residence for older individuals to receive care services specific to their needs while maintaining their independence and privacy. With the growing transition of older individuals into assisted living, facilities need to ensure that safe care is continually maintained. The purpose of this study was to determine the gaps and strengths in care related to safety in assisted living facilities (ALFs). A qualitative descriptive research design was used to provide a comprehensive understanding of client safety from the perspectives of clients, administrative staff and personal support workers. Interviews were conducted with 22 key informants from three ALFs in Toronto, Ontario throughout July 2012. All interviews were semi-structured, audio-recorded and transcribed verbatim. Initial deductive analysis used directed coding based on a prior literature review, followed by inductive analysis to determine themes. Three themes emerged relating to the safety of clients in ALFs: meaning of safety, a multi-faceted approach to providing safe care and perceived areas of improvement. Sub-themes also emerged including physical safety, multiple factors, working as a team, respecting clients' independence, communication and increased education and available resources. The study findings can contribute to the improvement and development of new processes to maintain and continually ensure safe care in ALFs.
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Affiliation(s)
- Brittany Speller
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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20
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Sudha S. Intergenerational relations and elder care preferences of Asian Indians in North Carolina. J Cross Cult Gerontol 2014; 29:87-107. [PMID: 24370947 DOI: 10.1007/s10823-013-9220-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The US older population is growing in ethnic diversity. Persistent ethnic disparities in service use among seniors are linked to structural barriers to access, and also to family processes such as cultural preferences and intergenerational relations. There is sparse information on the latter issue for immigrant ethnic minority seniors. Information on the Asian group (the fastest growing senior sub-population) is extremely scarce, due to this group's diversity in national, linguistic, and cultural origins. We conducted a qualitative study among community-dwelling Asian Indian families (including at least one member aged 60 years and older) in North Carolina to examine preferences of seniors and the midlife generation regarding elder care, and the role of intergenerational relations in desired care for elders, exploring the theoretical perspective of intergenerational relationship ambivalence. Our results suggest that cultural preferences, ambivalence in intergenerational relations, and regulations on health service eligibility among immigrant/transnational seniors and midlife adults influence preferences for elder care.
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Affiliation(s)
- S Sudha
- Department of Human Development and Family Studies, UNC Greensboro, 248 Stone Bldg, Greensboro, NC, USA,
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21
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Beeber AS, Zimmerman S, Reed D, Mitchell CM, Sloane PD, Harris-Wallace B, Perez R, Schumacher JG. Licensed nurse staffing and health service availability in residential care and assisted living. J Am Geriatr Soc 2014; 62:805-11. [PMID: 24749761 DOI: 10.1111/jgs.12786] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To create data-driven typologies of licensed nurse staffing and health services in residential care and assisted living (RC/AL). DESIGN Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services and the extent to which these clusters were related. SETTING RC/AL communities in the United States. PARTICIPANTS A convenience sample of administrators and healthcare supervisors from 89 RC/AL communities in 22 states. MEASUREMENT RC/AL characteristics, licensed nurse staffing (total number of hours that registered nurses (RNs) and licensed practical nurses (LPNs) worked), number of hours that contract nurses worked, and availability of 47 services. RESULTS Analysis revealed four licensed nurse staffing clusters defined according to total number of hours and the type of nurse providing the hours (RN, LPN, or a mix of both). They ranged from no or minimal RN and LPN hours to high nursing hours with a mix of RNs and LPNs. The 47 services clustered into five clusters: basic services; technically complex services; assessments, wound care, and therapies; testing and specialty services; and gastrostomy and intravenous medications. The availability of services was related to the presence of nurses (RNs and LPNs) except for the gastrostomy and intravenous medication services, which were not readily available. CONCLUSION The amount and skill mix of licensed nurse staffing varies in RC/AL and is related to the types of services available. These findings may have implications for resident care and outcomes. Future work in this area, including extension to include nonnurse direct care workers, is needed.
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Affiliation(s)
- Anna S Beeber
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Perkins MM, Ball MM, Whittington FJ, Hollingsworth C. Relational Autonomy in Assisted Living: A Focus on Diverse Care Settings for Older Adults. J Aging Stud 2012; 26:214-225. [PMID: 22707852 PMCID: PMC3374405 DOI: 10.1016/j.jaging.2012.01.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Consistent with Western cultural values, the traditional liberal theory of autonomy, which places emphasis on self-determination, liberty of choice, and freedom from interference by others, has been a leading principle in health care discourse for several decades. In context to aging, chronic illness, disability, and long-term care, increasingly there has been a call for a relational conception of autonomy that acknowledges issues of dependency, interdependence, and care relationships. Although autonomy is a core philosophy of assisted living (AL) and a growing number of studies focus on this issue, theory development in this area is lagging and little research has considered race, class, or cultural differences, despite the growing diversity of AL. We present a conceptual model of autonomy in AL based on over a decade of research conducted in diverse facility settings. This relational model provides an important conceptual lens for understanding the dynamic linkages between varieties of factors at multiple levels of social structure that shape residents' ability to maintain a sense of autonomy in this often socially challenging care environment. Social and institutional change, which is ongoing, as well as the multiple and ever-changing cultural contexts within which residents are embedded, are important factors that shape residents' experiences over time and impact resident-facility fit and residents' ability to age in place.
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Affiliation(s)
- Molly M. Perkins
- Division of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta, Georgia
| | - Mary M. Ball
- The Gerontology Institute, Georgia State University, Atlanta, Georgia
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Koenig TL, Lee JH, Fields NL, Macmillan KR. The role of the gerontological social worker in assisted living. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2011; 54:494-510. [PMID: 21714617 DOI: 10.1080/01634372.2011.576424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This qualitative study reports on thirteen assisted living (AL) administrators' perspectives of the role and the importance of the AL social worker in addressing the unmet needs of older adults as they move and transition into AL. Participant interviews were analyzed using the constant comparative method. Administrators described 5 AL social work roles: (a) decision-making and adjustment coordinator; (b) resident advocate; (c) mental health assessor and counselor; (d) family social worker; and (e) care planner. Implications include directly examining AL social workers' views, analyzing costs and benefits of employing AL social workers, and developing social work practicum sites within AL.
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Affiliation(s)
- Terry L Koenig
- School of Social Welfare, University of Kansas, Lawrence, Kansas 66044, USA.
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Horowitz BP, Vanner E. Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/02763891003757056] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Street D, Burge S, Quadagno J. The effect of licensure type on the policies, practices, and resident composition of Florida assisted living facilities. THE GERONTOLOGIST 2009; 49:211-23. [PMID: 19363016 DOI: 10.1093/geront/gnp022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Most assisted living facility (ALF) residents are White widows in their mid- to late 80s who need assistance with activities of daily living (ADLs) because of frailty or cognitive decline. Yet, ALFs also serve younger individuals with physical disabilities, traumatic brain injury, or serious mental illness. We compare Florida ALFs with different licensure profiles by admission-discharge policies and resident population characteristics. DESIGN AND METHODS We use state administrative data and facility survey data from the Florida Study of Assisted Living (FSAL) to classify ALFs by licensure type and to determine how licensure influences ALF policies, practices, and resident population profiles. RESULTS Standard-licensed traditional ALFs primarily serve elderly White women with physical care needs and typically retain residents when their physical health deteriorates. Some ALFs that hold specialty licenses (extended congregate care and limited nursing services) offer extra physical care services and serve an older, more physically frail population with greater physical and cognitive challenges. ALFs with limited mental health (LMH) licenses serve clientele who are more racially and ethnically diverse, younger, and more likely to be men and single. LMH facilities also have a significant proportion of frail elder residents who live alongside these younger residents, including some who exhibit behavioral problems. LMH facilities also employ discharge policies that make it more difficult for frail elderly residents to age in place. IMPLICATIONS These differences by facility type raise important quality of life issues for both the frail elderly individuals and assisted living residents who do not fit the conventional demographic profile.
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Affiliation(s)
- Debra Street
- Department of Sociology, State University of New York at Buffalo, Buffalo, NY 14260, USA.
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