Transferring control to others: process and meaning for older adults in assisted living

This study examines qualitative data describing transfers of control over life tasks (e.g., managing money, overseeing care) to close others in terms of the control by and outcome for the older person. The extant caregiving literature includes limited focus on how such task transfers occur, who controls them, and the reactions of older adults. The literature on control, however, provides extensive data that declining control has negative outcomes. Employing data from interviews with 77 adults in assisted living settings, narratives were identified where task transfers were discussed. These 26 instances were reviewed by the authors and categorized as chosen or not chosen by the older adult and their reactions categorized as positive, negative or neutral; if the initial narrative segment was ambiguous, further reading of the informant's interview or that of a family member were added to better understand these cases. Findings show that chosen transfers of tasks to children or others were linked with a positive reaction in all instances identified, while a majority of cases where tasks were taken over by others, the reactions were negative. While literature suggests that declining control is linked to negative outcomes, our findings suggest that the process involved when tasks are transfer to others (delegated or taken by them) may be an important, under-investigated element with potential implications for future research and practice.

Organizational Barriers to Cultural Competence in Hospice

This national mixed method study with directors of 207 hospices identified major barriers to cultural competence, including (1) lack of funding for additional staff for community outreach or development of culturally competent programs, (2) lack of applications from diverse professionals, and (3) lack of knowledge about diverse cultures and what cultural groups in the community are not being served. Qualitative results indicated that elements of an organizational culture, which create barriers to access included (1) failure to prioritize cultural competence, (2) failure to budget for culturally competent services, and (3) a staff that does not value awareness of cultural differences, is uncomfortable with diversity, and stereotypes diverse individuals. In phase 2, an interactive session with a 100-symposium audience provided strategies to address the barriers.

African American client satisfaction with hospice: a comparison of primary caregiver experiences within and outside of hospice

This study, conducted within a larger participatory action research project, explored satisfaction with end-of-life care among African Americans in a rural southeastern community. Researchers collaborated with practitioners and the African American community, conducting qualitative interviews with 1 African American hospice patient, 9 primary caregivers of terminally ill patients within hospice, and 10 family caregivers outside of hospice. Results indicated a more positive experience for hospice patients, and that most nonhospice participants preferred hospice after learning about it through the study. Participants made recommendations for public information efforts, the referral and intake process, and developing a relationship with the African American community. Implications for practice are to include the reasons found for African American preference for hospice in public information sessions with the African American community.

Community-Based Versus Institutional Supportive Housing

Numerous options for residential supportive housing are available for people who need long-term care. Some options are categorized as institutional while others are designated community-based; the movement to rebalance the long-term care system emphasizes the latter category. This study examines the experiences of 150 residents of two types of community-based supportive housing—assisted living (AL) and residential care homes (RCHs)—and one institutional category—nursing homes (NHs). Examining a wide range of both quantitative and qualitative outcomes, overall results show that AL residents have the best experiences and NH residents report the worst outcomes, with RCHs residents varying in the middle. However, other factors such as age, perceived health, involvement in the decision to move to the residence, and length of time in the residence, eliminate the independent effect of housing type, per se. Efforts to provide high-quality supportive housing should focus on these key factors.