Дисертації з теми "Assisted living residence"

En réponse à la crise salariale affectant les établissements sanitaires et médico-sociaux ces dernières années, cette recherche explore l'implication des personnels de santé envers leurs établissements, en se concentrant particulièrement sur les établissements d'hébergement pour personnes âgées dépendantes (EHPAD). Face à l'inquiétude exprimée par les personnels de soins concernant notamment les conditions de travail difficiles telles que le manque de personnel, l'absentéisme, les arrêts maladie et le burn-out, leur implication semble être au plus bas, voire absente. La littérature sur l'implication provient principalement des sciences de gestion, appliquée aux entreprises, et aborde peu le contexte des personnels de soin. Cette étude se demande donc si les EHPAD ne pourraient pas, à travers le management, améliorer l'implication de ces personnels. Pour cela, nous envisageons de réaliser une étude sur l'évolution du secteur sanitaire et médico-social face aux nouveaux défis et transformations majeures du secteur. Nous utiliserons des méthodes qualitatives pour mobiliser des outils managériaux qui pourraient renforcer l'implication des personnels de santé envers leur établissement. Après une analyse de la littérature portant notamment sur les théories de l'implication et des concepts connexes tels que l'engagement, la motivation, etc., nous élaborerons une grille pour mieux comprendre la réalité observée et dresserons un état des lieux des systèmes de santé et de la gestion des établissements sanitaires et médico-sociaux en France. En conclusion, l'objectif sera de proposer des outils managériaux pour encourager l'implication des personnels de santé. L'étude de terrain consistera en une observation participante auprès de plusieurs échantillons
In response to the wage crisis affecting healthcare and medico-social establishments in recent years, this research explores the involvement of healthcare staff with their establishments, focusing particularly on residential establishments for dependent elderly people (EHPAD). In the face of concerns expressed by care staff about difficult working conditions such as understaffing, absenteeism, sick leave and burn-out, their involvement appears to be at an all-time low, if not absent. The literature on involvement comes mainly from management sciences, applied to companies, and does not deal much with the context of care staff. This study therefore asks whether EHPADs could improve the involvement of these staff through management. To this end, we plan to carry out a study on the evolution of the health and medico-social sector in the face of major new challenges and transformations. We will use qualitative methods to mobilize managerial tools that could strengthen the involvement of healthcare staff in their establishments. Following an analysis of the literature, focusing in particular on theories of involvement and related concepts such as commitment, motivation, etc., we will develop a grid to better understand the reality observed, and draw up an inventory of healthcare systems and the management of health and medico-social establishments in France. In conclusion, the aim will be to propose managerial tools to encourage the involvement of healthcare staff. The field study will involve participant observation of several samples

The purpose of this study was to examine resident policies in assisted living facilities and to recommend consistent policies for resident handbooks. To accomplish this purpose, in the first phase, a mail survey form was developed to determine current resident policies provided in existing assisted living facilities in Virginia. In the second phase, the researcher analyzed each policy from the eight participating assisted living facilities and then compared the policies to determine which policies should be included in resident handbooks. Policies with similar content, but with different names were categorized together. The study employed the content-analysis method, which is oriented to qualitative research. The number of resident policies dealt with in this study totaled 56. The framework for analyzing resident policies was divided into three sections: 1) policies related to administration, 2) policies related to resident services, and 3) resident activities listed in the handbooks.

As a result of content analysis and evaluation of policies as they related to the aging process, a total of 27 recommendations were suggested. Two recommendations were suggested based on the findings of the resident handbooks survey, and 25 recommendations were suggested from analysis of the handbooks. The recommendation of resident policies can help staff to manage assisted living facilities efficiently, and the handbooks will be able to offer prospective residents clear information as they make decisions among various assisted living facilities. Moreover, current residents will benefit from lucid and consistent resident handbooks in that they will provide explicit information about policies and services.

Master of Science

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred and forty older adults residing in 14 assisted living facilities in the Portland, Oregon metropolitan area were interviewed about the frequency and types of social interactions they experienced with members of their facility-based social networks, as well as depression, mood, loneliness, self-esteem, and self-rated health. A 12-item, two-factor model of humor-related social exchanges was identified through confirmatory factor analysis, including both positive and negative humor-related social exchange factors. The newly developed scale displayed evidence of adequate reliability and validly in the current sample. Results indicated that both positive and negative humor-related exchanges were associated with various aspects of mental health, although negative humor-related exchanges appeared to be a stronger predictor of mental health than positive humor-related exchanges. Both positive and negative humor-related exchanges also served as mediators between resident and facility characteristics and indicators of mental health. Cultivating a better understanding of the relationships between humor-related social exchanges and mental health may be beneficial for researchers interested in the way humor impacts older adults' ability to cope with stress. This research may also be of value to long-term care providers who create interventions designed at improving residents' mental health and overall quality of life.

Women outnumber men in assisted living (AL). This gender imbalance promotes the feminization of AL settings and affects men’s social experiences, particularly their co-resident relationships. AL research connects peer relationships to resident well-being and suggests gender that influences co-resident interactions. Yet, few studies have specifically examined men’s social experiences in AL. This analysis aimed to: (1) learn how men experience co-resident relationships in AL; and (2) identify the factors shaping these peer relationships. The analysis utilized qualitative data collected from two AL settings. Data collection involved participant observation and informal and formal in-depth interviews. Analysis was informed by principles of Grounded Theory Method and shows high variability in men’s co-resident connections. A range of individual- and facility-level factors promoted or constrained relationship development. Gender remains pivotal in structuring men’s social engagements. Individual- and facility-level factors often intersected with gender and influenced men’s social lives. Ultimately, co-resident relationships are consequential for men in AL.

Thesis (M.A.)--Georgia State University, 2007.
Title from file title page. Mary Ball, committee chair; Jaye Atkinson, Frank Whittington, committee members. Electronic text (114 p.) : digital, PDF file. Description based on contents viewed Nov. 1, 2007. Includes bibliographical references (p. 106-114).

Treating aging as a disease has led to what Carrol Estes termed “the aging enterprise:” the development of services to house and care for elders. Much is known about the power structures in such facilities, but the issue of socio-economic decline and its relation to elder health has not received a great deal of attention. This thesis analyzes interview and participant-observation data from a sample of residents in an assisted living facility (ALF) to ethnographically explore the way physical and socio-economic experiences of decline emerge in participant narratives. Findings indicate elders construct identities of illness that draw from institutional discourses that diminish their personhood. The narrative structure of declining health is also found to be compatible with other socio-economic descriptions of decline. The multiple discursive patterns of decline culminate in a model of ALF resident dependency. Based on this model, recommendations are made to affirm elder personhood and enact agency in ALF.

Background: The behavioural and psychological symptoms of dementia (BPSD) are very common in people with dementia living in care homes. Training care home staff to understand and manage these symptoms is a potentially valuable intervention. This review aimed to understand the effectiveness of staff training interventions for reducing BPSD. Method: A systematic literature search was conducted. The search identified 273 studies. Twenty studies, published between 1998 and 2010, were found to meet the inclusion criteria. They were screened for quality using pre-specified criteria. Results: Overall the studies were found to be of adequate quality, although the majority of studies did not adhere to the recommended guidelines for the conduct of Cluster Randomised Controlled Trials. There were also a number of other methodological weaknesses. Twelve studies found evidence that staff training can reduce BPSD, four studies found positive trends and four studies found no evidence that staff training can reduce BPSD. Conclusions: The review found good evidence for the effectiveness of staff training interventions for reducing BPSD, although the methodological limitations made it difficult to draw definitive conclusions. No links were found between the theoretical orientation of training programmes and their effectiveness. There was good evidence that staff behaviour is improved following attendance at training programmes, but training was found to be less effective for improving the psychological well-being of care staff.

In the late 1980's assisted living emerged as a self-proclaimed new style of providing long-term care and supportive services. Assisted living as espoused by its early proponents and by industry leaders embodied certain specific philosophical tenets, such as dignity, autonomy, meeting scheduled and unscheduled needs and aging in place, in their daily operations. These tenets distinguished assisted living from other forms of institutional care such as nursing home care. In the past twenty years the assisted living industry has matured and grown substantially. However, despite the maturing of the industry and the general agreement on the basic tenets little is known about the degree to which the industry embodies these principles.

In addition public policy and consumer preferences have grown in their focus on substituting assisted living for nursing home care. Moreover, the degree to which assisted living can and does substitute for nursing home care has been largely unexamined. Elder care advocates and researchers have more and more called attention to the increasing acuity level of assisted living residents.

This study consists of three related components, each of which will broaden the understanding of current assisted living facilities and their residents. The first study examines person environment fit in assisted living. Lawton's theory of person environment fit, has largely defined the construction and physical environment of assisted living since the 1980's. Changes in Lawton's theory were proposed by Guiata and Jones in the Journal of the American Medical Association in 2012 in reaction to the increased level of dementia in assisted living residents. A third non-theoretical analysis using exploratory factor is designed assist with development of new constructs in person environment fit theory. The second study examines changes in assisted living facilities and residents from 1999 to 2010. This study uses the only two national surveys of assisted living, The 1999 National Survey of Assisted Living and the 2010 National Survey of Residential Care Facilities. This study will examine both facility level and resident level characteristics to explicate resident acuities and to examine the degree to which facilities are accommodating these acuities. The third study examines facility characteristics associated with discharge of residents from assisted living facilities. Understanding resident discharge from assisted living will give a better understanding how assisted living facilities meet scheduled and unscheduled needs of residents as well as embody the philosophical concept of aging in place.

The contribution of this research is improved understanding of the current assisted living facilities and residents and better understand the importance of facility characteristics in person environment fit and in aging in place. This contribution is significant because assisted living residents are a vulnerable population with no protection under federal statutes and limited protection in most states. If indeed, as advocates and researchers assert, assisted living residents mirror nursing home residents in acuity then this research will assist with developing policies to protect this vulnerable population.

In this study I explore boundary work processes that older adults do which influences friendships among residents of a progressive care retirement community. Accounts of boundary work as mechanisms for including some and excluding other residents as potential friends were collected by using a combination of quantitative surveys and qualitative interviews from residents (age 65+) of a progressive care retirement community in the United States. First, a survey explored symbolic boundaries related to cultural capital, defined as music and leisure interest and participation, as well as structural and social aspects of friendships among residents (N=66). Second, in-depth interviews of a sub-sample of residents of an assisted living facility within the community (N=15), were conducted to examine older adultsâ narratives of how they use cultural capital as a mechanism of symbolic boundary work that influences their friendships with others in the retirement community. The administrator of the assisted living facility (N=1) was also interviewed. Findings from this study suggested that cultural capital was associated with sociability which offers some support for the relational â tool kitâ model of the theory. However, findings from in-depth interviews suggested that while music and leisure interests and participation may be important, valuations of bodies were more likely to influence â otheringâ of residents, although the two are related. This study enriches our understanding of how symbolic boundary use varies by group and context, as well as makes theoretical contributions to the literature on symbolic boundaries by exploring the ways in which aging may alter the use of boundaries.
Ph. D.

Thesis (Ph. D.)--Florida State University, 2007.
Advisor: Jill Quadagno, Florida State University, College of Social Sciences, Dept. of Sociology. Title and description from dissertation home page (viewed July 26, 2007). Document formatted into pages; contains viii, 107 pages. Includes bibliographical references.

Thesis (Ph. D.)--Florida State University, 2006.
Advisor: Jill Quadagno, Florida State University, College of Social Sciences, Dept. of Sociology. Title and description from dissertation home page (viewed Sept. 20, 2006). Document formatted into pages; contains viii, 126 pages. Includes bibliographical references.

While play therapy is primarily used with children, recent research has begun to explore the use of this approach with adults and the elderly. The purpose of this study was to explore and describe in detail the process of Client Centered Play Therapy (CCPT) with an elderly assisted living facility resident through use of a qualitative case study. A single elderly resident participated in 12 CCPT sessions over a period of six weeks. Qualitative data were obtained through observational session notes, pre- and post-treatment interviews with the resident and the facility’s Licensed Practical Nurse, pre- and post-treatment administrations of the Geriatric Depression Scale, and review of the resident’s case file in order to gain insight into the process of CCPT with one elderly assisted living facility resident. Data collected were examined in relation to the play behaviors exhibited by the resident, typical stages of play therapy, potential therapeutic benefits, and the resident’s view of the CCPT approach. Results indicate that the play behaviors of one elderly resident were markedly similar to those of children participating in CCPT and that this may be an appropriate and enjoyable method for addressing mental health needs of the elderly. Implications and recommendations for future research are discussed.

The purpose of this exploratory study was to develop an instrument to measure perceived food autonomy (PFA) among cognitively alert residents in state licensed Assisted Living (AL) facilities, and to investigate the influence of PFA on food satisfaction, while controlling for functional (physical, social, and psychological) status, general health, and demographic characteristics. The study was designed to achieve four objectives: 1) to define a theoretical framework for food autonomy among residents in AL settings and to develop an instrument accordingly; 2) to evaluate the content and construct validity of the PFA scale; 3) to evaluate the reliability of the PFA scale; and 4) to investigate the effect of perceived food autonomy, functional (physical, social and psychological) status, and general health on food satisfaction in AL settings. Definitions for food autonomy and three underlying dimensions were developed based on conceptualizations of personal autonomy for older adults in long-term care settings, which provided a theoretical framework for the PFA scale development. Content validity was established by expert panel evaluation and a pilot study. Construct validity was achieved from factor analysis procedures with a sample of 120 residents from eleven AL facilities. Cronbach's alpha measure of internal consistency showed the 11-item PFA scale to be reliable (alpha = .71). Multiple linear regression analysis examined the effect of residents' PFA, health and functional status, and demographic characteristics on food satisfaction. Food satisfaction was measured by a highly reliable (alpha = .87) scale that was compiled for this study. Perceived food autonomy was the most significant predictor of food satisfaction, explaining 37% of its variance. Residents' perceptions of daily pain along with the joint effect of ADL needs and dentures use made a lesser but significant contribution. Altogether, the above variables explained 48% of the variance in residents' food satisfaction. Application of reliable%instruments such as the PFA and FS scales can be used by AL provider to guide food service quality improvement efforts. Residents' PFA and food satisfaction should be periodically measured due to the typical decline in overall health and functional status of AL residents.
Graduation date: 2004

Regular walking has several physical and psychological benefits for frail older people. However, many residents in long-term care facilities are too sedentary to achieve these benefits. Indoor walking appears to be a feasible way to promote active living among these residents and yet, there is little research that has been done in this regard. The researcher conducted two studies in Central Texas to explore how corridor design features influenced indoor walking behaviors among assisted living residents. In the first study, the researcher carried out six focus groups with 50 assisted living residents, discussing how they perceived the indoor corridor as "walkable." Residents reported that a walkable corridor should be safe, comfortable, and having beautiful/interesting things to see. In the second study, the researcher further examined the relationship between the built environment and walking behaviors among 326 residents from 18 facilities in a major city of Texas. The results indicated that 'perceived looped corridor' and 'number of stories' were significantly associated with residents' frequencies of indoor recreational walking. In addition, the availability and quality of sitting space around mailbox areas influenced the number of "walking to mailbox" trips. This research provides empirical evidence to develop activity-friendly facility design guidelines, and to create environmental interventions to facilitate active lifestyles among long-term care residents.

abstract: ABSTRACT The massive number of baby boomers approaching retirement age has been termed the `gray tsunami.' As America's gray tsunami approaches, healthcare workers and social workers will become overwhelmed with requests for services and supports (St. Luke's Health Initiative, 2001; Bekemeier, 2009). This impact can be ameliorated by assisting aging individuals in maintaining or in some cases regaining independence. Individuals who live in assisted living facilities (AFLs) come from diverse backgrounds. Many of these individuals have lived in paternalistic environments such as prisons and mental health institutions. As a consequence of these disempowering conditions, residents of ALFs may experience increased depression, decreased self-esteem, and decreased locus of control (R. Hess, personal communication, September 30, 2010). These disabling conditions can severely limit residents' choice-making opportunities and control over their own lives. If programs can be created to provide empowering experiences and to teach self-advocacy skills, I hypothesize that residents will report an improved quality of life and display fewer depressive symptoms, increased self-esteem, and increased locus of control. Helping these individuals to maintain or regain independence will not only reduce the workload for care workers, it will enhance the lives of residents. The only hypothesis that was supported by the study was an improvement in residents' quality of life, and that hypothesis was only partially supported. Two of the five domains in the Residents' Quality of life questionnaire indicated an increase in quality of life. ii The Activities subscale of the Ferrans & Powers Quality also indicated that there was an increase in quality of life.
Dissertation/Thesis
Ph.D. Social Work 2012

Encontramo-nos numa realidade cada vez mais globalizada, onde as fronteiras assumem em cada momento, um novo significado. É neste contexto actual que, atendendo ao envelhecimento da população mundial, sobretudo a europeia, que Portugal, apresenta características competitivas de hospitalidade, apresentando-se como um destino que poderá desempenhar um papel primordial nesse mercado. A presente dissertação pretende avaliar a viabilidade económico-financeira e a forma de implementação de um empreendimento turístico conjunto, assente em três vertentes - o turismo de natureza, o turismo residencial e o turismo sénior - tendo como objectivo a implementação de uma “aldeia turística” adaptada aos dias de hoje. Com efeito, o aumento das tendências deste segmento de mercado, para o qual se perspectiva, para os próximos vinte anos, um crescimento acentuado, torna necessário diversificar a oferta que naturalmente terá de estar alinhada com a respectiva procura. A execução do referido projecto assume características inovadoras, na medida em que assenta na promoção de parcerias com outros agentes económicos, locais e internacionais, tornando-se o trabalho prestado em prol do projecto, “moeda de troca” para aceder ao mesmo. Esta estratégia empreendedora e inovadora, manifestamente assumida ao longo do projecto, promove sinergias e potencia as condições intrínsecas do mesmo, tais como a localização – a quarenta minutos de Lisboa - e as condições naturais da envolvente - trata-se de uma propriedade familiar com uma área de 300ha, onde a natureza ainda é mantida de forma intacta. O que faz com que, o projecto necessite para o seu arranque de uma reconfiguração do modelo de negócio. Ancorado em pessoas reformadas mas ainda activas, pretendendo-se oferecer oportunidades a intervenientes por classes profissionais e geográficas, que permita difundir o conceito e optimizá-lo.
Nowadays, we live in an increasingly globalized reality where borders, once effective barriers, assume a new meaning. It is in this current context, given the aging of the world’s population, especially in Europe, that Portugal, with unique hospitality features, presents itself as a destination that may play a primordial role in this market. This dissertation aims to evaluate the economic and financial viability, and how to implement a touristic venture, focused on three main areas – eco tourism, residential tourism as well as senior tourism – with the purpose of implementing a “touristic village” adapted to today’s reality. The increasing trends of this market segment, for which the outlook for the next 20 years is a sharp rise, makes it necessary to diversify the supply that naturally has to meet the demand. The execution of this project introduces innovative characteristics as it is based on promoting partnerships, not only with other economic agents present in the area, but also through international partnerships, where the work done on behalf of the project would grant credit to access the services provided by this project, as we will explain later on. This entrepreneurial strategy, clearly assumed throughout the project, seeks, above all, to promote synergies and leverage its intrinsic qualities, such as its location – forty minutes from Lisbon – and the natural conditions of the environment – it’s a family owned property with a 300 hectares area, where nature has been kept intact. What makes the project requires for your start of a reconfiguration of the business model. Anchored in retired people but still active, intending to provide opportunities for stakeholders to professional classes and geographical spread that allows the concept and optimize it.