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Understanding the housing needs of older adults is crucial for policy makers, service providers, and professional carers. Evidence about the factors that contribute to older adults’ “sense of home” and their practical and policies implications are lacking. Semi-structured interviews were conducted with 78 community-dwelling older adults to investigate which structural and organizational requirements and relational-affective environments could contribute to their experiencing a sense of home. Through inductive content analysis 119 subcategories were derived and grouped into eight main categories: being considered as a person; a safe, quiet, welcoming, and personalizable environment; meaningful relationships; optional and stimulating activities; active involvement in the organization within the facility; competent care personnel; preserving life memories; facility open and integrated with the community. Findings suggest that multiple factors might influence “feeling at home,” and many strategies can be adopted to facilitate older adults’ successful adaptation. It is important that healthcare organizations consider these factors from a person-centered care perspective, and that care staff are trained in this type of care to enhance staff decision-making and older adults’ wellbeing. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignSetting and subjectsResultConclusion\nKEY POINTSTo explore the experiences of healthcare and social services professionals and their perceptions of using Certificate for self-care with support (CSS) for preventive self-care for older adults with home care, including the CSS process and collaborations between primary healthcare and social services.An inductive qualitative study including seven focus group interviews analyzed with reflexive thematic analysis.The study was conducted in the Stockholm Region 2022/23. In total, 23 informants were recruited from four key partners involved in the CSS process: professionals from primary care rehabilitation and primary healthcare, social services officers, and home care staff.The analyses resulted in five interconnected themes: ‘Guidelines with scope for interpretation,’ ‘Support for self-care is needed, but complicated in practice,’ ‘To trust the other professions’ competence,’ ‘There is a transfer of responsibility,’ and ‘Communication is key.’ The overarching theme ‘Principles or pragmatism for safe person-centered care,’ anchoring the other themes, revealed a common goal of achieving safe and individualized care within available resources, but from two conflicting perspectives: the importance of following the process according to the guidelines or taking a more pragmatic approach.This study highlights the need to establish structures facilitating safe self-care among frail groups, such as older persons dependent on home care. Our findings emphasize that the demarcation between, and responsibilities of, organizations need to be discussed and clarified to offer person-centered support. Comprehensible guidelines and functioning communication channels must be established so that all important perspectives can be heard, not least the patient’s. The support of a patient’s self-care is an important part of health promotion and preventive efforts.Collaboration between social services and healthcare services is crucial when supporting an older person in performing their self-care.The boundaries and responsibilities of organizations regarding person-centered support for self-care need to be discussed and clarified.Clear guidelines and functioning communication channels must be established to ensure all important perspectives are heard, especially the patient’s.The support of a patient’s self-care is an important part of health promotion and preventive efforts.Collaboration between social services and healthcare services is crucial when supporting an older person in performing their self-care.The boundaries and responsibilities of organizations regarding person-centered support for self-care need to be discussed and clarified.Clear guidelines and functioning communication channels must be established to ensure all important perspectives are heard, especially the patient’s. [ABSTRACT FROM AUTHOR]

Many older vulnerable adults live in care facilities or are in frequent contact with healthcare professionals, which in this article means professionals specializing in elder care such as nurses, social workers, and specialized elder care ombudspersons. Healthcare professionals are in a position of authority and can strongly influence the well-being of older vulnerable adults in their care. This article examines how such healthcare professionals perceive elder maltreatment and its contributing factors. A total of 25 elder healthcare professionals working in the United States were interviewed about what types of maltreatment they have observed working in healthcare facilities and the reasons to which they attribute this maltreatment. The findings in this study highlight two major themes in what healthcare professionals perceive impact the occurrence of elder maltreatment. The first theme reflects factors related to the individual care worker such as organizational and private stressors and healthcare professionals' mental state, attitudes, and training. The other theme reveals that characteristics of the older vulnerable adults such as reduced capabilities and combativeness can, according to the healthcare professionals, contribute to maltreatment occurring. Implications of these findings and future research avenues are also discussed. [ABSTRACT FROM AUTHOR]

Despite the clear benefits of engaging in regular physical activity (PA), research suggests that young people in Out-of-Home Care (OoHC) are less likely to achieve the recommended levels of PA than their same-aged counterparts in the general community. To date, there has been limited examination of the barriers to PA engagement specific to young people living in residential OoHC. This qualitative study aimed to better understand the barriers and/or challenges to regular PA engagement for young people in residential OoHC. The voice of young people, residential care staff, and key stakeholders in the OoHC sector were included through the use of interviews and focus groups. Three key barriers were identified including: (1) the residential OoHC setting is not conducive to PA; (2) young people require additional support to be physically active; and (3) there are community barriers which impact young people's engagement in PA. Discussions identified a number of individual barriers or challenges faced by young people, which are impacted or exacerbated by the barriers faced at the system and community level. Findings suggest there is a need for governments, agencies involved in OoHC and community sports and recreation facilities to re-examine current practices and policies and address barriers related to workloads of residential care staff, funding, resource allocations, and capacity to support young people's participation in PA. The need to take action is urgent and warranted. It is recommended that future intervention approaches develop innovative partnerships—that bring together research, practice, community, and policy resources—to ensure access to PA does not become an equity issue for YP living in residential OoHC. [ABSTRACT FROM AUTHOR]

Social interaction is an essential factor in ensuring the quality of older adult living. This study aimed to investigate socio-spatial features associated with social interaction in older adult care facilities. A socio-technological approach integrating space syntax and agent-based analysis was applied as an evaluation framework to measure the spatial and social attributes. Visibility from the nurses' and patients' locations, behavioural accessibility to social spaces, and strong to weak circulation patterns were examined. There was low patient visibility from the nurse stations in cluster-type units, and the visual connection was higher in the patient room corridors than the lounge areas in racetrack-type units. Increased inflows of patients to common areas appeared with a direct and uninterrupted connection between patient room corridors and central circulation area. This study contributes to potential applications of the spatial features to enhance social interaction possibilities with an awareness of the effects on visual and social properties. [ABSTRACT FROM AUTHOR]

Personalisation in adult social care, allied with more ‘austere’ funding of social services, is leading to a sharp decline in day care services. Support is becoming less placement-driven and instead woven into everyday spaces within the community. Consequently, support is being re-framed from ‘care’ in formal settings towards a broader effort at enabling meaningful lives nested in local neighbourhoods and ordinary spaces. This article explores what it means to live in a ‘welcoming community’ within the context of declining social care services from the perspective of adults with learning disabilities. It draws on empirical data collected from focus groups and photo diaries with adults with learning disabilities on their experiences of negotiating a life in the community. We identify a process of ‘self-building’ safe havens in ordinary British spaces, including allotments, marinas and ‘fish and chip shops’, and argue that adults with learning disabilities are reclaiming the welcoming communities agenda. [ABSTRACT FROM AUTHOR]

Like all spaces, concrete caring places both shape and are shaped by understandings and constructions of normativity and identity. The traditional understanding of care for older people, imagining clearly demarcated dyadic roles, is firmly embedded in heterosexual logics of relationships within families, the own (family) home and institutional support. Social and residential places for older people thus both assume particular gender and sexual identities and contribute to a (re)production of the very normativity. But how can this interlinkage between the construction of caring spaces and the normativity of identities be understood and, possibly, challenged? In this article we discuss the transformative potential of the social (and partly residential) space of La Fundación 26 de Diciembre, in Madrid, Spain, which opened up to specifically support older LGBT people. Drawing on an in-depth case study we explore a space that allows visibility of different forms of living and caring practices of people with different genders, sexual preferences, origins, classes or political backgrounds. Through the daily life narratives of the people who work, volunteer or simply use the centre we discuss the potential of challenging the restricted notions, assumptions and constructions through which particular places gain both social and political meaning. The article highlights the transformative power of the active and collective making of caring spaces through which narratives of care, collective sexual and gender recognition and practices of caring relationships can replace both traditional/informal forms of living together and institutional spaces that provide professional care. [ABSTRACT FROM AUTHOR]

Little is known about the role of gender in employee voice which is a particular research gap in feminised industries such as residential aged care. This article employs a multiple case study method to examine employee voice in residential aged care in New Zealand. It investigates the role of 'embedded' voice mechanisms, with a focus on informal voice and managerial agency as well as the impact of the external environment on organisational voice. This article questions the role of voice in maintaining low wages in residential aged care; and what role gender has in the embeddedness of voice. It finds that managerial agency is important at an organisational level, but that gender regimes influence institutional forces that have a greater influence on employee voice. [ABSTRACT FROM AUTHOR]

Swedish and international research points to serious problems for the education of students with social, emotional and behavioural difficulties (SEBD) in the care of social welfare, for example, in residential care. The aim of this article is to elucidate how documentation, care plans (CPs) and individual educational plans (IEPs) outline the educational prospects for SEBD students in residential care. A more specific aim is to study how the form or template partakes in the production of educational trajectories. Using post-structural theory and the concepts of actor-network theory, this paper highlights the forms or templates as agentive forces in a network with students, parents, teachers and social workers. Documentation reveals few expectations that these teenagers can become capable learners and almost all of the subjects have been given a reduced curriculum. The lack of headings such as ‘Student's or parents’ opinion’ or ‘School subjects’ can be understood as indications that these topics are considered to be of less importance. Individual differences between students disappear when the electronic document enables the use of the exact same phrases and words to describe different students. These results, along with previous research, point to an immediate need to discuss both the form and content of documentation in educational practice and to consider what, for what reason and for whom to document. [ABSTRACT FROM PUBLISHER]

Continuing Care Retirement Communities (CCRCs) typically offer communal social spaces such as lounges and cafes for informal resident interaction. Even when social spaces are attractive and functional, residents like and use some spaces more than others. Given the cost of providing communal spaces, under-used or un-liked spaces are an unacceptable outcome. This study's purpose was to determine which factors predicted how well communal spaces were liked and used for resident informal social interaction at a Midwestern CCRC utilizing insights of independent living residents (n=303). Findings from this mixed methods research suggested the best predictors of how well a space was liked and used were: 1) Proximity of social space to resident daily paths of travel; 2) Sense of privacy within the space; and 3) Opportunities to actively engage with other residents and the built environment. Results from this research provide theoretical insight as well as practical design implications in addressing the problem of designing more consistently successful retirement community social spaces. [ABSTRACT FROM AUTHOR]

During the early years of the AIDS epidemic, youth born with perinatally acquired HIV (PHIV) were not expected to survive childhood. Today, they are living well into young adulthood, necessitating a transition from pediatric to adult infectious disease care. Previous research has emphasized the importance of disease-specific knowledge in preparing adolescents for a successful transition. Additional research has found that the quality of patient–provider relationships is associated with the intent to seek and continue care among adolescents. Among adults living with HIV, high-quality patient–provider interactions are related to improved medication adherence. The purpose of this study was to investigate the association between knowledge of disease markers (CD4 count and viral load) and quality of patient–provider interactions among 40 adolescents with PHIV (mean age 17.3 years), 90% of whom were African-American, with attention to implications for transition readiness. Twelve participants (30%) accurately defined what a CD4 count is, and only two participants accurately reported their own CD4 counts. Less than half of the participants correctly defined viral load, and only eight participants (20%) knew their own viral load. Seventeen participants (42.5%) answered all four questions incorrectly. All participants completed the Adolescent Patient Provider Interaction Scale, which indicated that the majority of adolescents experienced positive interactions with providers. Knowledge of disease markers was positively associated with patient–provider interaction. The significant association between disease marker knowledge and quality of patient–provider interactions suggests that adolescents with higher quality interactions with their providers possess greater knowledge about the disease and their own status. Poor understanding of HIV disease markers may adversely influence the transition to adult care. However, the strong patient–provider relationship offers a vehicle to promote increasing medical autonomy among adolescents, including understanding of important disease-related markers. [ABSTRACT FROM AUTHOR]

Objectives: To describe factors that support and inhibit recruitment and participation of people with dementia living in care homes. Method: This article focuses on the methods used to recruit people with dementia to a longitudinal study that employed a mixed-method design to track events and care that older people with dementia experienced over two years in six care homes. A staged approach to recruitment was adopted involving separate meetings with staff, residents and relatives. Individual consent was secured with residents with dementia who could consent in the moment and for those without capacity, through mail and follow-up telephone contact with consultees. Data were collected on the frequency of meetings, issues raised by staff, consultees and people with dementia as well as the overall time taken to complete recruitment. Results: Over five months, 133 older people with dementia were recruited (62% of sampling frame). The recruitment process was supported or hindered by the number of individuals and organisations that needed to be consulted, the care home culture, staff's understanding of how people with dementia can be involved in research, and how they interpreted their role as mediators, protectors and gatekeepers. Conclusions: Care homes are isolated communities of care. To achieve the research objectives, researchers in the initial stages need to consider the philosophical underpinnings of individual care homes, and the politics of hierarchy both within the care home and between it, and health professionals. There is a need to develop credible infrastructures of support that enable people with dementia to participate in research. [ABSTRACT FROM AUTHOR]

While aerobic exercise has been linked to improved performance on cognitive tasks of executive functioning among older adults, not all older adults can avail themselves of such exercise due to physical limitations. In this study, community-dwelling older adults were evaluated on tasks of executive functioning before and after a month-long strengthening, nonaerobic exercise program. A total of 16 participants who engaged in such exercise showed significantly improved scores on Digits Backward and Stroop C tasks when compared to 16 participants who were on an exercise waiting list. Positive benefits of strengthening exercise on cognition are supported. Additional research is needed to clarify the generalizability of these findings. [ABSTRACT FROM AUTHOR]

Young people who live in residential care are caught between discourses of being a victim of abuse and inadequate care or being a troublemaker by their own conduct. Both discourses are rooted in the reasons for placement, and they will offer subject positions that are experienced as troubled. Repeated interviews with young people living in residential care provided by child protection services demonstrate how the youths position themselves within such prevailing discourses and negotiate social claims and expectations of appropriate development. While some try to normalise their problematic behaviour and thereby reject being a troublemaker, others insist that they are victimised as a result of the placement and thus displace the cause of their troubles. The study shows that, in this negotiation of possible subjectivities, some youths manage to take advantage of the placement in surprising ways, while others get blocked in their own developmental efforts. [ABSTRACT FROM AUTHOR]

This qualitative study of lesbian and gay elders seeks to identify the psychosocial challenges this community faces regarding long-term care. Two focus groups were conducted among 16 gay elders in community and long-term care settings. Participants reported fear of being rejected or neglected by healthcare providers, particularly personal care aides; fear of not being accepted and respected by other residents; fear of having to go back into the closet if placed in long-term care; and a preference for gay-friendly care. Participants suggested staff training to promote acceptance and respect for gay people, and favorably perceived gay-specific and gay-friendly living arrangements. [ABSTRACT FROM AUTHOR]

This analysis provides an overview of the major policy themes and promising practices emerging in recent years as policymakers and researchers struggle to design a long-term care system that meets the needs of an aging population. Themes that have dominated the long-term care policy debates include: recruiting and retaining a qualified long-term care workforce; devising financing mechanisms for those requiring long-term care; and moving away from an institutional-based long-term care system towards more home- and community-based services. Three promising practices that have emerged in the past few decades include: the culture change movement; service integration that combines medical and social care; and various forms of community residential care that bring together housing and services in a more home-like environment. It concludes with long-term care recommendations for policymakers. [ABSTRACT FROM AUTHOR]

This study assesses the administrative data compiled on residential care facilities for the elderly (RCFEs) by the state of California and considers the feasibility of their adaptation into a comprehensive information system. Required state RCFE reporting forms were reviewed for potential data elements. Recording and reporting variation was evaluated using a stratified probability sample of 340 facilities licensed in Northern and Central California. Stratification was by facility size and state district office. Data collection included a 5-year retrospective review of forms and documents in each facility's public file. Little of the information required from RCFEs is computerized. Most of it is maintained at the individual facility and not included in public files. Basic information, while included in the public file, is commonly either not available or not current. Resident characteristics and outcomes are not compiled, except indirectly in citations. The information required from RCFEs, if appropriately compiled and maintained, would produce a comprehensive quality assurance system and more effectively support consumer information and policy needs. [ABSTRACT FROM AUTHOR]

This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention should continue to be paid to staff supports, policy and practice should support the continued role of AFHs, which are of special interest because of their potential to provide more homelike, less costly care but with possible trade-offs compared to larger facilities. [ABSTRACT FROM AUTHOR]

Age-related cognitive declines can hinder older adults' ability to perform instrumental activities of daily living. As a result, this decline places an additional burden on formal and informal caregivers. Fortunately, based on the principles of cognitive reserve and neuroplasticity, cognitive remediation therapy shows promise in reducing the severity of such cognitive declines and improving everyday functioning. Incorporating such therapy into institutional settings represents an avenue for improving cognitive functioning, ameliorating self-care, and facilitating successful aging. Suggestions for adapting this approach in institutional settings are provided. [ABSTRACT FROM AUTHOR]

This article examines the long history and the recent demise of the liable relative rule, part of the framework of English welfare law for over 400 years. The liable relative rule allows official agencies to recover the costs of providing support to those depending on certain means-tested benefits and services from those persons' relatives, where the latter are deemed by law to have the primary responsibility for their maintenance. The liable relative rule has now effectively been abolished for most practical purposes by the Child Maintenance and Other Payments Act 2008 and the Health and Social Care Act 2008. [ABSTRACT FROM AUTHOR]

A life review is a systematic examination of several dimensions of life leading to a recorded life story, usually in writing, but sometimes with the aid of video or audio equipment. This activity can be both a powerful educational tool and a community service when students conduct a guided life review in the community with vulnerable older adults. This article describes an innovative university course curriculum that links student life review projects to an assisted living facility. Master's level students guided older residents of this facility through a 25-page life review, and facilitated a group sharing of life stories at this community site. While older adults reported on how satisfied they were with this project, their feedback also revealed several ongoing educational issues that need to be addressed. There are also interesting entrepreneurial career prospects emerging in the life review field. [ABSTRACT FROM AUTHOR]

Assisted living (AL) is a caregiving option between independent living and nursing home placement. This study explores women residents' experience of AL in four Midwestern facilities, using interview and field research methods. We found that most residents wanted to stay in AL rather than move to a nursing home; they looked backward nostalgically toward home, and complied with staff rules and directives in order to remain in place. In contrast to nursing homes, AL allows residents to experience continuities with self and home: a private room, some of their own belongings, and access to relationships and activities associated with self and home. Given the expanded lifespan and growing popularity of AL, it is becoming a new stage in the trajectory of women's aging. [ABSTRACT FROM AUTHOR]

This paper focuses on whether running away from adolescent residential care facilities is related to having off grounds passes with an adult resource. It was hypothesized that as off grounds passes increased in frequency and duration, runaway behavior would decrease in frequency and duration. Data were collected from two hundred closed client files. Spearman's rho correlation and linear regression were used to analyze the data. Results show a weak negative relationship exists between number of passes and both number of runaway occurrences and hours spent on the run. The data were collected from a single agency, suggesting that caution be used when attempting to generalize to the entire population. The results, however, are very useful to inform future research and guide the development of future hypotheses. [ABSTRACT FROM AUTHOR]

The article offers an account of the author's participation in secret filming in three small residential care homes for older people. The author gained access to the homes as a resident and made video-recordings that were used as part of a television documentary in 1994 that exposed the poor practice and lack of regulation in these types of homes in England at that time. The author discusses her motivations for taking on this undercover role, and some of the unexpected ethical challenges she faced when considering the impact of the exposure of these homes for the residents, their families, the owners and the staff. [ABSTRACT FROM AUTHOR]

This paper reviewed studies on staff training programs to address the behavioral problems associated with dementia among older people in residential care. The papers were classified according to whether or not the studies included a control group in the research design. The results of the review demonstrate that there has been a wide range of psychosocial and educational interventions to reduce behavioral problems among older people with dementia, with inconsistent results being obtained. However, many of these studies suffer from problems in their research design that make it difficult to evaluate their effectiveness. Problems in conducting research in the nursing home setting are highlighted, and suggestions for future research in this area are discussed. [ABSTRACT FROM AUTHOR]

Older adults in long-term care facilities have few opportunities for emotionally meaningful social interactions with noninstitutional social ties; yet having such relationships is a basic human need that affects well-being. Among institutional social ties, affective communication can enhance relationships between residents and nurse aides, who provide most of their care. This naturalistic study identifies types and examples of nurse aide-initiated communication with long-term care residents during mealtime assistance in the context of residents' responses. Verbal and nonverbal communication from videos of nurse aides and residents in two skilled nursing facilities (n = 17) and an assisted living facility (n = 6) were transcribed. The transcripts were coded and the data were organized into categories using grounded theory methods. Although substantial content emphasized instrumental communication (i.e., prompts to eat and/or drink), 4 types of affective communication initiated by nurse aides emerged: "personal conversation," "addressing the resident," "checking in," and "emotional support/praise." These results suggest that affective verbal communication needs further development in terms of scope and depth to optimize residents' well-being. The specific examples of nurse aides' affective verbal communication with residents from these findings can be incorporated and expanded on in nurse aide training programs to improve the way nurse aides relate to residents during care provision. [ABSTRACT FROM AUTHOR]

We investigated the experiences of older adults in residential care in relation to social activity and inclusion. We also examined the explored phenomenon of resident's social inclusion from the perspective of those providing care for the residents. Our participants were 25 care providers and 25 residents drawn from five low-level-care residential facilities in metropolitan Melbourne, Australia. We used one-to-one in-depth interviews which were aimed at tapping into themes related to social inclusion. Of special interest to us was residents' lived experience of social inclusion within the context of their lives in residential care. We found that although participation in activities emerged in our study as being valued and encouraged by care providers, residents were left feeling isolated, compromised, and as though they were not "at home". We concluded that the difference between caregivers' understanding and residents' experiences of social inclusion highlights the need to shift the focus from the provision of activities as an indicator of social inclusion to gaining a deeper understanding of the lived experiences of those in care. We suggest that such a focus would assist in the care of the growing number of older adults who face the transition from their own homes to a residential care facility, and guide us toward a more meaningful understanding of "well-being" in this context. [ABSTRACT FROM AUTHOR]

Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. "Age-prepared communities" utilize community planning and advocacy to foster aging in place. "Elder-friendly communities" are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care. safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities. [ABSTRACT FROM AUTHOR]

The chapter describes how a palliative approach to care is relevant in the context of residential aged care, with specific focus on the spiritual needs of residents. Three issues are described that make attention to spirituality in residential aged care particularly challenging: effects of cognitive changes, potential threats to dignity, and uncertainties about how to provide bereavement support to the range of people who experience loss in this care context. Reflections on how residential aged care staff might better assess the spiritual needs of residents are offered with suggestions from the literature about how to sensitively respond to these needs. [ABSTRACT FROM PUBLISHER]

The aim of this study was to explore elders' perspectives about supports and barriers for exercise participation, and the implications for occupational therapy. Results indicated that elders who participated in regular exercise at their senior housing facility did so because it was a meaningful occupation for them. They identified several reasons for participation including improved physical and mental health and increased ability in activities of daily living. Potential barriers for participation identified hut not experienced by participants included travel, costs and program design. Findings suggest that exercise can be an appropriate occupation for practitioners to use with elders as long as it is meaningful for the client, and contributes to the elder's well being. [ABSTRACT FROM AUTHOR]

The article focuses on the growth of residential services in Australia and the United States during 1997-2002. The most significant factors increasing demand for services and supports for people with intellectual disability are growth in national population and changes in the demographic structure of the population, particularly aging. To identify the extent of real growth in residential services, the researches compared annual changes in service provision with growth of national population in Australia and the United States since 1997. By 2002, the number of consumers of Australian residential services had increased by 5.69% relative to 1997, and the Australian population had grown by 6.15% in the same period.

The present study sampled 85 residents of assisted living facilities and delineated two groups based on functional independence, or objective control. The groups were then compared on measures of life satisfaction and affective experience. No significant differences were found on these criteria, suggesting that personal control capabilities are less instrumental in determining well-being among this population. Implications include the possibility that assisted living arrangements for older adults may assuage the often-observed decline in well-being reported under conditions of lesser functional capabilities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to consider the use of the Resident Profile as an evaluation tool for older adults considering a move to a CCRC setting. A total of 7,635 Resident Profiles were completed at 10 facilities. The average age of the participants was 81.8 ± 6.0, and over half were female (64%). There was a statistically significant difference in scores for each domain (function, physical parameters, cognition, social support, and mental health) of the Resident Profile, as well as the total score, between those who were recommended for independent living, assisted living or a skilled level of care. All domains of the Resident Profile together explained 15.5% of the level of care recommended. This tool can be used to help clinicians determine the level of care that is likely to be appropriate for the individual being evaluated. Future research should consider the relationship between the individual's score on the Resident Profile and successful living in the facility over time. In addition, future consideration of other factors that may help to better explain the level of care recommended for older adults moving into continuing care retirement communities will be helpful to comprehensively explain these recommendations. [ABSTRACT FROM AUTHOR]

This paper addresses issues related to family end-of-life care decision making by presenting the results of a qualitative study designed to explore this process with 15 African American families who had an elderly relative (65 years of age or over) die following 2 weeks or more of care in a hospice or an acute or long-term care facility. Findings suggest that family participants' end-of-life care decisions were characterized in thematic patterns focusing on the primacy of the dying family member' s wishes, inclusion of family members in the decision-making process, maximization of treatment options, and religious influences. The implications of this study for culturally sensitive social work practice are discussed. [ABSTRACT FROM AUTHOR]

Many Aged Care facilities in Australia are continuing to operate in a traditional medical model, with elders being dependant, living in large institutions and living a life of mere existence. It is Australia's challenge to change the culture of ageing and the perceptions held by the community that elders are powerless and feeble. Australia needs to turn Aged Care facilities into homes, making them attractive for residents, families and staff and to create a life worth living. In recent times some Aged Care providers have begun to research and implement new practices and philosophies such as the Eden Alternative™ and culture change, believing that they can create an environment filled with animals, plants and children. Australia has seen the positive results and data from the USA, and some homes in Australia are now beginning to gather base data and some comparative data, which in preliminary fashion indicate positive outcomes for staff and residents. Australia has to continue on the culture change journey, educating and spreading the awareness and positive changes nationally. Other Aged Care operators need to be aware of these new concepts in ageing, so that they can begin to practice self-determination; person-centred work and self-directed teams and leadership. Greater knowledge, awareness and Australian proactive data and results will assist and encourage others on the journey to culture change. [ABSTRACT FROM AUTHOR]

Objective: This exploratory study examined the viability of applying Prochaska's Transtheoretical Model (TIM) to community-living older adults making home safety changes over time. Method: The Readiness for Change (RFC) interview and the Westmead Home Safety Assessment were administered to 20 community-dwelling older adults. Eight to twelve weeks later, a follow-up home visit was made to determine how many home safety modifications had been implemented. Results: Participants in the action-related stages (i.e., action and maintenance stages) implemented significantly more home modifications than participants in the non-action stages (i.e., precontemplation, contemplation, and preparation stages, F(1,18) = 7.7; p ≤ 0.01. Conclusion: The readiness for change model was a useful approach to apply when working with older adults to implement home safety changes over time. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this pilot study was to investigate whether leisure activities are more effective than activities of daily living (ADL) in improving standing tolerance in an elderly population. Method. A single-case study AB design was used with five participants over the age of 75, who did not have adequate standing tolerance to complete their ADL. Baseline of standing tolerance was established while the participants performed ADL. Subsequent standing trials incorporated leisure activities. Results. Graphical analysis was used to demonstrate that for the five participants in this study, leisure activities were more effective than ADL in improving standing tolerance. Conclusions. Leisure activities can be used as an effective treatment tool to improve standing tolerance in the elderly. Further study is suggested to enable generalization of these results. [ABSTRACT FROM PUBLISHER]

The Leave-A-Legacy Program at Alterra Wynwood in Leominster, Massachusetts, is an example of a successfully emergent, multi-faceted, reminiscence and writing program within an assisted-living community. A group of residents meet voluntarily once a month, along with a facilitator, to read aloud from their journals, write and reminisce. The program has an enthusiastic facilitator who contributes greatly to its success by encouraging its members to translate their newly recalled memories into a journal where they can be clearly organized. Consequently, these memories and stories will be preserved on paper and available to read for many generations. The members benefit from therapeutic reminiscence sessions, which enhance their social relations and improve memory by sharing personal stories from their youth. Additional benefits accrued through the writing program include reduced anxiety and the capability to boost one's immune system. [ABSTRACT FROM PUBLISHER]

A study was conducted utilizing self-disclosure 24 hour activity/time diaries collected over an eight month period from 31 Hispanic males (average age 72.5) attending or living near a senior center in a southwestern city. Observations and recommendations concerning activity programming for similar groups of elderly Hispanic men are presented based on the study's findings. [ABSTRACT FROM PUBLISHER]

The article describes the resident and facility characteristics of several adult licensed residential care settings in Washington State. Residential care settings are receiving increasing attention as a long-term care resource among both private and public payers. One type of residential care setting that has experienced tremendous growth is assisted living. This paper presents the findings from a survey of facility and resident characteristics of adult family home (AFH), adult residential care (ARC), and assisted living (AL) settings in Washington State. Data describing resident and facility characteristics were obtained from a questionnaire mailed to these three types of licensed residential care settings. The outcome of findings suggests that the overall disability of residents was high, with AFHs serving a more impaired clientele than ARCs or ALs. ALs were more likely to serve private pay residents and had the highest occupancy rates. Although, hourly staff wages were similar, AFHs reported greater difficulties in hiring and retaining staff and were more likely to report difficult residents contributed to staffing problems. AFHs also reported the greatest dissatisfaction with state reimbursement rates. Finally, the need to carefully match resident impairment to provider capacity, especially among AFHs is the need of the hour.

An increasing number of elders will be moving into long-term care facilities in the coming decades. This review identifies a adjustment of factors that predict the degree to which an individual's adjustment to his or her new enviornment will be successful. In addition, a number of potential interventions are described whcih may help to alleviate some of the diffuclties elders may experience upon relocation. [ABSTRACT FROM PUBLISHER]

Presents information on a study which examined the prevalence of elder mistreatment as reported by social workers in a probability sample of adult day health care patients. Methodology of the study; Results and discussion on the study; Conclusion.

Presents a study which compared the application of guardianship and adult protective services interventions in the lives of vulnerable adults. Historical origins of guardianship and involuntary protection; Methodology; Results and discussion.

This study examines job classification and other workplace characteristics as potential mediators of role strain among university employees with adult care responsibilities. After controlling for background caregiver characteristics and the intensity of caregiving demands, it was found that job classification, hours worked, work demands, workplace support, and job flexibility contributed significantly to role strain. Caregivers in staff positions provided higher levels of caregiving assistance and experienced less flexibility, control, and support at the workplace than did academics and administrators. Staff employees also were significantly more likely than academics and administrators to endorse a variety of workplace policies and programs as helpful in meeting their adult care responsibilities. These findings have implications for the development of workplace policies and procedures that are responsive to the unique needs of diverse employee groups. [ABSTRACT FROM AUTHOR]

How long is it necessary to follow elderly patients discharged from a hospital into the community? The health outcome of 101 patients are monitored for one year. Survivor life tables describe the rate of patient failure to survive in the community, defined as readmission or death. After 42 days, this failure rate stabilizes at two readmissions every three weeks. From this data a six-week post-discharge critical period is defined and then compared to a 90-day post-admission criterion. The post-discharge rule is shorter, less affected by variability in hospitalization patterns, and offers a clear interval for intensive and integrated case management as well as a means of forecasting readmissions from the community. [ABSTRACT FROM AUTHOR]

The importation of life prolongation technology from acute and chronic care institutions to the home has given rise to a range of challenges for the practitioner engaged in the delivery of gerontological home care services. The prominent programmatic and training issues are identified in an ethical context and approaches to improving home care staff practice skills are offered. [ABSTRACT FROM AUTHOR]