THE VALUE OF INDEPENDENCE IN ASSISTED LIVING FACILITIES

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Independence is a central theme in gerontological research, policy, and practice. Surveys and psycho-social studies indicate that seniors want to maintain independent lives and that the ability to do for oneself and make decisions is positively correlated with well-being and health. As people reach very old age, that is, over age 80, they are more likely to suffer from chronic health conditions or cognitive impairments that affect their ability to live alone. A variety of long-term care options that address the health and social needs of such individuals are increasingly available, yet, there is still limited and fragmented support for programs that serve disabled older persons who do not require skilled nursing care. Many people who have relatively minor health problems or physical disabilities have no option but to go to a nursing facility where loss of independence may be part of the organizational reality. In Oregon, assisted living facilities, which serve both private-pay and Medicaid clients, offer an alternative to institutionalization for frail elders who have a variety of complex health or social needs, but who do not require skilled nursing care. Residents might have diabetes, Parkinson's disease, Alzheimer's disease, or stroke. Because assisted living facilities are staffed 24-hours a day, they are able to respond to unscheduled needs, such as falls, incontinence, or pain. A major feature of Oregon's assisted living model is a respect for resident independence, privacy and dignity. This model has attracted national, and international attention, yet little is known about the "philosophical" side of assisted living. In particular, how do assisted living facilities balance respect for an individual's personal choices with the need to protect? The proposed research builds on an expanding body of research on assisted living by focusing on this intriguing element which, it may be argued, is the basis of the appeal of assisted living residences. The specific aims are: 1. To explore how the state agency responsible for licensing and monitoring assisted living implements the philosophical component of assisted living, especially resident independence. 2. To explore how assisted living facilities respond to residents' desire for independence on a daily basis. These aims will be attained through a multi-site case study. The principle investigator will attend state-required training for assisted living directors and observe training of direct care staff in two assisted living facilities. In addition, the PI will observe the daily operations of these facilities. Residents and their family members will be interviewed regarding their decision to move, their personal preferences, and how assisted living compares to their prior living arrangements.