Convoys of Care: Developing Collaborative Care Partnerships in Assisted Living

辅助生活（AL）是长期护理行业中增长最快的部分，并且比更昂贵的医疗护理之家环境更受欢迎。非正式照顾者在居民能否搬到和留在这些非医疗住宿护理环境中发挥着关键作用，也影响居民和照顾者的生活质量。我们最近的工作表明，大多数AL居民有照顾车队，包括家人和朋友，并在应对居民下降和家庭，朋友和设施的过渡演变。然而，近年来，AL居民年龄增长和虚弱，需要更高水平的护理，这一趋势很容易改变对非正式护理的需求和护理角色的配置。非正式照顾者通常是成年子女，偶尔也是配偶，他们可能有多种相互竞争的需求，可能自己也有健康问题。一些居民缺乏这些传统的帮手，可能依赖其他家人和朋友，或者没有人。尽管不断变化的需求，这一人群和变化的可用性的支持，以及学习如何在AL发展合作护理伙伴关系的重大公共卫生和政策的影响，研究尚未充分解决的复杂性，在这些环境中的非正式护理，特别是它是如何组织和护理伙伴之间，并随着时间的推移展开。这项为期五年的研究的总体目标是了解如何支持非正式的护理和护理车队在AL的方式，促进居民的能力，年龄在最佳的居民和非正式和正式的照顾者的生活质量。具体目标是：（1）了解AL中的非正式护理是如何随着时间的推移在护理车队中经历、组织和谈判的;（2）了解影响AL中非正式护理工作的因素，以及它们如何运作以支持或阻碍护理伙伴关系的发展，从而促进老年化，使居民和非正式和正式护理人员的生活质量达到最佳水平;以及（3）确定在AL中建立护理伙伴关系的成功策略。本研究将在8个AL设置中使用参与者观察和非正式和正式访谈，这些设置因关键的个人，设施和社区因素而异，分2波收集数据，每波4个地点。将有目的地选择年龄、婚姻和父母状况、种族和民族以及认知和身体功能不同的50名居民，进行访谈，并随访24个月。他们的车队成员也将被确定，采访，并在同一时间内跟踪。前瞻性地跟踪居民的护理车队将提高对护理作为一个动态过程的理解，并阐明家人和朋友之间以及与其他车队成员（包括有偿护理人员）谈判的方式。扎根理论方法将指导数据收集和分析，这将提供对汽车过程的重要见解。这些知识将帮助我们确定发展和支持非正式和正式护理人员和接受者之间的合作护理伙伴关系的战略。

DESCRIPTION (provided by applicant): Assisted living (AL) is the fastest growing segment of the long-term care industry and preferred greatly over the more costly and medical nursing home environment. Informal caregivers play a critical role in residents' ability move to and remain in these non-medical residential care settings and also affect residents' and caregivers' quality of life. Our recent work shows that most AL residents have care convoys that include family and friends and evolve in response to resident decline and family, friend, and facility transitions. In recent years, however, AL residents have grown older and frailer and require higher levels of care, a trend that is apt to alter the demand for informal care and the configuration of care roles. Informal caregivers typically are adult children and occasionally spouses, who may have multiple competing demands and may be experiencing their own health problems. Some residents lack these traditional helpers and may rely on other family and friends or have no one. Despite the changing needs of this population and variations in the availability of support, as well as the significant public health and policy implications of learnig how to develop collaborative care partnerships in AL, research has yet to address fully the complexity of informal care in these settings, particularly how it is organized among and between care partners and unfolds over time. The overall goal of this five-year study is to learn how to support informal care and care convoys in AL in ways that promote residents' ability to age in place with optimal resident and informal and formal caregiver quality of life. The specific aims are: (1) To understand how informal care in AL is experienced, organized, and negotiated within care convoys over time; (2) To understand the factors that influence informal care work in AL and how they operate to support or hinder the development of care partnerships that promote aging in place with optimal resident and informal and formal caregiver quality of life; and (3) To determine successful strategies for building care partnerships in AL. This study will use participant observation and informal and formal interviewing in 8 AL settings that vary by key individual-, facility-, and community-level factors, collecting data in 2 waves of 4 sites each Fifty residents diverse in age, marital and parental statuses, race and ethnicity, and cognitive and physical functioning will be purposively selected, interviewed, and followed over 24-months. Their convoy members also will be identified, interviewed, and followed over the same time period. Following residents' care convoys prospectively will enhance understandings of care as a dynamic process and shed light on the ways families and friends negotiate amongst themselves and with other convoy members, including paid care workers. Grounded Theory Method will guide data collection and analysis, which will provide significant insight into the car process. This knowledge will help us identify strategies for developing and supporting collaborative care partnerships between informal and formal caregivers and recipients.