Convoys of Care: Developing Collaborative Care Partnerships in Assisted Living

描述（由申请人提供）：辅助生活（AL）是长期护理行业中增长最快的部分，比昂贵的医疗疗养院环境更受欢迎。非正式护理人员在居民进入和留在这些非医疗住宿护理机构的能力方面发挥着关键作用，也影响着居民和护理人员的生活质量。我们最近的工作表明，大多数人工智能居民都有包括家人和朋友在内的护理车队，并随着居民的衰退和家人、朋友和设施的过渡而发展。然而，近年来，老年痴呆症患者年龄越来越大，身体越来越虚弱，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，偶尔是配偶，他们可能有多种相互竞争的需求，并且可能正在经历自己的健康问题。一些居民缺乏这些传统的帮手，可能依赖其他家人和朋友，或者没有帮手。尽管这一人群的需求在不断变化，支持的可得性也在变化，以及学习如何在AL中发展合作护理伙伴关系对公共卫生和政策的重大影响，但研究尚未充分解决这些环境中非正式护理的复杂性，特别是如何在护理伙伴之间组织和随着时间的推移展开。这项为期五年的研究的总体目标是学习如何支持非正式护理和护理车队的方式，以提高居民的能力，以最佳的居民和非正式和正式护理人员的生活质量。具体目标是：(1)了解随着时间的推移，护理车队中的非正式护理是如何经历、组织和协商的；(2)了解影响老年人非正式照护工作的因素，以及这些因素如何支持或阻碍护理伙伴关系的发展，从而促进具有最佳住院医师、非正式照护者和正式照护者生活质量的老年化；(3)确定在人工智能中建立护理伙伴关系的成功策略。本研究将采用参与者观察和非正式和正式访谈的方式，在8个人工智能环境中进行访谈，这些环境因关键的个人、设施和社区因素而异，在2波4个地点收集数据，每个地点将有目的地选择50名年龄、婚姻和父母状况、种族和民族、认知和身体功能不同的居民，进行访谈，并随访24个月。他们的车队成员也将在同一时期内被识别、采访和跟踪。跟踪居民的护理车队可能会加强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）协商的方式。扎根理论方法将指导数据收集和分析，这将为汽车过程提供重要的见解。这些知识将帮助我们确定发展和支持非正式和正式护理者和接受者之间协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.