Quality Assisted Living

Doody's Medical Reviews Score: 92, 4 Stars!Considering that seventy-four million baby boomers will be the next generation of assisted living residents, there is a great need to create, sustain, and evaluate quality in these settings. Whereas most books focus on quality of care, this is the only volume to explicitly delve into the lives of those who inhabit assisted living facilities, seeking to understand and evaluate their perceived ideas of what constitutes quality of life. "Quality Assisted Living" provides results from a National Institute on Aging-funded study that gathered information from not only residents, but also staff and family members, who are considered experts who can better help us to understand how quality should be conceived and evaluated. The volume addresses the complexities underlying seemingly clear cut issues and provides concrete suggestions for reframing problems in order to find better solutions. Plentiful stories and quotations are used to identity those elements of assisted living that are most conducive to a satisfying quality of life, and address how this research has led to a consideration of quality as a process rather than as a single condition. Key Features Employs the views and voices of research participantsProvides down-to-earth and directly applicable resultsWritten in a language that is accessible to a wide readershipDescribes complex social situation within the wall of ALExamines issues arising from collective living such as regulations, financing and diverse resident needsUses real life stories to illustrate key points of the narrative

Preface	p. ix
Acknowledgments	p. xi
Quality in Assisted Living: Hearing Residents' Voices	p. 1
What Is Quality?	p. 1
Views of Quality: The Resident Quality Balance	p. 2
The Study	p. 4
Understanding the Complexity of Quality	p. 7
Understanding Quality: Key Questions	p. 11
Key Elements in Understanding Residents' Perspectives on Quality	p. 25
How Do Residents Rate Quality in AL?	p. 28
Profile of Coming Chapters	p. 29
The Everyday Experience of Quality in a ôSoft Institutionö	p. 33
Dining at the Greenbriar	p. 33
Institutional Life in an Assisted Living	p. 37
The Impact of the Institution on the Culture of AL Daily Routines	p. 40
The Sociophysical Environment	p. 44
The Medical Dimension of the Soft Institution	p. 49
Expressing Autonomy	p. 51
Balancing Quality in a Soft Institution	p. 53
A Culture of Caring	p. 57
Direct Care Staff and the Essence of Quality	p. 57
ôNo One Dies Aloneö	p. 58
Elements of Compassionate Care	p. 59
Human Touch and Interpersonal Warmth	p. 60
Sensitivity in Performing Body Care	p. 62
Someone to Talk With	p. 63
Philosophy of Care	p. 64
Staff Roles and Compassionate Care	p. 66
Complexity of Staff Roles: Is AL a Medical or Social Setting?	p. 67
Organizational Challenges to Providing Quality Care	p. 70
Exemplars of Compassionate Care	p. 78
Staff Orientation Toward Their Work	p. 79
Resident's Orientation Toward Staff	p. 82
Toward a Culture of Caring	p. 85
Compassion as a Calling	p. 87
Hidden Complexity: Food and Dining in Assisted Living	p. 89
Resident Activist and Foodie	p. 89
Complex Issues and Multiple Viewpoints of Food in AL	p. 92
Healthy Eating	p. 92
Diverse Preferences	p. 95
Corporate's Role	p. 96
Eating Beyond the Dining Room	p. 99
Dining Collectively	p. 103
The Place	p. 103
The Soft Institution Revisited: A Microcosm of food and Dining	p. 107
Making Choices in the Setting	p. 110
Food and Dining as the Crux of Life in AL	p. 114
Focusing on the Experiential Nature of Eating	p. 114
Challenges to AL Dining	p. 117
Successes in AL Dining	p. 120
Autonomy in Assisted Living	p. 123
Background	p. 123
ôThey Won't Let Me Do Nothingö	p. 124
Enhancing Autonomy	p. 125
Constraints on Autonomy	p. 129
ôThis Is My Room; I'm Paying for Itö	p. 130
Coming and Going	p. 131
Cigarettes, Alcohol, and Sugar	p. 134
The Influences of Ageism and Dementia on Autonomy	p. 136
Residents' Reactions to Diminished Control	p. 139
Understanding, Acceptance, and Accommodation	p. 140
Fear	p. 142
Assertiveness	p. 144
Advocating	p. 146
Autonomy: The Little Things Count	p. 147
Trading Autonomy for Safety	p. 149
External Constraints: Regulations, Rules, and Financial Realities	p. 153
Rules and Regulations in AL	p. 153
State Regulation	p. 155
Does Oversight Ensure Quality?	p. 155
Down the Nursing Home Path	p. 158
Corporate Influences	p. 163
Interpreting, Applying, and Enforcing the Rules	p. 165
Staff Perspectives	p. 165
AL Consumers' Perspectives	p. 166
Moving to the Next Level	p. 169
The Health Insurance Portability and Accountability Act	p. 172
The Financial Context	p. 174
When Regulations and Rules Cause Harm	p. 177
Quality Balance-Negotiating the Rule of Authorities With Resident Quality	p. 179
Broadening Our Perspectives on Quality: Change Over Time in the Quality Balance	p. 183
Quality as a Moving Target	p. 183
Changes Within Residents	p. 185
Unexpected Changes	p. 186
Changing Attitudes and Perceptions	p. 186
Changes in the AL Setting	p. 188
Ownership Change	p. 188
AL Managers: Change in Leadership	p. 190
Staffing Issues	p. 193
ALs in the Larger Economy	p. 199
The Changing Social Context of Other Residents	p. 202
Quality as a Process, Not a Product	p. 206
Moving Toward Quality Balance: Lessons Learned From Residents	p. 211
The Context of Quality in AL	p. 212
Quality as Related to the Self	p. 213
Quality of the Home Operations	p. 216
Quality of the Physical Environment	p. 216
Quality of the Staff	p. 216
Quality of the Food and Dining Arrangements	p. 217
Quality of Residents' Social Life	p. 217
The Basis of Quality in AL	p. 218
Lessons Learned and Strategies to Achieve a Quality Balance	p. 220
Appendix: Research Methods Used for the Study	p. 229
Setting Sample	p. 230
Gaining Access	p. 230
Sampling Persons Within Settings	p. 231
Resident Sample	p. 231
Family, Staff, and Manager Interviews	p. 232
Data Collection Techniques and Phasing of the Study	p. 233
Data Collection Techniques	p. 233
Phasing of the Study	p. 235
Data Management and Analysis	p. 236
Collaborative Coding Process	p. 236
Analysis	p. 237
Quality Interview Guide	p. 238
Resident/Family Interview	p. 238
Index	p. 241
Table of Contents provided by Ingram. All Rights Reserved.

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Quality Assisted Living

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