Jennifer R. Salmon

Attitudes and Preferences of Korean-American Older Adults and Caregivers on End-of-Life Care

A growing body of literature suggests that diverse attitudes toward the end of life exist across and within ethnic minority groups. This focus‐group pilot study examined social and cultural factors influencing views of Korean‐American older adults and caregivers on advance care planning and hospice care. A total of 20 older adults and 16 caregivers in west central Florida participated in one of four focus groups. This study found diverse attitudes among Korean Americans toward end‐of‐life care and cultural and structural barriers to advance care planning and hospice use. Older adults and caregivers both expressed a lack of knowledge about advance care planning and hospice and agreed that the family would make the final decision about the end‐of‐life care, while acknowledging the challenge of initiating communications about treatment preferences. They interpreted the Korean value of filial piety to support both curative and palliative treatment. The traditional norm of home death and importance of physician communication influenced preferences for hospice and advance care planning, respectively. Future outreach and education efforts should include development of culturally sensitive educational and communication tools and collaboration with ethnic community organizations and healthcare providers in the dissemination and education of these instruments.

Validation of the Caregiving at Life’s End questionnaire

The researchers in this study developed and validated a questionnaire to measure the needs of end-of-life (EOL) caregivers. The model is used to facilitate meaningful and supportive experiences for both the patient and caregiver. The questionnaire was developed using existing scales of meaning, self-acceptance, burden, and gain as well as new scales of caregiver comfort, importance of caregiving tasks, and caregiver closure. The sample included 34 current and 17 bereaved caregivers affiliated with The Hospice Institute of the Florida Suncoast. The scales performed well in terms of concurrent validity, internal consistency, and reliability.

Who is Being Served? Program Eligibility and Home- and Community-Based Services Use

Functional and economic eligibility criteria for publicly funded programs are causal factors in the use of home- and community-based services (HCBS). Thus, the study’s overall hypothesis was that the main program eligibility criteria would determine the particular characteristics of consumers in three of Florida’s HCBS programs: Aged and Disabled Adult Medicaid Waiver (ADW), Community Care for the Elderly, and Home Care for the Elderly (HCE). Data on 464 consumers who were 60 years and older and receiving services in one of the three programs support the overall hypothesis but revealed important exceptions. The ADW program is not serving a more functionally impaired population than the other programs. The HCE program is serving elders who are more cognitively impaired. Consumer-directed long-term care programs like HCE have the potential to better serve frail older adults and their caregivers if more public funding is allocated and other policy modifications are made nationwide.

The Unequal Availability of Affordable Assisted Living Units in Florida’s Counties

The supply of affordable assisted living facilities (ALFs) is now insufficient to meet the demands of low-income, frail older persons. This gap between demand and supply is much more apparent in some locations than others. This article uses various measures of locational inequality to assess the extent to which counties in Florida have less than their fair share of ALFs, particularly in comparison to the locations of Medicaid nursing home beds. It employs least squares regression models to identify the demographic and economic antecedents underlying the variation in the number and prevalence of affordable ALF units and Medicaid nursing home beds. The findings show that a large percentage of the older population who are vulnerable are underserved by affordable ALFs and that it is possible to explain adequately the variation in the number but not the unequal prevalence of affordable ALF units in Florida’s counties.

Social Relationships of African American and Hispanic Older Assisted Living Residents: Exploring the Role of Race and Ethnicity

African American and Hispanic older adults are underrepresented in assisted living communities, so little is known about how they experience social relationships in these settings. The purpose of the study was to explore resident-to-resident and resident-to-staff relationships experienced and perceived by African American and Hispanic older residents in assisted living settings. In-depth interviews with 15 African American and 15 Hispanic older adults were conducted in seven assisted living communities in Central Florida. Three salient themes emerged using a grounded theory approach: formation of relationships: emotional vs. instrumental support; language as a facilitator or barrier; and avoidance of inter-racial relationships. Implications for providing culturally competent services in assisted living communities with diverse populations are discussed.