Keith A. Anderson

Family involvement in nursing homes: effects on stress and well-being

While it is clear that families remain involved in the lives of loved ones following placement in a nursing home, little research has examined whether visiting and the provision of care has effects on the emotional stress and psychological well-being of family members. Utilizing pre-placement and post-placement data from the Caregiver Stress and Coping Study (n = 185) as well as a theoretical framework to delineate the manifestation of caregiver stress (i.e., the stress process model), the goal of this analysis was to determine whether frequency of visits and provision of personal and instrumental activities of daily living assistance following institutionalization were related to post-placement emotional distress, family conflict, and psychological well-being among family members. Following control of a wide array of pre-placement and post-placement covariates, multiple regression models found that visiting was negatively associated with post-placement role overload; moreover, the provision of instrumental activities of daily living help was negatively related to loss of intimate exchange at post-placement. The results suggest that family involvement following institutionalization may operate differently than when in the community, and add to the literature emphasizing the positive implications of family involvement in residential long-term care.

The emotional ramifications of unmet need in dementia caregiving

Using a unique measure of unmet need that taps into several dimensions of informal long-term care, the present study included data from 694 informal caregivers of persons suffering from dementia at different times in the caregiving career (e.g., at home, following institutionalization, following the death of the care recipient). Multivariate regression models found that unmet need for either confidante or formal support had key implications for caregivers’ emotional distress in each of the care situations. The findings suggest that conceptual models should incorporate unmet need as a viable predictor of caregiving outcomes and that assessment of unmet need may provide guidance in the development of more refined psychosocial and community-based intervention protocols.

The Effectiveness of Adult Day Services for Older Adults A Review of the Literature From 2000 to 2011

Adult Day Service (ADS) centers offer a variety of services to meet the needs of older adults and their caregivers. During the last decade, ADS has received increased attention due to shifts in policy toward home and community-based services for an aging population. This article reviews the effectiveness of ADS from 2000 to the present, with particular attention given to caregiver and participant outcomes, health care utilization, and future directions in ADS research. Multiple databases were searched to identify relevant research and 61 articles were selected for review based on inclusion criteria. The results of this review emphasize the need to implement and test more specific interventions targeting the needs of the ADS population.

Civic engagement for nursing home residents: a call for social work action.

Civic engagement has been found to be associated with a number of emotional and physical benefits for older adults. For those residing in nursing homes, however, opportunities for civic engagement are limited. Societal barriers such as ageism and practical issues such as transportation can limit their access to activities that promote civic engagement. In this article, we review past research on civic engagement for older adults and explore the challenges and barriers faced by nursing home residents. We conclude with a call for social work professionals to develop, implement, and evaluate interventions that increase civic engagement opportunities for this undervalued group.

Grief experiences of CNAs: relationships with burnout and turnover.

The deaths of nursing home residents can significantly affect staff members. The purpose of this quantitative study was to investigate whether work-related grief contributes to burnout and turnover in certified nursing assistants (CNAs). Participants (N=136) from 12 nursing homes completed self-administered surveys. Regression analyses revealed that complications from grief can contribute to burnout, whereas positive reactions to grief can protect CNAs from burnout. Grief was not found to be a significant predictor of turnover; however, grief may have a more complex, indirect influence on turnover than had been anticipated.

The state of adult day services: findings and implications from the MetLife National Study of Adult Day Services.

With approximately 4,600 centers serving over 260,000 persons each day, adult day services (ADS) continues to be a growing sector within the long-term care industry. However, due to the absence of national data, a full and detailed understanding of the ADS industry has been limited. In the first national study since 2002, researchers collected descriptive and programmatic data on a randomly selected sample (N = 557) of ADS facilities across the United States. Results indicated substantial changes in facility characteristics (e.g., size, staffing), participant characteristics (e.g., age, care needs), service provision (e.g., psychosocial, nursing, and medical services), and financing and funding (e.g., rates, reimbursement). Data suggested that the ADS industry has an increased capacity to serve as a provider of comprehensive health care for families and as a platform for chronic disease management. Implications for public policy makers, providers, and researchers are discussed in light of the current health care environment.

The Grief Experiences of Certified Nursing Assistants: Personal Growth and Complicated Grief

The grief that certified nursing assistants (CNAs) experience following the deaths of nursing home residents has received scant attention in past research, particularly from an empirical standpoint. The purpose of this quantitative study was to investigate the grief experiences of CNAs in the nursing home setting and to identify and evaluate factors that may mediate or exacerbate grief. Participants (N = 136) from 12 nursing homes completed self-administered surveys. Regression analyses revealed that CNAs with lower levels of perceived disenfranchised grief reported higher levels of personal growth, while CNAs with greater fear of death and those who experienced fewer deaths on the job reported higher levels of complicated grief. Practitioners and future researchers may benefit from these findings through the construction and implementation of interventions aimed at effectively enfranchising the grief experiences of this important group of healthcare workers.

Civic Engagement for Older Adults With Functional Limitations: Piloting an Intervention for Adult Day Health Participants

PURPOSE Past research has demonstrated the importance of civic engagement for older adults, yet previous studies have not focused specifically on the potential benefits of civic engagement for older adults with functional limitations. This pilot study explored the feasibility and effectiveness of an intervention designed to promote civic engagement in this growing and often overlooked population. DESIGN AND METHODS A convenience sample was recruited from 2 adult day health centers (N = 43). A multicomponent intervention was implemented comprising education, service, and recognition phases. Using a nonequivalent switching replications design, researchers compared participants receiving the civic engagement intervention with participants receiving treatment as usual. RESULTS In terms of feasibility, the intervention was unproblematic and amenable to this population; however, challenges existed in data collection. Participants receiving the intervention reported higher, yet nonsignificant, levels of purpose in life, self-esteem, and perceived physical health when compared with those in the control group. However, 5 weeks following the withdrawal of the intervention, participants reported a significant decrease in self-esteem and perceived physical health. IMPLICATIONS Civic engagement interventions appear to be quite feasible and possibly beneficial for older adults with physical and cognitive limitations, such as those enrolled in adult day health programs. Future studies should examine the nature and amount of engagement needed to maximize the benefits of such interventions.

Predictors of Family Involvement in Residential Long-Term Care

Abstract While much of the gerontological literature emphasizes the institutionalization of an older adult as an endpoint of family care, research has emerged illustrating the continued involvement of family members in the lives of residents. The purpose of the present study was to determine how resident setting, family context, resident background, staff background, and resident function influence the provision of family involvement in three long-term care environments: nursing homes, assisted living facilities, and family care homes. Five nursing homes, five assisted living facilities, and 16 family care homes and residents (N= 112) in the state of Kentucky were randomly selected. Results showed that type of facility was less important in accounting for different dimensions of family involvement than family context, family orientation of facilities, or resident need. The findings demonstrate the complex process of family involvement across the long-term care landscape, and have several research and practice implications for the facilitation of family integration in residential long-term care.

A Systematic Evaluation of Online Resources for Dementia Caregivers

Health care consumers are increasingly turning to the Internet for information, advice, and support. For dementia caregivers, the Internet is a convenient source of answers to their many questions and needs. Uncertainty remains, however, as to which Internet sites caregivers should rely upon. In this study, 16 of the most frequently listed Internet sites for dementia caregivers were systematically evaluated using an evaluation tool specific to dementia caregiving. A ranked list was generated based upon the content, quality, and usability of each site. Practical implications are discussed in terms of how dementia caregivers might use the Internet more effectively and how Internet providers might better serve dementia caregivers.