Molly M. Perkins

Pathways to Assisted Living: The Influence of Race and Class

This article examines how race and class influence decisions to move to assisted living facilities. Qualitative methods were used to study moving decisions of residents in 10 assisted living facilities varying in size and location, as well as race and socioeconomic status of residents. Data were derived from in-depth interviews with 60 residents, 43 family members and friends, and 12 administrators. Grounded theory analysis identified three types of residents based on their decision-making control: proactive, compliant, and passive/resistant. Only proactive residents (less than a quarter of residents) had primary control. Findings show that control of decision making for elders who are moving to assisted living is influenced by class, though not directly by race. The impact of class primarily related to assisted-living placement options and strategies available to forestall moves. Factors influencing the decision-making process were similar for Black and White elders of comparable socioeconomic status.

Kinship Care in Rural Georgia Communities: Responding to Needs and Challenges of Grandparent Caregivers

In 2005, the Georgia Division of Aging Services initiated the Kinship Care Program to provide services to grandparents raising grandchildren throughout Georgias 12 regional Area Agencies on Aging. Many of the grandparents who receive Division of Aging Services services reside in rural communities. To assess the impact of the program among rural grandparents and learn more about their needs, an evaluation study was conducted with 30 grandparents in four rural Kinship Care Program sites around Georgia. Analysis of focus group and questionnaire data indicated that grandparents had concerns about their own health and the health of their grandchildren and faced many challenges related to child rearing. Challenges included limited services for children with disabilities, lack of assistance with permanency planning and other legal issues related to adoption, and insensitive service providers. The data showed that grandparents also were plagued with feelings of isolation and marginalization within the community. Many grandparents reported that the most beneficial service they received from the Kinship Care program was the psychological support and information exchange provided by support groups. Barriers to support group participation, such as lack of transportation and child care services and lack of options for intergenerational activities were identified as service gaps. This paper presents findings from this evaluation. Included are implications for service programs targeting rural grandparents raising grandchildren and recommendations for improving service delivery to this group of older adults.

Mentoring in Gerontology Education: New Graduate Student Perspectives.

Involvement in a mentor-student relationship is an invaluable experience for new graduate students. These students frequently have opportunities and experiences provided to them by their mentor that may be otherwise unattainable. Mentoring can help new graduate students develop academically, personally, and professionally. This article describes mentoring in gerontology education from the perspectives and personal experiences of new graduate students in sociology and gerontology. Discussed in this article are types and phases of mentoring, the need for a mentor in gerontology education, selection a mentor, and issues related to mentoring and career advancement.Involvement in a mentor-student relationship is an invaluable experience for new graduate students. These students frequently have opportunities and experiences provided to them by their mentor that may be otherwise unattainable. Mentoring can help new graduate students develop academically, personally, and professionally. This article describes mentoring in gerontology education from the perspectives and personal experiences of new graduate students in sociology and gerontology. Discussed in this article are types and phases of mentoring, the need for a mentor in gerontology education, selection a mentor, and issues related to mentoring and career advancement.

Managing the Care Needs of Low-Income Board-and-Care Home Residents: A Process of Negotiating Risks:

Small, low-income board-and-care homes play a critical role in the long-term care system, serving a variety of at-risk groups, including chronically mentally ill individuals, frail elders, and developmentally disabled adults. Unfortunately, the supply of homes available to serve these populations is decreasing. The purpose of this study, based on an in-depth ethnographic case study of one small (13-bed) African American-owned and -operated home in metropolitan Atlanta, was to understand how and why some homes continue to operate despite significant challenges. Grounded theory analysis showed that the survival of this home and residents’ ability to remain in it involved a basic social process conceptualized as Negotiating Risks. This survival process often put participants at risk of losing their means of subsistence. Community support emerged as an important protective factor. Findings have implications for community interventions to increase these homes’ survival and improve resident care.

This is our last stop: Negotiating end-of-life transitions in assisted living.

Where people die has important implications for end-of-life (EOL) care. Assisted living (AL) increasingly is becoming a site of EOL care and a place where people die. AL residents are moving in older and sicker and with more complex care needs, yet AL remains largely a non-medical care setting that subscribes to a social rather than medical model of care. The aims of this paper are to add to the limited knowledge of how EOL is perceived, experienced, and managed in AL and to learn how individual, facility, and community factors influence these perceptions and experiences. Using qualitative methods and a grounded theory approach to study eight diverse AL settings, we present a preliminary model for how EOL care transitions are negotiated in AL that depicts the range of multilevel intersecting factors that shape EOL processes and events in AL. Facilities developed what we refer to as an EOL presence, which varied across and within settings depending on multiple influences, including, notably, the dying trajectories and care arrangements of residents at EOL, the prevalence of death and dying in a facility, and the attitudes and responses of individuals and facilities toward EOL processes and events, including how deaths were communicated and formally acknowledged and the impact of death and dying on the residents and staff. Our findings indicate that in the majority of cases, EOL care must be supported by collaborative arrangements of care partners and that hospice care is a critical component.

Adult Criminal Involvement: A Cross-Sectional Inquiry Into Correlates and Mechanisms Over the Life Course

In this article, the authors examine the relative contribution of four domains of predictors that have been linked to adult criminal involvement: (a) sociodemographic characteristics, (b) family-of-origin factors, (c) proximal processes developed during adolescence, and (d) current lifestyle and situational factors. Cross-sectional data were collected through face-to-face interviews with 242 community-recruited adults. Data analysis involved negative binomial regression. Being male, family size, juvenile delinquency, aggression, living with someone involved in illegal activity, and recent violent victimization were independently associated with nonviolent criminal involvement. Aggression, association with deviant peers, and recent violent victimization were independently associated with violent criminal involvement. Juvenile delinquency and aggression mediated the affect of multiple family-of-origin characteristics on nonviolent criminal involvement and aggression mediated the effect of childhood physical abuse on violent criminal involvement. The results emphasize the importance of investigating both antecedents and proximal risk factors predictive of different types of criminal involvement, which, in turn, will assist in developing risk-focused prevention and intervention programs.

“That Is So Common Everyday . . . Everywhere You Go” Sexual Harassment of Workers in Assisted Living

In assisted living (AL) facilities, workers are intimately involved in the lives of residents. Existing research on AL demonstrates the imbalance of this environment, which is a personal home for the residents and a workplace for staff. Using observational and interview data collected from six AL facilities, this grounded theory project analyzes how AL staff define, understand, and negotiate sexual comments, joking, and physical touch. We developed a conceptual model to describe how such harassment was perceived, experienced by AL workers, and how they responded. Sexualized behavior or harassment was experienced by workers of every status. We found that words and actions were contextualized based on resident and worker characteristics and the behavior. Staff members refused to engage residents, redirected them, or reframed the words and gestures to get the job done. Reporting the incidents was less common. We conclude by discussing implications for policy and research.

Exposing the Backstage: Critical Reflections on a Longitudinal Qualitative Study of Residents’ Care Networks in Assisted Living:

In this article, we analyze the research experiences associated with a longitudinal qualitative study of residents’ care networks in assisted living. Using data from researcher meetings, field notes, and memos, we critically examine our design and decision making and accompanying methodological implications. We focus on one complete wave of data collection involving 28 residents and 114 care network members in four diverse settings followed for 2 years. We identify study features that make our research innovative, but that also represent significant challenges. They include the focus and topic; settings and participants; scope and design complexity; nature, modes, frequency, and duration of data collection; and analytic approach. Each feature has methodological implications, including benefits and challenges pertaining to recruitment, retention, data collection, quality, and management, research team work, researcher roles, ethics, and dissemination. Our analysis demonstrates the value of our approach and of reflecting on and sharing methodological processes for cumulative knowledge building.

Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson’s disease patients

Background: A palliative approach is recommended in the care of Parkinson’s disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson’s disease patients. Aim: To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson’s disease patients and their reported referral practices. Design: A cross-sectional survey study of neurologists. Setting/participants: A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology’s clinician database. Results: Participants reported significantly stronger endorsement of the rewards (M = 3.34, SD = 0.37) of palliative care referrals than the costs (M = 2.13, SD = 0.30; t(61) = −16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral. Conclusion: Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

Determining attitudes toward acupuncture: a focus on older U.S. veterans.

OBJECTIVE To explore whether factors related to attitudes toward acupuncture use in a population of older veterans is similar to previously identified motivators for nonveterans. METHODS A sample of veterans was asked to complete a questionnaire, which included questions on sociodemographic traits, history of acupuncture, chronic diseases, and the Health Belief Model (HBM). Data reduction was performed by using principal components analysis to identify major factors among the HBM responses. Linear regression was performed to evaluate variables that may contribute to attitudes toward acupuncture. RESULTS There were 402 completed questionnaires. Principal components analysis yielded three significant factors. Linear regression resulted in a model that explained 35% of the variance for positive attitudes toward acupuncture: Age, race, religion, access to acupuncture, self-efficacy for nonpharmacologic treatments, and the presence of one or more physical and mental chronic health condition were significantly related to positive attitudes toward acupuncture. CONCLUSIONS Factors related to attitudes toward acupuncture were very similar to factors identified in other literature for nonveterans, with the exception of income and education. The findings suggest that availability of treatment influences attitudes toward acupuncture.