Paula C. Carder

The stability of core and peripheral networks over time

Abstract This article uses data on ‘network instability’ to show how differences across multiple measurements on the membership of personal networks can yield important insights into the nature of these networks. The data come from a sample of 234 recent widows, aged 59–85, who completed seven interviews about their networks over a 1-year period. We use these data to investigate the stability of both overall networks and individual ties, as well as the linkage between the stability of individual ties and the stability of the networks aggregate properties. We find that instability in these networks is best thought of in terms of an underlying ‘core-periphery’ structure, whereby some network members are likely to be named repeatedly (the core), while others are relatively unlikely to appear in any given elicitation of the network (the periphery). We explore the implications of this core-periphery structure for cross-sectional elicitations of personal networks.

Introducing Dyadic Interviews as a Method for Collecting Qualitative Data

In dyadic interviews, two participants interact in response to open-ended research questions. There are few precedents for using dyadic interviews as a technique for qualitative research. We introduce this method largely in comparison to focus groups, because both represent forms of interactive interviewing. We do not, however, view dyadic interviews as miniature focus groups, and treat them as generating their own opportunities and issues. To illustrate the nature of dyadic interviewing, we present summaries of three studies using this method. In the first study, we used dyadic interviews and photovoice techniques to examine experiences of people with early-stage dementia. In the second study, we explored the experiences of staff who provided services to elderly housing residents. In the third study, we examined barriers and facilitators to substance abuse treatment among Asian Americans and Pacific Islanders in Hawaii. We conclude with a discussion of directions for future research using dyadic interviews.

Medication administration errors in assisted living: scope, characteristics, and the importance of staff training.

OBJECTIVES: To compare rates of medication errors committed by assisted living staff with different training and to examine characteristics of errors.

Age-Friendly Portland: A University-City-Community Partnership

This article addresses the question of how creating an age-friendly city has come to be an important policy and planning issue in Portland, Oregon. In 2006, researchers from Portland State Universitys Institute on Aging examined the meanings of age friendliness among a broad range of participants in Portland, Oregon. The research was conducted in conjunction with the World Health Organizations (WHO) Age-Friendly Cities project and followed the completion of two earlier non–WHO-related projects. The city of Portland, through the Institute on Aging, was one of nine original members to apply for and be accepted into the WHO Global Network of Age-Friendly Cities and Communities. An Age-Friendly Portland Advisory Council was formed to guide the development of an action plan, monitor progress over time, and suggest additional research. To understand how Portlands age-friendly policy effort has developed over time, we use Kingdons (1984) agenda-setting framework to explain how the policy problem was formulated, how solutions were developed, and the influence of local politics. The policy actors, including individuals and organizations working within and outside of government, are described. The Portland experience provides a case study that other cities, especially those with a strong commitment to community-engaged urban planning, may find useful as they develop age-friendly initiatives.

Understanding the Intersection of Individual Needs and Choices With Organizational Practices: The Case of Medication Management in Assisted Living

PURPOSE Making choices about everyday activities is a normal event for many adults. However, when an adult moves into an assisted living (AL) community, making choices becomes complicated by perceived needs and community practices. This study examines the relationship between choice and need in the context of practices, using medication administration practices as the case in point. DESIGN AND METHODS A 5-year ethnographic study collected information from 6 AL settings in Maryland. Ethnographic interviews (n = 323) and field notes comprise the data described in this article. RESULTS AL organizations used practice rationales based on state regulations, professional responsibility, safety concerns, and social model values to describe and explain their setting-specific practices. The result was varying levels of congruence between the settings practices and individual residents needs and choices. That is, in some cases, the residents needs were lost to the organizations practices, and in other cases, organizations adapted to resident need and choices. These findings suggest that individuals and organizations adapt to each other, resulting in practices that are not bound by state requirement or other practice rationales. IMPLICATIONS AL residences vary due to both internal and external forces, not just the public policies that define them. State regulations need to be responsive to both the needs and the choices of individual residents and to the people who work in an AL.

Direct Care Worker’s Perceptions of Job Satisfaction Following Implementation of Work-Based Learning

The purpose of this study was to understand the impact of a work-based learning program on the work lives of Direct Care Workers (DCWs) at assisted living (AL) residences. The research questions were addressed using focus group data collected as part of a larger evaluation of a work-based learning (WBL) program called Jobs to Careers. The theoretical perspective of symbolic interactionism was used to frame the qualitative data analysis. Results indicated that the WBL program impacted DCWs’ job satisfaction through the program curriculum and design and through three primary categories: relational aspects of work, worker identity, and finding time. This article presents a conceptual model for understanding how these categories are interrelated and the implications for WBL programs. Job satisfaction is an important topic that has been linked to quality of care and reduced turnover in long-term care settings.

Promoting Independence: An Analysis of Assisted Living Facility Marketing Materials

This project examined the content of marketing materials published by assisted living facilities (ALF) in Oregon. The goals included comparing what is required by the state rules governing ALFs to what is described in marketing materials, focusing on the organizational principles of assisted living, services and fees, and residency criteria; identifying content addressing negative consequences of aging; and reviewing changes in marketing materials over nearly four years. Marketing materials from 63 of 66 ALFs licensed in Oregon as of August 1996 were collected first in 1997 and again in 2000. The dominant organizational principle at both times was supporting resident “independence.” The majority of ALFs address issues such as incontinence and cognitive impairment in their marketing materials. Although most facilities revised their marketing materials between 1997 and 2000, the majority of changes were cosmetic rather than content oriented. One issue notably lacking from these materials was descriptions of residency criteria.

Multigenerational Households of Caregiving Families Negotiating Shared Space

Data were collected from 54 primary caregivers, their husbands, and adult children who were members of multigenerational households that included a disabled person over age 65. Household characteristics were examined in relationship to perceptions of household space, burden, and satisfaction. Household characteristics did not predict either burden or satisfaction. Household conversion decreased perceptions of household space for women and for their husbands. In addition, for husbands, the more time an elder spent in shared living space, the more negative the perceptions of household space. For teenage children in the household, sharing amenities with elders resulted in more negative perceptions of household space. Results are interpreted in terms of caregiving stress and suggestions are made for home adaptations.

Exploring Identity and Aging: Auto-photography and Narratives of Low Income Older Adults

This study focused on meanings of health, housing, independence and aging among low-income adults age 55 and older who live in, or are on a waiting list for, publicly subsidized rental housing. The purpose was to learn how low-income older adults perceive their independence and health, and how their place of residence contributes to these perceptions, as well as related perceptions of self. Qualitative data were collected using in-person narrative interviews with 45 individuals and a second photo elicitation interview with 31 of these persons. Themes describe how disrupted identities influence subjective thoughts about the aging process, housing, health, and finances, the process of clinicalization, and place identities. These findings highlight the relationship between housing status, dignity, and shifting identities as older adults experience the aging process in a low-income context. This study expands the current scholarship on the relationship between environment and aging as well as our understanding of poverty among older persons. These topics are relevant for new policies and programs to support the aging in place of older persons in subsidized housing. Understanding the life worlds of those who live in or have applied to this form of housing will be instrumental in developing such strategies.

Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers

ABSTRACT Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV; previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons.