Running Head: Cutting Cost and Increasing Care
Higher Educated Caregivers: Cutting Cost and
Increasing Care in Assisted Living Facilities
Andrea Chandler
Research Writing
Marlen Harrison
March 16, 2010
Literature Review
Assisted living facilities are long term care facilities that care for the elderly. Staffing characteristics vary among assisted living facilities. However, research has been done to show what staffing characteristics are necessary to provide optimum care. “Staff working on-site, providing 24-hour coverage should be sufficient in numbers and experience to meet the ongoing needs of the residents. Staff should be knowledgeable about basic changes in aging, aging drug pharmacology, falls prevention, incontinence care, ADL skills, communication techniques, dementia care, and recognition of acute illness/delirium. In addition, staffing levels and expertise should be discussed with all potential ALF residents to assist in the initial choice of ALF. To provide the most effective care, staff working daily with persons requiring assistance should have a working knowledge of normal aging and common problems seen in aging. Staff must be able to assist persons in such a way that whatever residual independent capabilities the residents are not lost through learned helplessness. Also, staff must be able to discern when significant changes have occurred that require evaluation by qualified professionals (Stefanacci, RG, & Podrazik, PM. 2005).” The staffing of ALF must be educated and be able to provide basic nursing skills. Research has also been done on communication between staff and the residents in the facility. Williams, K. and Warren, C. researched communication between the staff and residents at an assisted living facility. The article also summarizes what living in an assisted living facility is like. Also, communication among residents, “local culture mirrors that of the larger society, with different patterns of communication attributed to women and men: the sociability of the women, and the dominance of the male “board of directors.” The women are seen by both staff and other residents as more likely to engage in activities and gossip, while the self segregating men talk of sports and politics, and then retreat to solitary activity” (p. 26 2009). The article also states that assisted living facilities should encourage their residents and help maintain their self control. Debra Dobb states of Assisted Living Facilities, “A better understanding can result in more empathetic staff and positively affect the type of care they provide: Social scientists doing ethnographic work in long term care settings could benefit the field by….educating staff on how to seek social explanations for residents’ behaviors” (As quoted from Williams &Warren 2009 p. 35).
Although studies have looked into ALF and the type of care that should be provided, there are still shortcomings of the AL system. “Assisted living is the fastest growing segment of long-term care. Despite its rapid growth, a recent national study indicates that assisted living is still not a complete substitute for nursing home care, especially in rural areas (Hawes, Rose, & Phillips, 1999). First, assisted living is often not affordable for moderate- and lower-income elderly, and in most states, Medicaid does not cover assisted living. Second, people with functional decline have limited access to assisted living. The majority of the facilities offer little assistance beyond aid with medications and basic personal care. In addition, most do not accommodate individuals with severe physical disabilities or cognitive impairments (p.81 2007).” ”A study commissioned by the Centers for Medicare and Medicaid Services (CMS) suggests that nursing homes would need to hire an additional 77,000 to 137,000 registered nurses (RNs) to achieve recommended staffing levels (Abt Associates, 2001). An American Nurses Association’s survey estimated that the nursing vacancy rate for NHs and HHAs was 19% and 13%, respectively (Cohen-Mansfield, 1997). There are also significant difficulties in recruiting and retaining trained nursing staff in rural locations. Barriers for nurses in rural areas include lower wages, lack of professional growth opportunities, and lifestyle differences when compared to urban communities (Stern, 2001 as qouted from Week-Maldonado 2007).” “Recent studies have demonstrated that there is a clear link between quality and staffing in acute and long-term care settings(Abt Associates, 2001; Aiken, Clarke, Sloane, Sochalski, & Silver, 2002; Eaton, 2000; Weech-Maldonado, Meret-Hanke, Neff, & Mor, 2004),yet nursing homes fall far below the staffing levels indicated by the quality studies (Abt Associates, 2001). High nurse staffing turnover contributes to the nursing shortages and high labor costs of nursing homes (Weech-Maldonado, R, Shea, D, & Elmendorf, K. 2007).”
One way for a researcher to bring new information about ALF into the academic world is by the use of Autoethnography. Autoethnography allows the researcher to explain personal experiences. “Charmaz (2006), in an issue of the Journal of Contemporary Ethnography devoted entirely to autoethnography, states more simply that autoethnography[is] concentrated on the researcher’s own previous or present experience(As qouted from Wright 2008 p. 338).” Wright also comments on autoethnography: “I suggest that by researching ourselves we can learn how our beliefs, attitudes and values about health, illness and care have been constructed. We can perhaps imagine how others have developed theirs and appreciate that others perspectives may be as valid as our own.” (Wright 2008) By examining personal experiences of ALF care givers researchers can have a better view of what working in an Assisted Living Facility is really like.
Reference Page
Stefanacci, RG, & Podrazik, PM. (2005). Assisted living facilities: optimizing outcomes.. Journal of the American Geriatrics Society, 53(3), Retrieved from http://web.ebscohost.com/ehost/detail?vid=5&hid=11&sid=73e293b6-662d-40bd-9644a9cf3e63eaa3%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN =20 05076192#db =c8h&AN=2005076192
Weech-Maldonado, R, Shea, D, & Elmendorf, K. (2007). Long-term care providers and their perceptions of the external environment: rural versus urban differences. Journal of Applied Gerontology, 26(78), Retrieved from http://jag.sagepub.com/cgi/reprint/26/1/78 doi: 10.1177/0733464806296145
Williams, K, & Warren, C. (2009). Communication in assisted living. Journal of Aging Studies, 23. Retrieved from http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6W51-4TKXD75-1-1&_cdi=6557&_user=3569841&_pii=S0890406508000844&_orig=search&_coverDate=01%2F31%2F2009&_sk=999769998&view=c&wchp=dGLbVlz-zSkzk&_valck=1&md5=4b74c957c61527358aa8d60f81ee54e3&ie=/sdarticle.pdf
Wright, J. (2008). Searching one’s self: the autoethnography of a nurse teacher. Journal of Research in Nursing, 13(4), Retrieved from http://jrn.sagepub.com/cgi/reprint/13/4/338 doi: 10.1177/1744987107088046
Pre Writing Questions
This lit review will help me as a writer to further identify the question that I would like to answer and to help illustrate the voice I would like to have as a researcher. I will show the reader what information has already been presented and accepted. This will differ from other sections of my project because the information presented here will be mostly other author’s ideas and information. I hope the Journal of Nursing and other medical journals will read over my research and what I found to be important. By writing this I hope to show the reader that I have a comprehensive understanding of my topic and the information that I am presenting.
Post Writing Questions:
The lit review helped me to identify the research that I have already compiled and how they all connected to one another. I have read and understood other author’s works which will then help me to develop my own voice when I write my research. I presented the information about the Assisted living Facilities and how personal experiences can demonstrate the reality of ALF. The information presented here was mostly of other authors works. I still hope to have the Journal of Nursing read over my research and lit review. However, my fiancé Stephen read over my lit review and helped to correct minor grammatical errors.
