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 Transitioning from independent living to assisted living to skilled
nursing in one place can be disruptive and stressful, as researchers
have known for 30 years, the authors write in The Gerontologist.
“Our sample is primarily white, mostly private pay,” but this type
of multilevel housing is found across the U.S., said lead author
Erin G. Roth of the department of sociology and anthropology at the
University of Maryland, Baltimore County.
Stigma is common in these settings, Roth told Reuters Health by
email.
“For senior housing developers, multilevel senior housing has proven
to be profitable in many ways – it’s heavily marketed and has become
the prevalent model for senior housing and care,” said Kevin Eckert,
another author of the paper, also of UMBC. “It is more
cost-effective, profitable, and convenient to group people together
by levels.”
“The social challenges that result are often recognized by staff and
administrators but the difficulty for everyone is in imagining a
true alternative, when the model so thoroughly dominates the senior
housing landscape,” she said.
The researchers considered two National Institute on Aging-funded
studies of various housing options, including continuing care
retirement communities and dementia care units where multiple levels
of care are available within a campus or building.
In total, they used 470 interviews with 367 residents, family, staff
and administrators at seven facilities.
Interviewers asked open-ended questions about what life is like at
the facilities, including transitions between levels of housing.
In every facility, the unit with the highest level of care was
stigmatized, with residents referring to it with names like “The
Twilight Zone,” “The Dark Side,” “Death Valley,” “Sleepy Hollow,” or
“God’s waiting room.”
One administrator noted that few residents in lower levels of care
like independent or assisted living seem comfortable going to the
higher level units to visit friends. Many interviewees commented
that residents didn’t like to mingle with others in different levels
of care.
In one case, residents refused to ride on a bus marked to indicate
that the people inside might be memory impaired.
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“Many people shopping for a senior housing setting are not wanting
to face the possibility of these next moves – and so staff have said
that some people will decline the part of the tour that includes the
nursing care center,” Roth said. “This points to a deeper
sociocultural fear of death and decline that is so pervasive and is
a contributing factor to the problems we layout in the article.”
Some residents fear that facility staff are closely watching them,
looking for signs of deterioration that would necessitate a move to
a higher level of care. One resident spoke of keeping her
progressive blindness from staff so they would not move her to
assisted living.
The power differential can lead to an adversarial relationship
between resident and staff, the researchers write.
“Most people aren’t aware of these social dynamics until after
they’re settled and may not have the energy or power to make a
change or advocate for a different model,” Roth said. “Instead, most
seniors choose to adapt or focus on the positives.”
The Metlife Mature Market 2012 Survey of long term care costs lists
some useful questions to ask when looking for a nursing home or
assisted living, said Debra Dobbs of the School of Aging Studies at
the University of South Florida in Tampa, a co-investigator on the
study.
The federal government’s Nursing Home Compare tool has useful
quality indicators, survey deficiencies and payment types for every
nursing home available for public view, Dobbs told Reuters Health by
email.
According to a new analysis by the Kaiser Family Foundation, more
than a third of the 15,500 nursing homes in the U.S. received low
ratings of 1 or 2 out of five stars in the Nursing Home Compare
quality rating system.
SOURCE: http://bit.ly/1Polm6t The Gerontologist, online May 4, 2015
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