The role of the gerontological social worker in assisted living

Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review

Background

Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality.

Methods

Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist.

Results

Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies.

Conclusion

Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03386-9.

"You Lose Some Good Friends": Death and Grief in Assisted Living

The purpose of this study was to investigate responses to death at multiple levels within the assisted living (AL) system and to characterize the psychosocial impact of death on surviving residents. This study used secondary thematic analysis of multiple data sources collected as part of a larger quantitative-focused study with 21 ALs. Data sources included: (a) community documents, e.g., newsletters; (b) descriptive and reflective observational field notes; and (c) memos and key statements from interviews with residents (n = 18). Three themes emerged from the data: administrative memorialization practices, resident perceptions of staff communication related to death, and resident psychosocial responses to death. Surviving residents reported using both adaptive and avoidant strategies to cope with psychological responses to death; noting that grief responses extended to the loss of the deceased resident's family, friends, and pets. Residents also perceived staff-resident communication and community memorialization practices as incongruent with a "family-like" social climate. Findings highlight the potential utility of a multi-level approach to improving psychosocial aspects of end-of-life care and grief management by targeting AL administration, workforce, and individuals. Social workers are well-positioned to lead these types of psychosocial interventions but must contend with staffing barriers limiting clinical roles in AL.

COVID-19 Recommendations for Assisted Living: Implications for the Future

OBJECTIVES

Assisted living (AL) emerged over 2 decades ago as a preferred residential care option for older adults who require supportive care; however, as resident acuity increased, concern has been expressed whether AL sufficiently addresses health care needs. COVID-19 amplified those concerns, and an examination of recommendations to manage COVID-19 may shed light on the future of AL. This review summarizes recommendations from 6 key organizations related to preparation for and response to COVID-19 in AL in relation to resident health and quality of life; compares recommendations for AL with those for nursing homes (NHs); and assesses implications for the future of AL.

DESIGN

Nonsystematic review involving search of gray literature.

SETTING AND PARTICIPANTS

Recommendations from key governmental bodies and professional societies regarding COVID-19 in AL, long-term care facilities (LTCFs) in general, and NHs.

MEASURES

We collected, categorized, and summarized these recommendations as they pertained to quality of life and health care.

RESULTS

Many recommendations for AL and NHs were similar, but differences provided insight into ways the pandemic was recognized and challenged AL communities in particular: recommending more flexible visitation and group activities for AL, providing screening by AL staff or an outside provider, and suggesting that AL staff access resources to facilitate advance care planning discussions. Recommendations were that AL integrate health care into offered services, including working with consulting clinicians who know both the residents and the LTC community.

CONCLUSIONS AND IMPLICATIONS

Long-term care providers and policy makers have recognized the need to modify current long-term care options. Because COVID-19 recommendations suggest AL communities would benefit from the services and expertise of social workers, licensed nurses, and physicians, it may accelerate the integration and closer coordination of psychosocial and medical care into AL. Future research should investigate different models of integrated, interdisciplinary health care in AL.

Growing Old in a Transnational Setting: Investigating Perceptions of Ageing and Changing Filial Ties Among Older Indians in Saskatoon

Numerous studies have examined the experience of growing old in a transnational context among Indians. However, in most of these studies, the older adults had immigrated as senior citizens to be with their adult children. Indians who have grown old in transnational settings have not been examined in detail in the gerontological scholarship. Adopting a cross-cultural lens, the present study focusses on perceptions of ageing among older Indians who have grown old in the city of Saskatoon. The study demonstrates how these older Indians refute the Successful Ageing model and accept their physical weaknesses in their course of ageing. Additionally, the study also examines how caregiving arrangements and intergenerational relationships are shaped among these older Indians and their adult children, in a transnational city, such as Saskatoon. Finally, the study highlights how later life gender roles are constructed in a transnational backdrop.

Extending the job embeddedness-life satisfaction relationship

Purpose

This exploratory study adopts a stakeholder perspective on organisational effectiveness. The purpose of this paper is to examine the job embeddedness (JE)–life satisfaction relationship, moderating roles of gender and community embeddedness and mediating role of innovative behaviour.

Design/methodology/approach

Using a snowballing approach, data were collected from 549 participants employed in organisations located in four major metropolitan centres in South Africa.

Findings

Analyses revealed a positive relationship between JE and life satisfaction. Gender moderated the JE–life satisfaction relationship, such that the relationship was stronger among females than males. Community embeddedness moderated the organisation embeddedness–life satisfaction relationship, such that the relationship was stronger when participants were highly embedded in their community. Finally, innovative behaviour mediated the relationship between organisation embeddedness and life satisfaction.

Practical implications

Managers could enhance employees’ life satisfaction through practices that increase on-the-job and off-the-job embeddedness. Furthermore, organisations could encourage employees’ innovative behaviours through workplace supervisors’ supportive responses to innovative employees.

Originality/value

JE researchers have yet to focus on the personal benefits of embeddedness for employees. Results of the study provide several contributions to this research direction. The study uses JE as a composite construct to confirm its relationship with life satisfaction. It also expands the JE–life satisfaction relationship by examining moderators of the relationship and a mediating variable in the relationship.

Marital Status and Persons With Dementia in Assisted Living

Despite the prevalence of dementia among residents in assisted living (AL), few researchers have focused on the length of stay (LOS) in AL among this population. Little is known about the factors that may contribute to LOS in these settings, particularly for residents with dementia. In the current study, a sub-set of AL residents with dementia (n = 112) was utilized to examine whether marital status was associated with LOS in AL as this has received sparse attention in previous research despite studies suggesting that marital status influences LOS in other health-care and long-term care settings. The Andersen-Newman behavioral model was used as a conceptual framework for the basis of this study of LOS, marital status, and dementia in AL. We hypothesized that persons with dementia who were married would have longer LOS than unmarried persons with dementia in AL. Cox regression was used to examine the association between marital status and LOS in AL of residents with dementia and whether activities of daily living were related to discharge from AL settings among married and unmarried residents with dementia. Main effects for marital status and the interaction between marital status and mobility with LOS were examined. Study findings provide information related to the psychosocial needs of AL residents with dementia and offer implications for assessing the on-going needs of vulnerable AL residents.

Drivers of change: Learning from the lived experiences of nursing home social workers

In response to the growing attention to integrated health care and the cultural change movement in nursing homes, this study examines the lived experiences of nursing home social workers to better understand their role perceptions, job satisfaction, and relationship with other staff members. Hermeneutic phenomenology was used in order to understand the lived experience of being a nursing home social worker. Ten nursing home social workers were recruited from a southern state and individual interviews were conducted. From the interviews, four themes emerged: challenge, coping, mattering, and rewarding. Guided by identity negotiation theory and social identity theory, these findings are discussed. Also, implications for social work education, nursing home administration, and policy is discussed.

Correlates of attitudes toward personal aging in older assisted living residents

This study explored factors contributing to older adults' self-perceptions about their own aging in assisted living (AL) communities. Data analysis was completed based on interviews with 150 older residents from 17 AL communities. Multiple regression analyses found that functional disability and hearing impairment negatively affected attitudes toward personal aging among AL residents, and satisfaction with social support positively influenced attitudes. Health perception mediated attitudes toward personal aging. Findings suggest the importance of social workers helping older AL residents recognize social support as a means of promoting their positive self-regard.

Deciding to institutionalize: caregiving crisis, intergenerational communication, and uncertainty management for elders and their children in Shanghai

This phenomenological study integrated crisis theory, social identity theory, and uncertainty management theory to conceptualize the decision-making process around institutionalization among nursing home residents and their children in Shanghai. I conducted face-to-face, semistructured interviews with 12 dyads of matched elders and their children (N = 24). The findings suggest that caregiving crises triggered intergenerational communication about caregiving alternatives and new arrangements, although each generation had different stances and motivations. Children finalized the decision by helping their parents to manage the uncertainties pertaining to institutionalization. This study sheds light on caregiving decision-making dynamics for the increasing aging population across cultures.