Master of Science / Department of Family Studies and Human Services / Rick J. Scheidt / In 2011, about 13 percent of the U.S. population, approximately 40 million people, were foreign born in the United States. Many of them participate in transnational caregiving, either as children supporting their parents in their country of origin or parents moving to the U.S. to help their children. This report examines research on transnational caregiving between immigrant adult children and their parents. Following the caregiving definitions of Finch (1989), the articles were reviewed and categorized as economic support, accommodation, personal care, practical support and childcare, and emotional and moral support. Changes in family norms and roles, and the caregiving responsibilities after immigration, are also presented. Keywords: transnational, caregiving, immigrant, elderly, economic support, accommodation, personal care, practical support and childcare, and emotional and moral support, living arrangement.

Master of Science / Department of Landscape Architecture/Regional and Community Planning / Stephanie Rolley / More than 5% of the 65 and older population utilize nursing homes, congregate care, assisted living, and board-and-care homes, with about 4.2% of these individuals occupying nursing homes at any given time (Administration on Aging, 2008). The rate of nursing home use generally increases with age and studies have shown that by the year 2030, the number of lesbian, gay, bisexual and transgender (LGBT) adults over the age of 65 is expected to be nearly 3 million (SAGE, 2010). With this overall increase in potential resident populations, those aging adults who identify as LGBT are faced with additional unique challenges commonly not encountered by their heterosexual counterparts. The majority of LGBT elders fear they will experience discrimination in long-term care organizations, with more than half maintaining that staff or even other residents will abuse or neglect them (Knochel, et al., 2010). Unrevised long-term care organizational rules combined with prejudice and hostile treatment from staff members can create unwelcoming environments for LGBT elders who are generally unable to advocate for themselves. Challenges that aging LGBT adults face in long-term care settings will be reviewed and discussed in this report. In addition, this report will provide educational guidelines to assist long-term care organizations in developing an educational model targeted at addressing LGBT elders’ concerns. When staff within a long-term care community lack proper training on and understanding of LGBT concerns, it can negatively affect the quality of care provided to these members. As such, the educational guidelines will encourage an educational model incorporating cultural competency training among the long-term care staff and organizational leadership, and will utilize community development principles to ensure inclusiveness and increase social capital.

Master of Science / Department of Hotel, Restaurant, Institution Management and Dietetics / Carol W. Shanklin / The purposes of this study were to explore factors associated with residents’ dining experience in assisted living facilities and to investigate the influence that these factors had on perceived quality and residents’ satisfaction with their dining experience. Food quality, service quality, mealtime customization, and dining room environment were the four constructs explored. Focus groups were conducted with residents of three assisted living facilities to determine attributes of the constructs that were important to them. A total of 22 residents participated in the three focus groups. A questionnaire developed by Huang was revised to include measurement items identified in the focus groups. The questionnaire was distributed to residents of 16 randomly selected assisted living facilities within a 110 mile radius of the research institution. Of the 492 residents in 16 facilities, 246 completed the questionnaire for a response rate of 50%. Residents evaluated the attributes on a 5-point likert scale (1-strongly disagree; 5-strongly agree). Service quality (4.03) and dining room environment (3.97) attributes were rated significantly higher than food quality (3.64) and customization attributes (3.42). Resident satisfaction also was evaluated on a 5-point scale (1-very dissatisfied; 5-very satisfied). Residents were satisfied with the overall dining experience (3.94) and the overall facility (3.97). Residents were less satisfied with food served (3.67) or the amount of choices they had at meals (3.58). Residents were satisfied with services (3.95) and the dining room atmosphere (3.98). Satisfaction with services and the dining room atmosphere were significantly higher than food served and amount of choices at mealtimes. Residents’ perceptions of food quality, service quality, level of customization, and dining room environment had a positive influence on their satisfaction with the overall dining experience. Residents’ perceptions of food quality had a positive influence on satisfaction with the food served, service quality impacted satisfaction with services, level of customization effected satisfaction with the amount of choices, and dining room environment influenced satisfaction with the dining room atmosphere. Administrators, foodservice directors, and dietitians employed in assisted living facilities can use the results to improve the dining experience for residents and ultimately improve residents’ quality of life.

Doctor of Philosophy / Department of Sociology, Anthropology, and Social Work / Laszlo Kulcsar / Retirement age migration is not new. However, it has recently been garnering the attention of both researchers and local policy makers. Older migrants present the possibility of economic stimulus without creating additional pressure on the labor market. That said, a majority of works on retirement migration come to the same conclusions. Conventional theories state that older people move to places based on natural amenities and recreation opportunities. Further, these findings are often utilize a binary dependent variable based on whether a county has achieved a certain level of growth from inmigration of all people age 60+. I argue that this view is too narrow. Older age migrants move for a variety of reasons. These motives also vary across different age, sex, and race-ethnicity characteristics of the migrants in question. Further, not all counties that attract older migrants have bountiful natural or recreation amenities. Not only have these unconventional retirement destinations (URDs) had different historical trajectories, they also possess a different kind of amenities that appeal to older people who have relocated to the area. Finally, a focus on binary retirement classifications misses both diversity in retirement patterns and fails to explicitly account for the influence of space in county desirability. The goal of this work is to address these issues. First, I discuss the history and theories of retirement migration. Second, I develop models accounting for variation across older age migrant groups with varying demographic characteristics. Third, I identify and describe URD counties. Fourth, I present the results of a small-scale survey, community leader interviews, and a new model with additional variables to get at what other kinds of things should be labeled as “amenities.” Finally, I examine the role of space in migration research. My analysis demonstrates that there is much to be learned from looking at spatial models, micro-regional effects, and relative advantage between neighboring counties. Results indicate that conventional theories of retirement migration, while not necessarily wrong, are at least incomplete. The addition of diversity, new amenities, and space may greatly enhance our understanding of older age migration and migration research as a whole.

Master of Science / Department of Family Studies and Human Services / Melinda Markham / The number of grandparents who are taking over the responsibility of raising their grandchildren is increasing over time. Despite society’s reliance on them, society is failing to meet the needs of these families. Grandparents consistently lack the necessary resources that could reduce and minimize their stress in what is usually an unexpected family situation. Family Life Education has failed to meet the needs of grandfamilies. Using Family Stress Theory as a theoretical framework, this study asked the question How can Family Life Education be used as a resource for grandparents raising grandchildren to avoid crisis? Focus groups and individual interviews were used to gather qualitative data from grandparents who are currently raising their grandchildren near a midwestern university. Findings suggest grandparents raising grandchildren could benefit from education regarding finding resources and answers to questions as they navigate the many systems they are involved with, communicating and guiding their grandchildren, balancing and maintaining the shifting family dynamics and changing family relationships, information regarding the growth and development of children across the lifespan, and education regarding content that is unique to their family situation. However there are multiple barriers that participants identified toward the utilization of FLE. Ultimately, there is a lack of collaboration among services for grandparents raising grandchildren and they lack support that could potentially come from support groups. Impact and implications for practice, research and policy were discussed. Strengths and limitations of the study were also presented.

Doctor of Philosophy / Department of Family Studies and Human Services / Rick J. Scheidt / Alzheimer's disease (AD) is a chronic illness that has the capacity to impact several domains of a person's life. The purpose of this qualitative study was to explore four particular domains of meaning of an AD diagnosis to gain a systemic understanding of couples' experiences when one spouse had recently been diagnosed with Alzheimer's disease. A social constructionist framework was used in conjunction with the biopsychosocial-spiritual model, to explore the biological, psychological, social, and spiritual factors which inform and possibly influence couples' experiences in relation to an AD diagnosis. The interview guide was constructed using the underlying biopsychosocial-spiritual framework for the purpose of exploring couples' experiences in a systemic manner. Four couples were interviewed in their homes, no more than two months following a formal diagnosis of AD. This particular time frame captured the raw experience couples went through when receiving an AD diagnosis. All interviews were recorded, transcribed, and analyzed according to a modified version of Moustakas' phenomenological method of analysis. A family medicine physician served as the co-interpreter throughout the entire analysis process. Results consisted of unique descriptions for each couple's case and a composite description of the cross-case analysis, highlighting similarities and differences among cases. The biopsychosocial-spiritual model was found to be a significant tool for elliciting a systemic understanding of each couple's experience, and recognizing unique aspects of couples' experiences. Analysis across cases revealed 14 common themes that emerged across the four (five biological, four psychological, four social and two spiritual) domains. Results revealed that of the 14 common emerging themes, five themes were shared by all cases: Recognizing a Problem, Experience of Diagnosis Process, Experience of Symptoms, Social Support, and Social Activities. The overall analysis illustrated many more similarities among biological experiences than any other domain of experience. One case, #3, displayed a particularly unique psychological experience, as well as a significant spiritual foundation. Overall, this study emphasized the importance of using a systemic framework, such as the biopsychosocial-spiritual model, to gain a rich, in-depth understanding of how different couples experience the diagnosis process of AD.

Master of Science / Department of Family Studies Human Services / Rick J. Scheidt / Currently in the United States there are 2.7 million grandparent caregivers caring for 5.4 million grandchildren, with 883,386 of these grandparents caring for their grandchildren without any assistance from the child’s biological parent. These grandparents have unique needs and require support services that understand and recognize those needs. However, many of the resources currently available are not designed to assist this population. This report explores many of the issues grandparents face when taking over as the primary caregiver for their grandchild. Specifically this report highlights the financial, legal, and medical issues, as well as the need for respite care and housing. These particular issues were selected because they are commonly cited as difficult areas to navigate for grandparent caregivers, and also because there are crucial resources in each of these areas that allow grandparents to successfully raise their grandchild. Without these tools, the process of raising the grandchild can prove extremely difficult for grandparents, which can have negative consequences on the grandchildren. In addition it offers suggestions for grandparents seeking assistance regarding these issues, also providing several resources. This report also offers guidance for grandparent caregiver advocates and encourages future research and scholarship to explore programs assisting this population.

Programs that use the arts to engage older people promote health, foster community, and give voice and legacy to participants. Creative practice in health care settings facilitates emotional, mental, and physical wellness for participants and staff, while improving the culture of care. Yet there is resistance to arts-in-medicine as a legitimate tool of health care. The predominant biomedical paradigm privileges quantitative assessment methods over qualitative studies which may accept anecdotal, arts-informed, or “common sense” evidence. Successful creative programs face challenges translating their benefits when evaluated inappropriately. This arts-informed inquiry uses creative writing to address multiple dimensions of knowing, integrating autoethnographical insights from work as a caregiver, artist, educator, and administrator of collaborative art. Serendipity and imagination in research were employed to explore how collaborating artists can facilitate creative engagement for elders, embodying preventative, community-based medicine to successfully address and transform myriad challenges and opportunities as the population continues to age.

Objective: determine whether accreditation through Accreditation Canada is associated with more favorable resident safety in Ontario LTC homes and which facility characteristics are predictive of accreditation. Methods: logistic regression was used to determine predictors of accreditation. To examine the association between accreditation and safety, safety was operationalized as five MDS-RAI quality indicators: prevalence of falls, restraints, catheters, pressure ulcers, and infections. Separate multivariable models were developed for each indicator. Results: the odds of accreditation were approximately six times smaller for municipal (p < 0.001) and non-profit facilities (p < 0.001) relative to for-profits; three times greater for chains relative to non-chains (p < 0.001); and twice as large for urban relative to rural facilities (p = 0.04). Of the five quality indicators examined, only one (falls) was associated with accreditation. After adjusting for confounders, accredited homes were estimated to have 8% lower fall rates than non-accredited homes (p = 0.01).

Programs that use the arts to engage older people promote health, foster community, and give voice and legacy to participants. Creative practice in health care settings facilitates emotional, mental, and physical wellness for participants and staff, while improving the culture of care. Yet there is resistance to arts-in-medicine as a legitimate tool of health care. The predominant biomedical paradigm privileges quantitative assessment methods over qualitative studies which may accept anecdotal, arts-informed, or “common sense” evidence. Successful creative programs face challenges translating their benefits when evaluated inappropriately. This arts-informed inquiry uses creative writing to address multiple dimensions of knowing, integrating autoethnographical insights from work as a caregiver, artist, educator, and administrator of collaborative art. Serendipity and imagination in research were employed to explore how collaborating artists can facilitate creative engagement for elders, embodying preventative, community-based medicine to successfully address and transform myriad challenges and opportunities as the population continues to age.