Direct care worker turnover and shortages plague long-term care, weakening its quality, heightening costs for governments and employers, and cyclically breeding further turnover and shortages of workers. To address these issues, I investigate why direct care workers chose employment in long-term care (LTC), assisted living (AL) and specific AL facilities. Data come from a mixed-methods study of 45 AL facilities in Georgia, including interviews with 400 direct care workers. Findings include qualitative data analyzed using a grounded theory approach and descriptive quantitative data. Care workers’ motivations for employment in LTC, AL, and specific AL facilities reflect a split between moral and material values for care work, and care workers’ motivations illustrate a process of reconciling moral and material values. Individuals become care workers for reasons that are both materialistic, like earning a living wage, and moralistic, like the desire to care for others. They take employment expecting it to be consistent with their moral ideals and to satisfy their economic needs. Various individual, facility, industry, and community level factors influence workers’ motivations, and these factors reinforce the inconsistency between moral and material values for care work. Considering the heightening demand for LTC and short supply of care workers, as well as the deindustrialization of the economy, several recommendations are made for policies and practices that would support workers’ motivations for employment in LTC. Areas for future research also are highlighted.

Past research advocates the need for long-term care (LTC) facilities to adopt a person-centred model of care to optimize residents quality of life. The construct of quality of life in LTC has been defined by satisfaction with a set of domains identified by Kane and colleagues (2003). One goal of this study was to determine which domain is the most predictive of overall well-being among LTC residents in a rural setting. Based on past research and on Deci and Ryans (1985; 1991) self-determination theory, satisfaction with autonomy was predicted to emerge as most predictive of overall well-being. The present study also examined the relation between resident quality of life and well-being, and the degree of routinization (i.e., adherence to a rigid, inflexible daily schedule) within the LTC environment. Routinization is conceptually at odds with a person-centred model of care, yet its relation to the well-being of care recipients had not been examined prior. One hundred and ninety-eight residents from 15 LTC facilities in rural Saskatchewan participated in individual interviews to measure their satisfaction with 11 quality of life domains (Kane et al., 2003), and their overall well-being (using the Memorial University of Newfoundland Scale of Happiness; MUNSH; Kozma & Stones, 1980). One hundred and thirty-one staff from the 15 facilities completed a questionnaire designed to assess routinization within the LTC environment. Contrary to predictions, autonomy failed to emerge as a significant predictor of overall well-being among sample residents. The domain of meaningful activity received residents lowest satisfaction rating of the 11 domains, and also accounted for the most unique variance in overall well-being. Routinization was negatively related to resident quality of life, with staff rating routinization higher in facilities which residents reported lower satisfaction with quality of life. Results provide focus for improving the quality of life of LTC residents, and point to areas for further study.

ABSTRACT As the population ages and family structure changes quickly, the demand for long-term care services from elderly people increased rapidly. In the aboriginal villages, due to insufficient medical sources, weak economic condition, and lack of young manpower in family, the need of aboriginal elderly people for health care is much more than urban residents. The study field located in Pingtung County is because it is the territory has the most indigenous townships in Taiwan. The study mainly adopts qualitative methodology with small amount of questionnaires to conduct quantitative analysis, it is expected to draw different dynamic result to generate useful outcome. Based on the findings and conclusion after collected and analyzed, the research could provide reference for the development of long-term care project in aboriginal area and long-term caring insurance in future. The research found that the county government and execution organization- NPO both built positive partnership, but the administration of indigenous people and local township office are not involved much. In additional, the provisions of caring health elder in community between Ministry of the interior and Council of indigenous people are duplicated. The users decreased significantly after implementation of users¡¦ pay concept for additional service hours, and it also caused aboriginal women who work as caregiver lost their jobs. In terms of service utilization, the top three services are body clean, house service and mental support, and the result of questionnaires presents great satisfaction. However, considering of weak economic condition, the elderly cannot accept self-afford service yet. Conclusion: 1. Government should adjust different users¡¦ pay level for isle and indigenous township. 2. It should integrate duplicated resources of community-base for health elderly people. 3. Home caregiver can play role of a propagator for welfare and health care policy in village. 4. To develop an integrated long-term care information system to improve the efficiency of case management and service resource.

An effective bibliometric analysis based on Science Citation Index (SCI) and Social Science Citation Index (SSCI) published by the Institute of Scientific Information (ISI) was carried out to identify the long-term care research between 1991 and 2008. The objective was to conduct a quantitative and qualitative analysis for global trends of long-term care related research. The characteristics related to publications were analyzed. Apparently more and more authors, institutes, and countries engaged in the research over the 18 years. The USA produced the most single country articles and international collaborative articles, followed by Canada and UK. Synthetically analyzing the distribution of paper title, author keyword and keyword plus, it could be concluded that application of long-term care mainly focused on five branches. There are gerontology, psychiatry, health care science, nursing and epidemiology.

This dissertation is a narrative inquiry of the ways in which cultural values, norms, and expectations shape the aging experience of elderly adults living independently in Kasson, a small rural town in southeastern Minnesota, and within Prairie Meadows, Kasson's residential assisted living facility. Despite significant evidence of the reciprocal relationship between community connectedness, successful aging, and healthy communities, we know relatively little about the ways in which contextual meanings of old age influence long-term care and perceptions of well-being in late life. I therefore utilized a variety of interpretive methods, including participant observation, textual analysis, in-depth interviews, and photovoice, to complement and enlarge existing research. Ultimately, I engaged crystallization methodology to co-construct with my participants a multivocal, multigenre text of layered accounts, photographs, stories, and personal reflections. My research design and presentation highlight the inherent possibilities of participatory methods, aesthetic ways of knowing, and asset-based community development for influencing policy and practice at individual, community, and societal levels with typically disenfranchised populations in future communication scholarship. My narrative analysis uncovered three overarching narratives - the "small town" narrative, the "aging in place" narrative, and the "old age" narrative - that guide communicative practices within and between Kasson and Prairie Meadows. Overall, elderly adults in these communities negotiate community connectedness in late life by drawing from or re-storying each of the three narratives. First, they co-construct personal and relational identities through social interactions and shared understandings (e.g., civic engagement, church membership, neighborliness, collective history) of what it means to live in a small town. Second, they face uncertainty (e.g., health and dependency issues) by turning to the past to make sense of the present and future. Third, they embrace old age through membership in age-specific contexts (e.g., Red Hats, senior center, Prairie Meadows) while resisting it in others (e.g., tensions between independence, isolation, and communal life). In total, their stories illuminate the ways in which personal meanings and cultural ideologies support and constrain interactions and decisions in late life as individuals strive for long-term living and a meaningful, supportive place in which to grow old.

Thesis (M.A.) - Simon Fraser University, 2006. / Theses (Dept. of Gerontology) / Simon Fraser University. Also issued in digital format and available on the World Wide Web.

Thesis (Ph.D.)--University of Texas at Arlington, 2009.

Thesis--University of California, San Francisco. / On spine: The Status passage of elderly persons. eContent provider-neutral record in process. Description based on print version record.

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, August, 2001. / Includes bibliographical references. Also available on the Internet.

This study used data from the 2008 wave of the Health and Retirement Study to examine variations in relationships among selected psychosocial characteristics, race/ethnicity and expectations of nursing home utilization in the United States, with a particular focus on Latino/a subgroups. This study sought to test a modified version of the Andersen and Newman model of health service utilization. Findings revealed that expectations of nursing home utilization remained lower among Latino/as than in the Non-Latino White sub-groups, even when levels of need, enabling, and predisposing factors were controlled for. However, for Mexican Origin respondents (who are often arbitrarily combined with other individuals of various Latino nationalities as one homogenous group) never differed significantly from the White reference group. The inclusion of the selected psychosocial characteristics (attitudes towards one's own aging, personal mastery, religiosity, and perceived family support/ family satisfaction) increased the explanatory power of regression models tested. Having a high sense of personal mastery, as well as having a more positive attitude towards one's own aging, were associated with lower expectations of nursing home use. An important implication of this study is that the Latino/a population in the United States should not be treated as a homogenous, pan-ethnic group, particularly in regards to health service use. Also, psychosocial characteristics are relevant when considering expectations for nursing home use