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In comparison with the national U.S. population, African American aged adults are less likely to reside in assisted living facilities (ALFs). At present, little qualitative data exist concerning how African American aged adults perceive living at home as opposed to living in an ALF. Using a phenomenological approach, this study explored how African American aged adults who live at home feel about residing in ALFs. The research questions focused on aged adults' perceptions, beliefs, and attitudes about ALFs and the conditions that may prevent African American aged adults from living in ALFs. A conceptual framework based on the Purnell Model of Cultural Competence was used to interpret study results regarding the cultural beliefs of African American aged adults. Data was collected through in-depth interviews with a purposive sample of nine African American adults aged 70 years and older who live at home and have not resided in an ALF. The data was managed through the NVivo 12 Plus program software, which assisted in providing inductive content analysis. The findings in the study revealed that the majority of the participants did not have knowledge about ALFs services however, the participant's attitudes to consider residing in ALFs were positive. There were some trust issues with the participants, indicative of a cultural heritage of beliefs and perceptions, as the participants stipulated they would reside in an ALF with support of family to monitor their care. The research study may contribute to a positive social change for African American aged adults by supporting an increased in knowledge and understanding of ALFs and increase the likelihood of African American aged adults residing in an ALF.

This is a qualitative, interpretive research study of how six senior citizens’ aged 70-85 describe their use and need of Smart home technology for their independent living and welfare. Data was collected through technology probing and interviews. Data analysis was done using a thematic method. The research was underpinned by the theoretical model Unified Theory of Acceptance and Use of Technology (UTAUT2). The research setting was senior citizens’ living in Care housing rented out by the municipality owned company. The findings show that technology is perceived by the senior citizens’ to be something must be taught and takes effort. Senior housing need to be better designed for its senior tenants. It was also found that if technology is used to ensure safety, fall detection for instance, trust and sufficient support is crucial. The findings suggest it could be difficult to assess your own need and to realize when assistance technology is needed. It also found that the use of technology was perceived as being individual and as something that cannot be treated collectively. It was suggested that health professionals do have some influence on the senior citizen and their use of technology. The findings of this study was compared to previous studies and how it relates to the determinants and moderating factors suggested by the theoretical model UTAUT2.

Avec le vieillissement de la population, le maintien à domicile des personnes âgées est devenu un enjeu majeur pour les pays développés et émergents. Parmi les solutions clés à explorer, les gérontechnologies sont considérées comme des plus prometteuses sans toutefois avoir apporté la preuve de leur efficacité pour l’autonomie domiciliaire, voire même être utilisables et acceptables pour le public visé. Dans ce contexte, une méthodologie de conception centrée-utilisateur a été mise en place pour proposer une plateforme d’assistance domiciliaire multi-tâches et multi-domaines (soutenant à la fois les activités quotidiennes, la sécurité de la personne et de son domicile et le lien social) ciblant un public âgé fragile en perte d’autonomie. Cette plateforme est appelée DomAssist. Sur la base d’une analyse des capacités physiques, cognitives et fonctionnelles en présence (étude 1) et des besoins d’assistance (étude 2) de notre échantillon d’étude, DomAssist a été conçu avec pour originalité une offre de services multi-domaines. En effet, la plateforme s’appuie d’une part sur un système de surveillance d’activités pour délivrer des assistances dites « context-aware » (étude 3) et d’autre part sur un système d’interaction homme-machine unifié et simplifié (étude 4), et ceci tout en promouvant l’auto-détermination (étude 5). Les résultats ont étayé la fiabilité du système de surveillance d’activités, et renforcé le bien-fondé de nos principes de conception concernant le système unifié d’interaction; et le soutien de l’auto-détermination. Notamment un rendu positif concernant l’utilisabilité et l’acceptabilité du système, et un effet bénéfique sur le sentiment de l’autodétermination des utilisateurs âgés ont été obtenus. De là, une dernière étude (étude 6) a évalué les bénéfices apportés après 6 mois d’utilisation de la plateforme, en termes de capacités fonctionnelles des participants fragiles, et de réduction du fardeau de l’aidant. Un effet positif (effet « protecteur » observé par les aidants professionnels) de DomAssist sur le statut fonctionnel des participants équipés (comparé aux contrôles) a été observé ainsi qu’une réduction du fardeau objectif de leur aidant. Au total, les résultats de ce travail pilote sont encourageants et ouvrent de nombreuses perspectives de recherche à fort potentiel d’impact sociétal concernant la problématique du maintien à domicile des personnes âgées / With the increase of life expectancy, aging in place is today a major concern for developed and emerging countries. Among the key solutions to explore, gerontechnologies are seen as the most promising. However, their evidence-based efficacy remains to be demonstrated for independent living or even for their usability and acceptance by the targeted old users. In this context, a user-centered conception methodology has been implemented for designing a multi-task and multi-domain (supporting everyday activities, safety, and social participation) assisted living platform targeting frail older adults with functional decline. This platform is named HomeAssist. Based on an analysis of physical, cognitive and fonctional abilities (study 1) and assistive technology needs (study 2) of our sample, HomeAssist has been designed with the originality of providing multi-domain services. Indeed, HomeAssist proposes an activity monitoring system to provide context-aware assistance (study 3), and a unified human-computer interaction system (study 4); while promoting self-determination (study 5). Results underpined the reliability of our activity monitoring system, and reinforced the rationale of our design principles, concerning the unified interaction system and the self-determination support. Notably, positive outcomes in terms of usability and acceptance of the system, as well as benefits concerning users’ feeling of self-determination have been obtained. From this, a last study (study 6) evaluated the benefits from a six-month use of HomeAssist, on functional abilities of frail older adults and caregiver burden. A positive effect of HomeAssist on functional status was obtained (“protective” effect reported by the professional caregivers), as well as a reduction of objective dimension of caregiver burden. Taken together, the results from these pilot studies are encouraging and open numerous research perspectives with high societal impact concerning the promotion of aging in place.

There has been growing concern over how state and federal governments can support the increasing population of aging Americans and their need for long-term care. Current insurance funding models cover acute hospitalization and skilled care only, leaving unskilled care needs and homemaker services at the full expense of those in need. Time banking allows individuals to exchange or barter time for goods or services without monetary payment. There is insufficient evidence to determine if members believe time banks to be a viable alternative to support aging-in-place care needs. This phenomenological study explored time banking as a potential vehicle for nonskilled health care support to defray health care costs as one ages. Ostrom's co-production theory provided the theoretical foundation for the research questions, which examined the participants' lived experiences with the role time banks played in their decision to age in place. Face-to-face interviews were conducted with 10 Southern California time bank participants, age 50 years or older. Using a Moustakas-modified van Kaam method and a priori coding emergent themes were extracted. Study findings illustrated that time bank participation did support aspects of nonskilled health care needs and provided members with confident options for aging in place. Study findings also indicated a need for continued collaborations between professional and managerial staff in public agencies, including California's Health and Human Services Agency and time bank users in their communities. Reducing health care costs for taxpayers in any government-funded health insurance model benefits positive social change, and nonskilled health care provider time bank initiatives may be a sustainable alternative for those wishing to age in place.

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This dissertation investigates videoconference technology adoption by aging-in-place organizations to facilitate the social engagement of older adults. It comprises three studies that examine the initiation and coordination of technology adoption by aging-in-place organizations and addresses the factors associated with successful adoption of relational videoconference technology by older adults. The first study is a systematic literature review exploring the role of aging-in-place organizations in social engagement of older adults through videoconference technology. The second study is a survey of adult relatives and friends of older adults regarding videoconference technology adoption by older adults during the COVID-19 pandemic and their experience with facilitating resources. It applies technology adoption theory and a structural equation model to characterize the role of aging-in-place organizations. The third study is a pilot test of a new online platform called Circular that is designed to support social engagement of older adults. Through these studies, this research extends the existing body of knowledge regarding modes to facilitate adoption of relational technology by older adults and to empower senior centers and other aging-in-place organizations as they seek to socially engage the aging members of their communities.

隨著政府職能的改變，面對財政壓力，引進民間企業的活力和專業創新的能力，委外經營模式成為政府推動各項為民服務業務的主要策略，而以「公設民營」的方式，結合民間資源共同推動老人福利服務工作。 「高齡化」是當今世界各國共同現象與趨勢，近年台灣人口老化迅速，在工商社會變遷與晚婚少子化下更形突顯。為因應「老人照顧」多元化的發展，以何種「老人安居住宅」的型態，達成融入「社區」、「在地老化」的政策目標，引發了研究者之研究動機。 本研究係採質化研究，以文獻分析，問卷調查深入訪談法等方式進行探討，由高齡社會學、公共選擇理論、社會資源整合等理論為分析導引，探討老人安居住宅需求重要性、老人照顧需求層面內涵、公設民營發展、政府及國內學者專家對老人住宅政策規劃方向，最後再結合個案入住老人、社區住民、公民營專家深入訪談，歸納並提供適合社區老人安居住宅之公設民營建議與結論。 本研究發現「毗鄰居住」的社區老人安居住宅，適合台灣傳統家庭的維繫；而公設民營模式可適合老人社會普遍性需求，以全政府照顧弱勢的社會責任。最後，本研究研擬幾項建議如下： 一、 硬體設施：政府擇定設置示範老人安居住宅，委由民間專業團隊經營，建立有效的監督機制與評鑑規範、以公設民營模式建構老人連續照顧體制的初級系統。 二、 醫療支援：政府應整合社會醫療資源，規劃多元醫療體制；及早實施長期照護保險政策；提供老人連續性服務之多功能窗口。 三、 在地老化：政府應推廣社區老人安居住宅概念，落實社區照顧，儘量讓老人在自己熟悉環境中在地老化。 四、 居住安養：運用居住空間「通用設計」概念，建構設置社區公設民營老人安居住宅，以使有限資源運用效益最大化。 五、 資源整合：政府應整合社會福利、現行老人補貼等相關政策資源，以發揮整體效益。 / To cope with the change of the functions and financial pressure, the government conveys the works to private sectors to make good use of their innovative and professional ability, or adopts outsourcing model to promote the social services. Therefore, the strategy of “government owned and private sector operated,” combined with non-governmental resources are provided jointly to promote the welfare of the elderly services. "Aging" is a common phenomenon and trends in today's world. In recent years, as Taiwan's population is aging rapidly, the birthrate is declining and late marriage is prevailing highlighted the need for reform. In response to development of "elderly care", my main question is to investigate what kind of "residential homes for the elderly" to attain the policy objectives of integrating with the "community", "aging in place". This study reviews the literature concerning the sociology of aging, public choice theory, theory of social resources and adopts qualitative research method, such as questionnaire and in-depth interviews to examine the importance of housing demand for the elderly care needs, development of public-private partnership, government policy planning directions for the elderly housing. Finally we work through the case study with the data collected from the elderly, community residents, public and private experts, and draw conclusions for providing the elderly suitable community-dwelling homes and the strategy of “government owned and private sector operated.” This study finds that adjacent to the community residential homes for the elderly, is suitable for maintaining the traditional family ties; and the government owned and private sector operated mode is suitable for the elderly needs. By doing so, the government can fulfill the social responsibility to take care of the disadvantaged. We make some suggestions for further efforts: 1. Hardware facilities provided The government selects the model residential homes for the elderly, and run by non-governmental professional team, and sets up effective monitoring mechanisms and evaluation standards in order to help civil organizations to run the elderly care system continuously. 2. Medical care support The government should integrate social and medical resources, planning pluralistic health care system; early implementation of long-term care insurance policies to provide multi-functional window for services of the elderly. 3. Aging in place The government should promote the concept of community-dwelling for the elderly, the implementation of community-based care as much as possible so the elderly can be aging in familiar environment. 4. Nursing homes provided in the neighborhood To use concept of "universal design" for living space, and build the “government owned and private sector operated” housing in nearby community in order to maximize the benefits of using limited resources. 5. Resource Integration The government should integrate social welfare resources, the current subsidies for the elderly and other related policy resources in order to increase the overall efficiency.