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This dissertation is a comparative, ethnographic study of emotion-work in two nursing homes – one part of a large, for-profit chain, the other part of a small, non-profit chain – and examines how nursing care-workers grapple with tensions between meeting organizational demands in an increasingly market driven field and providing compassionate care in times of personal crisis. Based on eighteen-months of fieldwork, sixty-five in-depth interviews and analysis of company documents, my research connects the financial and regulatory structure of long-term care to the emotional lives of staff in both nursing homes. While scholars have analyzed the consequences of medical reimbursement regimes on health care systems, my research uncovers the processes by which those consequences are created, and shows how their effects on residents are mediated through staff. Chapters 2-4 examine how proprietary status shaped the experience of work. Many scholars argue that for-profit facilities and non-profit facilities have become isomorphic since the imposition of market forces on long-term care. Although there were similarities between the two nursing homes, they were also strikingly different in their approach to reimbursement. While the for-profit won corporate awards for deftly maneuvering through the market, the non-profit’s community-oriented mission left them with a half-million dollar budget deficit. This section shows the processes by which market forces discipline community-oriented health services organizations such as nursing homes. Given this context, chapters 5-8 turn to how the staff used emotional attachments with residents to give their work dignity and meaning. Contrary to the established view that emotion work alienates employees, I argue that nursing care-workers used emotions – their own, their residents, and their colleagues – as resources in novel ways, even as their emotions were shaped and constrained by the financial and regulatory structure of long-term care. Emotions were shaped by organizations but they were not simply imposed on workers. Nursing care-workers themselves produced emotions, sometimes in ways consistent with organizational goals, and sometimes not, but they consistently found in their emotions a set of resources to manage the strains of their work lives.

Extending the human life span has long been a desire of human beings. It seems the wish has been actualized. However, simply living a long life does not always seem to be a blessing. Older adults report a lower level of psychological well-being and quality of life and even have a higher rate of suicide, compared to the general population. Furthermore, as older adults are likely to experience the death of a loved one, deteriorating health, retirement, and changing relationships with others, older adults have a high risk of depression. Social work has a long history of providing social services to older adults. In particular, social work has provided older adults with a variety of services to enhance their quality of life and mental health status. Because ageism is one form of discrimination that social work has long been concerned with, this study focuses on the relationship between perceived ageism and depressive symptoms among older adults. Therefore, the purpose of this study is to examine the relationship between perceived ageism and depressive symptoms among older adults and to investigate the mechanism linking perceived ageism to late-life depression. Three primary effects were examined: the direct effect of perceived ageism on depressive symptoms in later life, the mediating effects of self-perception of aging and purpose in life on the relationship between perceived ageism and late-life depression, and the moderating effect of perceived ageism on the association between religiosity and depression among older adults. The stress process model was used to provide an overall idea to explain the three types of the effects related to the mechanism of ageism. Cooley's looking-glass self, Beck's cognitive theory of depression, and Levy's stress embodiment theory were used to explain the mediating effect of self-perception of aging, and Beck's cognitive theory of depression was applied again to clarify the mediating effect of purpose in life. The stress buffer theory and the life-span theory of control indicated the moderating effect of perceived ageism on the relationship between religiosity and depression. Secondary analysis of existing data was conducted using the Health and Retirement Study (HRS) datasets, a longitudinal panel study of the U.S. population ages 50 and over. The sample of this study was 3,991 participants, who were older adults ages 65 and over and whose answers were available for the study analyses. Descriptive and preliminary analyses were performed to roughly examine the relationships between variables. With regard to the direct effect of perceived ageism on depressive symptoms, multiple regression analyses were performed controlling for significant variables. With regard to the mediating effects of self-perception of aging and purpose in life, structural equation modeling (SEM) analyses using structural regression models were conducted. In respect to the moderating effect of perceived ageism on the relationship between religiosity and depression, SEM analyses with multiple groups were performed. Based on the results of the several different analyses, a direct relationship between perceived ageism and late-life depression was found. That is, older adults who perceive ageism are likely to have a higher level of depressive symptoms than their counterparts. This direct relationship between perceived ageism and late depressive symptoms among older adults, however, was not detected after controlling for self-perception of aging and purpose in life, indicating the full mediation effects of self-perception of aging and purpose in life. That is, older adults who perceive ageism are likely to have negative self-perception of aging, and this negative view of their own aging is likely to increase depressive symptoms. Additionally, older adults who have a negative view of their aging are likely to have a negative view of their future, and this lower purpose in life also increases depressive symptoms. The strength of the effect of religiosity on depression did not differ between the perceived ageism and the not-perceived ageism groups, indicating no moderating effect of perceived ageism on the relationship between religiosity and depression. This study contributes to the existing body of knowledge by providing the information about the relationship between perceived ageism and depression and the mechanism of this relationship. Also, this study re-examined and supported established theories in the context of perceived ageism. Additionally, the current study suggests the necessity of anti-ageism policies and social work services and describes possible ways of providing such social policies and social work services at the micro, mezzo, and macro levels. The results of this study imply that more efforts and resources are necessary to reduce ageism and its negative effect on depression among older adults, and these efforts will eventually contribute to making a more just, better society. / A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester, 2015. / May 1, 2015. / Includes bibliographical references. / Bruce A. Thyer, Professor Directing Dissertation; Penny A. Ralston, University Representative; Jean C. Munn, Committee Member; Melissa Radey, Committee Member.

The onset of dementia represents a major life stressor for the individual and for the family system. In each family there tends to be a primary caregiver who experiences significant challenges in this role, which may be physical or psychosocial in nature. This study utilized archival data from the Resources to Enhance Alzheimer Caregiver Health (REACH II) study (N = 643) with caregivers from five states to examine the impact of self-care behaviors and psychosocial resources on caregiver well-being. This study explored caregiving as dynamic in nature, in that it required continuous adaptation to the increasingly complex needs of the care receiver. The caregiver used both internal and external personal resources to maintain well-being, thus enabling him or her to be most effective at providing care. Various theories and models of the stress process associated with caregiving were examined, as were the roles of common constructs that mediate the stresses experienced by the caregiver. Of primary interest was the influence of the caregiver lifestyle or self-care behaviors on his or her well-being. The role of participation in social activity, religious activities, and social support, were examined. The outcome of interest in this study was overall well-being of the caregiver, as measured by perceived benefits or positive aspects of caregiving, as well as overall well-being as shown by levels of physical health and depression. These outcome measures were conceptualized as indicators of adaptation to the caregiver role. This study found that these caregiver-driven resources provided a mediating impact on the effects of caregiving stress on well-being, providing a path through which less negative effects on well-being were experienced. Secondarily, the role of race or ethnicity on the perception of the caregiver role and its responsibilities, and the overall effect on the experience was examined. There were differences noted in the levels of mediation provided by psychosocial resources, with African American caregivers experiencing a lower benefit from these resources than their White counterparts. Finally, the study explored the differences among racial/ethnic groups in objective stress experienced, psychosocial resources, as well as reported well-being. The results showed that African American caregivers experienced significantly more stress, yet experienced significantly higher levels of well-being compared to White caregivers. African American caregivers also reported higher levels of psychosocial resources than White caregivers. Results from this study provided information that was largely generalizable to caregivers in the US, and contributed to the literature on policies and interventions for caregiver health and well-being. / A Dissertation submitted to the Educational Psychology and Learning Systems in partial fulfillment of the Doctor of Philosophy. / Spring Semester, 2015. / April 9, 2015. / caregiver, cultural impact, dementia, psychosocial resources, stress, well-being / Includes bibliographical references. / Deborah J. Ebener, Professor Directing Dissertation; Robert Glueckauf, University Representative; Angel Canto, Committee Member; Shengli Dong, Committee Member.

Osteoarthritis (OA) is a degenerative joint condition prevalent in older adults that causes pain, functional interference, affects mood, and contributes to use of scheduled as well as as- needed prn and extra over-the-counter (OTC) medication. Music, with imagery and relaxation, have been shown to impact pain perception and medication in this population, yet no studies have used a blended movement intervention with music, imagery, and relaxation, to assess movement-induced pain. Also, no studies have examined an intervention of this type within a one-week period. Participants were women, between 73 and 95 (N=76), who were randomly placed in an experimental group or control group, alternatively assigned by pain level and blocked to account for multisite study facilitation. A modified visual analog scale (VAS) for pain and modified visual analog mood (VAMs) subscales of tense/relaxed (T/R), exhausted/energized (E/E), and sad/happy (S/H) were assessed immediately following movement. The functional interference from pain (via the Brief Pain Inventory-Short Form) was assessed based on recall and medication usage was equated using the Medication Quantification Scale. The independent variable was a therapist-led daily session of blended movement intervention with music, imagery, and relaxation. A series of Mann Whitney U tests revealed that there were no differences between groups on measures of movement-induced pain, mood, or functional interference. However, all measures but T/R trended towards improvement from pre to posttest scores for the experimental group. Movement-induced pain showed directional change in the experimental group compared to the control group at a level considered clinically important in prior research (Tubach et al., 2005). There was no difference in extra medication usage, but a Friedman repeated measures analysis of variance showed there was a significant difference in the experimental group's total (scheduled plus prn/extra OTC) medication across time between pretest and average intervention day. Results indicated that, overall a short-term, blended movement intervention with music, imagery, and relaxation appears to not provide analgesia for pain, or affect mood and functional interference in a statistically significant way. However, this intervention may be beneficial within one week and further investigation into applications for pain management, mood enhancement, functional interference, and medication in the OA and older adult population is indicated. / A Dissertation submitted to the College of Music in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2014. / August 5, 2014. / imagery, Medication, music therapy, osteoarthritis, pain management, relaxation / Includes bibliographical references. / Jayne M. Standley, Professor Directing Dissertation; David E. Gussak, University Representative; Clifford K. Madsen, Committee Member; John M. Geringer, Committee Member; Alice-Ann Darrow, Committee Member.

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