Autonomy for nursing home residents: the role of regulations

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.     

The effect of gambling activities on happiness levels of nursing home residents

The current study evaluated the effect of participating in simulated gambling activities on happiness levels of 3 nursing home residents. A 4‐component analysis was used to measure objective responses associated with happiness during baseline, varying durations of engagement in simulated gambling activities, and 2 follow‐up periods. Results indicated that all residents exhibited a higher percentage of happiness levels while engaged in simulated gambling activities compared with baseline. Follow‐up assessment took place 10 min and 30 min following the intervention; no lasting effects were observed.     

Measuring the person-centeredness of caregivers working with nursing home residents with dementia

There is increasing interest in promoting person-centered caregiving within gerontology. However, few observational instruments have been developed to measure person-centered caregiving behaviors. In the present study, two innovative coding instruments—the Person-Centered Behavior Inventory (PCBI) and the Global Behavior Scale (GBS)—were used to test the hypothesis that caregivers’ person-centeredness would be negatively correlated with residents’ resistiveness to care. The study hypothesis was based on the need-driven dementia-compromised theory of behavior. It was expected that person-centered caregiving would better meet residents’ needs and be associated with less resistiveness to care. This hypothesis was tested by coding 70 videotaped interactions between 54 caregivers and 20 residents diagnosed with dementia. Resistiveness to care was measured by behaviorally coding residents’ resistive behaviors based on the Resistiveness to Care scale. The study hypothesis was supported when the GBS was used to measure person-centeredness, but not when the PCBI was used. The findings provide preliminary support for the predictive and construct validity of the GBS and the PCBI.     

Family decision-making for nursing home residents: Legal mechanisms and ethical underpinnings

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and specific ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers.     

Temporal patterns of negative and positive behavior among nursing home residents with Alzheimer's disease

Although clinical observations suggest a late-day peak in disruptive behavior in persons with dementia, results from studies of temporal patterns of behavior are equivocal. This study used direct observation methods and systematic time sampling to examine temporal patterns of negative and positive behavior in 177 residents of 2 long-term care facilities with clinically diagnosed Alzheimer's disease (AD). The authors found small statistically significant diurnal variation in both negative and positive behavior, characterized by a curvilinear pattern with a single peak. This pattern was unaffected by seasonal differences in length of day, severity of cognitive impairment, level of behavior, or sleep disturbances. Time when behavior peaked differed by type of behavior and by facility, and there was substantial heterogeneity in behavior patterns.     

Longitudinal reliability of the Life Satisfaction Index (Short Form) with nursing home residents: a cautionary note.

We administered the Life Satisfaction Index (Short Form) 18 times over a 39-wk. period to an initial sample of 76 old, frail, multiply impaired, and depressed nursing home residents participating in a longitudinal quasi-experimental study of the effects of cognitive group interventions on cognition and depression. As no changes over time were observed on the outcome variable of life satisfaction, the stability of the instrument's internal consistency could be examined. Kuder-Richardson KR-20 coefficients ranged from .11 to .60, with a mean of .42 (SD = .11). We conclude that caution should be used when applying this instrument to measure life satisfaction in frail nursing home residents.     

Using indices of happiness to examine the influence of environmental enhancements for nursing home residents with Alzheimer's disease

The present study extends the growing behavioral literature on indices of happiness for persons with developmental disabilities to the geriatric population. Data on indices of emotional affect (i.e., happiness) were collected prior to, during, and after each resident was exposed to environmental enhancement activities of various durations. Results showed that every activity improved each resident's level of happiness when compared to pre- and postactivity levels. These outcomes suggest that indexing affect may be as useful for nursing home residents as it has been for individuals with developmental disabilities.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Love and space in the nursing home

Nursing homes and other institutionsdesigned for persons with impairments are not,in fact, designed for persons with impairments.They are typically designed for theimpairments, not the persons, and therebybecome a part of the problem by reinforcingphysical and cultural manifestations of theimpairments. In the essay that follows, Idescribe an architectural design project inwhich students were asked to make changes to anexisting nursing home for the persons who livedthere. This requires not only becoming familiarwith the spaces, but with the personsthemselves and designing space to helparticulate their voices and being. This revised version was published online in June 2006 with corrections to the Cover Date.     

Social interaction patterns of geriatric home and community residents

Thirty elderly nursing home residents and ten community residing older adults were observed in group settings. Their behavior was assessed for dependent personal maintenance, independent personal maintenance, and appropriate and inappropriate behaviors. Responses by staff and peers to these behaviors were classified as positive, negative, or ignore. The frequency of occurrence of these behaviors as well as the relationship of resident to peer or staff behaviors were analyzed. Results indicate that community-residing elders' behaviors differ from nursing home residents' in quantity rather than quality of interactions. There was a lower frequency of behaviors in the nursing home residents. Though older adults respond differentially to various behaviors of other nursing home residents, staff responses were consistent regardless of residents' behavior. These results suggest that geriatric home residents' behavior can be characterized as withdrawn rather than dependent.     

Linking level of care to level of need. Assessing the need for mental health care for nursing home residents

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.     

Japanese social workers' healthy behaviours as related to masculinity: Focus on mental health workers and caregivers of children and nursing home residents

Due to the rapid ageing of the Japanese population, the demand for social services is increasing. However, these professions are not generally recognized yet. According to the report by Kawata (1984, 1986), social workers were distressed by low pay and low recognition for the profession, an inflexible, hierarchical administration system, and staff shortages. However, few studies have focused on social workers' healthy behaviours. The present study focused on the healthy behaviours of Japanese social workers and examined the relationship of these habits to masculinity and femininity, in addition to gender differences. To identify the healthy behaviours of social workers, we compared the behaviours of 32 mental health workers and 63 caregivers to those of 91 members of the general public who attended a summer course. Four questionnaires were administered: health locus of control (Watanabe, 1985), healthy behaviours (Munakata, 1996), health state, and Masculinity‐Humanity‐Femininity scale (Ito, 1978). The results revealed that females scored higher in masculinity than males, and females tended to assess their health state as poorer and were more active in preventive health than males. Social workers practice preventive healthy behaviours more than the general public. Between the two types of social workers, mental health workers tend to rely on medical services and believe that health and sickness are matters of luck, whereas caregivers tend to believe they can control their health by themselves. In the health locus of control, external control was more closely associated with poor health than internal control, and it was negatively correlated with masculinity. As masculinity is related to healthy behaviours, it may be an important factor influencing them. Both masculinity and femininity could be desirable, not for only better caregiving but also for the social workers' own health.