"It's a lot!" the universal worker model and dementia care in assisted living.

The culture change movement aims to create a more home-like environment in long-term care settings, promote person-centered care, and support the well-being of staff and residents. One feature of Culture Change is the Universal Worker (UW) model where direct care workers (DCWs) are responsible for housekeeping, laundry, and activities in addition to administering medication and personal support. The longitudinal approach in the ethnographic study on which this paper is based compares data collected from one assisted living across three NIA-supported research grants. This paper focuses on modifications to the UW model following the implementation of culture change over a period of ten years. As DCWs cared for residents with increasing levels of dementia, time constraints under the UW model led to sporadic attention to housekeeping chores and challenged person-centered care. Modifying the UW model, by using dedicated cleaning staff and other support workers, better preserves the intent of the culture change movement.

Identity, Semiotics, and Use of Symbols in Adult Day Services.

Purpose: This article explores experiences of older adults attending an Adult Day Service (ADS) center. We focus on semiotics, which is ADS clients' use of symbols to communicate with others and to assert their personal and social identities. We refer to the ADS as a semiosphere-a term that refers to the dense, symbolically mediated interactions among this community. Methods: Ethnographers observed and interviewed clients, family, and staff members at the religiously affiliated ADS. They focused on the daily life worlds of those who attended and worked there. Results: We identified three elements through which clients expressed and communicated in semiotic ways, aspects of their identity: (a) music and dance, (b) individual use of a symbol-a doll and, (c) symbolic organization of space through seating patterns at activity tables. Elements were created and shared communally. Discussion: The ADS, as a cultural entity, is itself an illustration of symbolic complexity. Ideologies about aging, dementia, identity, and the ADS' role in improving elders' cognition and health are structured into the setting, forming a semiosphere. Our study revealed that elders, with staff members' help, created a cultural world at the ADS.

Visitors and Resident Autonomy: Spoken and Unspoken Rules in Assisted Living.

Purpose of the Study: This article explores resident autonomy in assisted living (AL) and the effects that visitors and visiting the AL have on that autonomy. We examine formal and informal policies that govern visiting in AL, stakeholders' views and enforcement of these policies, and the complex arrangements that visiting often entails in everyday life in the setting. Design and Methods: Data are drawn from a multiyear ethnographic study of autonomy in AL. Research from multiple sites included participant observation, informal and in-depth, open-ended interviews of various stakeholders, and the writing of field notes. Research team biweekly discussions and the Atlas.ti software program facilitated coding and analysis of interview transcripts and fieldnotes. Results: Our ethnographic data highlight complicated factors related to visitors and visiting in AL. We discuss two important aspects of visiting: (a) formal and informal policies at each setting; and (b) how resident autonomy is expressed or suppressed through rules about visiting in AL. Implications: Our data underscore the importance of resident autonomy and quality of care in relation to visitors and visiting, especially how this relationship is affected by inconsistent and confusing formal and informal visiting policies in AL.

Mental Illness in Assisted Living: Challenges for Quality of Life and Care.

An unknown number of mentally ill elders in the U.S. receive care in assisted living [AL], along with persons facing physical or cognitive challenges. While dementia is familiar in AL, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily inter-resident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted living settings having varying presence of mental illness among residents.

The facade of stability in assisted living.

OBJECTIVES: The study sought to identify the varied types of change arising from internal and external influences in assisted living (AL) settings, expanding upon the literature's limited focus on resident decline and staff turnover and clarifying the importance of changes to life and work there. METHOD: This analysis employed qualitative interviews and observations from 4 studies involving 17 ALs to identify elements of change largely absent from the literature. Case material identified by the research team members relating to persons, groups, and settings exemplifying typical changes, as well as variations across settings, are presented. RESULTS: Multiple domains of AL change were identified, to include those in: (a) the external economic or competitive environments; (b) ownership, management, or key personnel; and (c) physical health or cognition of the aggregate resident population. In many cases, the changes influenced residents' satisfaction and perceived fit with the AL environment. DISCUSSION: Change of many types is a regular feature of AL; many changes alter routines or daily life; raise concerns of staff, residents, or families; or modify perceptions of residential normalcy. Environmental gerontology should more often extend the environment to include the social and interpersonal characteristics of collective living sites for elders.