Refworks Account Login. Exploring older adults' Open Collections. UBC Theses and Dissertations. Featured Collection. Simon Fraser University, B. Thompson Rivers University, M. Such investigations are important because of the variation in AL facilities internationally. Also, there is lack of research generally on the significance of the transition to AL for older adults or what their experiences are once they have arrived. To do this, the study employed thematic content analysis of 18 provincially-focused, publicly available documents about AL.
Collectively, the documents addressed both service users and providers and spoke to expectations and regulations for service delivery. The study also employed multi-level narrative analysis of four older adults' relocation stories, gathered over the period of a year. Findings from the study indicate that there are tensions between the foundational values and purposes of AL, how these are operationalized at the facility level, and how they are experienced by those moving in.
While participants were generally pleased with the supportive and health care services they accessed by relocating, their accounts also highlighted a lack of social connection within AL and restrictions to choice in a variety of areas including dining and recreational pursuits.
However, the findings also illuminate positive and innovative practices that iii can ease the transition to AL. Recommendations include: 1 finding avenues for residents to express their choices in meaningful ways, such as increasing resident input at an organizational level and expanding the type of activities offered; and 2 offering more deliberate facilitation of social and place connections in AL through an increased role for social workers in AL, peer support programs, and stronger community ties.
The findings show that there are some tensions between the guiding values of AL and how services are carried out in facilities. While participants were generally satisfied with the personal care services they received, they were less content with meals and the social and recreational opportunities offered.
Links to internet pages and documents referenced in this dissertation have been checked for functionality as of September 18, In this space I would like to acknowledge those who literally made this project possible. First — I so appreciate the time, wisdom, and enthusiasm of my participants.
It was a privilege to hear your stories. Second, I would like to thank my supervisor, Dr. I would also like to thank my committee members, Dr. Joanie Sims-Gould, and Dr. Jennifer Baumbusch for their solid support and feedback. I owe a special thank you to my third committee member, Dr. Clive Baldwin, for providing transcription resources as well as valuable methodological guidance. Third, I would like to express my deep gratitude to my army of friends for their never-ending cheerleading, and to my family for the necessary emotional and tactical support in juggling parenthood and academia.
Finally, I must thank my PhD cohort and friends. There is no one who can understand this process as you can; laughing and commiserating with you kept me going, many times over.
To Beatrix and Jasper, two very important chapters in my life. To my mom, who never doubted that I could or should. To my dad, who would have read every word. In this setting, patients and their families often had to grapple with the difficult reality that the older adult could no longer remain in their home, even with support. For individuals with the most complex medical needs who were to transition to long term residential care1, the hospital staff and dedicated transition team were available to assess, counsel, and place the individual.
For those moving to assisted living, however, I often felt at a loss as to what to say or do. My involvement in these cases was mostly related to recovery and the practicalities of returning home. In terms of AL resources, all I had to offer was a sympathetic ear and a small publication of property listings across the province. The message I took in was that moving to AL was somehow better, or at least less drastic a change, than moving to a long term residential care facility.
Yet, I could see that the weight of the pending relocation was felt just as deeply by older adults and families. Eventually I moved to a position as a social worker in a long term residential care facility, where I worked on the other side of the relocation process to receive and settle new residents. There were ample issues and questions to study in this environment, some of which I researched during my Masters degree. Yet, when I began my doctoral studies I found myself returning to the topic of older adults and AL.
I had witnessed what it was like for individuals to 1 For a definition of long term residential care, see sections 1. How did older adults feel about moving to AL? What was it like to live there? How did their expectations about AL match the reality of relocating? I began with a literature search, which identified several trends and gaps in the existing research that helped to define my research focus and questions. In the following sections I present a brief history of the AL model of care and define the way that it is structured in British Columbia.
However, understanding where it fits in the spectrum of care is challenging, because of the variations in terminology used internationally. Before discussing the evolution of AL in the United Sates and its spread to Canada, I will therefore briefly outline the different terms used in the two countries that are used to refer to similar types and levels of care.
Facilities providing maximum support are referred to as nursing homes. Key constructs in this early picture of AL remain ideological cornerstones of the model today. These include: 1 homelike environments that are adaptable to changing needs but also private and personalized; 2 the provision of services to enhance individual physical and emotional well-being; and 3 a particular orientation to values that preserve self worth, such as a focus on ability and supporting autonomy and decision-making including the right to live with some degree of risk to self Wilson, , p.
Being able to age in place was also a founding vision for AL, but differences in state regulations and funding structures resulted in two approaches to development. As a result, private facilities tended not to develop in-house services and instead helped families arrange for additional care, until lack of finances or additional resources necessitated a move to a nursing home Wilson, , p. These two models of AL currently continue to co-exist in the United States. So, even though there is a common discursive ideal of AL, it appears that a standard type or level of care does not strictly exist in AL in the United States.
It also seems that the line between nursing homes and AL may be becoming blurred. These labels refer to a congregate housing 5 arrangement with a level of support that is a middle step between a private home and long term residential care.
As with the United States, there are both government-subsidized and privately funded versions of this level of care across the country. Values typically associated with AL are independence, choice, self-direction, and autonomy, which position it as an attractive alternative to traditional residential care models. Individuals may live in AL as long as their physical care needs do not require hour skilled nursing or exceed a certain amount of care hours per day.
An important distinction from some American models is the limit to service levels in British Columbia: individuals who have cognitive impairment to the degree that they might put themselves or others at risk through their actions are not eligible to move to or remain in AL. In addition, ageing in place is not a tenet of AL in this province, and approximately half of those who move to AL will eventually move on to long term residential care because of increased care needs McGrail et al. The growth of AL in British Columbia occurred as part of a provincial restructuring of home and community care services beginning in AL was viewed as a model that would address that gap Cohen et al.
Critics of the restructuring pointed out several issues related to these changes. First, during the provincial election campaign, the victorious Liberal party promised to build 5, subsidized long term residential care beds. Over time, their targets were changed to include AL and supported housing units as comprising over half of the 5, The result was an actual reduction of long term care residential care beds between Cohen et al. Second, at the same time as the cuts to long term residential care, the number of acute care beds in the province was reduced, which resulted in older adults waiting in hospital for long term residential care spaces and people in the community being unable to access acute care beds Cohen et al.
Third, the provincial government justified the prioritizing of AL over long term residential care by suggesting they were listening to public preference over what model of care was more appealing. Yet, because the cost of long term residential care in British Columbia is partially born by the provincial Ministry of Health, critics pointed out that AL saved the government money by shifting costs to the older adults. Although most meals, housekeeping and light personal care are covered in the monthly rate for the current government-subsidized AL the rate of subsidy is based on income level , the rest of the costs of living remain the responsibility of the individual.
One study calculated that more than a quarter the people in AL move out of within one year McGrail et al. In spite of these critiques, AL is an increasingly important part of the system of care for older adults in British Columbia. As of , there were 4, registered subsidized AL units in the province and 3, registered private pay units for a total of 7, units Office of the Seniors Advocate, In light of the above discussion on the founding philosophy and goals of AL, the current variations in structure, and the controversy around the growth of AL in British Columbia, this model of housing plus support needs to be better understood in terms of its role in health and social care for older adults.
The goal of this research is to begin to critically examine the intersection of the philosophies, policies and personal experiences of AL in the context of British Columbia. Chapter Two provides a conceptual framework for the research in terms of the central theories, discourses, and literature that informed my approach.
Understanding some of the assumptions and discourses around ageing, scholarly work on transitions, and the relevant literature on AL was an important grounding from 9 which to begin my project. The chapter concludes with a statement on the purpose of the research. Chapter Three outlines the methodological approach that structured the project, including research design and analysis.
I also address the challenges faced in relation to carrying out the study and my responses to them. Chapters Four through Seven present the research findings. In Chapter Four I provide an analysis of relevant policy and information documents about AL in British Columbia in order to understand the conceptual and political discourses surrounding it. Chapters Five and Six offer an extended engagement with the relocation narratives of two participants, Rose and Ian. Following this, Chapter Seven synthesizes the major cross-case findings from all the participants alongside the documents and discursive themes discussed in Chapter Four.
Second, in line with the recent trends in gerontological literature, I will be referring to my participants and to persons of this age demographic as older adults. As Putnam , p. Adopting the language of older adult is an attempt to recognize that persons of high chronological age do not transform into a separate segment of the population, but remain full members of society.
In order to move to a broader understanding of this phenomenon, I turned to theoretical and research literature related to my specific research interests. I therefore begin this chapter with an overview of my guiding paradigms — critical theory and social constructionism.
Following this, I present a discussion on the Western discourses of ageing that currently provide a backdrop to our expectations and responses to older adulthood. Finally, I bring in scholarship around transition and life in AL, including a discussion of the current state of research and knowledge in this area.
Used together, they provide a more complete investigational lens and speak more aptly to my own 12 ontological and epistemological position. In this section I will outline the aspects of critical theory and social constructionism that informed my research.