Assisted Living: Needs, Practices, and Policies in Residential Care for the Elderly

13. Connectedness in Residential Care: A Qualitative Perspective

13 Connectedness in Residential Care A Qualitative Perspective J. Kevin Eckert, Ph.D., Sheryl Zimmerman, Ph.D., and Leslie A. Morgan, Ph.D. This chapter is about the nature of the connections in residential longterm care: connections between residents and staff, residents and residents , residents and the facilities in which they live, and residents and the larger community. Its goal is to view residents as people, living life within the range of residential care/assisted living settings (RC/AL). In lieu of interviewing residents directly about their quality of life or satisfaction, field evaluators who were trained to observe residents in their diverse settings acted as key informants. From their perspective, what emerged as most important while observing residents in situ was the nature and style of their interactions with people and place, a theme referred to as connectedness . The field evaluators were collecting data for the Collaborative Studies of Long-Term Care (CS-LTC), a four-state study of residential care provided in 193 facilities in Florida, Maryland, New Jersey, and North Carolina. The facilities were stratified to include those with fewer than sixteen beds; those with sixteen or more beds that reflected newer, purpose-built assisted living (new-model); and other facilities with sixteen or more beds (traditional). (See chapter 6 for details of the methods of the CS-LTC.) To further the understanding of life in such facilities, the CSLTC evaluators were asked to observe and record what was going on around them as they performed their structured observational, evaluative, and interviewing tasks. Since many of the evaluators conducted interviews in more than one state and across a range of RC/AL facilities and nursing homes, they were exposed to various dimensions of life. By virtue of their extensive exposure to facilities, residents, and staff, they constituted an important information resource. Although not key informants in the traditional sense (i.e., they were not members of the group or culture under study), they possessed important information on life within facilities that could not be captured by standard quantitative methods. Design The qualities of a good informant include having knowledge of the subject , understanding the information required by the investigator, and being willing and able to communicate. As noted by Bernard (1994), if an investigator is willing to become a “student,” a good informant can educate . Moreover, trustworthy informants who are observant, reflective, articulate , and know how to tell a good story are central to qualitative research . CS-LTC evaluators met these and other important criteria: they were trained, observant, articulate, and interested; they conducted interviews across the range of actors in RC/AL facilities and nursing homes (i.e., residents, caregivers, administrators, and families); they were in the facilities on multiple days and at different times of day; they were sensitized to making careful observation of the physical and social environment ; and they were eager to tell a story about what they saw and elaborate on their experiences while in the field. As multiple observers with systematic exposure to a wide range of facilities within a concentrated time frame, the evaluators were able to corroborate observations and subjective interpretations, thereby increasing the trustworthiness of their observations . Evaluator Characteristics The fourteen field evaluators for the CS-LTC had multiple experiences visiting RC/AL facilities and nursing homes. All of the evaluators had visited at least 50 long-term-care facilities in relationship to this and related studies of long-term care; nine evaluators had visited over 100 facilities. Twelve of the fourteen evaluators were female, thirteen were Caucasian, and one was African American. All of the evaluators had at least some college education. Seven evaluators were trained as nurses. Taken together, the evaluators’ extensive field experience and professional training increased the comparative value of their observations. Data Sources Questions of validity are often difficult to define in qualitative research because of its nonlinear design and its dependence on the investigator(s) as the central instrument of research. In this study, validity or, more appropriately , the trustworthiness of the data, is enhanced through triangulation of observers and methods (Gilchrist, 1992). First, in many instances Connectedness in Residential Care 293 more than one evaluator made multiple visits to the same facility. Second, in most cases evaluators spent multiple days within the same facility. Third, multiple methods were used to gather the observations and experiences of the evaluators. Specifically, three types of qualitative...