Inside Assisted Living: The Search for Home

Appendix: Technical Description of the Research Project

213 APPENDIX Technical Description of the Research Project This appendix describes in detail the qualitative research process that informed this book. Our study, entitled “Transitions from Assisted Living: Sociocultural Aspects” and funded by the National Institute on Aging, was designed to provide an understanding of the minor and major life transitions experienced by residents in assisted living. Using ethnographic methods, the research team studied daily life in six settings, exploring interactions among residents, their family members, direct care staff, and administrators. Data in the form of in-depth interviews and field notes, collected between 2001 and 2007, provide the core ethnographic material to help us understand not only the topic of transitions from assisted living but also the culture of this type of long-term care. Ethnography offers a perspective different from, but not antithetical to, traditional survey research; it thus contributes to and enhances our detailed knowledge of life inside assisted living. Research Design Research Objectives The main objective of this study was to understand the social and cultural factors that led to transfers into and out of assisted living settings. The specific aims of the research were the following: 1 to examine the social and cultural processes of change and decline leading to transfer from assisted living; 2 to explore how residents, their families, and the assisted living staff observe and talk about signs of decline, improvement, normalcy, and change in residents within the social and cultural environment of assisted living; 214 APPENDIX 3 to understand how the local explanatory models used by residents, family, caregiving staff, and administrators influence the processes of stability, decline, and change and how they relate to decisions about retention and transfer; 4 to examine how facility-level characteristics shape the processes of stability , decline, and change. Our ethnographic research used the qualitative methods of participant observation, intensive interviewing, and extended focal case study to better understand daily life inside assisted living, particularly from the perspectives of the individuals residing there. The basic research design consisted of sequential ethnographies, lasting 6 to 10 months each, in six diverse assisted living settings in Maryland. Following the Collaborative Studies of LongTerm Care (CS-LTC) typology, we conducted ethnographic studies in two small, two traditional, and two new-model settings (Zimmerman, Sloane, and Eckert 2001). We also collected performance-based physical and cognitive assessment data on strength, capacity to walk, and response to standardized cognitive questions with a sample of residents. In addition, during the time of our investigations the state agency responsible for overseeing assisted living facilities began a two-year series of public meetings on assisted living regulations , and a member of our research team attended many of them. Ethnography Ethnography involves research on individuals and groups within their own sociocultural and/or physical environments—the places where they live or work. Information is collected primarily through participant observation and in-depth interviewing. By immersing himself or herself in the setting, the researcher is able to both observe and participate in daily activities (hence the term “participant observation”) and thereby comes to understand the nature and meaning of interactions and ideas through the eyes of those who live and work in a specific place. In-depth interviews, conducted in an open format, provide essential information from the perspective of the individuals being studied, including their daily lived experiences and the processes involved in formal and informal decision making. The resulting data consist of interview transcripts and ethnographers’ descriptive and interpretive notes recorded in the field. In qualitative research, significance is determined not through sta- TECHNICAL DESCRIPTION OF THE RESEARCH PROJECT 215 tistical analysis but through the interpretation of events and interactions and the identification of common themes and patterns. Confidentiality of Information Before we began our study we sought and received permission from the assisted living administrators to observe and interview in each setting. We sent letters to residents and their families informing them of the project and offering the right of refusal to participate in the research. We obtained verbal consent from every person we interviewed, with that consent typically audiotaped at the start of the interview. In the book, we have used pseudonyms for persons and assisted living facilities, and we have altered certain details of both the assisted living settings and the persons interviewed to protect the identities of those involved. All research participants are protected by the confidentiality standards under the Institutional Review Board (IRB) of the University...