Five hundred and two skilled nursing facility residents were measured with a multidimensional assessment instrument within 4 weeks of admission, and then at 3 and 12 months following baseline, to determine the impact of deciding and wanting to make the move on well-being and adjustment. Dependent variables included measures of physical, social, and psychological functioning, social interaction, activity, satisfaction with services, and discharge. Regression analyses suggest an interactive effect on ADL change at 3 months.

Representative samples of 260 Oregon foster care residents and 179 cognitively intact nursing home residents were queried retrospectively about the nature and circumstances surrounding their decision to move to a foster care or nursing home, including the alternatives they considered, the circumstances leading to the move, their perception of the decision-making process and who influenced it, the characteristics important to them in choosing the care environment, and their perception of their own control over the move. Statistically significant differences were identified in the characteristics of the setting that each group deemed important, the circumstances surrounding the decision, the people influencing it, and the perceived control over the decision.

Bivariate and multivariate analyses were used to study the effect of deciding to move and wanting to move to a nursing home on the initial reactions of 502 elderly residents to their new environment. Data used in the analysis were taken from the Geriatric Nurse Practitioner Project in which residents were interviewed within one month of admission. Three scales were used to measure initial reaction: participation in nursing home activities, satisfaction with services, and social interaction. Covariates used to control for differences between groups were age, activities of daily living score, cognitive score, and affective status score. Bivariate relationships were found between the independent variables, deciding to move and wanting to move, and two measures, satisfaction with services and participation in nursing home activities. Multivariate analysis suggests that the two variables independently influence satisfaction and participation. Implications for practice and further research are discussed.

Recent immigrants and workers in foreign countries are two groups frequently identified as potential sources of new workers for nursing positions in long-term care (LTC). Recruiting workers directly from other countries, either permanently or temporarily, is difficult because of restrictive visa classifications; is unlikely to impact significantly the worker shortage; and may have risks that outweigh the potential rewards. On the other hand, with targeted recruitment and retention efforts, the nation's rapidly growing immigrant population (the so-called "New Americans") can become an even more important source of labor for frontline LTC workers. To be successful employees in LTC, however, New Americans will have to overcome a variety of cultural and language barriers. Equally important, the institutions and agencies that comprise the LTC system must exhibit a higher level of sensitivity to cultural differences. Efforts to recruit, train, and retain New Americans for positions in LTC present win-win opportunities and should be expanded.

This study, based on interviews with 1,215 assisted living and nursing home residents and family members in Oregon, compares assisted living residents and their family proxies with their nursing home counterparts regarding preferences for long-term care settings and circumstances and decisions surrounding their move. Analyses showed some differences between reported preferences of assisted living and nursing home groups, with the former placing more emphasis on control over private space and the latter on rehabilitation. There were also many similarities, however, especially in the views of residents themselves rather than those of their family proxies. For example, high value given by both groups to help with care from staff, decisions on how much care, and private rooms indicate policy planners and providers should take into account such preferences and develop a hybrid of positively valued features in both assisted living and nursing homes.The past decade has witnessed a major growth in the development of assisted living settings, so much so that one report likened their expansion to the phenomenal growth of nursing facilities in the 1960s and 1970s (Assisted Living Quality Coalition, 1998). Yet, the empirical literature on assisted living, a residential option that merges both housing and personal care services for persons with a wide range of disabilities, is sparse. Researchers have hardly begun to investigate the many topics related to this setting, such as health and social circumstances leading to the move to assisted living