“It’s Going to be Different for Everyone”: Negotiating Quality of Life and Care Priorities Within Care Convoys

Abstract

Objective: The overall goal of this analysis was to learn about residents’ quality of life and quality of care in assisted living over time and from multiple viewpoints within support networks. Method: This grounded theory analysis examined qualitative data collected from 50 residents and 169 of their care network members followed over two consecutive 2-year periods in 8 diverse settings. Results: Quality involved a dynamic process of “negotiating priorities,” which refers to working out what is most important for residents’ quality of life and care. Resident and care partner priorities were not always consistent or shared, in part because quality is personal, subjective, dynamic, and situational. Discussion: Communication and collaboration among formal and informal care partners are vital to residents’ ability to age in place with a high quality of life and quality care.

Understanding Capacity and Optimizing Meaningful Engagement among Persons Living with Dementia

“…Roland & Chappell, 2015), we focus on the more complex care convoy and the context of long-term care. Understanding engagement capacity at all levels, especially their intersections and ensuring process that minimize barriers and optimize meaningful engagement within this population, including among AL residents, can positively impact care interactions and quality of life (Adlebrecht et al, 2021; Burgess et al, 2022; Genoe & Dupuis, 2014; Phinney et al, 2007).…”

“…tools for engagement, care plans, time, job redesign) will enhance understanding and optimize engagement capacity among persons living with dementia. Support within convoys for consensus building, knowledge sharing, communication and collaboration also has the potential to realize shifts in capacity and quality of life (Burgess et al, 2022; Kemp et al, 2018). As part of person- and relationship-centered care planning, convoy members and insofar as possible care recipients, should collaborate to identify strategies for promoting meaningful engagement.…”

“…Maintaining access to meaningful activities and experiences to the highest degree possible is essential for quality of life and quality of care of persons living with dementia (Adlbrecht et al, 2021; Burgess et al, 2022; Fazio et al, 2018). Engagement is meaningful when the “the act of being occupied or involved in an external stimulus” (Cohen-Mansfield et al, 2009, p.…”

Beyond the Medication Pass: Attitudes, Ethics, Agency, and Antipsychotic Medications in Assisted Living/Residential Care

“…Furthermore, implications of and ethical issues with off-label APU to manage behavioral expressions have been discussed across the life course and globe ( 48–52 ). This conversation is further complicated by whether actors’ motivations align or conflict ( 32 ). An oversimplified example might manifest as clinicians pursuing therapeutic goals (eg, symptom management), families concern with safety goals, direct care staff aiming towards resident-centered goals, and administrative staff prioritizing compliance goals ( 50 , 53 ).…”

“…AL/RC care models that prioritize autonomy, choice, dignity, independence, individuality, and privacy introduce another component to the equation of medication management and APU ( 31–33 ). Balancing these espoused values (eg, autonomy) with the mandate to protect residents (eg, safety) can result in multiple sources and levels of conflict regarding an “appropriate response” to residents’ behavioral expressions and medication needs ( 32 ).…”