Decision Making In Long Term Care: Analysis Of Older Adults Who Maintained Community Residence After Nursing Facility Admission Screening

Rosemary Chapin
School of Social Welfare, Office of Aging and Long Term Care
The University of Kansas
1545 Lilac Lane
Twente Hall
Lawrence KS 66044-3184
785-864-4720
FAX: 785-864-3677
RChapin@ukans.edu
 
Kelley Macmillan
School of Social Welfare, Office of Aging and Long Term Care
The University of Kansas
1545 Lilac Lane
Twente Hall
Lawrence KS 66044-3184
785-864-3738
FAX: 785-864-3677
kelleym@ukans.edu
 
Mitsuko Nakashima
School of Social Welfare, Office of Aging and Long Term Care
The University of Kansas
1545 Lilac Lane
Twente Hall
Lawrence KS 66044-3184
785-864-0147
FAX: 785-864-3677
Miko@ukans.edu
Purpose:  Little is known about decision making in frail older adults who successfully maintained community residence after nursing facility (NF) application.  The purpose of the study was to explore the perceptions of these older adults to discover how they made the decision to remain in the community.  This qualitative analysis was a part of a longitudinal study that has investigated community tenure among older adults who received NF screening in 1999-2000 in the state of Kansas.
 
Methods:  In-depth interviews were conducted with 52 older adults or their family caregivers who received public funded in-home services and remained in the community after NF screening.  Interviews probed their perceptions of the decision-making process and factors that influenced their decisions.  All interviews were taped, transcribed and coded.  The constant-comparative method was used for the analysis.
 
Results:  Three different styles of decision-making were identified:  autonomous, collaborative, and delegated.  The style used was influenced by several factors:  older adults' level of cognitive ability, place of decision-making, the coping/communication style, and family involvement.  Older adults often had to successfully negotiate multiple relocations.  Factors that influenced their capacity to remain in the community included:  availability of information, formal services, professional and family support, financial resources, and informal assistance.   Skillful negotiation with in-home service providers, medical professionals and informal support group was key to maintaining community residence.
 
Implications for Practice:  Practitioners should assess the decision making style of older adults and tailor the intervention to their style.  Timely provision of information on options to NF is critical.  Policy makers and practitioners need to ensure that services essential to maintaining community tenure are available without delay at the critical time when older adults and their families are forced to consider NF placement.