Adult day services (ADS) have emerged as a significant non-institutional form of care for impaired older persons. There are about 4,601 ADS programs nationally serving about 260,000 clients. ADS centers offer daily programming (medical care, social activities and meals) for impaired elders at a central location and, at the same time, offer daily respite for family caregivers who receive time away at home from their often-onerous caregiving duties. There has been little or no study of the sociocultural backdrop or context to ADS. We are proposing a 48-month sequential study of 6 ADS centers (6 months each) in Maryland, conducting ethnographic research. The general goal of this proposed research is to examine the cultures, contexts, programming and activity content and client life within these centers. Through this research, we hope to better understand how ADS cultures (including values, meanings, taken- for-granted assumptions, patterns of attendance, problematic behaviors, staff relationships, client social interactions, activities and programming, and ideas on retention versus transfer) differentially affect the lives of clients, the key family members of the clients, and the ADS staff. This proposed research has 4 specific aims: 1. To examine the cultural and contextual beliefs, structures, similarities and differences among 6 diverse ADS centers;2. To examine the differential understanding among staff, family and clients of the lived experiences of clients, including perceived benefits and difficulties of each ADS center;3. To understand and describe the operation and meaning of both individually- and group-oriented programming and activities in each of the 6 ADS;4. To better understand, through case studies and other qualitative research methods, the following: a) local ADS policies on and attitudes to daily attendance;b) social relations of ADS clients;c) problem behaviors;d) retention versus transfer strategies;e) types of programming used;f) introduction of new forms of programming;g) "individual" versus "lowest-common-denominator" approaches to programming;and h) program goals and local meanings (definitions of what each ADS is trying to accomplish). This proposed research is highly innovative and would be, to our knowledge, one of the first ethnographic studies of ADS. Life and the first study to compare in detail multiple sites. Research would utilize participant observation (PO), ethnographic interviewing (EI), and case studies to better understand the culture and daily life of the 6 ADS centers. Standard methods of qualitative data analysis, including the development of a text base in Atlas.ti, would be utilized to manage and interpret the data we gather.
We are proposing a 48-month sequential study of 6 adult day services (ADS) centers (6 months each) in Maryland, using ethnographic research and data analysis to examine the cultures, contexts, programming and activity content and client life within these centers. There are 4,601 ADS programs nationally serving about 260,000 clients. The public health implications of the proposed research are profound since the research would enable us to have a much better idea on how ADS participants define and understand health and well-being within the context of ADS settings.