Assisted Living (AL) represents a relatively recent and increasingly important form of environmentally supportive setting for the aged. Little is known, however, about many dimensions of AL. In general, AL units provide few and strictly limited health interventions and employ few health personnel. Significantly, residents must transfer from AL facilities at the point at which their health and other declines exceed the capacity of the AL facility and its personnel to care for them. Generally, residents leave AL facilities for nursing homes. The general aim of the proposed 4-year qualitative, anthropological study is to explore the experiences of AL residents as they prepare to leave their facility as part of the transition from AL resident to a next living setting. It is the operating assumption of this proposed research that within the culture of AL, indicators of cognitive, health, personal, and social status will be of special importance and concern, as members of the AL community """"""""read"""""""" the signs and indicators of one's own and others' status. The major specific aims of the proposed research are these: (1) to examine the social and cultural processes of change and decline leading to transfer from assisted living; (2) to understand how residents, their family, and the AL staff read and interpret signs of decline, improvement, normalcy and change in the social and cultural environment of AL facilities; (3) to understand how the """"""""explanatory models"""""""" (Kleinman, 1981) used by residents, family and caregiving staff and administrators to emically monitor the processes of stability, decline and change map onto issues of retention and transfer; and (4) to examine facility-level characteristics as these might shape the processes of stability, decline and change. We propose a qualitative, ethnographic sequential study of 6 AL facilities in Maryland, to be varied by type of facility (""""""""small,"""""""" """"""""traditional,"""""""" and """"""""new model"""""""") and level of care (2"""""""" or 3,"""""""" according the Maryland system). Project staff will spend 4-5 months in each of the study facilities undertaking participant observation and in-depth qualitative interviews with residents, family, and staff. Data gathered in the study will be analyzed using qualitative and ethnographic techniques.
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