Continued developments in home and community-based care have occurred as part of the search for alternatives to institutional care (such as nursing homes) for older adults. Adult day services (ADS) (also known as adult day care) have emerged as a significant non-institutional form of care for older persons. The National Adult Day Services Association in 2014 had identified 5,685 ADS programs nationally, serving 300,000 clients. ADS centers provide daily programming (including medical care, social activities, and meals) for elders at a central location and, at the same time, offer daily respite for family caregivers. Prior research has examined both the effects of ADS on caregivers and, to a significantly lesser extent, on ADS clients, the results of which are complex and sometimes inconclusive. While there has been debate in the literature on the significance of key variables, there has been little or no study of the sociocultural backdrop or semiotic context to ADS. Our current fieldwork in three ADS centers has identified a phenomenon that we are calling interpretive social efficacy among clients who attend ADS several days a week. This can be defined as the ability to take on novel social roles and identities, despite having Alzheimer's disease and related disorders. Along with this, interpretive social efficacy also speaks to an expansion of semiotic abilities by clients as they adapt to the new symbolic and cultural circumstances of the ADS setting. The proposed study will examine in detail interpretive social efficacy and would compare what is found in the ADS setting to what we can learn about social relations and identities and their effects on the client when the client is at home in the evening or on days in which clients do not attend ADS. To our knowledge, this project would be one of the first to examine the meaningful lives and activities of ADS clients after they return home for the day. We are proposing a 24-month sequential study of three ADS centers in Maryland, in which ethnographers would spend approximately six months in each ADS center conducting ethnographic research (participant observation and ethnographic interviews), the general goal of which would be to examine the specific social involvement of clients in ADS who are diagnosed with Alzheimer's and related disorders and, similarly, their social lives at home. Several forms of data will be collected during 18 months of fieldwork: field notes based on participant observation; ethnographic interviews with clients, their family members, and ADS staff; informal interviews and conversations; and team memos. Further, researchers will meet biweekly to discuss fieldwork, findings, and data analysis. Data will be team-coded and entered into a text base for analysis using Atlas.ti, a software package for managing and analyzing qualitative data. The final six months of the project will be spent on data analysis and manuscript preparation. Standard methods of qualitative data analysis will be used.
Adult Day Services (Adult Day Care): Cultural Contexts and Programming Effects (SUPPLEMENT) PUBLIC HEALTH RELEVANCE Adult Day Services (ADS) provide a secure medically-monitored environment for community- dwelling older adults, which has been recognized for its effective intervention for caregivers and deferment of client institutionalization (e.g., movement into nursing homes). In this study, we focus on a critical understudied component of ADS, the one-half of its clients who have Alzheimer's disease and related dementias. In this ethnographic supplemental study of three ADS centers, we explore the ADS as a semiotic community that fosters an enlarged scope of interpretive social efficacy for many clients, as they take on and manage new social roles and social identities in the ADS setting.
| Black, Helen K; Rubinstein, Robert L; Frankowski, Ann Christine et al. (2018) Identity, Semiotics, and Use of Symbols in Adult Day Services. Gerontologist 58:730-738 |
