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Preface | p. ix |
Acknowledgments | p. xi |
Quality in Assisted Living: Hearing Residents' Voices | p. 1 |
What Is Quality? | p. 1 |
Views of Quality: The Resident Quality Balance | p. 2 |
The Study | p. 4 |
Understanding the Complexity of Quality | p. 7 |
Understanding Quality: Key Questions | p. 11 |
Key Elements in Understanding Residents' Perspectives on Quality | p. 25 |
How Do Residents Rate Quality in AL? | p. 28 |
Profile of Coming Chapters | p. 29 |
The Everyday Experience of Quality in a ôSoft Institutionö | p. 33 |
Dining at the Greenbriar | p. 33 |
Institutional Life in an Assisted Living | p. 37 |
The Impact of the Institution on the Culture of AL Daily Routines | p. 40 |
The Sociophysical Environment | p. 44 |
The Medical Dimension of the Soft Institution | p. 49 |
Expressing Autonomy | p. 51 |
Balancing Quality in a Soft Institution | p. 53 |
A Culture of Caring | p. 57 |
Direct Care Staff and the Essence of Quality | p. 57 |
ôNo One Dies Aloneö | p. 58 |
Elements of Compassionate Care | p. 59 |
Human Touch and Interpersonal Warmth | p. 60 |
Sensitivity in Performing Body Care | p. 62 |
Someone to Talk With | p. 63 |
Philosophy of Care | p. 64 |
Staff Roles and Compassionate Care | p. 66 |
Complexity of Staff Roles: Is AL a Medical or Social Setting? | p. 67 |
Organizational Challenges to Providing Quality Care | p. 70 |
Exemplars of Compassionate Care | p. 78 |
Staff Orientation Toward Their Work | p. 79 |
Resident's Orientation Toward Staff | p. 82 |
Toward a Culture of Caring | p. 85 |
Compassion as a Calling | p. 87 |
Hidden Complexity: Food and Dining in Assisted Living | p. 89 |
Resident Activist and Foodie | p. 89 |
Complex Issues and Multiple Viewpoints of Food in AL | p. 92 |
Healthy Eating | p. 92 |
Diverse Preferences | p. 95 |
Corporate's Role | p. 96 |
Eating Beyond the Dining Room | p. 99 |
Dining Collectively | p. 103 |
The Place | p. 103 |
The Soft Institution Revisited: A Microcosm of food and Dining | p. 107 |
Making Choices in the Setting | p. 110 |
Food and Dining as the Crux of Life in AL | p. 114 |
Focusing on the Experiential Nature of Eating | p. 114 |
Challenges to AL Dining | p. 117 |
Successes in AL Dining | p. 120 |
Autonomy in Assisted Living | p. 123 |
Background | p. 123 |
ôThey Won't Let Me Do Nothingö | p. 124 |
Enhancing Autonomy | p. 125 |
Constraints on Autonomy | p. 129 |
ôThis Is My Room; I'm Paying for Itö | p. 130 |
Coming and Going | p. 131 |
Cigarettes, Alcohol, and Sugar | p. 134 |
The Influences of Ageism and Dementia on Autonomy | p. 136 |
Residents' Reactions to Diminished Control | p. 139 |
Understanding, Acceptance, and Accommodation | p. 140 |
Fear | p. 142 |
Assertiveness | p. 144 |
Advocating | p. 146 |
Autonomy: The Little Things Count | p. 147 |
Trading Autonomy for Safety | p. 149 |
External Constraints: Regulations, Rules, and Financial Realities | p. 153 |
Rules and Regulations in AL | p. 153 |
State Regulation | p. 155 |
Does Oversight Ensure Quality? | p. 155 |
Down the Nursing Home Path | p. 158 |
Corporate Influences | p. 163 |
Interpreting, Applying, and Enforcing the Rules | p. 165 |
Staff Perspectives | p. 165 |
AL Consumers' Perspectives | p. 166 |
Moving to the Next Level | p. 169 |
The Health Insurance Portability and Accountability Act | p. 172 |
The Financial Context | p. 174 |
When Regulations and Rules Cause Harm | p. 177 |
Quality Balance-Negotiating the Rule of Authorities With Resident Quality | p. 179 |
Broadening Our Perspectives on Quality: Change Over Time in the Quality Balance | p. 183 |
Quality as a Moving Target | p. 183 |
Changes Within Residents | p. 185 |
Unexpected Changes | p. 186 |
Changing Attitudes and Perceptions | p. 186 |
Changes in the AL Setting | p. 188 |
Ownership Change | p. 188 |
AL Managers: Change in Leadership | p. 190 |
Staffing Issues | p. 193 |
ALs in the Larger Economy | p. 199 |
The Changing Social Context of Other Residents | p. 202 |
Quality as a Process, Not a Product | p. 206 |
Moving Toward Quality Balance: Lessons Learned From Residents | p. 211 |
The Context of Quality in AL | p. 212 |
Quality as Related to the Self | p. 213 |
Quality of the Home Operations | p. 216 |
Quality of the Physical Environment | p. 216 |
Quality of the Staff | p. 216 |
Quality of the Food and Dining Arrangements | p. 217 |
Quality of Residents' Social Life | p. 217 |
The Basis of Quality in AL | p. 218 |
Lessons Learned and Strategies to Achieve a Quality Balance | p. 220 |
Appendix: Research Methods Used for the Study | p. 229 |
Setting Sample | p. 230 |
Gaining Access | p. 230 |
Sampling Persons Within Settings | p. 231 |
Resident Sample | p. 231 |
Family, Staff, and Manager Interviews | p. 232 |
Data Collection Techniques and Phasing of the Study | p. 233 |
Data Collection Techniques | p. 233 |
Phasing of the Study | p. 235 |
Data Management and Analysis | p. 236 |
Collaborative Coding Process | p. 236 |
Analysis | p. 237 |
Quality Interview Guide | p. 238 |
Resident/Family Interview | p. 238 |
Index | p. 241 |
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The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.