Decision Making in Long-Term Care

Abstract

This article reports findings from a qualitative study of approaches to long-term care decision making used by older adults (N = 52) who continued to reside long-term in the community following nursing facility pre-admission screening. Older adults used different approaches to decision-making (autonomous, collaborative, and delegated) while seeking the ). Rosemary K. Chapin designed and provided overall direction of the operation of the three-year longitudinal study of customers diverted through the CARE program on which this qualitative study is based. Kelley Macmillan is the Coordinator of the Diversion Study. Mary Zimmerman is the methodologist of the project.Downloaded by [Stony Brook University] at 00:43 02 November 2014 most appropriate care setting. Factors such as mental capacity, the role of family caregivers, and self-advocacy skills influenced the choice of decision-making approach. Findings also illustrate how older adults moved through multiple pathways in order to reach their eventual long-term residence. These findings are discussed in terms of their implications for clinical practice and research.

Go to the Hospital or Stay at Home? A Qualitative Study of Expected Hospital Decision Making Among Older African Americans With Advanced Heart Failure

“…They may also have different perspectives about future care and treatment (Retrum, Nowels, and Bekelman, 2012). The existing research also suggests that there are a variety of approaches to health-care decision making, including those focused on autonomy of the elder, as well as those involving collaboration between elders and caregivers (Nakashima, Chapin, Macmillan, & Zimmerman, 2005). Clinicians and researchers have recently emphasized the importance of shared decision-making and patient-centered care as essential components of ethical and humane care for persons with serious illness.…”

Supporting Residents Moving Into Long-Term Care: Multiple Layers Shape Residents’ Experiences

“…Studies focused on pre-move decisionmaking have highlighted that older adults rarely initiate relocation decisions relying instead on family, professionals or both to determine when relocation is warranted (Fraher & Coffey, 2011;Keister, 2004;Reed, Sullivan, & Burridge, 2003). While self-initiated decisions are presumed to be most desirable, reliance on others can be experienced positively when older adults choose to delegate this decision, do not feel pressured, are involved in decisions associated with the move (e.g., the selection of facilities), and are provided with the opportunity to anticipate the move, even for a short period of time (Fraher & Coffey, 2011;Nakashima, Chapin, Macmillan, & Zimmerman, 2005;Reed et al 2003). Some researchers have suggested that older adults prefer to accept decisions made by others, viewing the decision to relocate as a personal failure (Lee, Woo, & Mackenzie, 2002;Leggett et al, 2011).…”

“I might be ahead to go to the nursing home”: The anticipated relocation of an older rural woman.

“…The RHQ study involved multiple in-home interviews with each participant over time rather than only one interview per participant, as in the study of Nakashima et al (2004). Project staff also contacted each woman for a monthly telephone conversation when an in-home interview was not scheduled.…”

“…Using qualitative methods, some researchers have explored facets of relocation by interviewing older persons who have already relocated (Bekhet, Zauszniewski, & Nakhla, 2009). A few qualitative studies have involved older persons living at home who were on waiting lists for facilities (Nakashima, Chapin, Macmillan, & Zimmerman, 2004; Rutman & Freedman, 1988) -- a factor that could influence perceptions about anticipatory relocation. Thus, the relocation event has been the fulcrum of interest in a process that often has a nebulous beginning.…”