"They Are the Reason I Come to Work": The Meaning of Resident-Staff Relationships in Assisted Living.

This article aims to provide understanding of how direct care workers (DCWs) in assisted living facilities (ALFs) interpret their relationships with residents and to identify factors that influence the development, maintenance, quality, and meaning of these relationships. Qualitative methods were used to study two ALFs (35 and 75 beds) sequentially over seven months. Researchers conducted in-depth interviews with 5 administrative staff and 38 DCWs and conducted 243 hours of participant observation during a total of 99 visits. Data were analyzed using a grounded theory approach. Results showed that the emotional aspect of caregiving provides meaning to DCWs through both the satisfaction inherent in relationships and through the effect of relationships on care outcomes. Within the context of the wider community and society, multiple individual- and facility-level factors influence DCW strategies to create and manage relationships and carry out care tasks and ultimately find meaning in their work. These meanings affect their job satisfaction and retention.

[1]  M. Patton Qualitative research and evaluation methods , 1980 .

[2]  L L Jervis,et al.  The pollution of incontinence and the dirty work of caregiving in a U.S. nursing home. , 2001, Medical anthropology quarterly.

[3]  William J. Scanlon,et al.  Nursing Workforce: Recruitment and Retention of Nurses and Nurse Aides Is a Growing Concern. Testimony before the Committee on Health, Education, Labor and Pensions, U.S. Senate. , 2001 .

[4]  K. Charmaz,et al.  Constructing Grounded Theory: A practical guide through qualitative analysis Kathy Charmaz Constructing Grounded Theory: A practical guide through qualitative analysis Sage 224 £19.99 0761973532 0761973532 [Formula: see text]. , 2006, Nurse researcher.

[5]  W. Broughton,et al.  A profile of Pennsylvania nurse's aides. , 1995, Geriatric nursing.

[6]  S. Zimmerman,et al.  Personal Care Aide Turnover in Residential Care Settings: An Assessment of Ownership, Economic, and Environmental Factors , 2005 .

[7]  T. Karner Professional caring: Homecare workers as fictive kin , 1998 .

[8]  Surviving Dependence: Voices of African American Elders , 1995 .

[9]  R. Stone Research on Frontline Workers in Long-Term Care , 2001 .

[10]  L. Morgan,et al.  Small Board-and-Care Homes: Residential Care in Transition , 1995 .

[11]  Kristin E. Smith,et al.  An Examination of Full-Time Employment in the Direct-Care Workforce , 2006 .

[12]  L. Fischer,et al.  Relationships between home care clients and their workers: implications for quality of care. , 1991, The Gerontologist.

[13]  V. Tellis-Nayak,et al.  Quality of care and the burden of two cultures: when the world of the nurse's aide enters the world of the nursing home. , 1989, The Gerontologist.

[14]  B. Bowers,et al.  The relationship between staffing and quality in long-term care facilities: exploring the views of nurse aides. , 2000, Journal of nursing care quality.

[15]  E. Abel Representations of Caregiving by Margaret Forster; Mary Gordon, and Doris Lessing , 1995 .

[16]  M. Moss,et al.  The metaphor of "family" in staff communication about dying and death. , 2003, The journals of gerontology. Series B, Psychological sciences and social sciences.

[17]  J. Tropman,et al.  The Managed Heart: Commercialization of Human Feeling , 1984 .

[18]  B. L. Combs,et al.  Managing decline in assisted living: the key to aging in place. , 2004, The journals of gerontology. Series B, Psychological sciences and social sciences.

[19]  Jonathan Eckert,et al.  Race Relations and Caregiving Relationships , 2001 .

[20]  Elzbieta Sikorska-Simmons,et al.  Predictors of organizational commitment among staff in assisted living. , 2005, The Gerontologist.

[21]  N. Kane,et al.  Who Cares for Them?: Workers in the Home Care Industry , 1990 .

[22]  Susan O. Mercer Dsw,et al.  Nurse's Aides in Nursing Homes , 1994 .

[23]  J. Deering,et al.  Job satisfaction of nursing assistants in long-term care. , 1995, The Health care supervisor.

[24]  Virginia Fraser,et al.  Nursing homes : getting good care there , 2002 .

[25]  Ari Houser,et al.  "We Shall Travel On": Quality of Care, Economic Development, and the International Migration of Long-Term Care Workers , 2005 .

[26]  J. K. Purk,et al.  Job Satisfaction and Intention to Quit Among Frontline Assisted Living Employees , 2006 .

[27]  I. Shannon The Caregiving Dilemma: Work in an American Nursing Home , 1994 .

[28]  Jaber F. Gubrium,et al.  Living and Dying at Murray Manor , 1975 .

[29]  Mary M. Ball Communities of Care: Assisted Living for African American Elders , 2005 .

[30]  K. Piercy When It Is More Than a Job , 2000, Journal of aging and health.

[31]  T. Gass Nobody's Home: Candid Reflections of a Nursing Home Aide , 2004 .

[32]  Chantal D. Caron,et al.  Deciding Whether to Continue, Share, or Relinquish Caregiving: Caregiver Views , 2003, Qualitative health research.

[33]  A. Strauss,et al.  Basics of qualitative research: Grounded theory procedures and techniques. , 1992 .

[34]  R. Rubinstein,et al.  Direct care workers' response to dying and death in the nursing home: a case study. , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[35]  S. Zimmerman,et al.  Assisted Living: Needs, Practices, and Policies in Residential Care for the Elderly , 2001 .

[36]  B. L. Combs,et al.  Quality of Life in Assisted Living Facilities: Viewpoints of Residents , 2000 .

[37]  Jonathan Eckert,et al.  The language of caring: nurse's aides' use of family metaphors conveys affective care. , 2007, The Gerontologist.

[38]  R. Monahan,et al.  Nursing home employment: the nurse's aide's perspective. , 1992, Journal of gerontological nursing.

[39]  H. Black,et al.  Moral Imagination in Long-Term Care Workers , 2004, Omega.

[40]  L. K. Olson The Not-So-Golden Years: Caregiving, the Frail Elderly, and the Long-Term Care Establishment , 2003 .