Decision as process: A conceptual model of black elders' nursing home placement

doi:10.1016/0890-4065(94)90020-5

Journal of Aging Studies

Volume 8, Issue 1, Spring 1994, Pages 77-94

https://doi.org/10.1016/0890-4065(94)90020-5 Get rights and content

Abstract

This processual decision-making model emerged from qualitative interviews with 10 African American nursing home residents about their placement decisions. Case descriptions are used to illustrate the model. The model is presented as an organizing framework for exploring placement decisions on a largr scale and with different populations. Although there is little about the model that appears to be specific to African Americans, the model lends itself to exploring differences between African American and other elders in their decision-making process. The decision to institutionalize revealed itself as a complex process involving multiple actors, multiple decisions, distinct phases, variable modes of interaction between the actors, and variable outcomes that are provisional and may change over time.

References (38)

P.G. Clark
Individual Autonomy, Cooperative Empowerment, and Planning for Long-Term Care Decision Making
Journal of Aging Studies
(1987)
AARP
A Portrait of Older Minorities
(1987)
J. Arras
A Philosopher's View
Generations
(1987)
B.M. Barer et al.
A Critique of the Caregiving Literature
Gerontologist
(1990)
E. Chachkes
A Social Worker's View
Generations
(1987)
W.C. Chenitz
Entry into a Nursing Home as Status Passage: A Theory to Guide Nursing Practice
Geriatric Nursing
(1983)
B.J. Collopy
Autonomy in Long Term Care: Some Crucial Distinctions
Gerontologist
(1988)
C. Coulton et al.
Dimensions of Post-Hospital Care Decision-Making: A Factor Analytic Study
Gerontologist
(1988)
C.J. Coulton et al.
Discharge Planning and Decision Making
Health and Social Work
(1982)
A.E.P. Dill
The Case of George Sellers: A Safe Plan
Generations
(1987)

A.E.P. Dill

The Case of Rose Cepato: In Limbo on the Geriatric Ward

Generations

(1987)

N. Dubler

Improving the Discharge Planning Process: Distinguishing between Coercion and Choice

Gerontologist

(1988)

J.K. Eckert

The Unseen Elderly

(1980)

L. Groger

Tied to Each Other Through Ties to the Land: Informal Support of Black Elders in a Southern U.S. Community

Journal of Cross-Cultural Gerontology

(1992)

L. Groger

“African American Elders' Choices for Long-Term Care: An Exploratory Study.” Report

(1993)

Z. Harel et al.

Social Integration, Health, and Choice

Research on Aging

(1982)

T. Hickey et al.

Daily Illness Characteristics and Health Care Decisions of Older People

Journal of Applied Gerontology

(1991)

D.M. High

All in the Family: Extended Autonomy and Expectations in Surrogate Health Care Decision-Making

Gerontologist

(1988)

B.F. Hofland

Autonomy in Long Term Care: Background Issues and a Programmatic Response

Gerontologist

(1988)

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Family experiences related to the decision to institutionalize an elderly member in Taiwan: An exploratory study
1999, Social Science and Medicine
Industrialization and urbanization have changed the structure of Taiwanese families. Placing elder family members with impairments in nursing homes has become a new caregiving alternative. However, Taiwanese commonly consider this placement to be a violation of traditional filial obligation. Therefore, institutionalization is a highly sensitive cultural issue. Data were gathered through semi-structured interviews with nine family members, revealing three major processes in the decision of institutionalization — breaking harmony, rebuilding harmony and evolution, as well as four important factors that influence the decision — the quality of the relationship between the elder and his/her family, characteristics of the elder, financial condition of the family and perceived public opinion toward institutionalization. The findings suggest that the decision process in institutionalization is a gradual, fluid, cyclical movement without definite steps.
Attitudes about entering a nursing home: Comparisons of older rural and urban African-American women
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This research examines the attitudes of older (65+) rural and urban African-American women about the possibility of entering a nursing home. Personal, in-depth interviews consisting of structured and open-ended questions were conducted among community-dwelling elders (N = 98) and their responses subjected to content analysis. Approximately one-third of the sample, expressed positive attitudes about entering a nursing home. Positive attitudes reflected three themes: (1) nursing homes are a good option if the elder's physical condition demands them; (2) nursing homes are a good option if the care is good; and (3) an undifferentiated appreciation for or positive perspective on nursing homes. Slightly more than half of the respondents reported negative attitudes about nursing homes. Their responses fell into four categories: (1) they expressed the feeling that moving to a nursing home would require a big adjustment; (2) they perceived nursing homes as bad places to live; (3) they believed that nursing homes are places where you go to die; and (4) some elders described an undifferentiated but generalized resistance to entering a nursing home. The remainder of the sample (about one in seven elders) offered assessments of nursing homes (either positive or negative) that were dependent on their family's circumstances. Residential differences were observed in both positive and negative categories. These findings lend further evidence to the proposition that residential context shapes perceptions of long-term care choices and raises questions about the degree to which entering a nursing home is perceived as negative, particularly among African-Americans.
A nursing home can be a home
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This article is based on semistructured, open-ended interviews that explored the long-term care choices of 20 African-American elders—10 nursing home residents and 10 home care clients—in a midwestern metropolitan area. Informants' ability to consider a nursing home a “home” was related primarily to the criteria they used to define “home.” Other indicators included the circumstances of nursing home placement, previous experience with nursing homes, and the degree of continuity achieved after placement. Findings from this study suggest that a consideration of home and nursing home both as abstractions and as concrete places is useful in explaining differences in informants' ability to regard the nursing home as a home.
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Decision as process: A conceptual model of black elders' nursing home placement

Abstract

Journal of Aging Studies

A Portrait of Older Minorities

A Philosopher's View

Generations

A Critique of the Caregiving Literature

Gerontologist

A Social Worker's View

Generations

Entry into a Nursing Home as Status Passage: A Theory to Guide Nursing Practice

Geriatric Nursing

Autonomy in Long Term Care: Some Crucial Distinctions

Gerontologist

Dimensions of Post-Hospital Care Decision-Making: A Factor Analytic Study

Gerontologist

Discharge Planning and Decision Making

Health and Social Work

The Case of George Sellers: A Safe Plan

Generations

The Case of Rose Cepato: In Limbo on the Geriatric Ward

Generations

Improving the Discharge Planning Process: Distinguishing between Coercion and Choice

Gerontologist

The Unseen Elderly

Tied to Each Other Through Ties to the Land: Informal Support of Black Elders in a Southern U.S. Community

Journal of Cross-Cultural Gerontology

“African American Elders' Choices for Long-Term Care: An Exploratory Study.” Report

Social Integration, Health, and Choice

Research on Aging

Daily Illness Characteristics and Health Care Decisions of Older People

Journal of Applied Gerontology

All in the Family: Extended Autonomy and Expectations in Surrogate Health Care Decision-Making

Gerontologist

Autonomy in Long Term Care: Background Issues and a Programmatic Response

Gerontologist