EVERYDAY MATTERS IN THE LIVES OF NURSING-HOME RESIDENTS - WISH FOR AND PERCEPTION OF CHOICE AND CONTROL

OBJECTIVES: This study examined the importance that nursing home resid ents and nursing assistants ascribed to control and choice over everyd ay issues, the satisfaction of residents with their control and choice over these issues, and the nursing assistants' impressions of the ext ent to which control and choice exist for nursing home residents on ev eryday matters. DESIGN: Cross-sectional in-person interviews with a st ratified representative sample of nursing home residents and nursing a ssistants using semi-structured interview protocols with both fixed-ch oice and open-ended questions. SETTING: A random sample of 25 nursing homes in the Twin Cities, MN area; a random sample of five nursing hom es in North Little Rock, AR; all five nursing homes in Sante Fe, NM; a nd five purposively selected nursing homes in each of New York City an d Los Angeles, CA. PARTICIPANTS: One hundred thirty-five cognitively i ntact residents, three from each facility, were selected and included the resident council chair, one randomly selected short-stay resident, and one randomly selected long-stay resident from each facility. Also participating were 134 nursing assistants (1 selected randomly from e ach shift from those employed at least two-thirds time and who had wor ked in the facility for at least 3 months). MEASUREMENTS: The most imp ortant measurements were ordinal-level ratings of the importance of ch oice and control for nursing home residents over 10 selected areas of everyday life; ordinal measures of residents' satisfaction with their choice and control over these areas; and nursing assistants' ratings o f the extent to which they thought it possible for residents to achiev e choice and control. Open-ended comments were also elicited. Also mea sured were demographic data, ADL status, frequency of trips away from the nursing home, frequency of receiving visitors, and (for nursing as sistants) length of employment, wages, job satisfaction, and extent to which they knew the residents under their care. MAJOR RESULTS: Cognit ively intact nursing home residents attach importance to choice and co ntrol over matters such as bedtime, rising time, food, roommates, care routines, use of money, use of the telephone, trips out of the nursin g home, and initiating contact with a physician. Nursing assistants vi ew such control as important to residents. Residents and staff differ significantly in the importance attached to particular items, with sta ff placing lower importance than residents on use of the telephone and personal expenditures and higher importance on control and choice ove r visitors and formal nursing home activities. Residents were not very satisfied with their control and choice, and nursing assistants viewe d them as unlikely to experience control and choice. Nursing home, res ident, and staff characteristics were not associated with the patterns of results. CONCLUSIONS: A self-defeating cycle has been identified w here neither resident nor staff are optimistic about achieving more re sident control and choice, which both groups perceive as desirable. To end this cycle, suggestions are offered for structuring the role of t he nursing assistant, physician and nurse leadership, changes in nursi ng home routines and practices, and public policy changes.