Type of Document	Dissertation
Author	Harris, Brandy Danielle
URN	etd-07042006-215630
Title	Determinants of Resident Mental Health in Florida's Assisted Living Communities
Degree	Doctor of Philosophy
Department	Sociology, Department of
Advisory Committee	Advisor Name Title Jill Quadagno Committee Chair Anne Barrett Committee Member Doug Schrock Committee Member Michelle Bourgeois Committee Member
Keywords	Depression Elderly Assisted Living Quality Of Life
Date of Defense	2006-06-13
Availability	unrestricted
Abstract In 2002 I began working as a research assistant on the Florida Medicaid Assisted Living Project. The research project, which was funded in part by the National Institute on Aging (NIA) and the Florida Agency for Health Care Administration (AHCA), compared nursing home care to care given to the population in assisted living. Because Medicaid is the main source of payment for long term care services provided outside of the home, our research team was contracted by the state of Florida to: (1) gather baseline data in an effort to learn more about Medicaid populations in assisted living, (2) examine the role of Florida Medicaid assisted living programs in overall Medicaid long term care spending, and (3) compare facilities that serve Medicaid populations to private pay facilities. The project was completed in 2005, yielding a final sample of 692 participants in the resident survey, and 475 participants among the facility administrators. Using data from the Florida Medicaid Assisted Living Study, this dissertation examines the relationship of demographic predictors, such as age, gender, education, as well as social support and physical impairment to the mental health of residents in assisted living. In addition to those indicators, I also look at philosophical tenets and organizational policies as possible predictors of mental health among assisted living residents. In the dissertation, I used two separate measures to assess mental health – adaptations of both the Geriatric Depression Scale and the Life Satisfaction Index. I would like to note that, in general, the residents have good mental health -- low average scores on the depression index and relatively high average scores on the quality of life index. Findings show that women, on average, have greater physical impairment than men; women, on average, report higher scores on the “actual family support” index than men (meaning that on average women report more phone calls and visits from family than men); female residents are older than male residents; widowhood, on average, is more likely to be experienced by female residents than male residents; male residents, on average, are more likely to have a professional degree (beyond the 4-year college degree) than female residents; and men, on average, are more often the new arrivals in assisted living (residing in assisted living for less than 1 year). In addition, being married, completing a college or professional degree, believing that assisted living is “home”, having complete control over the decision to move into assisted living, having knowledge of the facility policies regarding what could lead to resident discharge; having both actual and perceived support from family; visits from friends outside of the facility; and perceiving that the amount of money they have takes care of their needs very well are related to positive mental health outcomes of assisted living residents. As expected, having less education is related to worse mental health (lower quality of life and higher rates of depression); negative perceptions of financial status are related to worse mental health; having greater physical impairment is related to worse mental health; and perceived support from friends inside of the facility is also related to worse mental health –however, this may be due to the level of physical impairment among the population (as denoted by the continued significance and increase in the physical impairment coefficient). Of the assisted living philosophical tenets, results show that feeling that assisted living is home is beneficial to the mental health of residents. This adds to research showing that reaching “at homeness” is a good indicator that residents have successfully adjusted/transitioned to a new environment by further showing that reaching “at homeness” is also good for the mental health and well-being of the transitioner. These results confirm many of the findings in the sociology of mental health literature, namely that higher education provides protective benefits for mental health and having greater physical impairment influences negative mental health outcomes. Moreover, this study shows the importance of family support and friendships outside of the facility for positive mental health of assisted living residents. Among the philosophical tenets, feeling at home in assisted living is the only tenet that provides for lower rates of depression and greater quality of life. In addition to its relevance for the sociology of mental health and aging and the lifecourse, there are vast policy implications arising from this research. Homelike environment is a central tenet of the assisted living philosophy. These findings show that it is important for resident mental health and so it should be heeded by the industry. In addition to those findings, although the organizational policies variable was not significant in the regression analyses, about 55 percent of the residents who answered the open-ended item felt that they would only be allowed to stay if they were in good health and 32 percent who answered that portion felt that they would be able to stay if their money did not run out. However, this is not consistent with data from the facility administrators. The top three reasons administrators give for discharge are engaging in physically aggressive behavior, being confined to a bed, and engaging in verbally aggressive behavior. So, although facilities will discharge based on extreme physical limitations, the main reasons for discharge are behavioral problems. Moreover, close to half of the facilities sampled accept some form of governmental subsidy for payment if the resident exhausts their own finances. Unfortunately, there seems to be some disconnect between the information given to the residents, or their level of understanding of the information provided, and the actual policies regarding resident discharge. However, because each state determines how assisted living will be run, there is no consistency of protocol. Federal oversight of the assisted living industry may provide for stricter guidelines and uniformity of procedures. This study is not without its limitations, which should be noted. These data are cross-sectional so there can be no determination of causality (selection effects); also, biases resulting from the missing data may pose a problem for getting a clear picture of resident mental health. However, these findings provide a baseline understanding of the assisted living residents participating in the Florida Medicaid Assisted Living Study and are a good start for providing researchers, caregivers, and policymaker’s basic descriptive information about the Florida assisted living population.
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