Living Arrangements for the Elderly

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Abstract
The articles prior to January 2008 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here Margaret R Grier Institutional care for the elderly is a topic of major concern. Some facilities are excellent and provide a high quality of care, but many are badly managed and provide poor care for their residents. Institutional care is needed, and will continue to be needed for a small proportion of the elderly population; consequently, nurses must become more involved in caring for the elderly and in improving nursing home conditions. About 100 years ago much the same thing was being said about hospitals as is being said today about nursing homes. Dr. Ashley's historical analysis of nursing indicated that nurses contributed greatly to making hospital care desirable for the sick,1 and nurses also have the potential to make nursing home care exceptable for the aged. A problem in providing care for elderly people in any setting is that many older people are in environments incongruent with their needs. One reason for this problem may be that nurses are not adequately involved in the selection of living arrangements for the aged. Nursing's holistic approach, considering all facets of a person's life, can be invaluable in selecting living arrangements for the elderly. But if a living arrangement conducive to maintaining well-being during the aging process is to be chosen, the nurse must have· knowledge of what living situations are available to the older person, of what is expected to happen in those living situations, and of what is desirable in living arrangements. Two descriptive studies concerning the choosing of living arrangements were conducted to gain understanding of how both nurses and elderly people go about choosing a living situation for the elderly. The process of decision making2 was studied since this process focuses on variables pertinent to choosing living arrangements and also provides a means for selecting living arrangements. Subjects were given a written description of a patient situation (Figure 1), that of Mr. Thomas, and were to make choices between three living arrangements for him: his own apartment, his son's home, or a nursing home. Twenty-one visiting nurses, 26 hospital nurses, and 16 elderly people ranked the three living situations according to which living arrangement was best for Mr. Thomas. This decision was considered to be intuitive. After ranking the living situations, subjects gave the probability (0-100%) of each of seven needs (activity, dietary, environmental, health care, medication, selfcare, and social) being met in each of the three living situations, and assigned a value to each need (0-100) according to its importance. The quantitative decisions were computed by the investigator from the probabilities and values Σ (Ρ χμ) for each alternative, and the living situation having the highest number was the quantitative choice. Findings The data indicate that visiting nurses disagree with hospital nurses, and both groups of nurses disagree with the elderly, when intuitively choosing a living arrangement for Mr. Thomas (Table I). Intuitively, visiting nurses choose the patient's own home, hospital nurses choose the nursing home, and the elderly are divided between these two living situations. The subjects agree remarkably, however, when quantitatively choosing a living arrangement for Mr. Thomas (Table II); about three-fourths of the subjects quantitatively choose the nursing home. Analysis of the data in Tables I and II reveals that hospital nurses and the elderly have some agreement between their intuitive and quantitative decisions-visiting nurses do not. The intuitive decision of the visiting nurses is in keeping with the actual choice of living arrangement, however, according to the VNA patient record. The patient upon whom the Thomas description was based remained in his own apartment. A personal and organizational reason for an irrational choice of living arrangement… 10.3928/0098-9134-19770701-06

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