Social engagement and its relationship to service provision in residential care and assisted living

Abstract

The purpose of this study was to categorize the underlying constructs of social activity participation in a residential care and assisted-living population, determine the extent of social engagement and how it varies by facility type, and relate social engagement to service provision. Data were collected far 2,078 residents of 193 facilities in Florida, Maryland, New Jersey, and North Carolina participating in the Collaborative Studies of Long-Term Care. An 11-item scale, the Assisted Living Social Activity Scale, was developed that was composed of three factors: private activities, group activities, and outings. Cognitive and functional status related to participation in these activities, visit and telephone contact, and social withdrawal. In adjusted analyses, differences by facility type were noted, and service provision related to social engagement in all areas except social withdrawal. Key words: assisted living; elderly people; residential care; service provision; social engagement ********** Residential care/assisted-living (RC/AL) facilities have become common residences for elderly people in need of assistance with activities of daily living (ADLs). In early 1998 approximately 11,500 RC/AL facilities provided care for more than 500,000 residents (Hawes, Rose, & Phillips, 1999); by 2010, it is estimated that these settings will provide care for more elderly people than do nursing homes (Meyer, 1998). Whereas RC/AL incorporates a wide variety of care, ranging from small mom-and-pop homes to large, apartment-style living facilities, these facilities have in common a social model of care, as opposed to the medical model on which nursing home care is based. The social model reflects principles such as providing or coordinating activities and services and encouraging family and community involvement in the life of the resident (Assisted Living Quality Coalition, 1998), two important components of engagement required for successful aging (Rowe & Kahn, 1998). Although the number of elderly people residing in RC/AL facilities is increasing, little is known about the social engagement of these residents and how well these facilities support residents' need for activity and social contact. The importance of examining social engagement and how the facility can optimize it is easily appreciated in light of the extensive evidence linking social relations to well-being (Berkman & Syme, 1979; Blazer, 1982; Lemke & Moos, 1986; Noelker & Harel, 1978). For example, involvement in activities is associated with decreased mortality rates (Rozzini, Bianchetti, Franzoni, Zanetti, & Trabucchi, 1991), the slowing of functional decline (Choi & Wodarski, 1996; Unger, Johnson, & Marks, 1997), increased happiness and quality of life (Graney, 1975; Ho et al., 1995), and decreased rates of stress and depression (Mitchell & Kemp, 2000; Patterson, 1996). The purpose of this study was to examine social engagement of residents in RC/AL facilities and the extent and variability of service provision in RC/AL and to determine whether there is an association between the provision of social or recreational activities and resident engagement. Although a thorough understanding of the broader concepts of social networks, social support, and social integration awaits further study, this article is the first to identify the underlying constructs of social activity participation among RC/ AL residents; to present a scale, the Assisted Living Social Activity Scale (AL-SAS), to quantify this participation; and to examine how participation and other areas of engagement (for example, visit and telephone contact and social withdrawal) relate to facility service provision. METHOD Sample and Design Data for this study were derived from the Collaborative Studies of Long-Term Care (CS-LTC), a four-state study of 2,078 RC/AL residents from 193 facilities in Florida, Maryland, New Jersey, and North Carolina. …