Continuing Care Retirement Community Research Articles

Intergenerational Service-Learning During COVID-19

Mentor Up is a technology training program designed to reduce loneliness through technology training and intergenerational relationships. The program, which has similarities to Cyber Seniors, has been held at Eckerd College for four years and has traditionally been held in-person at a local Continuing Care Retirement Community (CCRC). During the pandemic we partnered with AARP to re-think the program and offer a modified version of Mentor Up on Zoom. Five one-hour one-on-one virtual technology training sessions led by 16 students were scheduled. Participants joined to ask questions about how to use features on their smartphones or how to navigate the Zoom virtual platform more effectively. The remote nature of programming allows for expanded 2021 participation, including AARP members across Florida and all three Westminster Communities of Florida in the area (CCRC, ALF, SNF). Participation rates, strategies to implement intergenerational programs on a virtual platform, and lessons learned will be highlighted.

Residential Care in California: Spatial and Temporal Trends in Facility Development and Care Capacity

As COVID-19 has resulted in a skilled nursing facility (SNF) staffing crisis, administrators attempt to maintain adequate staffing and stem decreasing patient census levels. We conducted four repeated interviews to date (n=130) at 3-month intervals with administrators from 40 SNFs in eight diverse healthcare markets across the United States. We used thematic analysis to examine their perspectives over time, including the perceived impact on staffing. Results include: 1) the impact of COVID-19 on staffing levels, and 2) strategies used in response to this crisis. Staffing levels have decreased throughout the pandemic, and struggles to maintain adequate staffing levels and patient census numbers have continued as the pipeline of potential new staff constricts. Facilities turned to agencies, many for the first time. Since agencies offer higher salaries, staff are drawn away from employment by SNFs, leading to a cycle of wage wars, and agencies are also challenged to provide staff. SNF administrators describe their responses to this crisis, such as flexible schedules, increased paid time off, sharing of non-direct-patient-care tasks, financial incentives (referral, sign-on, “no-call out”, and other general bonuses); wage analyses, and enhanced employee benefit packages. Some hire recruitment specialists, collaborate with nearby administrators, use creative advertising, or work with local schools. The vaccine mandate worries administrators; as one stated: “I can't afford to lose one person, let alone 20 because of this mandate...”. Given the dwindling pool of potential employees, we present NH administrators’ strategies to attract and retain staff.

Enhancing Collaborations between our Age-Friendly Community and University Initiatives

Community involvement and synergistic partnerships are key to fostering a holistic approach to programming and outreach that assess and meet the needs of the older adults in our communities. The University of Illinois Urbana-Champaign has created an Age-Friendly network to facilitate these partnerships featuring our designation of Age-Friendly City and Age-Friendly University as well as partnerships with our state and local governments, community aging services providers, and continuing care retirement communities. Through these partnerships, we have identified the landscape of the community, assessed the unique needs older adults, and identified novel solutions. We will discuss our plans for activities that will empower older adults in our community and at our university by promotion connection, collaboration, and inclusion.

The StrongerMemory Program: A Brain Health Intervention for Mild Cognitive Impairment

The StrongerMemory program is a brain health intervention targeting older adults with mild cognitive impairment (MCI). Approximately 20% of individuals over 65 years old have MCI and 38% will potentially develop dementia after 5 years of MCI onset. Participants in the 16-week StrongerMemory program practice exercises involving math, writing, and reading aloud for 20-30 minutes a day, stimulating the prefrontal cortex of the brain, which governs the brain’s ability to retrieve memories. The current research exploring participants’ experiences with the StrongerMemory program was approved by the University’s Institutional Review Board. A semi-structured interview was implemented with each participant and the interviews took about 15 to 30 minutes to complete. There was a total of 24 respondents associated with a local continuing care retirement community, each providing their verbal consent to be interviewed and recorded over Zoom. The respondents were mostly female ranging in age from 65 to 90. Most respondents reported having advanced degrees and were participating in the program on their own, with a spouse or friend. Each interview transcript was coded by at least two members of the Mason research team. Participants reported being motivated to participate in the program due to fearing memory loss because of experiences of family members and friends and others wanted to remain “cognitively fit.” Codes and themes representing participants’ perceptions and reactions to exercises and their challenges and lessons learned from their participation will be discussed, including participants feelings of being “less foggy” and better able to remember information.

Older Adults as Virtual Subject Matter Experts in COVID Graduate Education

COVID-19 has further illuminated the need for educational approaches in gerontology that are person-centered and experiential. Ideally, this includes in-person experiences with students and older adults. Through their classroom participation as subject matter experts in aging, older adults share their personal experiences, and react to gerontological theories and ideas. Shared learning offers a platform for exploration of shared humanity, so that older adults are not seen as the “other”, but “us”. This prepares a generation of gerontologists to identify and reject ongoing ageism, again highlighted by the pandemic. COVID-19 has also challenged educators to offer these experiential opportunities. In this presentation we will outline how older adults from a Continuing Care Retirement Community participated virtually in a graduate course. We will discuss how their virtual involvement was structured, how their real-time COVID experiences were integrated, and share feedback from older adult participants and students on their shared learning experiences.

Depression and Anxiety in Residents of a Retirement Community during the Covid-19 Pandemic

Background: During the COVID-19 pandemic, the State of Louisiana implemented a quarantine leading to a decrease in social interaction, a risk factor for anxiety and depression among the elderly population. The objective was to determine if quarantine would negatively affect the mental health of the elderly in a residential community. Methods: This limited longitudinal assessment and analysis, uitilizing the Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI) to assess depression and anxiety during quarantine. Data was collected three times over 12 weeks during the quarantine from 46 of 57 residents stratified as nursing home, assisted living, and independent living of a Continuing Care Retirement Community (CCRC) in the New Orleans area. 37 (80%) of 46 patients were females, mean age 86.1 (SD 9.1) years old; 25 (54.3%) were nursing home residents, 13 (28.3%) were in assisted living, and 8 (17.4 %) were in an independent living community. Results: 16 (34.8%) patients were diagnosed with depression before being surveyed. Five (10.9%) had previous diagnoses of anxiety. Anxiety scores decreased significantly from baseline (average 4.35 vs. 3.28, p-value = 0.045) at 6 weeks, but did not change from 0 to 12 weeks or 6 -12 weeks. Depression, scores did not change significantly between time periods. Our data indicate a trend toward an increase in depression and anxiety during periods of pandemic quarantine isolation. Conclusion: Assessing these indicators may help mitigate economic burden and cognitive decline resulting from the complications of depression and anxiety in elderly populations.

Learning from a multidisciplinary randomized controlled intervention in retirement village residents.

Retirement villages (RVs), also known as continuing care retirement communities, are an increasingly popular housing choice for older adults. The RV population has significant health needs, possibly representing a group with needs in between community-dwelling older adults and those in long-term residential care (LTC). Our previous work shows Gerontology Nurse Specialist (GNS)-facilitated multidisciplinary team (MDT) interventions may reduce hospitalizations from LTC. This study tested whether a similar intervention reduced hospitalizations in RV residents. Open-label randomized controlled trial in which 412 older residents of 33 RVs were randomized (1:1) to an MDT intervention or usual care. RVs across two District Health Boards in Auckland, New Zealand. Residents were eligible if considered high risk of health/functional decline (triggering ≥3 interRAI Clinical Assessment Protocols or needing special consideration identified by GNS). GNS-facilitated MDT intervention, including geriatrician/nurse practitioner and clinical pharmacist, versus usual care. Primary outcome was time from randomization to first acute hospitalization. Secondary outcomes were rate of acute hospitalizations, LTC admission, and mortality. Twelve residents died before randomization; all others (n= 400: MDT intervention=199; usual care=201) were included in intention-to-treat analyses. Mean (SD) age was 82.2 (6.9) years, 302 (75.5%) were women, and 378 (94.5%) were European. Over median 1.5 years follow-up, no difference was found in hazard of acute hospitalization between the MDT intervention (51.8%) and usual care (49.3%) groups (Hazard ratio [HR]=1.01, 95% CI=0.77-1.34). No difference was found in the incidence rate of acute hospitalizations between the MDT intervention (0.69 per person-year) and usual care (0.86 per person-year) groups (incidence rate ratio=0.81, 95% CI=0.59-1.10). Similar results were seen for the proportion of residents with LTC transition (HR=1.18, 95% CI=0.65-2.11) and mortality (HR=0.70, 95% CI=0.36-1.35). Further studies are needed to assess the effects of other patient-centered interventions and outcomes with adequate primary care integration.

Outcomes of Team-Centered, Occupational Adaptation-Based Versus Traditional Dementia Workforce Training.

Background. Dementia workforce training aligned with Occupational Adaptation (OA) theory may facilitate teams resolving challenges in the care environment more than traditional skills-based (SB) training, although comparisons are needed. Purpose. This pilot study compared effectiveness of an OA and SB program on relative mastery and team development for dementia care teams at a continuing care retirement community. Method. In a quasi-experimental study, employees underwent nine sessions in an OA or SB program. Relative Mastery Measurement Scale and Team Development Measure results were collected pre-, mid-, post-intervention. A 3 × 2 ANOVA determined differences in group score changes across time. Findings. Data from 28 employees (14/group) showed group-by-time interaction reached statistical significance for both relative mastery (F = 3.17, df = 2, p = .05) and team development (F = 8.38, df = 2, p = .001). Implications. OA-based training may improve dementia care teams' collaborative mastery over real-world challenges. While preliminary findings inform program developers, further research must explore clinical effectiveness.

Tell Me Your Story: Experiential learning using in-home interviews of healthy older adults.

To create a curriculum innovation for early preclinical medical students to explore personal perspectives by listening to and learning from the lived experience of community-living older adults. Tell Me Your Story (TMYS) paired first-year medical students (MS1s) with community-dwelling older adult partners (OAPs) residing in the independent living portion of a continuing care retirement community (CCRC) for a half-day educational experience. MS1s conducted 1-hour semi-structured interviews with their OAP and then formed small groups with geriatric faculty members to explore experiences and views that were either reinforced or challenged. The authors evaluated the effectiveness of this exercise using post-activity surveys. A mixed-methods analysis of 7 years of data (2013-2019) was conducted. TMYS had 1251 MS1 participants from 2013 to 2019. Students completed 1052 surveys for a response rate of 84%. During the semi-structured interview with OAP, the frequency of issues discussed included relationships (94%), professionalism/art of medicine (91%), healthcare accessibility (83%), death/dying/grieving/loss (72%), nutrition (69%), ethics (64%), and cultural competence (61%). Exactly 97% (n=1023) responded that the overall organization was "good, very good or excellent." The most prominent themes identified by student responses highlighted person-centered care, patient perspective, life experience/personal stories, and doctor-patient relationship. Fifty-three faculty members completed the post-program survey. Exactly 100% (53/53) rated the quality of this exercise as an educational experience high. TMYS was highly valued by students and provided an important experiential learning activity in preclinical medical education. Themes related to person-centered care emerged from the intervention.

Residential care in California: Spatial and temporal trends in facility development and care capacity

The development of residential care has not kept pace with the growth of the older population in many places. We merged the California Department of Social Services residential care for the elderly dataset with census place data to document the growth of facilities and beds per older adults in all of California and in its three largest cities. From 1996 to 2015, residential care steadily increased in California by the number of facilities and beds relative to older adults. However, due to a consistently increasing older adult population, the Cities of San Diego and San Jose experienced gradual and intermittent decline in capacity per older adults, respectively, even as they added many beds to their inventories from the sporadic development of large assisted living and continuing care retirement communities. Additionally, San Jose and Los Angeles exhibited the most overlap in densities of facility development and oldest old adults, with San Diego showing less intersection in cartographic analyses. Understanding facility development and care capacity trends can help local agencies and jurisdictions in the United States and other countries discern whether planning policies and other geographical and development factors appropriately encourage the development of residential care and other long‐term care facilities.

Yoga Balance: Decreasing Fall Risk in Seniors

<h3>Research Objectives</h3> To investigate the effect of yoga in decreasing fall risk for activities of daily living and community mobility in the senior population thru occupational therapy. <h3>Design</h3> Basic yoga poses related to primal movement were selected/ executed with NDT techniques; 1 year. <h3>Setting</h3> Continuing Care Retirement Community(CCRC). <h3>Participants</h3> 10 clients with inclusion criteria of age 80+, live in the CCRC, can include co-morbidities, joint replacements accepted. <h3>Interventions</h3> Example of pose: horse stance was selected because as children we have a wide base of support with hips in external rotation and equine stance. Overtime this integrates to a narrower base of support, external/ internal rotation equalizes, and equine stance becomes plantar. Utilizing poses that follow typical patterns allows for neuro plasticity to engage in a way it has before enhancing the progression of decreased fall risk as it relates to ADL's. Alignment is key when addressing posture and fall risk in occupational therapy as well as in Iyengar yoga. Used handling techniques, visual work (mirror), and verbal cueing. Cues were a combination of OT and yogic cues to create proper alignment. Handling promoted neck retraction, scapular depression/ stabilization, shoulder/ pelvic girdle anterior alignment, and knee/ ankle alignment. <h3>Main Outcome Measures</h3> Tinetti: scores increased by an average of 11 points. <h3>Results</h3> When used as an individual therapeutic intervention yoga postures with NDT regressive handling techniques increases the Tinetti score by an average of 11 points; proving a marked decrease of fall risk for ADL's in seniors. Secondary outcomes that were reported by patients included scoliosis curvature decrease, bladder control improvement, and an increased ability to orgasm. <h3>Conclusions</h3> With an average number of Tinetti score improvement by 11 for the total of 10 clients with no regression this study does prove that yoga is effective in decreasing fall risk in seniors. Due to our results we believe expanded studies utilizing yoga as an individualized intervention during therapy sessions is necessary to promote decreased fall risk in elderly patients. <h3>Author(s) Disclosures</h3> N/A.

There Is No Place Like Assisted Living: Can the Setting Evolve While Staying True to Itself?

There Is No Place Like Assisted Living: Can the Setting Evolve While Staying True to Itself?

Continuing care retirement community senior housing in Shanghai: an analysis of the development barriers

PurposeShanghai is currently faced with a rapid increase in the ageing population and demand for elderly homes. Continuing care retirement community (CCRC) has been emerging as a high-end alternative to offer specialised accommodation to the elderly in major cities. Since the first development in 2008, the industry is now still at the infancy stage. This study aims to examine the investment barriers hindering the supply and demand of CCRCs with an aim to recommend practical and senior housing policy measures to facilitate CCRC developments.Design/methodology/approachMultiple-case study method was used to confirm whether the literature findings on investment barriers apply to the context of Shanghai. Four representative CCRC development cases in Shanghai were examined, in which qualitative data were collected from interviews with experienced CCRC development managers and quantitative data from a questionnaire survey of the CCRC residents.FindingsOperation management experience, financial risks and government support policy were found to be the main supply barriers. Chinese traditional family-oriented culture and affordability were not the main demand barriers of CCRCs in Shanghai. Poor quality of services and living environment were identified as the main barriers suppressing the demand for CCRC.Research limitations/implicationsAlthough common trends and views can be drawn from the representative cases in Shanghai to provide valid results, further research should be conducted on other major cities in China so that the results can be widely applied.Practical implicationsSuccessful CCRC investment strategy should focus on partnering with experienced professional eldercare management companies, provisions of high-quality medical professionals and trained care personnel and delivery of flexible care service, along with intensive capital flows for land, construction and operating costs.Social implicationsAdditional senior housing policy support should be established to promote the CCRC supply to address the ageing needs, particularly granting lands for CCRC developments at Tiers 1 and 2 major cities where the land cost is high.Originality/valueThis research’s practical and policy measures can be applied to enable and promote CCRC developments in Shanghai, thus benefitting both housing investors and the government. The findings also form a baseline for CCRC developments in other major cities.

Testing of path-based visual cues on patterned carpet to assist older adults' gait in a continuing care retirement community

Fall accidents lead to hospitalization and medical costs among all age groups, especially severe for older adults. Both intrinsic (e.g., visual impairment, fear of falling) and extrinsic (e.g., inappropriate carpet design, poor lighting) factors contribute to fall accidents. Older adults increasingly rely on visual perception to maintain balance as their health conditions decline. Patterned carpet is common in the built environment, which is one of the factors contributing to fall accidents among older adults. This study examined the role of path-based visual cues (provide visual guidance while walking along the patterned carpet) in helping older adults maintain safe movement and overcome the fear of falling. The experimental field study was conducted at a Continuing Care Retirement Community. Thirty-two residents were recruited. Within-subjects design was employed to examine the effects of path-based visual cues (light color and brightness) on the gait characteristics of older adults with and without visual impairment while walking on patterned carpet. Wearable sensors collected older adults' gait characteristics and questionnaires were used to evaluate their perceptions of confidence and safety with different visual cues provided. Individual repeated measures analysis results indicated that older adults significantly decreased stride length and stride velocity under 8.3fc white and 7.3fc blue lighting conditions compared to the baseline condition. In addition, the principal component analysis also indicated significant differences in gait performance among lighting colors and lighting brightness. The subjective responses indicated that the path-based visual cues were helpful in improving walking confidence, particularly for older adults with visual impairment.

'We have become prisoners of our own age': from a continuing care retirement community to a total institution in the midst of the COVID-19 outbreak.

Background and objectivesduring the coronavirus disease 2019 pandemic in Israel, people residing in continuing care retirement communities (CCRC) found themselves under strict instructions to self-isolate, imposed by the CCRC managements before, during and after the nationwide lockdown. The present study explored the personal experiences of CCRC residents during the lockdown.Research design and methodsin-depth interviews were conducted with 24 CCRC residents from 13 different CCRCs. Authors performed a thematic analysis of interview transcripts, using constant comparisons and contrasts.Resultsthree major themes were identified: (i) ‘Us vs. them: Others are worse off’. Older residents engaged in constant attempts to compare their situation to that of others. The overall message behind these downward comparisons was that the situation is not so bad, as others are in a worse predicament; (ii) ‘Us vs. them: Power imbalance’. This comparison emphasised the unbalanced power-relations between older adults and the staff and management in the setting and (iii) ‘We have become prisoners of our own age’. Interviewees described strong emotions of despair, depression and anger, which were intensified when the rest of society returned back to a new routine, whilst they were still under lockdown.Discussion and implicationsthe measures imposed on residents by managements of CCRCs during the lockdown, and the emotional responses of distress among some of the residents, revealed that CCRCs have components of total institutions, not normally evident. This underscores the hidden emotional costs of the lockdown among those whose autonomy was compromised.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BackgroundContinuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data.ObjectiveThis study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions.MethodsContinuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes.ResultsDuring the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use.ConclusionsMost continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

The Six Dimensions of Resident Satisfaction and Their Impact on Word-of-Mouth (WOM) Intention in a Continuing Care Retirement Community (CCRC): A Case Study

The Six Dimensions of Resident Satisfaction and Their Impact on Word-of-Mouth (WOM) Intention in a Continuing Care Retirement Community (CCRC): A Case Study

Perceived barriers and contributors to sense of purpose in life in retirement community residents

AbstractDespite the growing use of retirement communities and ageing care facilities, little is known about how residing in retirement residences may impact aspects of older adult wellbeing. Living in these communities may hold particular influence on residents’ sense of purpose, if they feel limited in their opportunities for individual action, or could serve to promote purposefulness depending on the social connections available. The current study sought to explore contributing factors as well as barriers to purpose in older adults living in three continuing care retirement communities. Using brief semi-structured interviews, 18 older adults were asked to describe their purpose in life, community-related activities and any perceived challenges limiting their ability to pursue this purpose. Thematic analysis was used to examine themes common across interviews. Interviews presented a mixed picture of the nature of purposefulness in retirement facilities. Residents espoused several benefits of community living such as social and leisure opportunities, while also noting several obstacles to their purpose, including health concerns and the belief that purpose in life was not relevant for older adults. These findings provide insight into how older adults can derive a sense of purpose from activities within their retirement community and how facilities can better tailor programmes to promote purposefulness and support personally valued roles for residents.

Envy and Jealousy of Living-Apart-Together Relationships in Continuing Care Retirement Communities

Moving to a continuing care retirement community (CCRC) and living apart together (LAT) as a repartnering form, represent new late-life beginnings. A larger qualitative study on LAT relationships constructed in the CCRC identified envy and jealousy yet they were not examined in-depth. Envy is wanting something we lack whereas jealousy is fear of losing something that is ours to another. These emotions are rarely explored in the context of older adults’ relationships. Our aim is to examine experiences of envy and jealousy from perspectives of residents aged 79 to 96 and staff, heuristically using Goffman’s framework on (semi)-totalitarian institutions. 30 semi structured qualitative interviews were conducted in three CCRCs in Israel with 10 LAT residents, 10 residents not LAT, and 10 CCRC staff members including social workers. Analysis was conducted based on principles of thematic analysis and triangulation. Findings refer to kinds of envy, ignoring envy, and the development and consequences of jealousy and/or envy related to LAT in the CCRC. Conclusions address how semi-totalitarian CCRC features influence envy and jealousy experiences including implications for assisting social workers, older adults and their family members to adjust to life in the CCRC and assist CCRC management and staff to address possible consequences of envy and jealousy.

Association of Physical Activity, Muscle Mass, Strength, and Function to Quality of Life in Older Adults

Physical inactivity and loss of muscle mass, strength, and function are associated with negative outcomes including disability and a decline in health-related quality of life (HRQoL) among older adults. Older adults living in continuing care retirement communities (CCRCs) are at greater risk for declining physical activity and muscle outcomes compared to community-dwelling older adults. Few researchers studying the association of muscle and physical activity have examined the distinction between physical and mental HRQoL. Understanding the differential association of physical and mental HRQoL to physical activity and muscle outcomes can inform the development of useful interventions. The aim of this study was to examine the relationships between physical activity, muscle mass, strength, function and physical and mental HRQoL. Using a descriptive, correlational design, 105 older adults living in CCRCs were recruited. Light physical activity (LPA), moderate physical activity (MPA), sedentary behavior, and steps per day were assessed using ActiGraph GT3X. Appendicular skeletal muscle mass (ASMM) was assessed with bioelectrical impedance spectroscopy, handgrip strength with JAMAR Smart Hand Dynamometer, muscle function with the Short Physical Performance Battery (SPPB) test, and physical and mental HRQoL with the SF-36 questionnaire. The mean age of participants was 83 (SD=7.4). Using multiple regression models adjusted for sex and age, steps per day and SPPB score explained 38.4 % of the variance in physical HRQoL. Handgrip strength explained 8 % of the variance in mental HRQoL. These findings suggest that QoL improvement programs should include components to improve physical activity, muscle strength and function.