Informal Help in the Assisted Living Setting: A 1‐Year Analysis

Informal Help in the Assisted Living Setting: A 1-Year Analysis* Using statewide data from Oregon (N = 596 at baseline), this study compares informal help received by assisted living (AL) and nursing home (NH) residents over a I -year period. The analysis also identifies predictors of informal help among AL and NH residents with an expanded version of the Behavioral Model. Instrumental assistance (i.e., help with shopping, appointments, transportation) was more prevalent in the AL setting throughout the analysis. Regression models found multiple predictors of informal help among AL and NH residents (i.e., predisposing, enabling, and need characteristics). The results imply that the AL setting facilitates informal help provision; however, predictors of support are varied and require greater attention in future research. Key Words: assisted living, family caregiving, informal care, informal help. Over the past two decades, awareness of the different sources of care for disabled older adults has steadily increased. In particular, much research has explored informal (i.e., unpaid) support networks that provide the bulk of care to the chronically impaired elderly (Abel, 1987; Arno, Levine, & Memmott, 1999; Doty, 1986; Shanas, 1979). These support networks consist of relatives, friends, neighbors, and community volunteers. Informal care also encompasses a wide range of tasks, such as bathing, dressing, toileting, transferring in and out of bed, and assistance with walking, that are known as "activities of daily living" (ADLs), as well as assistance with shopping, medications, transportation, arrangement of appointments, and preparation of meals, known as "instrumental activities of daily living" (IADLs). Other kinds of help include supervision, psychological support, social and recreational activities, spiritual assistance, and even bureaucratic mediation (Albert, 1991). Most work on informal support focuses on elderly relatives living at home. Much less studied is the informal care that families provide to people living in congregate group settings, though a few efforts have recognized that informal care occurs and has serious implications for family members and residents in skilled nursing facilities (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995; Gaugler, Leitsch, Zarit, & Pearlin, 2000; Maas et al., 2000; Max, Webber, & Fox, 1995; Penrod, Kane, & Kane, 2000). How informal care provision is affected in other long-term care environments (such as assisted living) is not understood. This study has two objectives. First, we compare informal help over a 1-year period among assisted living and nursing home residents. In the current analysis, informal help refers to the uncompensated help and assistance older adults receive from family members or friends. Second, we determine the relevant predictors of informal help for assisted living and nursing home residents over a 1-year study period. Assisted Living as a Concept In several ways, the boundaries between home and institutional care have become blurred into a new form of congregate care, often called assisted living (AL). Shaped by state licensing laws and the market (Mollica, 2000), AL is generally defined as a residential setting not licensed as a nursing home (NH) where personal care and routine nursing services are delivered and arranged on a scheduled or unscheduled basis (Kane, 1995; Kane & Wilson, 1993). At their most "homelike," ALs are composed of privately occupied apartments with independence-enhancing features such as full bathrooms, kitchenettes, and locking doors. Residents control their space, furnishings, time, activities, and care plans within those apartments. More study is needed on how AL affects older adults' functioning and quality of life, though recent research shows benefits to residents and no harm related to the greater amounts of privacy, more normal environments, and lesser surveillance in AL (Frytak, Kane, Finch, & Kane, 2001; Mitchell & Kemp, 2000; Pruchno & Rose, 2000). …