Choosing an Adult Foster Home or a Nursing Home: Residents' Perceptions about Decision Making and Control

Representative samples of 260 Oregon foster care residents and 179 cognitively intact nursing home residents were queried retrospectively about the nature and circumstances surrounding their decision to move to a foster care or nursing home, including the alternatives they considered, the circumstances leading to the move, their perception of the decision-making process and who influenced it, the characteristics important to them in choosing the care environment, and their perception of their own control over the move. Statistically significant differences were identified in the characteristics of the setting that each group deemed important, the circumstances surrounding the decision, the people influencing it, and the perceived control over the decision. Key words: adult foster care; control; decision making; long-term care; nursing homes Given the current emphasis on cost containment, quality of life, and alternatives to nursing homes for older people with long-term care needs, family-like settings (often called adult foster care programs) are an appealing policy option for cost and quality considerations. Yet compared with their knowledge about nursing homes, policymakers' and practitioners' knowledge about adult foster care programs, their clientele, and, in particular, the decision to enter such a residential setting is scant. This article explores the circumstances of the decision to move to a foster home rather than a nursing home through the retrospective perceptions of cognitively intact residents who had moved to each setting. We take as a given that the decisions to move to any residential long-term care setting are complex and multiply determined and made in a social context where family members and others have potential to influence those decisions. This article also examines what residents consider important in seeking a care setting, aspects of the decision-making process, and the residents' sense of control over that decision. Of particular interest is how the decision-making process might influence resident satisfaction and social participation in either care site. Social workers are involved as advisors to older people and their families as they make life transitions--and particularly to those making such transitions from hospital settings. Any systematic information about care decisions for options less known than the nursing home should help refine social work practice. Nursing Homes Nursing homes are well known to health and social services professionals as the long-term care service for elderly people that accounts for the vast majority of public funding. A nursing, home is defined, somewhat circularly, as a residential health care facility that meets the federal requirements for certification for payment under Medicare and Medicaid and any additional state licensure requirements. These standards have evolved since their initial enactment in 1965, particularly since the implementation of the Nursing Home Reform Act of 1987 (P.L. 100-203), which grew out of the Institute of Medicine (1986) report on the quality of nursing homes. Nursing home standards are organized in categories such as administrative practices, environmental concerns, quality of care, quality of life, residents' rights, and infection control. Federal regulations that articulate some minimum nursing standards and staffing standards for training of nursing assistants also have been enacted. Within these requirements, nursing homes vary in size and other attributes. For the most part, however, they are modeled on hospitals, with the preponderance of accommodations being shared and a predominance of nursing routines (Gamroth, Semradek, & Tornquist, 1995; Kane & Caplan, 1990). Adult Foster Care Although adult foster care in the United States has been traced back to colonial times, when boarding homes provided meals and laundry, foster care specifically for older adults with disabilities is a fairly recent development (Sherman & Newman, 1979). …