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OBJECTIVES: To assess the staffing patterns of direct care nursing staff by shift in nursing homes (NHs), assisted living communities (ALCs), and their corresponding memory care units (MCUs). DESIGN: Observational study of the 2021 Ohio Biennial Survey of Long-Term Care Facilities and the Payroll-Based Journal data for December 2021. SETTING AND PARTICIPANTS: NHs (n = 678) and ALCs (n = 542) that reported staffing by shift in Ohio. METHODS: Resident-to-staff ratios in Ohio were calculated from staffing data. The proportion of daily nursing staff assigned to each shift was based on staffing data from the Biennial Survey for NHs and ALCs. Outcomes were calculated for aides and licensed nursing staff. RESULTS: Ohio's NHs and ALCs had lower resident-to-staff ratios on the day shift. Lower resident-to-staff ratios mean there were more staff per resident (ie, better staffed). For both types of staff and all shifts, overall resident-to-staff ratios were lower in NHs than ALCs. However, resident-to-staff ratios for ALC MCUs were on par with NH MCUs. This was consistent with ALC and NH MCUs staffing in a more similar manner. Across all settings, the day shift had the most staff members present, while a number of ALCs had no licensed nurses on duty during the overnight shift. CONCLUSIONS AND IMPLICATIONS: NHs and ALCs have different staffing patterns due to differences in resident needs. However, as ALCs provide for more residents that need NH level of care, ALCs may require additional staffing, especially on the overnight shift where some ALCs have no licensed nurses on duty. The evidence here can be used for decision making about future staffing policies, whether facility-wide policies that encompass MCUs or state-wide policies, so that care delivery aligns with care needs.

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Family caregivers may be at particular risk for social isolation and loneliness. Multiple factors can impact caregivers' health and well-being outcomes, including loneliness. Guided by an adaptation of the Stress Process Model of Caregiving, this study uses the 2019 National Survey of Older Americans Act Participants (NSOAAP)-Family Caregiver Support module to inform efforts to reduce loneliness through family caregiver support programs. A hierarchical multiple regression model reveals that caregivers who report more loneliness are more likely to be female, Hispanic, living alone, not a child or other caregiver of the care recipient, have a care recipient with 3+ ADL needs, experience more social life conflict related to caregiving, experience less joy in caregiving, feel less appreciated by the care recipient, feel less support in caregiving, and attend counseling. This study helps advance the goals of the National Strategy to Support Family Caregivers, and the findings underscore the importance of continuing and expanding efforts to address loneliness and related well-being outcomes among family caregivers.

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Loneliness is increasingly understood as a public health crisis, and older adults are experiencing particularly severe impacts. Social distancing efforts during the COVID-19 pandemic may have increased loneliness among older adults. Guided by the Social Ecological Model, this study uses two cross-sectional waves of the National Survey of Older Americans Act Participants (NSOAAP) from 2019 and 2021 to expand understanding and identify possible points of intervention to increase social support for vulnerable older adults. Results reveal that while home-delivered meal participants have higher levels of loneliness than congregate meal participants, levels of loneliness did not increase during the COVID-19 pandemic and their loneliness levels did not differ significantly by age, geographic location, or living arrangement. Congregate meal participants' loneliness increased during the first year of the pandemic, particularly for participants aged 65-74, those living in suburban or rural areas, and those living alone. These findings suggest opportunities for policymakers and aging services providers who seek to increase social engagement among older adults who participate in Older Americans Act (OAA) nutrition programs. The evidence suggests a need for increased social engagement initiatives through OAA programs that prioritize social support for groups who are disproportionately burdened by loneliness.

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OBJECTIVES: Home- and community-based services (HCBS) help older adults remain living safely in their homes by delaying or preventing the need for institutionalization. This analysis is guided by the Andersen Behavioral Model of Health Services Use to examine the association between informal support and use of HCBS. METHOD: Health and Retirement Study data from 2011 and 2012 are used in the bivariate analyses and multivariate logistic regression models to examine differences in HCBS utilization among extremely vulnerable older adults who have informal caregivers and those who do not. RESULTS: For extremely vulnerable older adults who report difficulties with any instrumental or basic activities of daily living, use of HCBS is not strongly associated with access to informal caregivers. However, for this same population of extremely vulnerable older adults, those who live alone have roughly 3 times the odds of using any HCBS compared to those who do not live alone. DISCUSSION: Among already vulnerable older adults, this study revealed that living alone is an important enabling factor of the Andersen Behavioral Model as applied in HCBS research. Further investigation is needed to see if more resources should be allocated to senior centers and local providers to identify vulnerable older adults who live alone and may have unmet needs.

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This study examines whether the delivery of three components, (a) exercise training, (b) behavior management skill building, and (c) dementia-related education, in an evidence-based program are differentially associated with changes in outcomes for individuals with dementia (IWDs) after 3 months. Data come from 508 IWDs participating in the community replication of the evidence-based "Reducing Disability in Alzheimer's Disease" program. Regression results indicate that after 3 months, more exercise sessions are associated with improvements in physical functioning, mobility, minutes exercising, and symptoms of depression; more dementia education sessions are related to fewer restricted activity days; and more behavior management sessions are related to more symptoms of depression. As resource-strapped agencies look to best serve participants, further analysis and consideration is needed to determine the ideal balance of program efficacy, feasibility, and resources, as well as program benefits for IWDs and caregivers.

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With a growing number of evidence-based programs, it is necessary to understand the translation activities, experiences, and challenges of program replication in a community setting. This article reviews the implementation tasks necessary for agencies to implement the Reducing Disability in Alzheimer's Disease (RDAD) intervention. It presents the importance of using original evidence-based program protocols and enhancing them to best fit service settings by reviewing the translation and implementation activities of (a) selecting and training program and supervisory staff; (b) recruiting, screening, and consenting participants to enroll in the program; and (c) developing a manual to guide community-based program replication. Furthermore, the process revealed that the replication of an evidence-based program can take place within the realities of a community setting with input from program oversight, implementation, and evaluation staff and the original researcher.

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There have been few replications of efficacious evidence-based programs for dementia caregivers offered in community settings. This study highlights the replication of the evidence-based Reducing Disability in Alzheimer's Disease program and explores the changes in outcomes for participating caregivers and whether those changes are related to level of program utilization. With data from 219 caregivers, regression results indicate that more exercise sessions are associated with a decrease in caregiver strain and more behavior management sessions are associated with a decrease in unmet needs after 3 months. Findings demonstrate how a multicomponent program can have positive benefits for family caregivers.

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This analysis assesses the activity level of 324 older adults and the relationship of activity to quality of life with a specific emphasis on the role of cognitive ability. Although the number of older adults with cognitive impairment continues to grow, few studies have examined the variation in activity and quality of life based on the older adults' cognitive status. Results indicated that cognitively impaired older adults were less active than their nonimpaired peers; however, correlations revealed that regardless of impairment status, more activity was related to a higher quality of life. There was no support for the hypothesis that impaired older adults who have more cognitive ability will have a higher rated quality of life. These results should be considered in the development of programs for older adults. Regardless of impairment level, activity is paramount to maintaining quality of life.

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PURPOSE: Individuals with dementia (IWDs) face particular challenges in managing and coping with their illness. The experience of dementia may be affected by the etiology, stage, and severity of symptoms, preexisting and related chronic conditions, and available informal and formal supportive services. Although several studies have examined particular features of IWD's illness experience, few draw upon a conceptual model that outlines the global illness experience and the resulting stressors that commence with symptom onset, proliferate over time, and continue through the later stages of cognitive loss. Building on the work of Pearlin and colleagues (1990, Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583-594), this article proposes a stress process model (SPM) for IWDs that conceptualizes and examines the illness experience of IWDs. IMPLICATIONS: The proposed SPM for IWDs serves as a guide to (a) consider and understand the short- and long-term complexities of the illness experience for IWDs, (b) investigate specific hypotheses by outlining key stressors in the illness experience and by positing relationships among stressors and outcomes, and (c) help inform the development of interventions to prevent or reduce the negative stressors and enhance the positive experiences of living with a dementing illness.

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Objective. This research was guided by a stress and support model to examine the effects of frontline workers' background characteristics, personal stressors, job-related stressors, and workplace support on satisfaction with supervision. Method. Survey data were collected from 644 workers in 49 long-term-care settings that employed them. Regression analysis were used to determine the effects of worker level and then Hierarchical Linear Modeling (HLM) and organizational factors on the outcome. Results. Although all four variable categories made significant contributions to explaining satisfaction with supervision, the most powerful were personal stressors and job-related stressors. Results from HLM analysis showed frontline workers in nursing homes and those employed in for-profit organizations had lower levels of satisfaction with supervision. Discussion. Findings suggest organizational interventions to address workers' financial and health issues and management practices such as better training programs and peer mentoring could enhance workers' satisfaction with supervision.

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PURPOSE: This research applies a stress and support conceptual model to investigate the effects of background characteristics, personal and job-related stressors, and workplace support on direct care workers' (DCW) job satisfaction. DESIGN AND METHODS: Researchers collected survey data from 644 DCWs in 49 long-term care (LTC) organizations. The DCWs included nurse assistants in nursing homes, resident assistants in assisted living facilities, and home care aides in home health agencies. We examined the influence of components of the LTC stress and support model on DCW job satisfaction. Initially, we ran a multiple regression analysis by entering individual-level DCW predictors with job satisfaction as the outcome. Subsequently, we used hierarchical linear modeling to examine the influence of organizational factors on DCW job satisfaction after controlling for significant individual-level DCW variables. RESULTS: Components of the model explained 51% of the variance in DCW job satisfaction. Background characteristics of DCWs were less important than personal stressors (e.g., depression), job-related stressors (e.g., continuing education), and social support (e.g., interactions with others) in predicting job satisfaction. Results from hierarchical linear modeling analysis showed that nursing homes compared to the two other types of LTC organizations had lower average DCW job satisfaction rates, as did organizations offering lower minimum hourly rates and those reporting turnover problems. IMPLICATIONS: Study findings underscore the importance of targeting both DCW-level and organizational-level factors to increase DCW job satisfaction.

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This report describes the development and preliminary psychometric properties of the Decision-Making Involvement Scale for individuals with dementia and family caregivers. Data were collected from 217 individuals with dementia and their respective caregivers. Principal axis factor analysis, Kendall tau, and Pearson correlations were used to determine the Decision-Making Involvement Scale's psychometric properties, mean differences of caregiver and individual with dementia, and the relationship between scores of Decision-Making Involvement Scale and measures of well-being. Analyses support a reliable, 1-factor solution of the Decision-Making Involvement Scale for both individuals with dementia and caregivers. Socio-demographic, impairment, and well-being variables are differentially related to the perceptions of how involved the individual with dementia is in decision making. The Decision-Making Involvement Scale provides useful information about daily decision making of an individual with dementia, and it shows promise as a means for understanding the relationship between decision-making involvement and well-being of individuals with dementia and caregivers.

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Training of direct care workers (DCWs) varies depending upon the setting in which they work and the state in which they are trained. Evidence points to the importance of adequate training as critical to DCW job satisfaction and reduction in turnover. Several approaches have been taken to enhance the training of DCWs with the objective that as job satisfaction increases, the quality of care provided to consumers will also be enhanced. Based on a sample of 644 DCWs across the nursing home, assisted living, and home health settings, we share DCWs' perceptions and recommendations for better training and continuing education.

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PURPOSE: Research underscores how autonomy and decision-making involvement may help to enhance the quality of life of older adults; however, individuals with dementia are often excluded from decision making that is related to their daily functioning. In this study we use a modified version of the Stress Process Model to consider the stress process of individuals with chronic illness, and in particular to explore the predictors of decision-making involvement among individuals with dementia (n = 215). DESIGN AND METHODS: We collected data from individual with dementia (IWD)-family caregiver dyads. Relying primarily on data from the IWD, we used hierarchical multiple regression analysis to determine the predictors of the IWD's decision-making involvement. RESULTS: Results indicate that individuals who report more decision-making involvement are younger, female, have more education, have a nonspousal caregiver, have fewer months since their diagnosis, exhibit fewer problems with activities of daily living and fewer depressive symptoms (based on caregiver report), and place more importance on autonomy/self-identity. IMPLICATIONS: In our discussion we examine the importance of autonomy and impairment levels for understanding the decision-making involvement of persons with dementia.

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