Visitors and Resident Autonomy: Spoken and Unspoken Rules in Assisted Living

Area of Science:

• Gerontology
• Sociology of Health and Illness
• Healthcare Management

Background:

• Resident autonomy is a critical aspect of quality care in assisted living (AL) settings.
• Understanding the influence of social interactions, such as visits, on autonomy is essential for improving AL environments.
• Existing research often overlooks the nuanced impact of visiting policies on resident independence.

Purpose of the Study:

• To explore the concept of resident autonomy within assisted living facilities.
• To investigate the effects of visitors and the visiting process on resident autonomy.
• To examine the formal and informal policies governing visiting in AL and their implications.

Main Methods:

• A multiyear ethnographic study was conducted across multiple assisted living sites.
• Data collection involved participant observation, informal and in-depth open-ended interviews with stakeholders, and detailed field note writing.
• Qualitative data analysis was facilitated by biweekly research team discussions and the use of Atlas.ti software.

Main Results:

• Ethnographic data revealed complex factors influencing visitors and visiting in AL.
• Formal and informal policies governing visiting were identified as key determinants of resident autonomy.
• Resident autonomy was observed to be either expressed or suppressed based on the rules surrounding visiting.

Conclusions:

• Inconsistent and confusing formal and informal visiting policies in AL settings significantly affect the relationship between visitors, resident autonomy, and overall quality of care.
• There is a critical need for standardized and clear visiting policies to support and enhance resident autonomy.
• Addressing policy ambiguities is crucial for ensuring resident well-being and independence in assisted living environments.