Institutional Permeability in Long Term Care

The public and academic image of residential long-term care in the U.S., particularly nursing facilities, is one of 'worlds apart,' places where older adults--separated from home, family, friends, and past lifestyles--become disengaged from society and await death. Pilot research in a rural nursing facility has questioned the inevitability of this image and suggested that, insofar as long-term care facilities are able to sustain a high level of institutional permeability (defined as the dynamic exchange of people, communication, and support between a long-term care facility and the community in which it is located), it is possible to enhance well-being and sustain a high quality of life by reinforcing continuity in resident's lives and maintaining links with the world beyond the doors of the facility. Little systematic research has investigated the concept of institutional permeability and its relationship to well-being in different kinds of long-term care environments. Using complementary quantitative and qualitative approaches, this study wilI: describe, measure, and compare manifestations, characteristics, and meanings of institutional permeability in an array of different nursing and assisted living facilities (urban-rural, ethnically diverse-ethnically homogeneous, small-large); investigate the relationship between institutional permeability and the psychosocial status of residents; and test and refine a theoretical model of institutional permeability. Quantitative datawilI be collected from a sample of 600 long-term care residents (300 from nursing facilities and 300 from assisted living facilities), their primary family members, and the staff persons most closely involved in their day-to-day lives. Interviews wilI be conducted at baseline, six-months, and one-year to tap dynamic aspects of institutional permeability. A growth curve modeling approach will be utilized to test a series of hypotheses regarding institutional permeability. The qualitative component will involve in-depth ethnographic research in two of the nursing facilities and two of the assisted living facilities. This will include monitoring the institutional permeability of 64 resident/family member/staff member constellations through participant observation, repeated in-depth semi-structured interviews, and event analysis. Case study and thematic analysis will facilitate integration of tIJe qualitative findings with those from the quantitative research. This study, the first in-depth investigation of institutional permeability, will not only develop new theory but also may lead to a reframing of the manner in which society views the relationship between long-term care facilities and their environmental contexts as well as the development of new strategies for enhancing the quality of life of elders in long-term care.