Center for Excellence in Assisted Living CEAL@UNC

Advancing the well-being of the people who live and work in assisted living through research, practice, and policy.

Mental Health

Attachment Behaviours in Adults with Intellectual Disabilities in Assisted Living Facilities: Representations from Direct-Care Staff

Jun 1, 2023
WHAT THIS MEANS FOR YOU: In this study, 19 support staff from 7 assisted living communities in Belgium were interviewed to understand about how adults with intellectual disabilities related to these staff. Themes revealed that staff often struggled finding a balance between supporting select attachment behaviors and maintaining a professional distance from residents to prevent negative impact on their work.

Attachment Behaviours in Adults with Intellectual Disabilities in Assisted Living Facilities: Representations from Direct-Care Staff

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In this study, 19 support staff from 7 assisted living communities in Belgium were interviewed to understand about how adults with intellectual disabilities related to these staff. Themes revealed that staff often struggled finding a balance between supporting select attachment behaviors and maintaining a professional distance from residents to prevent negative impact on their work.

“I Have a Lotta Sad Feelin'” – Unaddressed Mental Health Needs and Self-Support Strategies in Medicaid-Funded Assisted Living

Jun 1, 2023
WHAT THIS MEANS FOR YOU: This study investigated mental health needs and barriers among residents at Medicaid-funded AL communities. At one AL community in the Bronx, 13 residents completed questionnaires and interviews; analysis revealed patterns of mental health needs, feelings of losing control, mistrust of organizational staff, and lack of resources and support.

“I Have a Lotta Sad Feelin'” – Unaddressed Mental Health Needs and Self-Support Strategies in Medicaid-Funded Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study investigated mental health needs and barriers among residents at Medicaid-funded AL communities. At one AL community in the Bronx, 13 residents completed questionnaires and interviews; analysis revealed patterns of mental health needs, feelings of losing control, mistrust of organizational staff, and lack of resources and support.

Well-being of professional older adults’ caregivers in Alberta’s assisted living and long-term care facilities: a cross-sectional study

Feb 1, 2023
WHAT THIS MEANS FOR YOU: A study in AL and other long-term care communities in Alberta assessed nurses’ and professional care aides’ physical, mental, and emotional health, behavior, stress, quality of life, turnover, and absenteeism. Mental and emotional health, quality of life, and stress related to turnover and absenteeism. Although 68% of caregivers reported being satisfied with their general health, they experienced heavy workloads and high stress. These issues may result in decreased job satisfaction, absenteeism, and higher turnover.

Well-being of professional older adults’ caregivers in Alberta’s assisted living and long-term care facilities: a cross-sectional study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A study in AL and other long-term care communities in Alberta assessed nurses’ and professional care aides’ physical, mental, and emotional health, behavior, stress, quality of life, turnover, and absenteeism. Mental and emotional health, quality of life, and stress related to turnover and absenteeism. Although 68% of caregivers reported being satisfied with their general health, they experienced heavy workloads and high stress. These issues may result in decreased job satisfaction, absenteeism, and higher turnover.

Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada

Dec 1, 2022
WHAT THIS MEANS FOR YOU: Surveys from 673 assisted living direct caregivers revealed that coping behaviors such as alcohol and smoking/cannabis use, and psychotropic drug use increased during the first two waves of the COVID-19 pandemic and were more common among caregivers who had anxiety or depression symptoms before the pandemic. These caregivers are thus particularly vulnerable to negative coping behaviors during stressful events and may require additional support.

Coping Behaviors and Health Status during the COVID-19 Pandemic among Caregivers of Assisted Living Residents in Western Canada

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Surveys from 673 assisted living direct caregivers revealed that coping behaviors such as alcohol and smoking/cannabis use, and psychotropic drug use increased during the first two waves of the COVID-19 pandemic and were more common among caregivers who had anxiety or depression symptoms before the pandemic. These caregivers are thus particularly vulnerable to negative coping behaviors during stressful events and may require additional support.

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel

Sep 1, 2022
Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus […]

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel

by Lea Efird-Green

Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents’ medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus […]

Caregivers’ Concerns about Assisted Living Residents’ Mental Health during the COVID-19 Pandemic: A Cross-Sectional Survey Study

Sep 1, 2022
WHAT THIS MEANS FOR YOU: Surveys with 673 caregivers from Western Canada found that concerns about residents' depressed mood, loneliness, and anxiety doubled three months after the COVID-19 pandemic started, compared with three months before the pandemic. Factors that may alleviate concerns in the future include improving residents' access to counseling services and better informing caregivers about resident care.

Caregivers’ Concerns about Assisted Living Residents’ Mental Health during the COVID-19 Pandemic: A Cross-Sectional Survey Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Surveys with 673 caregivers from Western Canada found that concerns about residents’ depressed mood, loneliness, and anxiety doubled three months after the COVID-19 pandemic started, compared with three months before the pandemic. Factors that may alleviate concerns in the future include improving residents’ access to counseling services and better informing caregivers about resident care.

Prevalence and Correlates of Anxiety and Depression in Caregivers to Assisted Living Residents during COVID-19: A Cross-Sectional Study

Aug 1, 2022
WHAT THIS MEANS FOR YOU: A study of 673 family and friend caregivers of residents in AL from two Canadian provinces from Oct 2020 – Mar 2021 found that 29% had clinically significant anxiety and 39% had clinically significant depression. Caregivers who faced personal stressors such as health issues, reduced income, and lack of social support, along with concerns about residents due to COVID-19, were more likely to experience anxiety and depression. Healthcare providers and assisted living staff should be aware of caregivers' mental health challenges during public health crises and provide appropriate screening and support.

Prevalence and Correlates of Anxiety and Depression in Caregivers to Assisted Living Residents during COVID-19: A Cross-Sectional Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A study of 673 family and friend caregivers of residents in AL from two Canadian provinces from Oct 2020 – Mar 2021 found that 29% had clinically significant anxiety and 39% had clinically significant depression. Caregivers who faced personal stressors such as health issues, reduced income, and lack of social support, along with concerns about residents due to COVID-19, were more likely to experience anxiety and depression. Healthcare providers and assisted living staff should be aware of caregivers’ mental health challenges during public health crises and provide appropriate screening and support.

A Home, an Institution and a Community – Frames of Social Relationships and Interaction in Assisted Living

Aug 1, 2022
WHAT THIS MEANS FOR YOU: Through qualitative observations of an AL community and interviews with ten residents, those who perceived the assisted living community as a home reported more meaningful, informal relationships. When the community was perceived as an institution, residents reported impersonal, formal interactions.

A Home, an Institution and a Community – Frames of Social Relationships and Interaction in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Through qualitative observations of an AL community and interviews with ten residents, those who perceived the assisted living community as a home reported more meaningful, informal relationships. When the community was perceived as an institution, residents reported impersonal, formal interactions.

Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters

Aug 1, 2022
WHAT THIS MEANS FOR YOU: Data from a national survey of 2,651 assisted living residents found that approximately 35% moved to assisted living from an acute/post-acute facility; they were more likely to have depression compared to those moving from community-based residences.

Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Data from a national survey of 2,651 assisted living residents found that approximately 35% moved to assisted living from an acute/post-acute facility; they were more likely to have depression compared to those moving from community-based residences.

Interactions, Relationships and Belonging: Comparing Social Connectedness and Perceived Isolation among Older Women Living Alone in Private Homes and in Assisted Living

Jul 1, 2022
WHAT THIS MEANS FOR YOU: This qualitative study of social connections among 16 women aged 75 and older found that those living in the community focus on feeling connected to the world at large, while those in assisted living have more casual interactions and feel like they are a part of the community. Most women in both groups did not experience perceived isolation; they had adjusted their expectations about socializing to fit their living situation.

Interactions, Relationships and Belonging: Comparing Social Connectedness and Perceived Isolation among Older Women Living Alone in Private Homes and in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This qualitative study of social connections among 16 women aged 75 and older found that those living in the community focus on feeling connected to the world at large, while those in assisted living have more casual interactions and feel like they are a part of the community. Most women in both groups did not experience perceived isolation; they had adjusted their expectations about socializing to fit their living situation.

Yoga Practice as a Coping Strategy for Older Adults in Assisted Living Facilities: A Qualitative Content Analysis

Jun 1, 2022
WHAT THIS MEANS FOR YOU: This study explored how 15 residents of 4 assisted living communities used yoga as a coping strategy during and after an 8-week yoga intervention. Qualitative interviews indicated that residents found yoga helpful for relaxing, felt more energized, and that it helped connect them with others.

Yoga Practice as a Coping Strategy for Older Adults in Assisted Living Facilities: A Qualitative Content Analysis

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study explored how 15 residents of 4 assisted living communities used yoga as a coping strategy during and after an 8-week yoga intervention. Qualitative interviews indicated that residents found yoga helpful for relaxing, felt more energized, and that it helped connect them with others.

Exploring the Effectiveness of Virtual Compassionate Presence Sessions in Reducing Loneliness and Isolation among Assisted-Living Older Adults: A Pilot Study

Mar 1, 2022
WHAT THIS MEANS FOR YOU: A pilot study investigated the effectiveness of virtual compassionate presence (CP) sessions in reducing loneliness and isolation among older adults in AL when facilitated by college students trained in CP. CP involves deep, attentive, and nonjudgmental listening while being fully present. Eighteen older adults participated in CP sessions over 10 weeks and were interviewed 2 months after the last session. Semi-structured interview results revealed a self-reported decrease in participants’ feelings of isolation and loneliness and an increase in overall mood.

Exploring the Effectiveness of Virtual Compassionate Presence Sessions in Reducing Loneliness and Isolation among Assisted-Living Older Adults: A Pilot Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A pilot study investigated the effectiveness of virtual compassionate presence (CP) sessions in reducing loneliness and isolation among older adults in AL when facilitated by college students trained in CP. CP involves deep, attentive, and nonjudgmental listening while being fully present. Eighteen older adults participated in CP sessions over 10 weeks and were interviewed 2 months after the last session. Semi-structured interview results revealed a self-reported decrease in participants’ feelings of isolation and loneliness and an increase in overall mood.

“You Lose Some Good Friends”: Death and Grief in Assisted Living

Mar 1, 2022
WHAT THIS MEANS FOR YOU: In a qualitative study including interviews with 18 residents in 21 assisted living communities, as well as reviews of community documents and observational field notes, residents reported that staff communication and community-level memorials following residents’ death were not consistent with a “family-like” atmosphere, and residents’ grief took many forms.

“You Lose Some Good Friends”: Death and Grief in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In a qualitative study including interviews with 18 residents in 21 assisted living communities, as well as reviews of community documents and observational field notes, residents reported that staff communication and community-level memorials following residents’ death were not consistent with a “family-like” atmosphere, and residents’ grief took many forms.