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.

Staff/Staffing

“You Gotta Have Your Cry”: Administrator and Direct Care Worker Experiences of Death in Assisted Living

Dec 1, 2022
Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and […]

“You Gotta Have Your Cry”: Administrator and Direct Care Worker Experiences of Death in Assisted Living

by Lea Efird-Green

Assisted living (AL) is increasingly a site of end-of-life care and a long-term care location where growing numbers of people are aging in place and dying. Despite these trends, limited research focuses on how death and grief impact the work environment in AL. This grounded theory analysis examined qualitative data collected from 27 administrators and […]

Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations

Dec 1, 2022
ObjectivesTo examine perceptions of patient safety culture (PSC) among assisted living (AL) administrators and direct care workers (DCWs), and their associations with state regulations. DesignWe conducted a survey using the PSC instrument developed by the Agency for Healthcare Research & Quality. Secondary data on ALs and residents were derived from the Medicare Master Beneficiary Summary […]

Patient Safety Culture in Assisted Living: Staff Perceptions and Association with State Regulations

by Lea Efird-Green

ObjectivesTo examine perceptions of patient safety culture (PSC) among assisted living (AL) administrators and direct care workers (DCWs), and their associations with state regulations. DesignWe conducted a survey using the PSC instrument developed by the Agency for Healthcare Research & Quality. Secondary data on ALs and residents were derived from the Medicare Master Beneficiary Summary […]

Staff Attitudes Related to Antipsychotic Prescribing in Assisted Living

Sep 1, 2022
Assisted living (AL) provides the majority of residential long-term care in the United States. Almost 40% of AL residents display behaviors such as aggression and refusing care, 57% of whom receive medications for these behaviors. In nursing homes, concerns about inappropriate antipsychotic prescribing led to initiatives to reduce prescribing, and although there has been concern […]

Staff Attitudes Related to Antipsychotic Prescribing in Assisted Living

by Lea Efird-Green

Assisted living (AL) provides the majority of residential long-term care in the United States. Almost 40% of AL residents display behaviors such as aggression and refusing care, 57% of whom receive medications for these behaviors. In nursing homes, concerns about inappropriate antipsychotic prescribing led to initiatives to reduce prescribing, and although there has been concern […]

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living

Aug 1, 2022
The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited […]

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living

by Lea Efird-Green

The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited […]

Factors Associated with the Quality of Staff-Resident Interactions in Assisted Living

Jun 1, 2022
Background Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral. Purpose The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL). Methods Regression analysis […]

Factors Associated with the Quality of Staff-Resident Interactions in Assisted Living

by Lea Efird-Green

Background Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral. Purpose The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL). Methods Regression analysis […]

“We Weathered the Storm”: A Qualitative Phenomenological Study of the Lived Experience of Assisted Living Administrators during the COVID-19 Pandemic

May 1, 2022
The purpose of the current qualitative phenomenological study is to learn about the lived experiences of assisted living (AL) community administrators during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about how administrators coped with the ever-changing mandates (e.g., visitation, testing, communal activities, acceptance of COVID-positive residents). Semi-structured interviews with AL administrators were conducted, […]

“We Weathered the Storm”: A Qualitative Phenomenological Study of the Lived Experience of Assisted Living Administrators during the COVID-19 Pandemic

by Lea Efird-Green

The purpose of the current qualitative phenomenological study is to learn about the lived experiences of assisted living (AL) community administrators during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about how administrators coped with the ever-changing mandates (e.g., visitation, testing, communal activities, acceptance of COVID-positive residents). Semi-structured interviews with AL administrators were conducted, […]

Bridging the Transition to Assisted Living: A Framework for Faith Community Nursing

Apr 1, 2022
The transition from independent living to assisted living is a significant life process that may be compared to crossing a bridge. Faith community nurses can support older adults through this transition. This article presents a conceptual meaning of transition, a framework with a spiritual dimension, and implications for Christian nurses. A case study illustrates how […]

Bridging the Transition to Assisted Living: A Framework for Faith Community Nursing

by Lea Efird-Green

The transition from independent living to assisted living is a significant life process that may be compared to crossing a bridge. Faith community nurses can support older adults through this transition. This article presents a conceptual meaning of transition, a framework with a spiritual dimension, and implications for Christian nurses. A case study illustrates how […]

Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families

Mar 1, 2022
Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness […]

Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families

by Lea Efird-Green

Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness […]

“What Keeps Me Awake at Night”: Assisted Living Administrator Responses to COVID-19

Mar 1, 2022
Background and Objectives Assisted living (AL) constitutes an important sector of residential long-term care, yet there has been limited research about the impact of the coronavirus disease 2019 (COVID-19) pandemic in this setting. This qualitative study sought to understand the impact of the early stages of the pandemic (February–August 2020) from AL administrators’ perspectives. Research […]

“What Keeps Me Awake at Night”: Assisted Living Administrator Responses to COVID-19

by Lea Efird-Green

Background and Objectives Assisted living (AL) constitutes an important sector of residential long-term care, yet there has been limited research about the impact of the coronavirus disease 2019 (COVID-19) pandemic in this setting. This qualitative study sought to understand the impact of the early stages of the pandemic (February–August 2020) from AL administrators’ perspectives. Research […]

Staff Reports of Behavioral Expressions of Persons with Dementia in 250 Assisted Living Communities 

Mar 1, 2022
Background and Objectives Assisted living (AL) residents with dementia commonly exhibit behavioral expressions (BEs), yet no study has examined how AL staff perceive and respond to BEs in terms of the “ABC” model of antecedents, behaviors, and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. Research Design and Methods […]

Staff Reports of Behavioral Expressions of Persons with Dementia in 250 Assisted Living Communities 

by Lea Efird-Green

Background and Objectives Assisted living (AL) residents with dementia commonly exhibit behavioral expressions (BEs), yet no study has examined how AL staff perceive and respond to BEs in terms of the “ABC” model of antecedents, behaviors, and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. Research Design and Methods […]

Assisted Living Administrators’ Approaches to Advance Care Planning

Feb 1, 2022
Objectives This project examined administrator processes, barriers, and facilitators for conducting advance care planning in assisted living. Method Data from qualitative interviews with 27 administrators from seven diverse assisted living communities in the metropolitan Atlanta area were linked with descriptive and administrative data collected from each site and analyzed using thematic analysis. Results Although administrators […]

Assisted Living Administrators’ Approaches to Advance Care Planning

by Lea Efird-Green

Objectives This project examined administrator processes, barriers, and facilitators for conducting advance care planning in assisted living. Method Data from qualitative interviews with 27 administrators from seven diverse assisted living communities in the metropolitan Atlanta area were linked with descriptive and administrative data collected from each site and analyzed using thematic analysis. Results Although administrators […]

The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

Feb 1, 2022
The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living […]

The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

by Lea Efird-Green

The purpose of this study was to describe differences in pain, behavioral symptoms, quality of staff-resident interactions, participation in function focused care and physical activity among residents with and without cognitive impairment in assisted living. This was a secondary data analysis using baseline data from an ongoing trial testing Function Focused Care for Assisted Living […]