It would seem that conversations around quality of life get louder as we age.  How do we adjust to changing abilities of aging parents, partners with complex health needs or our own challenges? Assisted living or long-term care facilities often come into play when physical limitations, health concerns and memory challenges such as dementia pose a challenge to living independently. And quality of life when one can no longer live independently is what University of Lethbridge associate professor Dr. Carla Carnaghan with her colleague Dr. Helen Kelley from the Dhillon School of Business sought to explore.

Carla has an undergraduate degree in health information science, a Ph.D. in business administration (accounting) and a working history with Alberta Health. She was one of a few faculty members from the U of L approached by an organization to study quality of care and life in assisted living versus traditional long-term care facilities. With a vested interest in health and organizational performance and effectiveness, Carla took on the project which culminated in conference presentations in Japan and Nova Scotia.

Here Carla reveals answers to 5 Questions on the differences between assisted living and long-term care residences, the challenges those facilities face, ways to improve quality of life for seniors and more.

1. Can you explain the underlying differences between assisted living and traditional long-term care models?

The main principle of assisted living is that it emphasizes greater autonomy and privacy. The intent is to give residents more control over their daily lives and environment. This might include for example, letting individuals make decisions about when they get up, when they have meals, allowing them to keep the doors in their room closed and choose their furnishings.  Assisted living typically provides less health care supports, as individuals are assumed to have less complicated health care needs.

More traditional long-term care focuses more on maintaining health and places less emphasis on autonomy.  This may mean for example that someone’s diet is more constrained to healthier choices, or their furnishings may place more emphasis on avoiding tripping hazards. There is an assumption that residents have more challenging health care needs and there are more health care supports, including more use of staff with greater health care training.

In practice, these models form a continuum, which is reflected in Alberta’s current continuing care model, where residents move from assisted living to nursing homes as their care needs increase.

2. What factors effect quality of life for seniors living in residences?

Health care systems used to view quality of life for the elderly from more of a medical perspective, meaning that the absence of illness was key. Later research has shown that many individuals feel like they have good quality of life even when they have significant health problems, and more modern approaches emphasize enjoying life. Thus, while health problems can certainly affect quality of life for seniors, other factors that are important include feeling happy, having good seeing and hearing and energy levels.

Our research suggests that autonomy (feeling like you have control over your life) may be the most important factor in residents feeling like they have good quality of life. Regardless of whether individuals have low, medium or high health status, if they feel like they have more autonomy, they tend to report higher quality of life. Being able to maintain daily routines and participate in leisure activities are also important.

3. Quality of care is also an essential factor when choosing a supportive living residence. What factors should be considered when assessing the care residents will receive?

Quality of care plays a very important role in quality of life, but needs to be seen as going beyond health care. Having pleasant interactions with staff and other residents, being treated with respect and a feeling of belonging can all be important aspects of quality of care.

4. What are some of the challenges facing the supportive living sector that we should be aware of?

Research shows that individuals are tending to stay in their homes longer as they age and are therefore often more frail and sick by the time they move into assisted living. This can lead to assisted living having to emphasize health supports to a greater extent. This may make it more challenging to continue to provide residents autonomy, particularly as resources get more constrained.

One of the factors driving this change may be increased supports for individuals staying in the community which allows individuals to stay in their own places or with family longer, but means they tend to be more ill by the time home supports are no longer sufficient. To the extent that staying in the community increases autonomy however, this likely means better quality of life for the elderly.

5. What might help seniors adjust to their changing abilities as they age?

Research related to successful aging indicates that seniors can adopt a number of strategies to adapt to their changing abilities. To start, learning to focus on high priority interests and needs rather than continuing to try to do everything one used to. For example, it may be helpful to focus on a particular hobby that one enjoys, rather than trying to continue to do all the cooking and cleaning as well. It’s also helpful to continue to challenge oneself in ways that enrich life. For example, learning a new hobby or joining a new club may be part of continuing to grow. Another strategy would be learning to compensate for loss of abilities. Compensation may include hearing aids, using notes as reminders or acquiring a tablet to stay in touch with family when driving becomes more difficult.

Dr. Carla Carnaghan

Dr. Carla Carnaghan is an Associate Professor of Accounting and the Director of Graduate Programs for the Dhillon School of Business.  She has an undergraduate degree in Health Information Science from the University of Victoria and received her Ph.D. in Business Administration (Accounting) from the University of Alberta. Dr. Carnaghan is also a Certified Management Accountant (CMA) and Chartered Professional Accountant (CPA). She has conducted research related to financial disclosure, earnings management and financial literacy, with her most recent research (done with Dr. Helen Kelley of the Dhillon School of Business) examining quality of life and quality of care in assisted living residences versus more traditional long-term care residences. You can explore more about Carla and her research here.