UCSF

Though discussions of well-being and quality of life for older adults in American nursing homes have flourished over the past decade, relatively few studies have explored these notions from the perspective of older residents themselves. The purpose of this research is to understand experiences and perceptions of "doing well" in older nursing home residents.

Using interview, observational and interpretive methods, this qualitative study explored the phenomenon of "doing well" from the perspective of frail older adults (>=65 years old) living in two nursing homes, one private for-profit and the other government sponsored. Data were collected in three overlapping phases: (a) initial interviews exploring the participants' experiences and perceptions of how well they are doing, (b) participant observation focusing on daily activities and experiences of residents and the environment of the nursing home, and (c) follow-up interviews to clarify understandings of doing well that surfaced during the initial interview and observation phases.

Data analysis resulted in identification of an over arching theme, bringing the past to the present, and three sub themes: (a) familiar territory, (b) family bonds, and (c) settled in. Major factors that facilitated doing well included advocacy, control of discomfort, and breaking the routine. Findings prompted fusion of reinterpreted concepts from the life course capital (LCC) discourse with Kayser-Jones' nursing home environment framework to develop a heuristic for understanding biographically informed resources that residents rely on to do well.

This study is a first step in understanding what it means for residents to "do well" in a structured long-term care setting. Discerning factors related to the experience of doing well may provide a foundation for development of health care policies and direct caregiver approaches that support the transition and adjustment of older adults to congregate living environments and contribute to subjective quality of life.