Communicative Competence: Responding to Residents’ Health Changes in Assisted Living

• Published in: The Gerontologist 2020-05, Vol.60 (4), p.754-764
• Main Authors: Kemp, Candace L, Ball, Mary M, Jason, Kendra, Appel, Joy Anna Dillard, Fitzroy, Andrea F
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Assisted living facilities; Assisted Living Facilities - standards; Caregivers; Communication; Communication in Health Care; Competence; Delivery of Health Care; Disability; Disabled Persons; Female; Frailty; Grounded Theory; Health research; Health services; Health Status; Humans; Long term health care; Male; Middle Aged; Older people; Patient Care; Patient Care Team - standards; People with disabilities; Primary care
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/gnz119

Abstract Background and Objectives Frail and disabled individuals, including assisted living (AL) residents, are embedded in care convoys composed of dynamic networks of formal and informal care partners. Yet, little is known about how care convoys operate over time, especially when health changes occur. Thus, our aim was to provide an in-depth understanding of care convoy communication during times of residents’ health changes in AL. Research Design and Methods Data for this analysis come from a Grounded Theory study that involved 50 residents and their care convoy members (n = 169) from 8 diverse AL communities followed over 2 years. Researchers conducted formal and informal interviewing, participant observation, and record review. Results We identified “communicative competence” as an explanatory framework in reference to a resident’s or care partner’s ability, knowledge, and action pertaining to communication and health change. Individual and collective competencies were consequential to timely and appropriate care. Communication involved: identifying; assessing significance; informing, consulting or collaborating with others; and responding to the change. Variability in communication process and properties (e.g., pace and timing; sequencing, timing, content, and mode of communication) depended on multiple factors, including the nature of the change and resident, informal and formal caregiver, convoy, AL community, and regulatory influences. Discussion and Implications Formal and informal care partners need support to establish, enhance, and maintain communicative competence in response to health changes. Findings reinforce the need for timely communication, effective systems, and well-documented accessible health care directives and have implications that are applicable to AL and other care settings.