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Age-related changes shape social connectedness, isolation and loneliness among older adults. Ageing often accompanies decisions about ageing in place or moving (i.e. senior living facility). Scant research compares these two living arrangements and even sparser research focuses on older women. This study, thus, poses the following questions: How do older women (aged 75+ years) experience social connectedness and perceived isolation? How does this experience vary between older women living alone in private homes and those living in assisted living facilities? Data include semi-structured interviews with women aged 75+ years who live alone in a private home or in an assisted living facility (N = 16). Findings revealed differences in three aspects of social connectedness: interactions, relationships and belonging. Private home participants' interactions underscored intentionality, with minimal investment in forging new or deeper relationships and an emphasis on belonging to the world through awareness, contribution and cognitive ability. The experiences of participants living in assisted living were characterised by availability of interactions and casual relationships. They emphasised belonging to the facility community, while positioning themselves between the status of resident and staff. Surprisingly, most participants in both groups did not express feelings of perceived isolation. Both had adapted their social connectedness expectations to reflect their current situation.

Health care rights for transgender and/or nonbinary people have dramatically expanded in recent years, including in insurance coverage for the treatments and procedures they need. Yet, trans people themselves still identify health insurance problems as a top priority for research and policy change because of significant difficulties gaining and using coverage. Wrangling over coverage determinations happens through multiple types of interactions, bureaucratic, interpersonal, and medical. When these interactions become difficult, it is because key terms such as medical necessity are both powerful and indeterminate. This study examines how trans people and health care intermediaries navigate the health insurance process and contest the meaning of medical necessity in coverage determinations. These disputes constitute the ground-level reality for instantiating health care rights to gender affirming care. Relying on analysis of contract language and 32 interviews with people who sought gender-affirming care and allied professionals, we find that health insurance policy language, interpretation, and implementation often create disadvantages and barriers for trans people who attempt to access care. Our study highlights how the contested life of insurance policy terminology produces a reality for rights but also details the mechanisms through which insurance-mediated care is a socially contested and negotiated process

Black gay and bisexual older men face numerous barriers across the life course that can contribute to negative health and well-being as they age. Drawing on strengths-based social determinants discussed in the health literature and literature on intersectionality, justice, and critical consciousness, this study examines qualitative data from seventeen Black gay and bisexual older men about sources and strategies of resilience and thriving amidst intersecting systems of power and oppression that shape health inequities. The findings revealed an evolution of positive support networks across their life courses, including biological family and families of choice such as “houses” and support groups. Early and ongoing negative experiences relating to intersecting positionalities (e.g., race, gender, sexual orientation) also provided sources of strength and resilience. Participants identified three strategies for building resilience and thriving: naming external ignorance, acknowledging common struggles, and reconciling contradictions. These strategies reflected various levels of critical consciousness that helped them navigate complex and intersecting systems of power that they encountered as Black gay men across the life course. Overall, the findings underscore the importance of considering intersecting systems of power and critical consciousness when examining resilience and social determinants of health and contribute new insights on a vastly understudied population.

Lesbian, gay, bisexual, and transgender (LGBTQ +) older adults face heightened risks of social isolation, given decades of discrimination. Research on telephone buddy programs with non-LGBTQ + participants has proved predominantly unsuccessful at addressing social isolation. However, evidence suggests that LGBTQ + adults may actually benefit from telephone buddy programs and in ways uniquely different from other groups. This article shares lessons learned from 35 participants across a 12-month pilot program that matched LGBTQ + older adults to mostly LGBTQ + volunteer callers of various ages. Over one-third of participants identified as people of color and over 20% as transgender or gender nonbinary. This project employed community-based participatory action research to identify, implement, and evaluate the program. Data includes information from questionnaires and telephone interviews prior to and during the program. Nearly all participants identified the importance of LGBTQ + community in addressing social isolation and loneliness. Intergenerational matches also provided promising findings for making connections. While the project aimed to capture two groups (LGBTQ + older adults experiencing isolation and volunteer callers providing support), the project revealed a third group: LGBTQ + older adults at risk of social isolation. This third group usually emerged among the “Volunteer” callers who identified concerns about their own social isolation. The persistence of structural barriers also required the program to adapt to best meet participant needs. This article concludes with lessons learned and clinical implications for social workers who are addressing social isolation and loneliness among LGBTQ + older adults.

Abstract Background and Objectives While research on transgender older adults and health is growing, gaps remain about transgender older adults of color, immigrants, and other groups experiencing multiple forms of marginalization who are shaped by concurring experiences of oppression across the life course. This article aims to address these gaps by examining health challenges and supports among transgender older adults—many of whom are racially minoritized and immigrants—through an Equitable Aging in Health framework. Research Design and Methods This community-driven study incorporates qualitative data from 37 transgender older adults from a larger study of 23 focus groups with 208 lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) older adults in California to examine challenges, thriving and surviving strategies, and recommendations regarding health, housing, social services, and caregiving. Data foreground experiences of transgender older adults who are racially underrepresented, immigrants, and have low incomes. Results Transgender older adults identified challenges related to healthcare access, housing, employment, economics, and violence that often intersected with disability and aging. Transgender older Latina immigrants experienced elevated challenges related to language barriers, immigration status, and discrimination. Supports included community connections, financial and legal assistance, educational workshops, and homesharing programs. Healthcare access, health experiences, and overall well-being were intricately tied to challenges and supports in housing, social services, healthcare systems, and employment that existed at micro, mezzo, and macro levels. Discussion and Implications The Equitable Aging in Health framework helps illuminate how challenges and supports described by transgender older adults, including immigrants and older adults who are racially minoritized, can shape health-related experiences for transgender older adults. Policies, services, and programs targeting transgender older adults, thus, would benefit from a multi-level, multi-systems approach.

Abstract Conflicting rights arise often in nursing homes among residents, staff, and family. Nursing home social workers sit at a unique nexus of these rights, given their macro, mezzo, and micro-level training. This study employs a multi-method qualitative design with semi-structured staff interviews (n=90) (direct care, mid-level professional, top management), content analysis of long-term care facility policies (n=376), and ethnographic observation of two facilities (n=8 months) for a multi-layered cross-comparative in-depth case study. While social workers represented only a very small number of the overall nursing home workforce, data revealed the overwhelming reliance on social workers to resolve conflicting rights that arose among residents, staff, and family. Certified nursing assistants, nurses, directors, and administrators regularly deferred to social workers via written policies and unwritten practices to resolve a variety of issues, including discrimination concerns by staff, residents, or family, concerns about quality of care and workforce shortage, and concerns about conflicting rights to resident autonomy, dignity, medical decision-making, and safety (e.g., bed rails). Staff at all levels and professions described the emotional labor and unique professional experience that these conflicts required and felt ill-equipped to resolve these issues. While social workers resolved most of these conflicts, they, too, reported feeling ill-prepared for this role and worried about out-of-scope practice. Ultimately, they relied on their social work training in systems-level change, case management, and interpersonal communication to resolve conflicting rights. This presentation will discuss social worker challenges as informal legal intermediaries and opportunities for better support and training.

Abstract Long-term care regulations require staff to keep residents safe while also respecting their autonomy. Building on street-level bureaucracy theory (Lipsky, 2010), which focuses on how front-line workers use discretion to implement ambiguous policies, this study examines how staff at various levels (floor staff, mid-managers, top management) balance these rights. This study employs a multi-method qualitative extended comparative case study of three levels of staff in two long-term care facilities (independent, corporate structure). Data includes in-depth semi-structured staff interviews (n=80), participant observation (n=8 months), and review of facility policy documents (n=376) and legal data (i.e., laws and regulations). Autonomy and safety presented conflicting rights for staff in three situations: fall prevention, food intake/refusal, and medication management. Staff exercised discretion via interpersonal conversations, documentation, and organizational lenses/resources and used interprofessional team approaches across staff hierarchies, especially among floor staff and mid-managers. Even when upper-managers sought external guidance (e.g., attorneys/risk managers), they deferred to the discretion of floor staff and mid-managers to communicate and implement decisions. Team approaches across staff hierarchy were less common when conflicting rights arose in medication management. Differences in organizational structure became relevant only when conflicting rights regarding autonomy and safety arose for food intake. This presentation will discuss the study’s strategies for employing coding teams and data software to analyze large datasets across diverse methodological approaches. It will also discuss ethical dilemmas with sharing large qualitative datasets as secondary data of populations deemed “vulnerable” by IRB.

Abstract Conflicting rights between residents with dementia and staff pose unique problems for quality of care in long-term care (LTC) facilities. Residents relying on staff for care may be afraid to express concerns. A disproportionate female (and often women of color) staff may be exposed to discrimination that stems from a resident's loss of executive functioning and inability to control emotions. Family often find themselves somewhere in the middle. This study, thus, poses two research questions: (1) How do residents, families, and LTC staff understand their rights when conflicts arise between residents with dementia and staff?; (2) How can we leverage collective expertise of residents, families, and LTC staff to deliver a more holistic approach for addressing these conflicts? To answer these questions, I employed a multi-method qualitative design using semi-structured interviews (n=90) and participant observation (n=8 months). Building on legal consciousness theory-which explains how individuals invoke (or do not invoke) legal principles to define everyday experiences-findings revealed that staff rarely invoked legal framings to describe interactions whereas residents readily invoked rights rhetoric. Families mostly avoided rights rhetoric and instead focused on storytelling. All groups (residents, staff, and families) employed an array of emotional literacy and life experiences to navigate conflicts that coalesced around empathy. This paper concludes with research, policy, and practice suggestions for invoking principles of empathy to advance quality of care for residents with dementia by improving interactions among residents, staff, and family and workforce conditions for staff that flow from these interactions.

Abstract Nursing homes (NHs) are one of the most heavily regulated industries in the United States. However, concerns about quality of care remain, especially for more vulnerable residents, including those with dementia. Concerns only increased during recent natural disasters and the COVID-19 pandemic. Community and industry advocates have suggested diverse reforms that prompted new federal policies. This study poses the following research questions: (1) How do federal policies compare with proposals by community (staff and patient advocates) and industry (NH) advocates to improve quality of care in NHs before and during the pandemic; and (2) How do federal policies address micro, mezzo, and macro level issues? To address these questions, this study employs a multi-level comparison case study design. Primary data includes systematically collected and analyzed federal bills, CMS regulations, and community and industry reports, press releases, and website data from 2018 through 2022. Findings revealed that policy proposals fell into three categories: reframe, reform, and transform. Reframe approaches included minimal transformation at the micro-level. Reform approaches involved more mezzo and macro-level changes. Transform approaches proposed significant structural changes at the macro-level. Community advocates presented far more transformative changes than industry advocates and federal policymakers. Federal policies focused on reframe and reform solutions at the micro level and rarely proposed transforming macro-level structures (e.g., workforce structural inequities). This study has important implications for research, policy, and practice by exposing limitations and strengths of proposed solutions for addressing resident care and concludes with suggestions for better aligning with community advocates.