Understanding Decision Making among Direct Care Workers in Assisted Living

An increase in the older adult population will likely be associated with an increased need for long-term-care communities, such as assisted living. A primary goal of assisted living communities is to help residents maintain their health and well-being. To accomplish this goal, direct care workers employed in these settings are responsible for monitoring residents for cues that might signal problems and then responding appropriately. However, very little is known about these workers' decision making. To gain a better understanding, direct care workers from assisted living facilities took part in a critical incident interview and a scenario-based interview. The interview data revealed various cues that were categorized as cognitive, physical, or emotional in nature. Specific explanations for the scenarios were primarily that the situation was the result of a cognitive/emotional/social issue or a physical health issue. The type and number of explanations varied widely from scenario to scenario. Of the actions participants described taking to handle the scenarios, gathering and using information was discussed more than any other action. This research has implications for training of formal and informal caregivers and also highlights the potential need for decision support systems in this domain.