Examining the Assisted Living Environment and Residents’ Satisfaction with Assisted Living

Abstract

Background: Understanding satisfaction with assisted living (AL) is essential for creating supportive environments that are specifically targeted toward the needs and desires of residents. Moreover, the AL environment may play an important role in residents’ satisfaction with AL. Unfortunately, few measures have been developed and tested to evaluate residents’ satisfaction with living in these settings. Additionally, limited research has examined the impact of the AL environment on residents’ satisfaction with AL. Purpose: The purpose of this dissertation was to: (1) develop and test a comprehensive AL environment measurement model; (2) evaluate the psychometric properties of the Resident Satisfaction Index (RSI) in a sample of AL residents; and (3) test the impact of the AL environment on residents’ satisfaction with AL. Guided by the ecological theory of aging, it was hypothesized that controlling for residents’ age, gender, functional level, cognition, and comorbidities, the AL environment would be significantly associated with residents’ satisfaction with AL. Methods: Secondary data analysis using baseline data from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 501 residents in 54 AL facilities across three states were included in the sample. Structural equation modeling was used to test the AL environment model and examine associations between the AL environment and residents’ satisfaction with AL. Rasch analysis and differential item functioning (DIF) analysis was used to evaluate the RSI. Results: Findings showed that the AL environment model fit the data (2/df=1.861, p<.05; CFI=.858, RMSEA=.126). In addition, the RSI is a reliable and valid measure. Significant and substantive differences were noted on 6 items by cognition and gender. Finally, gender and function were significantly associated with residents’ satisfaction with AL and accounted for 2.6% of the variance. The AL environment, based on staffing, health care services, amenities, and physical environment, was not related to residents’ satisfaction with AL. Conclusions: Understanding the interplay between individual and environmental factors that influence residents’ satisfaction with AL will inform strategies to modify the environment to target the needs and preferences of residents and thereby improve residents’ satisfaction with AL.