Presentation Title:	Long-Term Care Residents: Relationship Between Perceived Fairness and Several Outcomes
Abstract:	The number of older adults entering long-term care (LTC) has increased over the past few decades, rising from 1.3 to 1.5 million from 1985 to 1999 (Department of Health and Human Services Administration on Aging, 2005). The goals of long-term care have been described by the U.S. Senate Special Committee on Aging as differing from other areas of senior housing and healthcare because of a focus on optimizing functioning instead of curative medicine (Federal Interagency Forum on Aging-Related Statistics, 2008). Living in Long-Term Care: Like Living at Work? Although LTC residents pay to receive care, there are several notable similarities between the experience of the LTC resident and the experience of an employee in the workplace. For example, both environments require an individual to function according to a defined, daily schedule. In the workplace, employees arrive at and leave work at a set time, attend scheduled meetings, and meet deadlines. Residents of LTC function on a set schedule for waking and grooming, and must report to breakfast, lunch, dinner, and activities at designated times, or they face questions from facility staff about why they were not in attendance (Cohn & Sugar, 1991; Lidz, 1992). Despite this and other notable similarities, research has not examined the LTC resident living experience with an organizational framework. The present study will do so by addressing fairness (or justice), a concept which has been studied extensively in the workplace. How Justice Fits Within LTC When an older adult enters an LTC facility, he/she inevitably relinquishes some independence previously achieved by living in the community, and the LTC staff has more decision-making authority than the resident (Parr & Green, 2002). In this respect, the older adult is no longer the primary decision-maker in several aspects of her/his life, for example, at what time she/he will eat meals. Several decisions will be made, in part, by the LTC facility staff, and others will be made with minimal or no resident input. The procedures used to make these decisions may be seen as fair, or unfair by residents. For example, if the facility administrator decides to change the decor of the facility, and does not elicit resident input in deciding what motif to choose, the residents may believe that facility procedures are unfair (procedural justice). Additionally, residents expend time and effort in an attempt to adhere to facility rules, follow care their care plans, and comply with staff requests. In return, the staff exchange personal attention, emotional support, and special privileges. When this exchange takes place, the resident likely compares her/his own contributions and subsequent privileges (input to output ratio) to that of other residents of the facility. These ongoing distributive exchanges may be viewed as fair or unfair by residents. For example, if a particular resident expends more effort to follow facility procedure and receives less personal attention or privileges than other residents, he may believe that he has been treated unjustly (distributive justice). Furthermore, residents have numerous interpersonal interactions with several staff on a daily basis. Long-term care researchers often write about the importance of treating residents with dignity, and avoiding demeaning or condescending interpersonal treatment (Olson, 2001). Through this and other means, the goal of LTC has been focused on empowering the residents to retain as much autonomy as is possible in the care environment (American Health Care Association, 2005). Fair and just interpersonal treatment by staff includes treating residents with dignity, kindness, and honesty, and respecting residents' rights as human beings. Accordingly, residents likely perceive the interpersonal interactions encountered with staff to be fair, or unfair (just or unjust). When a resident believes that a member of the staff has spoken to her inconsiderately, she may believe that she has been treated unfairly by that staff member (interactional justice). Present Study The purpose of the present study is to examine LTC residents' perceptions of justice (or fairness) and how these relate to mental health-related quality of life, satisfaction with LTC staff, and psychological sense of community. Fairness will be examined by eliciting resident perceptions of fairness regarding procedures, distribution of privileges, and staff-resident interpersonal interactions, thus, fairness will be understood without making a judgment about what is "fair" based on a specific ideological value set (Colquitt, Greenberg, & Phelan, 2005). Given the assertion put forth by the transactional model of stress that an individual's two-fold appraisal of a situation is associated with a psychological state (Lazarus & Launier, 1978; Lazarus & Folkman, 1984), the present study will explore the relationship between fairness perceptions and mental health-related quality of life (QOL). This expands upon the transactional model of stress by addressing QOL, a construct more suited for understanding the experience of the LTC resident. Specifically, the association between three types of fairness, distributive, procedural, and interactional, and QOL will be examined. Further, the relationship between fairness perceptions and satisfaction with LTC staff with be explored. The present study will elicit satisfaction assessments from asking specifically about satisfaction with the staff, a concept relevant in examining outcomes of fairness perceptions of the staff. Additionally, the relationship between three types of fairness perceptions and psychological sense of community (PSOC) will be explored. PSOC will be conceptualized and measured based on the four dimensions proposed by McMillan and Chavis (1986). Age, gender, tenure at the facility, functional status, and physical health-related QOL will serve as control variables in each analysis. Procedures Participants Older adults (65 and older) residing in LTC will be the target sample for the present study. However, given the difference between cognitively intact residents, and individuals residing on locked-dementia care wards, older adults residing in locked, dementia-care wards will be excluded to minimize participant burden. Procedures Residents will be administered a questionnaire surveying demographic information, and will be asked to complete the following measures: Moorman's (1991) procedural and interactional justice scales, Colquitt's (2001) distributive justice scale, the Short-Form Health Survey-12 (Ware, Kosinski, & Keller, 1996), the Staff Care subscale of the Resident Satisfaction Questionnaire (Boldy & Grenade, 1998; Chou, Boldy, & Lee, 2002), and the Brief Psychological Sense of Community Scale (Peterson, Speer, & McMillan, 2007). Results and Conclusions Data will be collection will be completed in the spring of 2009, and the proposed poster will offer results, conclusions, and suggestions for future research.
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