Resident Quality of Life and Family Satisfaction: Developing Measures for Minnesota Assisted Living Report Card

Abstract The 2019 Minnesota Legislature requested the Department of Human Services (DHS) and Minnesota Board on Aging to develop and administer a report card for assisted living (AL), including conducting annual resident and family surveys in Minnesota AL settings. This presentation includes the perspectives of representatives from MN DHS and Vital Research, as well as the University of Minnesota team who worked together to develop survey items, carry out the cognitive testing, and conduct analyses. Survey items were developed from published literature and existing tools on assisted living quality and underwent testing with MN stakeholders and cognitive testing with MN AL residents. Pilot testing assessed any further changes that needed to take place for resident and family satisfaction with AL quality (n=400). Presenters will share lessons learned with implementing the new tools and different aspects of the of the report card development and implementation process as well as the survey findings.


THROUGH THEIR LENS: USING VISUAL METHODS TO ILLUMINATE THE LIVED EXPERIENCES OF DIVERSE OLDER ADULTS
Chair: Jarmin Yeh Discussant: Tam Perry Visual methods, like photovoice and photo-elicitation, have attracted modest attention in gerontological inquiry with diverse and vulnerable community-dwelling older adults. Visual methods are based on the idea of inserting images, produced by informants or not, into research interviews, allowing informants to be the experts of knowledge and meaning-making while the researcher becomes the student. The empowerment of informants as subjectcollaborators in the research process is a distinctive feature of visual methods. Benefits include revealing unique insights into diverse phenomena by evoking elements of human consciousness, feelings, and memories that words may not easily express and surveys may not easily capture. This symposium presents qualitative research using visual methods to illuminate the lived experiences, voices, and perspectives of diverse and vulnerable older adults living in New Jersey, Connecticut, and California. Reyes' research critiques how the operationalization of mainstream notions of civic participation becomes exclusionary and provides a more inclusive understanding of how civic participation is enacted and performed through the practices of Latinx and African American older adults living in New Jersey. Versey's research with homeless older adults subverts the attention often focused within cities by interrogating the meaning of place with informants whose needs and desires are often overlooked or obscured by residing in a small, rural town in central Connecticut. Yeh's research on aging in place inequalities chronicles the everyday lives of housed and unhoused older San Franciscans to reveal their tactics for negotiating a moving tension between the daily interiority of identity and contingencies of a changing environment. Qualitative Research Interest Group Sponsored Symposium.

NEGOTIATING THE GERONTOLOGICAL UNCANNY AND PASSING TACTICS FOR AGING IN PLACE
Jarmin Yeh, 1 Pat Fox, 1 David Vlahov, 2 and Howard Pinderhughes, 1 1. University of California,San Francisco,San Francisco,California,United States,2. Yale University,Orange,Connecticut,United States Insisting people are equally worthy of aging in place is a radical but challenging idea. Scenes of homelessness texture the contemporary city, manifesting broader issues of inequality. This qualitative study explored material with twenty-two housed and unhoused San Franciscans born in 1950 or earlier, who participated in semi-structured in-depth interviews and chronicled their everyday lives using disposable cameras. Theoretical work on social and spatial practices was drawn upon to help understand their aging in place experiences. In interpreting themes, informants elucidated a moving tension between the daily interiority of identity and the negotiation of a changing environment that produces a sensation characterized as the uncanny. The vicissitudes of life and precariousness of their positionalities exposed tactics for "passing" as creative forms of resistance to their expulsion from society. Utilizing visual methods helped reveal assumptions and contributed to gerontological discourse and critical theorizations about aging in place inequalities. Part of a symposium sponsored by the Qualitative Research Interest Group.

OLDER LATINX AND AFRICAN AMERICANS' EXPERIENCES OF CIVIC PARTICIPATION Laurent Reyes, Rutgers, The State University of New Jersey, Highland Park, New Jersey, United States
By 2030 Latinx and African Americans are expected to be the largest non-White groups of older adults. In the past 20 years, older adults' civic participation has received considerable attention. However, until now most scholarship has focused on formal volunteerism and voting, activities that remain inaccessible to many marginalized groups. As a consequence, other civic activities are going unrecognized. The aim of this study is to understand how civic participation is experienced throughout the lives of 24 African American and Latinx adults 60+ living in New Jersey. Because civic participation is a concept that has many names and meanings depending on culture, language, and history I employ photo-elicitation techniques followed by in-depth interviews to understand civic participation through participants' lens. Findings from this study can serve to improve conceptualizations and measurements of civic participation for future studies and inform efforts to strengthen civic participation among these populations. Part of a symposium sponsored by the Qualitative Research Interest Group.

HOMELESS ON MAIN STREET: USING PHOTOVOICE TO HIGHLIGHT OLDER ADULTS AMONG THE HIDDEN HOMELESS H. Shellae Versey, Wesleyan University, Middletown, Connecticut, United States
Homelessness is a reality for a growing number of Americans living in small towns and rural areas. However, unlike in cities, housing instability may be less visible. Using a photo-elicitation method (i.e., Photovoice), this study explores the meaning of place and obscured visibility to currently and formerly homeless older adults living in a small town in central Connecticut.
Participants (N = 27) were recruited from a local service agency, given cameras and asked to photograph areas around town that were meaningful to them. Photographs were developed and followed by in-person, semi-structured interviews with participants in which photos and experiences during the project were discussed. Primary themes included belonging, generativity, social isolation, and place-making as meaning-making. The study culminated in a community photography exhibition in which photographs from the project were displayed in public spaces around town. Implications for community-based interventions to reach homeless groups in rural areas are discussed. Part of a symposium sponsored by the Qualitative Research Interest Group.

TRANSFORMING GERONTOLOGICAL RESEARCH BY MEANINGFULLY ENGAGING PERSONS LIVING WITH DEMENTIA
Chair: Michael Lepore Discussant: Richard Fortinsky Whereas persons living with dementia have commonly been subjects of gerontological research, participation of persons with dementia in designing and conducting studies and in scientific research meetings has been rare in the United States. In recent years, person-centered research models have arisen which give persons with dementia and their caregivers core roles in the research enterprise. As "co-researchers" with academic/professional researchers, persons with dementia and their caregivers are engaged in all aspects of the research enterprise, jointly developing research questions and study designs, collecting and analyzing data, planning research meetings, and disseminating results. International studies have shown that conducting research in collaboration with the population that is being studied has potential to enhance the quality and appropriateness of research and has been identified as an essential component of studies examining the effectiveness of different approaches to care. This session spotlights innovative advances in gerontological research that meaningfully engages persons with dementia. First, the engagement of persons with dementia in scientific meetings is addressed drawing on the examples of the 2017 and 2020 National Research Summits on Care Services and Supports for Persons with Dementia and their Caregivers (i.e., Summits). Next, a study using a patient engagement framework for caregivers and individuals with mild cognitive impairment living at home is discussed. Finally, the Empowering Partnerships program, which prepares researchers, persons with dementia, and care partners to collaborate in conducting research is reviewed. Outcomes and challenges of these innovations are examined, and the need for academic/professional researcher roles to evolve is discussed. Lori Frank, RAND Corporation, Arlington, Virginia, United States In the US few research initiatives actively engage persons living with dementia (PLWD) as partners in the research. The 2017 Summit actively engaged multiple types of stakeholder groups, including one for Persons Living with Dementia (PLWD), and was the first large-scale US research meeting to actively engage PLWD in planning and conduct of the meeting. The PLWD conducted a self-evaluation of their work that yielded best practices, meeting the need for guidelines for engaging with PLWD. The 2020 Summit presented the opportunity to test best practices. Some were implemented by the group conveners, like use of video-enabled meetings. Others were implemented with the PLWD, including decisions about governance structure for the group. The use of learnings from the first Summit in engaging with PLWD in the following Summit supported refinement of some engagement practices, yielding a list of recommendations for future work.

ELICITING CARE MANAGEMENT PREFERENCES WITH ENGAGED CAREGIVERS AND INDIVIDUALS WITH MILD COGNITIVE IMPAIRMENT
Tabassum Majid, University of Maryland, Baltimore County, Baltimore, United States The goal of this study was to engage individuals with mild cognitive impairment (MCI) in developing a survey instrument that assists in the selection and prioritization of meaningful treatment outcomes in health care decision making. A multi-stakeholder advisory panel was engaged throughout the first qualitative phase of the study. 15 in-depth, guided interviews were conducted with caregiver-care recipient dyads who had been recently diagnosed with MCI. In addition to questions about meaningful outcomes, individuals were asked about quality of life and the severity of their symptoms using the Functional Attainment Staging Tool. 14 thematic concepts identified in an earlier, non-engagementbased caregiver study were all endorsed as relevant to the dyads interviewed. However, participants included 6 more thematic concepts, many of which were focused on social and community factors relevant to health care decision making. Engaging patients and caregivers allowed for focused dialogue within the interviews on shared treatment goals.