Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

James J. Cotter

Second Advisor

Ayn E. Welleford


This dissertation research was designed as two independent research studies. The first study, qualitative, and non-experimental, aimed to examine residents’, family members’, and staff members’ (stakeholders’) satisfaction with, and attitudes toward Green House living one month prior to moving and again at one and three months after moving. Focus groups were the primary method of data collection. Thirty residents and 40 staff members transitioned to one of three Green House homes beginning January, 2013. Data collected began in December, 2012. Following each focus group, tape recordings were transcribed, and coded. Using grounded theory and the constant comparative method of analysis, themes emerged. Pre-move focus group themes revealed that stakeholders were concerned about (a) the quality of care in a system using fewer staff members and (b) the challenges associated with adjusting to a new environment. Post-move focus group themes revealed that (a) stakeholders remained concerned about staffing levels; (b) residents’ had improvements in appetite, socializing, and ambulation; and (c) staff members struggled with autonomous work teams, but preferred the Green House model of care to that of a traditional nursing home. The final model reflects a synthesis of themes from which self-efficacy beliefs were hypothesized. Themes were also linked to existing gerontological theories: Person-Environment Fit, Place-Space, Thriving, and Personhood. The second study, designed to explore the construct validity of the Person-Centered Care Attitude Tool (Per-CCat), consisted of 42 Likert-type questions divided into four sections that align with person-centered care principles. Eighty-six employees of Virginia Mennonite Retirement Community completed the survey; only 70 were analyzed due to missing data. Principal Components Analysis was the analytic approached used for these data. Bartlett’s Test of Sphericity (X2 = 2006.56, p = 0.000) and Keiser-Myers-Olkins measure of sampling adequacy (0.746) indicated that the data were factorable. The final four-factor 34-item solution aligned with the following person-centered care principals: resident autonomy, social interaction and community, work culture, and feelings toward work. Further validations studies of the Per-CCat are necessary. Given the trend in long-term care toward person-centered care, a validated survey will be useful for hiring and educating caregivers and other nursing home personnel.


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